Toilet psychology: why do men wash their hands less than women?

By hiding in toilet cubicles for a new study, psychologists observed how long people spend using the loo, and how long they wash their hands for afterwards. That men usually wash their hands less conscientiously than women is a well-established finding. Thomas Berry and his colleagues wanted to find out more about the reasons for this gender difference.

toilet.hideFor one day, between 10am and 4pm, a male researcher secreted himself inside one of three cubicles in a gents toilet facility at a U.S. University. For optimal observational purposes he chose the cubicle adjacent to a row of three urinals. Nearby, in a similarly designed female toilet facility, a single female researcher positioned herself in one of the three cubicles available. Don’t worry, both researchers were provided with a “customised wooden bench” for comfort.

They were also equipped with stopwatches. The researchers used an “unobtrusive sight procedure” – that is, they spied on other visitors to the lavatories using the gaps beneath and by the side of the cubicle doors (for some reason, US toilet cubicles always have a gap of about a centimetre either side of the door). The researchers also used an “acoustic procedure”. That is, they listened to the visitors’ actions. The study authors explained:

“… research assistants recorded the facility [urinal or cubicle], and then started a stopwatch when the patron’s feet stood relatively still. For the men, the research assistants also recorded the orientation of the feet to gauge the patron’s use of the commode (i.e. as a commode or a urinal). When research assistants heard the flushing of the patron’s commode or urinal the stopwatch was turned off … and the duration of the restroom event was recorded.”

Similar procedures were followed for recording each visitor’s “hand washing event” if there was one. A clever twist was that for part of the study, the researchers put “out-of-order” signs over the men’s urinals. This was to see how much they’d hand wash if they were forced to urinate in a cubicle, rather than at a urinal.

The psychologists managed to observe the toilet behaviour of 34 women using cubicles; 32 men who used a cubicle to defecate; 40 men who had no choice but to use the cubicles for urinating (because of the out-of-order signs); and 64 men who used a urinal. The bare statistics show that the hand-washing rates for these four groups were 91 per cent, 87.5 per cent, 75 per cent and 59.4 per cent, respectively.

The difference in hand washing rates between women using a cubicle and men using a cubicle (for defecating) was not statistically significant. In contrast, both women using a cubicle, and men using a cubicle (for defecating), showed significantly higher hand-washing rates than men who used a urinal.

The data are somewhat compromised because, as the researchers delicately put it – the women’s “facility use is a constant (i.e., commode) and their behaviour (urination, defecation, or menstrual care) is confounded within the one environment.” However, taken together, the results suggest that the reason men wash their hands less than women overall, is not because of gender norms (i.e. men are less bothered about being clean), but because of the differences in the toilet environment and toilet behaviour for men and women. In fact, after using a toilet cubicle to defecate, men tended to wash their hands for longer than women (but remember we don’t know what the women had been doing).

Surveys still suck, here’s an alternative: video observation and data coding methods to assess food handling practices at food service

Ben Chapman, who was a Phd student with me at Guelph and is now plying his trade at North Carolina State University, Tanya MacLaurin, who used to be at Kansas State and is now at Guelph, and me, who used to be at Guelph and now is at Kansas State, got together to create a how-to paper for video observation to measure food safety behaviors. Abstract below.

Eating at foodservice has been identified as a risk factor for foodborne illness. The World Health Organization (WHO) has identified four food handler-related factors that contribute to foodborne illness: improper cooking procedures; temperature during storage; lack of hygiene and sanitation by food handlers; cross-contamination between raw and fresh ready to eat foods.

Evaluation of food handler behaviors, important for risk assessment calculations and for the effectiveness of training strategies, has historically been limited to self-reported data, inspection and participatory observation. This article describes the framework of a video observation methodology, novel to food service situations used capture and code food handler practices for analysis.

Through the piloting of this technique in a working foodservice establishment, a number of lessons were learned, including best equipment to use, equipment location and configuration, as well as pitfalls in coding practices. Finding and working with partner organizations and navigating institutional ethics review is also discussed.

Chapman, B., MacLaurin, T. and Powell, D.  2013. Video observation and data coding methods to assess food handling practices at food service. Food Protection Trends. 33 (3). 146–156.


Campylobacter in the kitchen: observational trial of safe food handling behavior during food preparation

Austrian researchers report on an observational trial of safe food handling behavior during food preparation using the example of Campylobacter spp.

chicken.thermJournal of Food Protection®, Number 3, March 2013, pp. 376-551 , pp. 482-489(8)

Hoelzl, C.; Mayerhofer, U.; Steininger, M.; Brüller, W.; Hofstädter, D.; Aldrian, U.


Campylobacter infections are one of the most prominent worldwide food-related diseases. The primary cause of these infections is reported to be improper food handling, in particular cross-contamination during domestic preparation of raw chicken products. In the present study, food handling behaviors in Austria were surveyed and monitored, with special emphasis on Campylobacter cross-contamination. Forty participants (25 mothers or fathers with at least one child ≤10 years of age and 15 elderly persons ≥60 years of age) were observed during the preparation of a chicken salad (chicken slices plus lettuce, tomato, and cucumber) using a direct structured observational scoring system. The raw chicken carcasses and the vegetable part of the salad were analyzed for Campylobacter. A questionnaire concerning knowledge, attitudes, and interests related to food safety issues was filled out by the participants. Only 57% of formerly identified important hygiene measures were used by the participants. Deficits were found in effective hand washing after contact with raw chicken meat, but proper changing and cleaning of the cutting board was noted. Campylobacter was present in 80% of raw chicken carcasses, albeit the contamination rate was generally lower than the limit of quantification (10 CFU/g). In the vegetable part of the prepared product, no Campylobacter was found. This finding could be due to the rather low Campylobacter icarly.chicken.cell.handscontamination rate in the raw materials and the participants’ use of some important food handling behaviors to prevent cross-contamination. However, if the initial contamination had been higher, the monitored deficits in safe food handling could lead to quantifiable risks, as indicated in other published studies. The results of the observational trial and the questionnaire indicated knowledge gaps in the food safety sector, suggesting that further education of the population is needed to prevent the onset of foodborne diseases.

More on pink and thermometers

Surveys still suck.

Using I-own-a-thermometer as an indicator of thermometer use is as useful as I-own-a-sink therefore I wash my hands. Or, I own a toilet, so I always hit the bowl. Or … use your imagination.

Researchers at the U.S. Food and Drug Administration report in the Journal of Food Protection that the use of a food thermometer is the best way to ensure that meat, poultry, and other foods reach an internal temperature sufficient to destroy foodborne pathogens.

The 1998, 2001, 2006, and 2010 Food Safety Surveys were used to analyze changes in food thermometer ownership and usage for roasts, chicken parts, and hamburgers in the United States.

But surveys still suck.

The paper notes that when E. coli O157:H7 was first associated with ground beef in the 1980s, the U.S. Department of Agriculture (USDA) recommended that consumers cook hamburgers until the meat was ‘‘brown or pinkish brown in the center. However, as a result of research that showed that one out of four hamburgers may be brown in the center before reaching a safe internal temperature, the USDA changed its advice to consumers— instead of using color as an indicator of doneness in hamburgers, consumers should use a food thermometer to ensure that a safe temperature has been reached. In May 2000, the USDA launched the Thermy educational campaign to encourage consumers to use a food thermometer when cooking small cuts of meat, such as hamburgers and chicken parts. The USDA also provided guidance to consumers about the safe temperature for various cuts of meat and poultry.

Ho Phang and Christine Bruhn reported earlier in JFP that in video observation of 199 California consumers making hamburgers and salad in their own kitchens, handwashing was poor, only 4% used a thermometer to check if the burger was safely cooked, and there were an average of 43 cross-contamination events per household. They concluded Thermy had not been successful.

We did our own survey with 40 people brought in to cook a chicken meal in a Kansas State kitchen and videotaped their behaviors. Many participants reported owning a food thermometer (73%) and nearly half (42.5%) of participants reported knowing the suggested end temperature for cooking poultry to ensure doneness. When asked the final recommended internal temperature for chicken, the mean response was 214°F with a range of responses from 140°F to 450°F. (The correct answer is 165F)

Of those participants observed measuring the internal temperature of the product, only three used the thermometer correctly. During observation, two individuals who used the thermometers failed to remove protective casings prior to taking internal temperature readings, and therefore used the instruments incorrectly.

Surveys do not measure behaviors: they give an indication of what people think their behavior is, or what the survey person wants to hear, but that isn’t going to get people to use a thermometer (tip-sensitive, digital).

We don’t need no education: burger preparation, what consumers say and do in the home

I cringe when someone says, ‘food safety is simple.’

A review of existing studies by the U.K. Food Standards Agency found that, although people “are often aware of good food hygiene practices, many people are failing to chill foods properly, aren’t following advice on food labels and aren’t sticking to simple hygiene practices that would help them avoid spreading harmful bacteria around their kitchens.”

Yes, individuals are impervious to risk; been known for decades.

And there’s that word, ‘simple’ again.

I especially cringe when someone says, ‘cooking a hamburger is easy with these simple food safety steps.’

Ho Phang and Christine Bruhn report in the current Journal of Food Protection that in video observation of 199 California consumers making hamburgers and salad in their own kitchens, handwashing was poor, only 4% used a thermometer to check if the burger was safely cooked, and there were an average of 43 cross-contamination events per household.

There’s some good data in the paper about what consumers do in their own kitchens, and the results are an additional nail in the self-reported-food-safety-survey coffin: people know what they are supposed to do but don’t do it.

But what the paper doesn’t address is how to influence food safety behaviors. Instead, the University of California at Davis authors fall back on the people-need-to-be-educated model, without out providing data on how that education – I prefer compelling information – should be provided.

The authors state:

• educational materials need to emphasize the important role of the consumer in
preventing foodborne illness and that foodborne illnesses can result from foods prepared in the home.;

• the gap between the awareness of the importance of hand washing and the actual practice of adequate hand washing should be addressed by food safety educators.

• food safety educators should address the lack of reliability of visual cues during cooking (stick it in — dp);

• food safety educators should emphasize faucet cleaning with soap and water as a way of preventing cross-contamination; and,

• ignorance about food irradiation point to a further need for education.

The authors do correctly note that program to promote the use of thermometers when cooking burgers, initiated by the introduction of Thermy in 2000, has not been successful. So why do more education?

And the E. coli O157:H7 outbreak in Jack-in-the-Box hamburgers happened in Jan. 1993, not 1994 as stated in the paper; someone should have caught that.

Burger preparation: what consumers say and do in the home
Journal of Food Protection®, Volume 74, Number 10, October 2011 , pp. 1708-1716(9)
Phang, Ho S.; Bruhn, Christine M.
Ground beef has been linked to outbreaks of pathogenic bacteria like Escherichia coli O157:H7 and Salmonella. Consumers may be exposed to foodborne illness through unsafe preparation of ground beef. Video footage of 199 volunteers in Northern California preparing hamburgers and salad was analyzed for compliance with U.S. Department of Agriculture recommendations and for violations of the U.S. Food and Drug Administration’s Food Code 2009. A questionnaire about consumer attitudes and knowledge about food safety was administered after each filming session. The majority of volunteers, 78%, cooked their ground beef patties to the Food Code 2009 recommended internal temperature of 155°F (ca. 68°C) or above, and 70% cooked to the U.S. Department of Agriculture consumer end-point guideline of 160°F (ca. 71°C), with 22% declaring the burger done when the temperature was below 155°F. Volunteers checked burger doneness with a meat thermometer in 4% of households. Only 13% knew the recommended internal temperature for ground beef. The average hand washing time observed was 8 s; only 7% of the hand washing events met the recommended guideline of 20 s. Potential cross-contamination was common, with an average of 43 events noted per household. Hands were the most commonly observed vehicle of potential cross-contamination. Analysis of food handling behaviors indicates that consumers with and without food safety training exposed themselves to potential foodborne illness even while under video observation. Behaviors that should be targeted by food safety educators are identified.

People say they will pay more for safer food, will they? Someone needs to test at retail

Willingness-to-pay studies are excellent indicators of what people think they will do in imaginary situations.

Willingness-to-pay studies are terrible indicators of what people will actually do at the grocery store.

Brian Roe, professor of agricultural, environmental and development economics at Ohio State University (isn’t that The OSU?) and Mario Teisl of the University of Maine report in the journal Food Policy, that based on surveys from 3,511 individuals, Americans would be willing to pay about a dollar per person each year, or an estimated $305 million in the aggregate, for a 10 percent reduction in the likelihood that hamburger they buy in the supermarket is contaminated by E. coli.

A monkey just flew out of Wayne Campbell’s butt (see video below from last week’s Saturday Night Live).

By comparison, a 2008 U.S. Department of Agriculture analysis estimated the value of eradicating a specific type of E. coli contamination from all food sources would result in a benefit valued at $446 million.

In the questionnaire, they set up six hypothetical scenarios around the purchase of either a package of hotdogs or a pound of hamburger. They set prices for the packages – both "status quo" foods and those treated with either ethylene gas processing or electron beam irradiation to reduce contaminants – and then laid out a variety of probabilities that the treated or untreated food packages contained contamination with either E. coli or listeria, another pathogen that can cause food-borne (sic) illness.

They followed by asking respondents to choose one of three actions: buy the food treated with the pathogen-reducing technology, buy their usual brand, or stop buying this product altogether.

The results showed that consumers will reach a limit to how much they want to pay to reduce their chances of getting sick. If the treated product cost only 10 cents more than an untreated package, about 60 percent of respondents said they’d buy the improved product. But when that higher price reached $1.60 more per package, less than a third would opt for the treated product.

The structure of the survey also allowed researchers to see the influence of human behavior and opinions on likely illness outcomes.

"If the food industry were forced to put technology in place that lowered the presence of E. coli and that ramped up prices to the extent where everybody had to pay about a dollar more out of pocket each year for hamburger, we’re saying that, according to this model, that would be about an equal tradeoff for the U.S. population. And if the technology costs only about 10 cents per person instead, that would seem like a good deal to most people," he said.

"If regulators could become more comfortable with this measurement process, agencies might change the way they conduct their cost-benefit analysis. And that would be an interest of ours, to see if our work and others’ work in this area will eventually change the way people attack these questions."

So it’s more about changing the way estimates are done. Estimates are lousy surrogates. I’m all for marketing food safety – at retail, food service, markets, everywhere. Brag about test results, use big signs, smart phone readers, just be able to back it up.

Most don’t do the Dracula when sneezing or coughing

Observational research is so much more meaningful – either direct or with video – than self-reported surveys. Of course, everyone says they wash their hands, but they don’t.

Same with blowing the nose or coughing. Health types have been promoting the Dracula-move – expelling your inner germs into the crook of your arm – but when medical students secretly watched hundreds of people cough or sneeze at a train station, a shopping mall and a hospital in New Zealand, most people failed to properly prevent an airborne explosion of infectious germs.

The work was done in the capital city of Wellington over two weeks last August, at the tail end of a worrisome but fairly mild wave of swine flu illnesses. It was a time when the pandemic was international news, and public health campaigns were telling children and adults to be careful about spreading the virus.

The good news is that about three of every four people tried to cover their cough or sneeze, in at least a token attempt to prevent germs from flying through the air.

The bad news is that most people — about two of three — used their hands to do it.

Study author Nick Wilson, an associate professor of public health at the Otago University campus in Wellington, said,

"When you cough into your hands, you cover your hand in virus. Then you touch doorknobs, furniture and other things. And other people touch those and get viruses that way.”

Only 1 in 77 pulled the Dracula move, and about 1 in 30 used a tissue or hankerchief.

The researchers didn’t report numbers on this, but several times they saw people spit on the floor, including at the hospital.

Wilson’s team logged 384 sneezes and coughs.

People handle food any way they want

Some form of direct observation is the only way to do meaningful food safety behavior research, and the phrase, consumer food safety education, should be banned.

Or at least try something new – the stuff that is out there just doesn’t work.

That’s what I take from a preliminary summary of research led by Christine Bruhn, director of the Center for Consumer Research at the University of California, Davis, and Ho Phang, prepared by Meatingplace.

Sure, those are a couple of my primary messages, so it’s easy to agree with someone who agrees with me, but nice to hear it confirmed.

Bruhn and colleagues videotaped 200 volunteers in their homes while they prepared burgers and salad. She observed their methods of defrosting the meat — frozen, preformed burgers — their refrigerators’ temperature, whether or not they put themselves at risk for cross-contamination and how they determined whether the meat was done.

Of those in the study:

* Twenty-five percent said they prefer their burgers pink.
* Eighty-three percent said they used visual clues, rather than a meat thermometer, to determine the doneness of their burgers.
* About half owned a meat thermometer, but almost all of those participants said they used it on larger cuts of meat, not burgers.
* Seventy-five percent said they were unlikely to use a meat thermometer on burgers.

Even though participants knew they were being videotaped, many did not follow recommended guidelines when preparing their burgers:

* Although 90 percent of consumers were observed washing their hands prior to food preparation, the average hand-washing time was just seven seconds, and only 31 percent dried their hands with a clean towel (either a paper towel or a cloth towel that had not been used previously).

* Potential cross-contamination — defined by the study as "an event in which pathogens could be transferred from one surface to another as a result of contact with a potential source of contamination" — occurred in 74 percent of the households.

* While a bar graph showing the temperature distribution of the finished burgers demonstrated that many were at or near the recommended 160 degrees F, a few of the burgers’ temperatures were recorded to be much lower — as low as 112 degrees F. (Study coordinators observing consumer behavior made sure all burgers were cooked to 160 F before volunteers consumed them.)

Even after the exercise, only 23 percent of participants said they would use a meat thermometer on burgers in the future.

Bruhn said,

"Consumer education is not sufficient. Take the extra step. It protects the public, and it protects you."

Shoot, shovel and shut up – the wrong approach for animal and zoonotic diseases

Daughter Sorenne woke up around 6:15 a.m. after a big Halloween night (thanks for the costume, Katie). Then the clocks on the computer changed and I realized it was 5:15 a.m.

Damn you daylight savings.

So while Sorenne plays on the floor and fills her diaper, I’m looking at a poignant release from the France-based World Organization for Animal Health, inexplicably referred to as OIE (it’s a French thing) reiterating the importance of animal health rules to control human disease.

When the first case of bovine spongiform encephalopathy or mad cow disease was discovered in Canada in May, 2003, Alberta premier Ralph Klein famously declared that any

"self-respecting rancher would have shot, shovelled and shut up."

In 1184, city leaders in Toulouse, France, introduced some of the first documented measures to oversee the sale of meat: profit for butchers was limited to eight per cent; the partnership between two butchers was forbidden; and, selling the meat of sick animals was forbidden unless the buyer was warned.

By 1394, the Toulouse charter on butchering contained 60 articles, 19 of which were devoted to health and safety.

As outlined by Madeleine Ferrières, a professor of social history at the University of Avignon, in her 2002 book, Sacred Cow, Mad Cow: A History of Food Fears, the goal of regulations at butcher shops — the forerunners of today’s slaughterhouse — was to safeguard consumers and increase tax revenues. Animals from the surrounding countryside were consolidated at a single spot — the evolving slaughterhouse, originally inside city walls — so taxes could be more easily gathered, and so animals could be physically examined for signs of disease.

It’s no different today: slaughterhouses are common collection points to examine animals for signs of disease and to collect various levies. And like medieval times, one of the most basic rules is animals that cannot walk are forbidden from entering (the slaughterhouse or city).

Bernard Vallat, Director General of the World Organisation for Animal Health (OIE), reminded the world this morning that veterinary legislation is the foundation of any efficient animal health policy.

Veterinary legislation is a critical infrastructure element for all countries. In many OIE Member countries, the veterinary legislation has not been updated for many years and is obsolete or inadequate in structure and content for the challenges facing veterinary services in today’s world.

Dr Vallat says that it is important that the veterinary services have the authority to enter livestock premises and other establishments and take the actions needed for early detection, reporting and rapid and effective management of any animal diseases as soon as they are detected. Such actions include the capacity to seize animals and products, to impose standstills, quarantine, testing and other procedures; to control animals and products at frontiers; and to require the destruction and safe disposal of animals and all articles considered to present a risk of disease transmission and to public health. These activities represent the core activities of veterinary services in the field of animal health control and veterinary public health and the legislation must provide the necessary authority as a minimum.

Shock and shame: How to increase handwashing compliance

A British study by the London School of Hygiene and Tropical Medicine concluded that people are more likely to wash their hands properly after using the toilet if they are shamed into it or think they are being watched.

As part of a flood of handwashing information for today’s World Handwashing Day, the study, published in the American Journal of Public Health found that with no reminders, 32 percent of men and 64 percent of women used soap.

The observational study reported on the behavior of people using toilets at motorway service stations in Britain over 32 days.

When prompted by an electronic message flashing up on a board asking: "Is the person next to you washing with soap?," around 12 percent more men and 11 percent more women used soap.

Other messages flashed on the electronic boards included:

• Water doesn’t kill germs, soap does; and,
• Don’t be a dirty soap dodger.

The message that produced the strongest positive response was: "Is the person next to you washing with soap?"

The researchers also noted "intriguing differences" in the behavior of men and women: While women responded to simple reminders, men tended to react best to messages that invoked disgust, such as:

• Don’t take the loo with you — wash with soap, and
• Soap it off or eat it later.

I like the last one.

We’ve undertaken both shock and shame attempts at handwashing messages (below). Results pending.