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Surveying the food safety training needs of environmental health specialists in the U.S.

Introduction

The retail food industry in the U.S. is composed of nearly one million establishments providing an estimated 70 billion meals every year (National Restaurant Association [NRA], 2009). To serve all of these meals, the industry employs an estimated 13 million people (NRA, 2009). While the U.S. food supply is among the safest in the world, each year 76 million Americans are still stricken with foodborne illness, and some--mostly the very young, elderly, and the chronically ill--die as a result (Mead et al., 1999). Between 50% and 70% of documented foodborne illnesses in the U.S. have been attributed to food service and retail establishments (Bean, Goulding, Daniels, & Angulo, 1998; Lynch, Painter, Woodruff, & Braden, 2006). Scientific risk assessments performed by the U.S. Food and Drug Administration (FDA) indicate that more than 40% of food service and retail establishments were out of compliance during its study inspections with critical items that could lead to foodborne illness (FDA, 2000, 2004). Given the approximately 1.7 million inspections of retail and food service operations annually (Association of Food and Drug Officials [AFDO], 2001), this indicates a significant risk.

Prevention is the key to reducing foodborne illness. Prevention can be accomplished by minimizing the foodborne illness risk factors in an operation. The ultimate responsibility to produce and process safe foods lies with the management and employees of food service, restaurant, and retail food store operations. The high percentage of establishments found to be out of compliance suggests that the foodservice and retail industry needs help. One method of help suggested by FDA (2004) is to provide more food safety education followed by verification via inspection.

In 2004, the Retail-Foodservice Food Safety Consortium (RFSC) was founded to address food safety needs within the retail food service industry. RFSC is a collaboration among five land-grant universities (University of Arkansas, Clemson University, Purdue University, Rutgers University, and Utah State University) and three science-based associations that involve retail food safety stakeholders (Association of Food and Drug Officials, NEHA, and the International Association for Food Protection). One of RFSC's goals is to collect, develop, review; and disseminate retail food safety educational resources. A global food system, shifting demographics, and limits on time and budgets all impact the ability of food safety professionals to educate and train operators.

Without proper training, food service operators and workers may commit errors that could lead to foodborne illness. Many food service operators do not have the resources to provide in-house food safety training. Environmental health specialists and their departments may be the primary source, or in some cases only source, of food safety education and training for millions of retail food service workers in the U.S. Therefore, the objective of our study was to determine environmental health specialist opinions and needs with respect to food safety training and education.

Methods

Survey Participants

Environmental health specialists who provide food safety training to the retail food service industry were the target population. To recruit from this population group, a description of the study and a link to the online survey were published in NEHA's enewsletter and the main page of the NEHA Web site. The newsletter and Web site reach approximately 4,500 members. Environ mental health specialists were also contacted directly via e-mail by members of RFSC in case they were not active in NEHA. As compensation for participating, respondents had an option of entering their name into a drawing for one of three NEHA food safety manager training kits ($69.95 value).

Survey Design

An online survey, including both openended and closed questions, was developed for this study based on a previous NEHARFSC focus group project (Nummer, Fraser, Marcy, & Klein, in press). The survey contained 14 items regarding demographics of participants including background and experience, four items regarding food safety training programs, four items regarding opinions of food safety training, and 10 items regarding food safety training needs. For questions in which respondents could select from a response list, "other" was included as an option along with a write-in box. Write-in responses were included in the data analyses.

The survey instrument was created and reviewed for content, bias, language, clarity, and sequence by RFSC members and project administrators using guidelines from Couper (2000) and Iraossi (2006). The final survey and study protocol were reviewed and approved by the human subjects committee of the Institutional Review Board (Clemson University, Clemson, SC).

Data Collection and Analyses

The survey was posted online using Survey-Monkey, an online survey company (www.surveymonkey.com). The link to the survey was active for six weeks between March and April 2009. NEHA staff sent out two e-mail reminders (several weeks apart) after the initial posting to increase the response rate. Additional e-mails and invitations were sent from RFSC members including the Association for Food and Drug Officials. SPSS for Windows software was used for all data analyses. Frequency distributions were computed for all variables and cross-tabulations were computed for select variables.

Results and Discussion

Survey Participant Characteristics

A total of 346 surveys were completed. When considering the total NEHA membership (4,500), the response rate would be about 8%. The survey, however, requested a response only from environmental health specialists who performed food safety education as part of their job. Out of 4,500 NEHA members, 483 list themselves as "food safety professionals (V. DeArman, personal communication, July 2009)." Using that number, the survey response rate would be 71%. Because not all NEHA members active in food safety training indicate themselves as "food safety professionals," this data is most likely an overestimate.

Survey respondent characteristics are summarized in Table 1. The majority of respondents had either a four-year or advanced college degree. Nearly 65% of the respondents reported that they were either a registered environmental health specialist (REHS) or a registered sanitarian (RS). Only 23.9% reported that they were a certified professional-food safety (CP-FS). All respondents indicated they participate in some form of professional food safety development. Forty-seven respondents (14%) reported speaking a language other than English; Spanish was the most common second language. Other languages spoken by one or more respondents included German, Korean, Persian, Polish, Russian, Tagalog (Philippines), and Turkish.

Food Safety Training Offered

Survey responses related to food safety training are summarized in Table 2. Nearly all respondents (97.1%) reported that food safety was one of their current job responsibilities. If respondents were not working in this area, they were asked to complete the demographic questions and exit the survey Two-thirds (67.7%) of survey participants stated that they provide food safety training to the retail food service industry, with the largest percentage (32.5%) offering one to three trainings within the past 12 months, followed by 24.7% offering more than 12 trainings per month. The top three target audiences were restaurants (57%), schools (35%), and temporary food establishments (18%). The ServSafe exam was the most commonly administered examination (26%), followed by the National Registry for Food Safety Professionals (12%), and Prometric (5%).

Food Safety Opinions

An overview of the survey questions related to food safety opinions is presented in Table 3. Respondents listed experience as a trainer (27%) and experience working in the retail food service industry (24%) as the most important characteristics of an effective food safety trainer. The response choice "other" was selected by 18% of respondents who listed knowledge (6%) and communication (4%) as two other important characteristics. The importance of trainer effectiveness can also be seen in the amount of professional development educators have reported (Table 1). Having a college degree was not cited as a basis for whether or not one would be an effective trainer, despite the fact that such a large number of respondents were college graduates. Using activities and demonstrations to teach content was cited as the best way to make training effective (46%), followed by having trainers who have experience with retail food service regulations (30%).

The top three opinions about why workers do not attend training are that workers think they know how to handle food safely (50%), workers are not given leave by management to attend training (44%), and training is not mandated by a regulatory agency (40%). The opinion that workers feel they know how to handle foods safely has been cited as a barrier to food safety education by Seaman and Eves (2006). The perceived lack of risk may result in a lack of importance of training (i.e., in allowing leave time) and a lack motivation unless training is mandated. The top three reasons respondents believed managers do not send workers to training were that training is not mandated by a regulatory agency (53%), training is too expensive (51%), and training focuses on generic food safety and not practices specific to their establishment (34%). These opinions agree with studies cited by Seaman and Eves (2006) that in dicate training is often only undertaken to meet regulatory requirements and that cost is a major concern for operators.

Training Needs

An overview of the questions related to food safety training needs is shown in Table 4. Photographs, illustrations, and graphics (55%); presentations (slides; 52%); video clips (41%); regulatory guidelines (32%); and fact sheets (30%) were the top five resources cited as needed. Most respondents (88.4%) want to edit or modify existing resources before using them, with the most important edit/ modification being jurisdiction regulations (60%), followed by agency contact information (45%), and agency logo (23%). Write-in edit requirements reported include audience, information, facility, and regulations. This echoes what Foster and Kaferstein (1985) reported, which is that differences in cultural, economic, and social factors associated with workers themselves make it difficult to use the same educational food safety program in all situations. Not surprisingly, 278 (96%) respondents think food safety materials are needed in languages other than English with Spanish, simplified Chinese, and traditional Chinese being the top choices followed by Vietnamese and Korean. This outcome is similar to the results of a survey of environmental health officers' views of food hygiene in the United Kingdom (Worsfold & Griffith, 2004). The respondents in that study cited the need for materials in other languages because lack of multilingual training materials could be a reason that operators might not be training staff.

Only 68 (23.2%) respondents reported using online food safety resources in the past month. When asked to list up to three commonly used online sources, FDA was cited by 34 respondents, followed by the U.S. Department of Agriculture (USDA) (16 respondents) and state regulatory agencies (15 respondents). This result could be due to the difficulty of locating online resources that match jurisdictional regulations, which was cited by 60% of respondents (Table 4) as a reason that materials need to be edited. When asked which were the top five new resources needed, food preparation practices, hygiene, raw food handling practices, microbial hazards, and ready-to-eat food handling practices were cited most frequently (Table 4). The least-needed resources were model forms and guides, physical hazards, water, and waste (Table 4).

Conclusion

Based on this survey, it is clear that environmental health specialists play a critical role in food safety education. Many conduct trainings monthly or several times monthly. Survey participants felt that effective and relevant food safety training for food workers and managers requires both adequate resources and effective delivery. The survey data from this study is currently being used by RFSC and NEHA to help meet some of the stated food safety education and training needs. Also, a Web site has been developed to provide links to resources and editable education and training resources: www.retailfoodsafety.com.

Corresponding Author: Brian A. Nummer, Assistant Professor, Nutrition, Dietetics, and Food Sciences Department, Utah State University, 8700 Old Main Hill, Logan, UT 84322. E-mail: Brian.nummer@usu.edu.

Pre-published digitally November 2009, National Environmental Health Association. Final publication Journal of Environmental Health, April 2010 72(8).

References

Association of Food and Drug Officials. (2001). State resource survey. York, PA: Author. Retrieved October 14, 2009, from http://www.afdo.org/resources/stateresourcesurvey.cfm#

Bean, N.H., Goulding, J.S., Daniels, M.T., & Angulo, FJ. (1997). Surveillance for foodborne disease outbreaks: United States, 1988-1992. Journal of Food Protection, 60(10), 1265-1286.

Couper, M. (2000). Web surveys: A review of issues and approaches. Public Opinion Quarterly 64(4), 464-494.

Foster, G.M., & Kaferstein, FK. (1985). Food safety and the behavioural sciences. Social Science and Medicine, 21(11), 1273-1277.

Iraossi, G. (2006). The power of survey design: A user's guide for managing surveys, interpreting results, and influencing respondents. Washington, DC: The World Bank.

Lynch, M., Painter, J., Woodruff, R., & Braden, C. (2006). Surveillance for foodborne-disease outbreaks--United States, 1998-2002. Morbidity and Mortality Weekly Report, 55(SS10), 1-34.

Mead, PS., Slutsker, L., Dietz, V., McCaig, L.F, Bresee, J.S., Shapiro, C., Griffin, PM., & Tauxe, R.V (1999). Food-related illness and death in the United States. Emerging Infectious Diseases, 5(5), 607-625.

National Restaurant Association. (2009). Restaurant industry--facts at a glance. Retrieved September 6, 2009, from http://www.restaurant.org/ research/ind_glance.cfm

Nummer, B.A., Fraser, A., Marcy, J., & Klein, R. (2010, in press). Assessing food safety training needs of environmental health specialists in the U.S.: Focus group summary. Journal of Environmental Health, 72(8), (forthcoming).

Seaman, P, & Eves, A. (2006). The management of previous food safety--the role of previous food hygiene training in the UK service sector. International Journal of Hospitality Management 25(2), 278-296.

U.S. Food and Drug Administration. (2000). Report of the FDA retail food program database of foodborne illness risk factors. Washington, DC: Author.

U.S. Food and Drug Administration. (2004). FDA report on the occurrence of foodborne illness risk factors in selected institutional foodservice, restaurant, and retail food store facility types. Washington, DC: Author. Retrieved October 14, 2009, from http://www.fda.gov/Food/FoodSafety/ RetailFoodProtection/FoodborneIllnessandRiskFactorReduction/ RetailFoodRiskFac-torStudies/ucm089696.htm

Worsfold, D., & Griffith, C. (2004). A survey of environmental health officers' views of food hygiene training. British Food Journal, 106(1), 51-64.

Angela M. Fraser, PhD

Brian A. Nummer, PhD
TABLE 1 Survey Participant Characteristics

Characteristics                                  No. Responses (%) (a)

Age
45-64 years                                            164 (56)
25-44 years                                            118 (40)
65 years and over                                        8 (3)
18-24 years                                              3 (1)

Gender
Male                                                   157 (54)
Female                                                 136 (46)

Education level
Four-year college degree                              183 (62.5)
Post-graduate degree                                   89 (30.4)
Some college                                           12 (4.1)
High school graduate                                    4 (1.4)
Associate or technical degree                           5 (1.7)
Less than high school                                      0

Credentials
Registered environmental health specialist            190 (64.8)
(REHS) or registered sanitarian (RS)
Certified Professional-Food Safety (CP-FS)             70 (23.9)

Professional food safety development
Training offered by a governmental agency              157 (45)
Sessions at a conference                               148 (43)
Online training                                        106 (31)
Training offered by a professional                      29 (8)
society, such as NEHA
College or university courses                           69 (20)
Food safety workshops offered by your employer          67 (19)
Other                                                   15 (4)

(a) Percentages do not always total 100% because of nonresponses and m

TABLE 2 Survey Responses Related to Food Safety Training

Questions                                            No. Responses
                                                     (%) (a)

Food safety trainer

Food safety as a job responsibility                  329 (97.1)
Provide training                                     222 (67.7)

Food protection manager certification examinations

National Restaurant Association                       91 (26)
Solutions--ServSafe[R]
National Registry of Food Safety Professionals        42 (12)
Prometric (formerly Experior Assessments)             17 (5)

Food safety trainings taught in past 12 months

1 to 3 trainings                                      75 (32.5)
More than 12 trainings                                57 (24.7)
4 to 6 trainings                                      44 (19.0)
7 to 9 trainings                                      25 (10.8)
No trainings                                          19 (8.2)
10 to 12 trainings                                    11 (4.8)

Food safety training audiences

Restaurants                                          198 (57)
Schools                                              120 (35)
Temporary food establishments                         62 (18)
Grocery stores and supermarkets                       54 (16)
Catering operations                                   44 (13)
Child and adult care facilities                       46 (13)
Health care facilities, including hospitals           34 (10)
and nursing homes
Convenience stores                                    31 (9)
Other                                                 37 (0.3)

(a) Percentages do not always total 100% because of
nonresponses and multiple responses where allowed.

TABLE 3 Self-Reported Opinions About Food Safety Training (N = 346)

Opinions                                            No. Responses
                                                       (%) (a)

Most important characteristic of an effective food safety educator

Experience as a traine                                 82 (27)
Experience working in the retail food                  72 (24)
service industry
Other                                                  55 (18)
Experience as a government regulator                   46 (15)
Degree in food science, environmental health,          42 (14)
or related field

Best way to make food safety training for retail food service worker

Using activities and demonstrations                   139 (46)
Trainers who have experience with retail food          69 (23)
service regulations
Valid and reliable evaluation tools to assess          30 (10)
the effect of training
Having a packaged curriculum that includes             25 (8)
training aids
Other                                                  21 (7)
Offering food safety training in languages             17 (6)
other than English

Beliefs why retail food service workers do not attend training

Think they already know how to handle food safety        172 (50)
Not given leave by management to attend training         151 (44)
Do not think training is important                       138 (40)
Not mandated by the local regulatory agency              139 (40)
Cannot afford the training registration fee              130 (38)
Cannot find training appropriate to their                67 (19)
English language abilities
Cannot find training appropriate to their                 31 (9)
literacy level
Other                                                     23 (7)
Cannot find training appropriate for their                12 (4)
skill level

(a) Percentages do not always total 100% because of nonresponses and
multiple responses where allowed.

TABLE 4

Self-Selected Food Safety Training Needs

Food Safety Training Need                         No. Responses
                                                      (%) (a)

Resources to effectively conduct food safety training

Photographs, illustrations, and graphics             190 (55)
PowerPoint slide sets                                179 (52)
Video clips                                          140 (41)
Regulatory guidelines                                111 (32)
Fact sheets                                          103 (30)
Media stories                                        104 (30)
Case studies                                         101 (29)
Evaluation tools                                      77 (22)
Model forms and guides                                77 (22)
Collaboration with local health jurisdiction          69 (20)
Audio aids                                            49 (14)
Signs                                                 46 (13)
Packaged curriculum                                   35 (10)
Posters                                               34 (10)
Other                                                 30 (9)
Public service announcements and press releases       19 (6)
Extension bulletins and reports                        6 (2)
Refereed publications and journal articles             5 (1)

Which edits or modifications are important

Jurisdiction regulations                             208 (60)
Agency contact information                           157 (45)
Agency logo                                           81 (23)
Other                                                 51 (15)

Languages for food safety training materials

Spanish                                              273 (79)
English                                              218 (63)
Chinese--simplified                                  181 (52)
Chinese--traditional                                 165 (48)
Vietnamese                                           151 (44)
Korean                                               132 (38)
Arabic                                                57 (17)
Other                                                 59 (16)
Tagalog                                               24 (7)
French                                                16 (5)

Topics in which new food safety materials are needed

Food preparation practices                           225 (65)
Hygiene                                              194 (56)
Raw food handling practices                          150 (43)
Microbial hazards                                    129 (37)
Ready-to-eat food handling practices                 129 (37)
Sanitation                                           122 (35)
HACCP aids                                            93 (27)
Food storage practices                                93 (27)
Food processing criteria                              66 (19)
Equipment and utensils                                47 (14)
Facilities                                            33 (10)
Plumbing                                              36 (10)
Chemical hazards                                      30 (9)
Model forms and guides                                31 (9)
Other                                                 19 (6)
Physical hazards                                       8 (2)
Waste                                                  5 (1)
Water                                                  8 (2)

(a) Percentages do not always total 100% because of nonresponses
and multiple responses where allowed.
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Title Annotation:GUEST COMMENTARY
Author:Fraser, Angela M.; Nummer, Brian A.
Publication:Journal of Environmental Health
Article Type:Report
Geographic Code:1USA
Date:Apr 1, 2010
Words:3149
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