Food safety perceptions and behaviors of participants in congregate-meal and home-delivered-meal programs.

The Elderly Nutrition Program

According to the U.S. Census, the population of individuals 65 years of age and older grew by 74 percent between 1970 and 1999 (U.S. Department of Health and Human Services [DHHS], 2000). Today, 44 million individuals 60 years of age or older live in the United States (DHHS, n.d.a). By 2030, the number of adults 65 years of age or older is expected to double, to more than 70 million (DHHS, 2001). The fast growth of this age group has increased demand for social services to serve this population. The Elderly Nutrition Program (ENP), implemented under the Older Americans Act (Title III), provides congregate meals in various group settings, such as senior centers, faith-based settings, and school locales, as well as in the homes of homebound elderly people (DHHS, n.d.b).

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Under Title III, a person must be at least 60 years of age to be eligible for ENP (DHHS, n.d.b). The program targets older people who are most vulnerable, such as members of ethnic-minority groups and people living alone. It also provides services to individuals with lower incomes, individuals with lower levels of education, individuals living in rural areas, and individuals in fair or poor health (DHHS, n.d.a; Millen, Ohls, Ponza, & McCool, 2002). ENP has been instrumental in allowing older people to maintain independence and avoid premature nursing home placement (DHHS, n.d.a).

In Kentucky, in fiscal year 2003-2004, nearly 3.3 million elderly people received home-delivered meals (HDMs) or participated in congregate meals (National Aging Program Information System, 2003). In fiscal year 2005, over 1.8 million meals were served to homebound elderly people in Kentucky (Kentucky Department for Aging and Independent Living, 2005). Nationally, in fiscal year 2002, 250 million congregate meals and HDMs were provided to the elderly (Congressional Research Service, 2004). A 2003 study by the Administration on Aging found that 62 percent of HDM recipients received one half of their daily food intake from an HDM and that 58 percent of congregate-meal recipients received one half of their daily food intake from a congregate meal (DHHS, n.d.b). A study conducted in Lake County, Indiana, found 39 percent of elderly people participating in the HDM program to be at moderate nutritional risk and 33 percent to be at high nutritional risk (Herndon, 1994).

Food Safety and Foodborne Illness 

Food safety is a serious issue in America. Infants, young children, elderly people, and immune-compromised individuals are most at risk of incurring a foodborne illness (CDC, 2001; Kendall, Medeiros, Hillers, Chen, & DiMascola, 2003; McCabe-Seller & Beattle, 2004). As people age, immune system functions decrease and antibiotic treatment is less effective because of a decrease in physiological function (Smith, 1998). The elderly have a higher incidence of major surgeries that affect the body's ability to fight infections and are more likely to experience more severe consequences from an infection (Klontz, Adler, & Potter, 1997). In addition, changes in the gastrointestinal tract, malnutrition, lack of exercise, and excessive use of antibiotics may all increase morbidity and mortality from foodborne illness (Smith).

Purpose of Study

Given seniors' increased susceptibility to foodborne illness, special attention needs to be paid to the food safety perceptions and behaviors of HMD clients. Optimization of home-delivered nutrition services requires a better understanding of the food-related risks and practices of HMD program participants. Seniors have been found to use a wider array of inappropriate practices to cook, cool, and thaw food than does the general population (Gettings & Kiernan, 2001). Several factors can affect the food safety of elderly people participating in congregate-meal and HDM programs, including 1) perceptions about foodborne illness and food safety that can lead to unsafe practices, 2) delayed consumption and improper storage of HDMs or congregate meals, and 3) lack of food safety preparedness in cases of emergency. The purpose of our study was to expand current understanding of food safety perceptions, food safety behaviors, and emergency food preparedness among elderly people participating in congregate-meal and HDM programs. This exploratory study attempted, in particular, to provide additional knowledge about the handling of HDMs once the food arrives at the client's home.

Methods

Study Population

A food safety survey was conducted at senior center sites providing congregate meals and HDMs in nine counties in central Kentucky. On the basis of the criteria for participating in ENP, subjects were at least 60 years of age. The counties recruited for this study were primarily rural, except for one county containing a major city with a population of approximately 260,000 people. The survey was conducted in April 2004 in five counties and in May 2005 in the other four counties. It received prior approval and cooperation from the management team of the senior centers.

Survey Instrument

A 21-question survey was developed based on questions from the U.S. Food and Drug Administration Survey of Consumer Food Handling Practices and Awareness of Microbiological Hazards (FDA, 1993). The researcher added additional questions specific to home-delivered-meal practices and emergency food preparation, and these questions were reviewed by ENP administrators. The majority of the questions were Likert-type and closed-ended. Demographic information, on race, gender, level of education, marital status, age, and number of individuals living in the household, was also solicited. The University of Kentucky's Institutional Review Board (IRB) approved the survey questions and research protocol.

Data Collection

Registered dietitians from the district Dietetic Association and dietetic interns from the university's Nutrition and Food Science Department administered the survey orally to the congregate-meal and home-delivered-meal recipients in a personal interview. Before conducting the survey, the researchers were trained in conducting interviews and were required to complete the Human Subjects Protection Training offered through the university's IRB. In addition to the training, a detailed instruction guide was provided to ensure uniformity among the interviewers in administration of the survey. All participants in the study gave written, informed consent.

Variables

To address the objectives of the study, four questions from the survey were categorized as perception questions, 12 questions were identified as behavior questions, and five questions were categorized as emergency preparedness questions. Perception questions consisted of the following: 1) How common is it for people in the United States to get foodborne illness? 2) Where are food safety problems most likely to occur? 3) What amount of foodborne illness has there been in the United States in the last five years? and 4) How likely are elderly people to become sick because of a foodborne illness? The questions about food safety behaviors pertained to the practices elderly people employ when they receive an HDM or bring home a congregate meal. These questions addressed issues such as when people eat their HDM (upon delivery or later in the day), how often they save part or all of their HDM to eat later, how they handle their HDM upon delivery if they eat some or part of it later in the day, how long they leave food on a counter before throwing it away, what they do with food left out on the counter overnight, and whether they wash their hands before eating. Questions on emergency preparedness included whether people had available in their home a three-day supply of nonperishable food, a gallon of water for each family member, a cooler and frozen gel pack, a portable refrigerator/freezer thermometer, and a handheld can opener.

Data Analyses

All analyses were conducted with SPSS 13.0 for Microsoft Windows. Descriptive statistics were computed for demographic characteristics. Cross-tabulation and Fisher's exact Chi-square tests were used to investigate associations between demographic variables and respondents' food safety perceptions, food-handling behaviors, and emergency food preparedness. A statistical significance of p [less than or equal to] .05 was used for all tests.

Results

Description of the Sample

At the time of the study, 633 seniors participated in the congregate-meal and HDM program in the nine targeted counties in central Kentucky (400 received congregate meals; 233 received HDMs). A total of 246 subjects agreed to participate in the food safety survey, and of these responses, 220 were usable (a 35 percent response rate). Out of the usable responses, 92 were from HDM recipients (41 percent) and 130 were from congregate-meal recipients (59 percent). Unbeknownst to the participant, the interviewer discreetly deemed 26 interviewees incapable of participating in the study because of concerns about the participant's limited cognitive abilities.

The demographic characteristics of the respondents are presented in Table 1. Eighty-four percent of the sample was female and 16 percent was male. The largest age groups were 71-80 and 81-90 years of age (each group had 35.7 percent). Eighty-five percent of the sample was white. The preponderance of the sample (52 percent) had not completed high school or obtained a high school equivalency degree. Slightly less than 20 percent of the respondents had some college or a college degree. Seventy-three percent were divorced, separated, or widowed, while an additional 9 percent were single, and 18 percent were married. Nearly 69 percent of the sample lived alone.

Food Safety Perceptions

Table 2 provides the results of the cross-tabulation and Fisher's exact Chi-square test used to identify differences in respondents' perceptions of food safety issues on the basis of demographic and socioeconomic characteristics. Statistically significant differences were found in seniors' perceptions of food safety issues for meal site location, age, marital status, and household composition. When responses of seniors at congregate-meal sites and seniors receiving HDMs were compared, it was found that significantly more seniors at congregate-meal sites believed foodborne illness was very common. Older respondents (81 years of age and older) were more likely to believe that food safety problems were more likely to occur at places other than the home than were younger respondents (60-80 years of age). Twenty-one percent of all age groups believed food safety problems were more likely to occur outside the home. Significantly more married respondents believed that foodborne illness had increased in the past five years than did elderly people who were single or divorced, separated, or widowed. In addition, seniors who lived alone or were male were more likely to believe that older people were more likely to get foodborne illness.

Food Safety Behaviors

Analysis was conducted to determine differences in seniors' food safety behaviors in relation to demographic and socioeconomic variables. Table 3 shows that significant differences were found for marital status, meal site location, age, gender, household composition, race/ethnicity, and education level. Thirty-three percent of elderly respondents stated that at least half the time they saved their congregate meal or HDM to eat later in the day instead of at the time they received it. The practice of saving some of the meal to eat later occurred significantly more often among seniors participating in congregate meals than among seniors receiving HDMs. Single and divorced, separated, or widowed seniors were significantly more likely to eat their meal right away, while married seniors were more likely to eat some of it within one to two hours of receiving it. Among all marital groups, 18 to 22 percent of the sample ate their meal more than two hours after it was delivered. Fifty percent of the oldest group (91 years of age or older) kept all or a part of their unconsumed meal on the counter instead of in a refrigerator or warm oven. In addition, a significant number (36 percent) who were 60 to 70 years of age practiced this behavior.

Males, along with those who lived with someone, were also significantly more likely to leave leftovers on the counter for two hours or more before throwing them away. With respect to leaving a casserole or similar food out over night, seniors who were 80 years of age or less, who were white, and who had a high school education or less than a high school education were significantly more likely to throw the food away than were those who were older than 80 years of age, were nonwhite, and had more than a high school education. Last, seniors participating in the congregate-meal program were significantly more likely to wash their hands before eating than were seniors who participated in the HDM program.

Emergency Food Preparedness

Additional analysis was conducted to determine difference in seniors' self-reported food preparedness for emergencies such as floods, hurricanes and ice storms (Table 4). Whites were significantly more likely than other racial/ethnic groups to have a three-day supply of nonperishable foods in their home. Elderly people who had attended some college or had a college degree were more likely to have a cooler, frozen gel packs, and refrigerator and freezer thermometers in their homes than were elderly people with less formal education.

Discussion

Our study of elderly people participating in the congregate-meal and HDM program used three distinct categories of food safety questions: questions about food safety perceptions, questions about food safety behaviors, and questions about emergency food preparedness. Significant correlations between these food safety areas and seniors' demographic characteristics were found. ENP participants are often part of the vulnerable population that has compromised immune systems. By better understanding the perceptions and practices of ENP participants, agencies can establish food safety policies and procedures that protect the elderly.

Some food safety perceptions of elderly people can be problematic. Our study of central Kentucky elderly people participating in ENP revealed that 27 percent thought foodborne illness was uncommon. When combined with the finding that over 20 percent of the sample thought food safety problems were more likely to occur in places other than their homes, this finding indicates that a considerable number of elderly people who participated in the study may be at risk of foodborne illness. In addition, the study found that respondents in the oldest age group were more likely to believe that food safety problems occur in places other than the home. While fewer foodborne illnesses are reported from the home (Bruhn, 1997), home kitchens are, in reality, more likely than restaurants to introduce foodborne pathogens when personal hygiene and proper food-handling procedures are not practiced (Medeiros et al., 2004). About one-fifth of the study population appeared to believe that food safety problems could not occur in their homes and to be more suspicious of "outside influences" on the safety of food.

Two other perceptions that were found in the study and that could prompt elderly people to make erroneous food-handling decisions were the belief that foodborne illness had declined in the last five years (18 percent of the sample) and the belief that older people are not more susceptible to foodborne illness (22 percent of sample). An interesting finding of the study, not reported in previous research, is that seniors who lived alone were significantly more likely to believe that older people were more susceptible to foodborne illness than were seniors who lived with someone. The findings indicate that 20 to 25 percent of ENP participants have risky food safety perceptions. Mathieu (2002) has reminded readers that "agencies must take precautions depending on what kind of client they are dealing with" (p. 1746).

Our study found that some demographic and socioeconomic characteristics had a significant relationship to elderly people's food safety behaviors. One of the most resonant concerns revealed by the study was the handling of unconsumed HDMs. Seniors who were married were significantly more likely to delay eating their HDMs than were seniors who were not married. Overall, 44 percent of ENP participants (both congregate-meal and HDM recipients) saved some of their meal to eat later. This finding is comparable to those of previous studies, which reported that about one-half of HDM recipients saved food to eat later (Asp & Darling, 1988; Fey-Yensan, English, Ash, Wallace, & Museler, 2001; Roberson, Binkley, Almanza, Ismail, & Nelson, 2005). This study found that significantly more congregate-meal than HDM recipients saved some of their meal to eat later. Since this generation is known for saving leftover food, this finding suggests the possibility that portion sizes may be too large in the congregate-meal settings where this study took place. Of those who ate all or part of their meal later, individuals 60 to 70 years of age and over 90 years of age were significantly more likely to leave the meal sitting on the counter. Alarmingly, 50 percent of elderly people over 90 years of age left an unconsumed meal on the kitchen counter.

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Previous research has also found delayed consumption of HDMs after improper storage in the home (Fey-Yensan et al., 2001). In that study, younger HDM participants (65-74 years of age) and males were more likely to eat their entire meal upon receiving it. The majority stored part of the meal for later; of that group, 38 percent stored it in the refrigerator and 30 percent on the counter. As in our findings, leaving the meal on the counter was more likely among those in the oldest age group. In contrast to our study, which found that 81 percent of seniors ate their meal within two hours, another study found that 77 percent of the clients who received HDMs ate their meal within one hour of delivery. Of those who did not eat the meal immediately, 41 percent left the meal on the counter, 44 percent refrigerated it, and 12 percent stored it in a hot oven (Roberson et al., 2005). A focus group of seniors 65 years of age and older found prompt refrigeration of food to be lacking (Boone et al., 2005). These findings suggest that ENP agencies should combat unsafe practices of the elderly by having delivery drivers encourage clients to eat their meal right away or make sure it is refrigerated upon delivery. In addition, agencies could implement strategies to encourage safe food-handling practices in the home by changing food container types, providing storage information on containers, and so forth.

Another major concern revealed in the study was seniors' handling of leftover food. Twenty-two percent of the sample stated they would leave a casserole or similar food on the counter for over two hours before they would throw it away. This unsafe practice was significantly more prevalent among males and married ENP participants than it was among females and seniors who were single or divorced, separated, or widowed. In addition, the study found that almost 10 percent of the sample would eat a casserole or similar food that had been left on the counter overnight. This practice of eating food left out overnight was significantly more prevalent among respondents 81 years of age or older, among respondents of a race/ethnicity other than white, and among respondents with the highest level of education. Similarly, Redmond and Griffith (2004) reported that men had riskier hygiene and cooking practices than did women.

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An annual survey of supermarket shoppers conducted in 2000 indicated that 60 percent of respondents thought that washing their hands and food preparation surfaces were the two most important methods they used to keep food safe from bacteria (ERS/USDA Briefing Room, 2004). In our study, considerably more seniors (nearly 84 percent) washed their hands before eating. One could postulate that eating meals in a group setting increases handwashing since we also found that respondents who participated in congregate meals were significantly more likely to wash their hands than were HDM participants.

The last section of the survey investigated how prepared ENP participants were with regard to emergency food and water. This inquiry was prompted by recent catastrophic events in the United States such as hurricanes, floods, ice storms, and tornadoes. The study found that certain demographic variables (race and education level) were significant. Our findings also suggest that more attention should be given to preparing elderly people for emergencies, especially members of the ethnic/racial groups that showed less preparedness for emergencies and less knowledge of safe-food-handling principles.

One limitation of the study is that it was conducted in only nine counties in Central Kentucky; therefore, the results can be generalized only to Kentucky's ENP participants. Nevertheless, because of the thoroughness of the research design according to which personal interviews were conducted, findings from this study should provide useful information on the food safety perceptions and behaviors of elderly people enrolled in ENP programs nationwide.

Conclusions

The findings of our study are a reminder of how important it is for elderly people, especially those in high-risk populations, to adhere to safe food practices. They also indicate that sometimes elderly people participating in ENP have precarious food safety perceptions and partake in risky food-handling behaviors. As elderly people age, these behaviors may escalate because of physical and mental impairments.

The study found that elderly people have misconceptions that are of significant importance to their overall health. Some respondents believed that foodborne illness was not likely to happen to them or that foodborne illness occurred elsewhere other than the home. These misconceptions, along with a lack of proper food safety education, can put elderly people at risk. Our study found that along with these misconceptions, ENP participants in central Kentucky displayed several unsafe food practices, such as frequently not eating their meals upon delivery, coupled with unsafe disposition of the meals. In addition, over 20 percent of respondents ate food that had been left out in unsafe conditions for over two hours and nearly 10 percent stated that they would eat a casserole that had been left out overnight. In national data from 1993 through 1997, the food preparation practice most commonly reported as contributing to foodborne disease was improper holding temperature (Olsen, MacKinon, Goulding, Bean, & Slutsker, 2000). Since many elderly people experienced the Great Depression and are on fixed incomes, they may feel uneasy discarding food that has been held at an improper temperature for too long. They need consistent reminders and encouragement to throw out food that is potentially unsafe. In addition, since many elderly people participating in the ENP program are vulnerable, the findings of the study indicate that encouragement and assistance are warranted with respect to proper storage of prepared foods and the stocking of adequate food, water, and supplies in the home for emergency situations.

More research is needed to understand the food safety perceptions and behaviors of ENP participants. As this population grows, the risk of foodborne illness will increase. Better understanding of misconceptions and inappropriate behaviors can be applied in ENP strategies. Continued independence of seniors in their home can be achieved if congregate-meal and HDM recipients practice safe food-handling procedures at home.

Acknowledgements: The study was funded by the Thomas P. Rogers Endowment from the University of Kentucky's Department of Gerontology. Additional thanks go to the Kentucky Division of Aging Services, the Bluegrass Area Agency on Aging, and the Bluegrass Community Action for providing research locations and assistance. In addition, the author gratefully appreciates research and technical assistance by graduate students and dietetic interns of the University of Kentucky Department of Nutrition and Food Science and by dietitians from Bluegrass District Dietetic Association.

Corresponding Author: Mary G. Roseman, Associate Professor, University of Kentucky, Department of Nutrition and Food Science, 120 Erikson Hall, Lexington, KY 40506. E-mail: [e-mail].

REFERENCES

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Congressional Research Service. Library of Congress. (2004). Older Americans Act Nutrition Program. Retrieved June 18, 2006, from http://www.nationalaglawcenter.org/assets/crs/RS21202.pdf.

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Food & Drug Administration. (1993). CATI specifications to the FDA survey of consumer food handling practices and awareness of microbiological hazards (OMB No. 0910-0280). Washington, DC: U.S. Government Printing Office.

Gettings, M.A., & Kiernan, N.E. (2001). Practices and perceptions of food safety among seniors who prepare meals at home. Journal of Nutrition Education and Behavior, 33, 148-154.

Herndon, A.S. (1994). Nutrition screening of clients participating in a home delivered meals program. Journal of the American Dietetic Association, 94(suppl.), A-51.

Kendall, P., Medeiros, L.C., Hillers, V, Chen, G., & DiMascola, S. (2003). Food handling behaviors of special importance for pregnant women, infants and young children, the elderly, and immune-compromised people. Journal of the American Dietetic Association, 103, 1646-1649.

Kentucky Department for Aging and Independent Living. (2005). National Aging Program Information System (NAPIS) fiscal year 2005 report. Frankfort: Kentucky Cabinet for Health and Family Services, Commonwealth of Kentucky.

Klontz, K.C., Adler, W.H., & Potter, M. (1997). Age-dependent resistance factors in the pathogenesis of foodborne infectious disease. Aging Clinic, 9, 320-326.

Mathieu, J. (2002). Food safety and home delivery. Journal of the American Dietetic Association, 102, 1744, 1746.

McCabe-Seller, B.J., & Beattle, S.E. (2004). Food safety: Emerging trends in foodborne illness surveillance and prevention. Journal of the American Dietetic Association, 104, 1708-1717.

Medeiros, L., Hillers, V.N., Chen, G., Bergmann, V, Kendall, P., & Schroeder, M. (2004). Design and development of food safety knowledge and attitude scales for consumer food safety education. Journal of the American Dietetic Association, 104, 1671-1677.

Millen, B.E., Ohls, J., Ponza, M., & McCool, A.C. (2002). Journal of the American Dietetic Association, 102, 234-240.

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Olsen, S.J., MacKinon, L.C., Goulding, J.S., Bean, N.H., & Slutsker, L. (2000). Surveillance for Foodborne Disease Outbreaks--United States, 1993-1997. Morbidity and Mortality Weekly Report, 49, 1-51.

Redmond, E.C., & Griffith, C.J. (2004). Consumer perceptions of food safety risk, control and responsibility. Appetite, 43, 309-313.

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Mary G. Roseman, Ph.D., R.D., L.D.

TABLE 1 Descriptive Characteristics of Congregate-Meal and
Home-Delivered-Meal Respondents

                        Home-Delivered Meals     Congregate Meals
Characteristic          Frequency  Percentage  Frequency  Percentage

Gender
  Male                  13         14.1%        23        18.0%
  Female                79         85.9%       105        82.0%
  Total                 92         41.8%       128        58.2%
Age
  60-70                 14         15.2%        38        29.5%
  71-80                 38         29.5%        48        37.2%
  81-90                 42         45.7%        37        28.7%
  91 and above           5          5.4%         6         4.7%
  Total                 92         41.6%       129        58.4%
Race
  White                 86         93.5%        99        78.6%
  Other                  6          6.5%        27        21.4%
  Total                 92         42.2%       126        57.8%
Education
  <High school          46         50.0%        68        53.1%
  High school/GED       29         31.5%        34        26.6%
  Some college/         17         18.5%        26        20.3%
    college degree
  Total                 92         41.8%       128        58.2%
Marital status
  Single                 6          6.6%        14        10.8%
  Married or living     17         18.7%        23        17.7%
    as married
  Divorced, separated,  68         74.7%        93        71.5%
    or widowed
  Total                 91         41.2%       130        58.8%
Status of home
  Live alone            61         66.3%        91        70.0%
  Live with someone     31         33.7%        39        30.0%
  Total                 92         41.4%       130        58.6%

                               Total
Characteristic          Frequency  Percentage

Gender
  Male                   36         16.4%
  Female                184         83.6%
  Total                 220        100.0%
Age
  60-70                  52         23.5%
  71-80                  79         35.7%
  81-90                  79         35.7%
  91 and above           11          5.0%
  Total                 221        100.0%
Race
  White                 185         84.9%
  Other                  33         15.1%
  Total                 218        100.0%
Education
  <High school          114         51.8%
  High school/GED        63         28.6%
  Some college/          43         19.5%
    college degree
  Total                 220        100.0%
Marital status
  Single                 20          9.0%
  Married or living      40         18.1%
    as married
  Divorced, separated,  161         72.9%
    or widowed
  Total                 221        100.0%
Status of home
  Live alone            152         68.5%
  Live with someone      70         31.5%
  Total                 222        100.0%

TABLE 2 Respondent Perceptions of Food Safety Issues as Influenced by
Demographic Variables

Variable           Questionnaire Item

                   How common is it to get foodborne illness in the
                   United States?
                   Very    Somewhat  Not Common
                   Common  Common    at All      Total

Meal site  Home    33.3%   30.0%     36.7%        (90) 100%
           Center  48.4%   31.3%     20.3%       (128) 100%
           Total   42.2%   30.7%     27.1%       (218) 100%
                                     p = .018

            Where are food safety problems most likely to occur?
            Home   Other Places  Total

Age  60-70  92.2%   7.8%          (51) 100%
     71-80  78.9%  21.1%          (76) 100%
     81-90  71.6%  28.4%          (74) 100%
     91+    60.0%  40.0%          (10) 100%
     Total  78.7%  21.3%         (211) 100%
                   p < .012

                                      What amount of foodborne illness
                                      has there been in the past 5
                                      years?
                                      More   Less   The Same  Total

Marital status  Single                21.1%  15.8%  63.2%      (19) 100%
                Married or living as  53.8%  15.4%  30.8%      (39) 100%
                  married
                Divorced, separated,  30.5%  19.5%  50.0%     (154) 100%
                  or widowed
                Total                 34.0%  18.4%  47.6%     (212) 100%
                                                    p = .051

                           As people get older, are they more likely to
                           get foodborne illness?
                           Yes    No     Not Sure  Total

Household      Live alone  60.9%  17.2%  21.9%     (151) 100%
  composition  Live with   54.3%  31.4%  14.3%      (70) 100%
                 someone
               Total       58.8%  21.7%  19.5%     (221) 100%
                                         p = .052
Gender         Male        77.1%  14.3%   8.6%      (35) 100%
               Female      55.4%  22.8%  21.7%     (184) 100%
               Total       58.9%  21.5%  19.6%     (219) 100%
                                         p = .054

TABLE 3 Respondent Food-Handling Behaviors as Influenced by Demographic
Variables

Variable                     Questionnaire Item

                             When do you eat the meal?
                             Right Away  1-2 Hours  >2 Hours  Total

Marital   Single             73.3%        6.7%      20.0%      (15) 100%
  status  Married or living  37.5%       40.6%      21.9%      (32) 100%
            as married
          Divorced,          62.5%       20.0%      17.5%     (120) 100%
            separated, or
            widowed
          Total              58.7%       22.8%      18.6%     (167) 100%
                                                    p = .036

                   How often do you save some of the meal to eat later?
                   Always  About Half the Time  Rarely/Never  Total

Meal site  Home     4.4%   29.7%                65.9%          (91) 100%
           Center  18.4%   35.7%                45.9%          (98) 100%
           Total   11.6%   32.8%                55.6%         (189) 100%
                                                p = .002

            What do you do with your meal if you do not eat all or part
            of it right away?
            Put on Counter  Put in Refrigerator/Oven  Total

Age  60-70  36.1%           63.9%                      (36) 100%
     71-80  15.7%           84.3%                      (51) 100%
     81-90  24.2%           75.8%                      (62) 100%
     91+    50.0%           50.0%                      (10) 100%
     Total  25.8%           74.2%                     (159) 100%
                            p = .044

                           How long do you leave casserole or similar
                           food on counter before throwing it away?
                           <2 Hours  2 Hours/>2 Hours  Total

Gender         Male        58.8%     41.2%              (34) 100%
               Female      82.0%     18.0%             (178) 100%
               Total       78.3%     21.7%             (212) 100%
                                     p = .004
Household      Live alone  82.1%     17.9%             (145) 100%
  composition  Live with   69.6%     30.4%              (69) 100%
                 someone
               Total       78.0%     22.0%             (214) 100%
                                     p = .031

                                      What would you do if you left a
                                      casserole or similar food on
                                      counter overnight?
                                      Eat It  Throw It Away  Total

Age             60-70                  3.9%   96.1%           (51) 100%
                71-80                  5.4%   94.6%           (74) 100%
                81-90                 16.7%   83.3%           (78) 100%
                91+                   18.2%   81.8%           (11) 100%
                Total                  9.8%   90.2%          (214) 100%
                                              p = .030
Race/Ethnicity  White                  7.2%   92.8%          (180) 100%
                All other races       22.6%   77.4%           (31) 100%
                Total                  9.5%   90.5%          (211) 100%
                                              p = .015
Level of        <High school           7.3%   92.7%          (109) 100%
  Education     High school            4.8%   95.2%           (62) 100%
                Some college or B.S.  23.3%   76.7%           (43) 100%
                  degree
                Total                  9.8%   90.2%          (214) 100%
                                              p = .007

                          Wash hands before eating meal?
                   Very Likely  Somewhat or Not Likely  Total

Meal Site  Home    75.0%        25.0%                    (92) 100%
           Center  89.8%        10.2%                   (128) 100%
           Total   83.6%        16.4%                   (220) 100%
                                p = .005

TABLE 4 Respondent Behaviors with Respect to Emergency Preparation, as
Influenced by Demographic Variables

Variable                         Questionnaire Item

                                 Three-day supply of nonperishable food?
                                 Yes    No        Total

Race/ethnicity  White            83.3%  16.7%     (180) 100%
                All other races  62.5%  37.6%      (32) 100%
                Total            80.2%  19.8%     (212) 100%
                                        p = .014

                                          Cooler and frozen gel packs?
                                          Yes    No        Total

Level of     <High school                 30.9%  69.1%     (110) 100%
  education  High school                  44.4%  55.6%      (63) 100%
             Some college or B.S. degree  57.1%  42.9%      (42) 100%
             Total                        40.0%  60.0%     (215) 100%
                                                 p = .009

                                   Refrigerator/freezer thermometer?
                                   Yes    No        Total

Level of     <High school           9.3%  90.7%     (107) 100%
  education  High school           11.3%  88.7%      (62) 100%
             Some college or B.S.  31.0%  69.0%      (42) 100%
               degree
             Total                 14.2%  85.8%     (211) 100%
                                          p = .005