Restaurants and COVID-19: What are consumers' risk perceptions about restaurant food and its packaging during the pandemic?

The COVID-19 pandemic and subsequent U.S. in-restaurant dining restrictions deleteriously affected the restaurant industry. While dining restrictions were adopted to prevent human contact, evidence suggests that consumers may mistakenly perceive that restaurant "food" and its "packaging" are risky sources of COVID-19. To explore consumers' COVID-19 risk perceptions about food itself, restaurant food specifically, and restaurant food packaging, this study collected nationwide U.S. consumer survey data (n = 958) using an online consumer panel. Findings showed that: (1) consumers were less concerned about contracting COVID-19 from food in general than restaurant food and its packaging, with consumer restaurant concern highest for food served in restaurants, and lowest for hot/cooked restaurant food followed by restaurant food from carry-out; and (2) the risk perceptions of consumers varied with financial concern for food, gender, and being in a high-risk category of COVID-19. Implications for researchers, restauranteurs, government, and food safety professionals are discussed.

Adding sodium information to casual dining restaurant menus: Beneficial or detrimental for consumers?

High sodium levels in restaurant food have prompted Philadelphia and New York City to require inclusion of sodium content in addition to calories on menus to "nudge" consumers toward lower sodium foods. However, taste perceptions may impact the effectiveness of this intervention. An online survey tested whether sodium and calorie menu nutrition information (MNI) influenced consumer choices from a casual dining restaurant menu, accounting for consumers' intuition about taste of food relative to sodium, calories, and healthiness. Consumer choices were assessed based on calorie and sodium content of the menu items they selected. Participants were randomized to a menu with (1) calorie MNI only, (2) calorie plus numeric sodium MNI, (3) calorie MNI plus a sodium warning symbol for foods with 2300 mg of sodium or more, or (4) no MNI. Calorie plus numeric sodium MNI was associated with selection of meals lower in sodium compared to meals from the calorie MNI only menu or no MNI menu, but only for consumers with a taste intuition that (relatively) lower sodium, lower calorie, healthy foods were tasty. Consumers with the opposite taste intuition *(foods with these characteristics are not tasty) ordered meals higher in sodium. Inclusion of the sodium warning symbol did not result in a significantly different meal sodium content compared to the other menu conditions, regardless of taste intuition. However, differing levels of taste intuition alone, without consideration of MNI, was associated with ordering meals of significantly different calorie content. Overall, findings suggest adding calorie plus numeric sodium MNI may lead to beneficial outcomes (i.e., selecting meals lower in sodium) for some consumers and detrimental outcomes (i.e., selecting meals higher in sodium) for others, depending on their taste intuition.

Cookbooks in U.S. history: How do they reflect food safety from 1896 to 2014?

Historical cookbooks as a source of recipes and food preparation information would be expected to document advancements in food safety related to kitchen equipment, cleaning, foodborne illness knowledge, and consumer education materials. In turn, this food safety information might be expected to contribute to consumers' food safety behaviors. Using both quantitative and qualitative research methodology, this study assessed how food safety information in cookbooks changed and how quickly advancements were incorporated. Faster assimilation into cookbooks was associated with kitchen equipment, educational resources (hotlines and websites), and foodborne illness outbreaks. The rate of incorporation of education materials was moderate. Cleaning advances were the slowest to be incorporated. Modern cookbooks published after the 1980's rapidly evolved with advances in food safety knowledge.

Consumer Perception of the Food and Drug Administration's Newest Recommended Food Facility Inspection Format: Words Matter.

The Food and Drug Administration recommended restaurant inspection scores change to a format that incorporated three new categories of violations: priority, priority foundation, and core. It was uncertain whether interested consumers would value the more in-depth information or become more confused. The purpose of this study was to assess consumer perception of the recommended inspection system. Data were collected from an online survey. Results showed that consumers want convenient access to the information either online or on the wall of restaurants, and some consumers do want to read inspection reports and use them in making dining decisions. Choice of restaurant inspection format did appear to change consumer understanding and perceptions about some of the violations. Results also demonstrated the importance of the words used to categorize violations.

Inspector Perceptions of the Food and Drug Administration's Newest Recommended Food Facility Inspection Format: Training Matters.

The Food and Drug Administration publishes the Food Code to guide restaurant inspections. The most recent version proposes a three-tier system categorizing violations as priority, priority foundation, and core. This study used a scenario-based questionnaire to examine inspector perceptions and preferences for inspection formats. Results suggest that inspectors would be able to maintain consistent evaluations when changing to the three-tier system, although the classifying terms under the three-tier system were confusing. Additionally, inspectors were not very positive about the new system; they were concerned that the new system would not be easy to understand and use, inspections would take a longer time, it would not accurately reflect the amount of risk associated with violations, and it would not be easy for consumers and managers to understand and use. The results suggest the need for additional training for inspectors before adoption, especially on the rationale and benefits of changing to a three-tier system.

Yelp Versus Inspection Reports: Is Quality Correlated With Sanitation in Retail Food Facilities?

Consumer-generated restaurant review sites offer a wealth of information about dining options. These sites are based on consumers' experiences; therefore, it is useful to assess the relevance between restaurant review (for food quality) and retail food facilities (RFFs) inspection results (for sanitation) from health departments. This study analyzed New York City restaurant ratings on Yelp.com to determine if there was a relationship to RFFs' violation scores for those same facilities found on the New York City Department of Health and Mental Hygiene web pages. In addition, we assessed differences between RFFs defined on Yelp as quick service versus full service, and chains versus nonchains. Yelp ratings were found to be correlated only with sanitation in chain RFFs.

How Clean Are Hotel Rooms? Part I: Visual Observations vs. Microbiological Contamination.

Current evidence of hotel room cleanliness is based on observation rather than empirically based microbial assessment. The purpose of the study described here was to determine if observation provides an accurate indicator of cleanliness. Results demonstrated that visual assessment did not accurately predict microbial contamination. Although testing standards have not yet been established for hotel rooms and will be evaluated in Part II of the authors' study, potential microbial hazards included the sponge and mop (housekeeping cart), toilet, bathroom floor, bathroom sink, and light switch. Hotel managers should increase cleaning in key areas to reduce guest exposure to harmful bacteria.

How Clean Are Hotel Rooms? Part II: Examining the Concept of Cleanliness Standards.

Hotel room cleanliness is based on observation and not on microbial assessment even though recent reports suggest that infections may be acquired while staying in hotel rooms. Exploratory research in the first part of the authors' study was conducted to determine if contamination of hotel rooms occurs and whether visual assessments are accurate indicators of hotel room cleanliness. Data suggested the presence of microbial contamination that was not reflective of visual assessments. Unfortunately, no standards exist for interpreting microbiological data and other indicators of cleanliness in hotel rooms. The purpose of the second half of the authors' study was to examine cleanliness standards in other industries to see if they might suggest standards in hotels. Results of the authors' study indicate that standards from other related industries do not provide analogous criteria, but do provide suggestions for further research.

A strategic cleaning assessment program: menu cleanliness at restaurants.

The importance of clean food contact surfaces has been recognized; however, the importance of cleanliness on nonfood contact surfaces such as menus may be underestimated. The aim of the study described in this article was to determine the cleanliness of restaurant menus, evaluate typical cleaning methods used in a restaurant, and provide recommendations for improving menu cleanliness. The authors' study used an adenosine triphosphate meter to assess the cleanliness of the menus. A pretest identified the most commonly touched areas of the menu by consumers. Based on the results of the pretest, menus were collected from casual-family dining restaurants and analyzed for cleanliness. Results suggested that menus should be cleaned after each shift and that menus distributed by the staff when guests are seated are cleaner than those kept on the table.

The negative spillover effect of food crises on restaurant firms: Did Jack in the Box really recover from an E. coli scare?

Despite the enormous impact of food crises on restaurants, limited understanding of their long-term impacts and associated factors has undermined crisis managers' ability to handle crisis situations effectively. This article investigated the long-term impact of food crises on the financial performance of restaurant firms and identified the factors that influenced this impact. This explanatory study examined the case of Jack in the Box, whose 1993 Escherichia coli scare was the first and largest restaurant-associated food crisis in modern times. An event study method was used to uncover stock price movements of Jack in the Box, in conjunction with 73 unrelated food crises that occurred from 1994 to 2010. Stock prices of Jack in the Box exhibited significantly negative responses to other firms' food crises, moreover, the negative spillover effect was stronger if the crisis occurred closer in time, was similar in nature, and was accompanied with no recall execution. These findings shed light on the long-term financial impact of food crises and offer insights for crisis managers to develop more effective crisis management strategies.

Persistence of Salmonella and E. coli on the surface of restaurant menus.

To the authors' knowledge, the role of restaurant menus as a vehicle for pathogens has not been explored. Menus, however, can pose as a vector for bacterial contamination and transfer. Sampling menus from two restaurants in the Houston, Texas, area showed the presence of up to 100 CFU/cm2 aerobic bacteria. Follow-up studies designed to investigate the ability of Salmonella and E. coli to persist on paper and laminated menus at various time points (0, 6, 24, 48, and 72 hours) demonstrated that bacteria persist more efficiently on laminated menus as compared to paper menus. Transfer studies performed to quantitatively determine the ability of bacteria to transfer from menus to fingertips and from fingertips to clean menus showed that bacteria can be transferred for up to 24 hours. The study described here showed that restaurant menus may serve as vehicles for pathogens and hence present a public health issue within the retail food environment.

The impact of food safety events on the value of food-related firms: An event study approach.

Food safety events threaten not only consumers' health, but also the value of associated firms. While previous studies examined the impact of food safety events on consumer demand for products, little attention has been paid to the impact on the market value of firms. Using the event study method (ESM), this study investigated abnormal returns (ARs) and cumulative abnormal returns (CARs) of firms associated with 40 food safety events over the past 25 years in the U.S. The results of this study demonstrated the magnitude and duration of the impact of food safety events on firm value. Moreover, firm-specific factors (past history and firm size) and situational factor (media attention) were found to influence the magnitude of the impact. This study contributes to the hospitality literature by extending the knowledge of the impact of food safety events and its practical implications for effective crisis management strategies for food-related firms.

Fast-Food Optimal Defaults Reduce Calories Ordered, as Well as Dietary Autonomy: A Scenario-Based Experiment.

BACKGROUND: Low-calorie menu items as optimal defaults may encourage healthier choices when people eat out. Limited research has studied default effects from the restauranteurs' perspective, as well as the public health perspective. OBJECTIVE: To examine the effects of optimal defaults on calories ordered, dietary autonomy, and visit intention in the context of a fast-food drive-through. DESIGN: Between-subjects randomized scenario-based experiment. PARTICIPANTS/SETTING: In all, 377 adults who lived in the United States were recruited through a crowdsourcing platform in July 2020. INTERVENTION: Participants were asked to visualize ordering a combo meal in a fast-food drive-through. They were randomly assigned to order from 1 of 3 menu boards: (1) menu items available for combos by customer choice, (2) combos that included traditional high-calorie default items, or (3) combos that included low-calorie optimal defaults. MAIN OUTCOME MEASURES: Differences in calories ordered among groups, dietary autonomy, and restaurant visit intention. ANALYSIS: Statistical tests included multiple regression, Kruskal-Wallis, χ2, and 1-way analysis of variance. Covariates such as education and sex were tested in regression models as potential confounders. RESULTS: Compared with the choice combo meals, optimal combo meals reduced calories ordered by consumers (-337 kcal, standard error = 19, P < .001), while traditional combos increased them (+132 kcal, standard error = 20, P < .001). No significant difference was found in visit intention. Dietary autonomy was affected by the optimal defaults (P = .025), even in participants with high health concern. Conversely, the traditional combo's effect on dietary autonomy was moderated by health concern (B = -0.26, P = .023), with only individuals with very high levels of health concern perceiving less autonomy. CONCLUSIONS: Optimal defaults provided a robust reduction in calories ordered but had implications for dietary autonomy.

Visual Cues and Optimal Defaults in Fast-Food Combo Meals Benefit Health-Concerned Consumers-A Randomized Scenario-Based Experiment.

BACKGROUND: The use of low-calorie menu items as optimal defaults and visual cues may nudge consumers to healthier choices at restaurants. However, little is known regarding their effects on emotions and behavioral intentions, particularly among people with different levels of health concern. OBJECTIVE: Evaluate optimal defaults and visual cues' effect on anticipated pleasure and order intention depending upon consumers' health concern level. DESIGN: Between-subjects randomized scenario-based experiment. PARTICIPANTS/SETTING: In all, 636 US adults recruited through an online crowdsourcing platform in July 2020. INTERVENTION: Participants saw 1 of 6 menu boards in a fast-food drive-through simulation. Half the menu boards included meal photos with (1) menu items to be arranged as a combo by choice (ie, create-your-own combo); (2) traditional combos that included high-calorie default items; or (3) optimal combos that included low-calorie default items. The remaining 3 boards were identical without photos. MAIN OUTCOME MEASURES: Anticipated pleasure, order intention, and health concern were evaluated with 7-point Likert scales. ANALYSIS: Statistical tests included multiple regression, Kruskal-Wallis, χ2, and analysis of variance. Education and sex were tested as potential confounders. RESULTS: Optimal combos negatively affected anticipated pleasure (P = .003) and order intention (P < .001) compared with choice combos. Order intention reduction was the same for traditional and optimal combos (P = .128). The presence of photos changed order intention for optimal combos but varied by consumer's health concern level. When health concern was lower, photos decreased the likelihood of ordering the optimal combos (B = -3.06, P = .001), but when health concern was higher, photos enhanced ordering intention compared with the choice group (B = 0.60, P = .001). The photos did not affect anticipated pleasure for any level of health concern. CONCLUSIONS: The adverse effect of optimal defaults and how visual cues may reduce their negative effect should be considered in menu design.

Nutrition knowledge of rural older populations: can congregate meal site participants manage their own diets?

Congregate meal sites were funded to assist socioeconomically disadvantaged, rural older individuals in improving their health-related practices. Although the participants in the program are largely female, the meals are designed to meet one third of the daily caloric intake of a 70-year-old male, and to satisfy his recommended dietary allowances for total fat, fiber, calcium, and sodium. The actual percentage of the required nutrient intake contributed by meals served at congregate sites is indefinite. Moreover, the ability of congregate meal participants to manage their diets and their receptiveness to helpful nutrition information in that regard is unknown. Our objective was to promote nutritional knowledge in economically disadvantaged, rural older participants by studying its impact on their ability to benefit from congregate meal programs. We used a test, intervention, retest methodology to examine the effect of short-term nutrition interventions on congregate meal site participants' nutrition knowledge. The objective was to determine the participants' potential for managing their own diets (e.g., their ability to determine what diet behaviors are appropriate for specific chronic conditions). We found that while congregate meal site participants have knowledge of nutrition recommendations, their ability to apply this information in helping themselves to prevent or control their chronic conditions remains in question.

Pet Ownership and Pet Type Influence Food Safety in the Home: Evidence from a National Survey.

ABSTRACT: Physical contact between humans and their pets increases the potential for zoonotic disease transmission. This study used the 2016 U.S. Food and Drug Administration (FDA) Food Safety Survey to compare the food handling behaviors of pet owners and non-pet owners, because poor food handling and hygiene habits can increase the likelihood of disease transmission from animals to humans. Results show that both pet ownership and pet type were important in predicting food safety behaviors. After controlling for sociodemographic factors included in this study (gender, age, household income, household size, and race or ethnicity), pet ownership was significantly associated with overall food safety practices and, more specifically, with better hand washing behaviors, kitchen cleaning, and ownership and use of a food thermometer, as well as a greater awareness of foodborne pathogens. Cat owners and cat-dog owners had better overall food safety practices and better hand washing behaviors compared with those of dog owners. After controlling for sociodemographic variables, there were no significant associations between pet ownership and perception of risks associated with unsafe food handling practices.

Using health inspection scores to assess risk in food services.

This study gathered health inspectors' opinions about appropriate weightings of critical, noncritical, and repeat violations under the current food inspection system, and developed a classification of violations for high-, medium-, and low-risk restaurants. Results showed that health inspectors thought that the appropriate weights were five points for a critical violation, one point for a noncritical violation, and double points for a repeat violation. In addition, health inspectors thought that the maximum numbers of critical violations for a high-, medium-, and low-risk category were 2.05, 3.02, and 4.83, respectively, and for noncritical violations, 4.59, 7.30, and 10.37, respectively. A paired t-test was used to compare these values with estimations based on the traditional health inspection scoring system. Results indicate that the maximum number of critical violations for medium risk and maximum numbers of noncritical violations for low-, medium-, or high-risk restaurants were significantly different between health inspectors' opinions and mathematical estimations. Health inspectors appear to be stricter than the traditional health inspection scoring system about violations, particularly repeat violations, and their importance in enforcement of food safety.

Reported Action to Decrease Sodium Intake Is Associated with Dining Out Frequency and Use of Menu Nutrition Information among US Adults.

BACKGROUND: Restaurant foods have been shown to be high in sodium and limited sodium content information provided through menu nutrition information (MNI) is available at the point of purchase. Dining out and use of MNI are behaviors that can be altered by consumers who are trying to decrease their sodium intake. OBJECTIVE: The aim of this study was to determine the relationship between reported consumer actions to decrease sodium intake and dining out frequency and awareness and use/or intended use of MNI. DESIGN/PARTICIPANTS: A secondary analysis was conducted using responses from 5,588 US adults aged 20 years or older who participated in the 2013-2014 cross-sectional National Health and Nutrition Examination Survey household interview. MAIN OUTCOME MEASURES: The main outcomes were dining out frequency and seeing MNI, using MNI if seen, or would use MNI if provided. STATISTICAL ANALYSES PERFORMED: Linear and logistic regression models were used to assess the relationship of consumers reporting and not reporting action to decrease sodium intake and the outcome measures. RESULTS: Reported consumer action to decrease sodium intake compared to no action was associated with an overall decreased dining out frequency of approximately one meal per week (mean±standard error=3.12±0.10 compared to 4.11±0.14; P<0.01). When separated by type of restaurant, the relationship was significant for fast-food or pizza establishments (mean±standard error=1.35±0.05 meals compared to 2.00±0.07 meals; P<0.001), but not other types of foodservice operations. The odds of seeing MNI, using MNI when seen, or would use MNI if provided were higher for consumers reporting actions to decrease their sodium intake compared to those who were not for both fast-food or pizza establishments and restaurants with wait staff (odds ratio ranged from 1.17 [95% CI 1.04 to 1.32] to 2.24 [95% CI 1.82 to 2.76]; P values ranged from <0.05 to <0.001). CONCLUSIONS: Compared to consumers reporting no actions to decrease sodium intake, consumers reporting actions indicate they dine out less frequently, specifically at fast-food or pizza restaurants and report they are more likely to use MNI. These results may inform the restaurant industry of the actions of a potentially growing consumer group and provide insights for future public health initiatives targeting population sodium reduction.

Clients' safe food-handling knowledge and risk behavior in a home-delivered meal program.

OBJECTIVE: To determine typical handling practices of home-delivered meals, and provide appropriate handling instructions to reduce the risk of foodborne illness by improving consumer handling of home-delivered meals. DESIGN: Once permission was given by the home-delivered meal site directors, clients were provided a voluntary survey and requested by the delivery drivers to complete the self-administered questionnaire. The completed questionnaire was collected by the driver the following day. Because of the special needs of the home-delivered meal populations, the questionnaire was made as easy and convenient to answer as possible. SUBJECTS: Two hundred fifty-eight male clients (31%) and 575 female clients (69%) whose mean age was 79 years participated in the study. MAIN OUTCOME MEASURES: The respondents' safe food-handling practices, food safety knowledge, and demographic information were assessed. Average time for delivery and consumption of meals were also measured. STATISTICAL ANALYSIS: Descriptive statistics (frequency and chi(2) test) of the participants' handling of home-delivered meals, their general food safety knowledge, and demographic information were reported. Delivery time and consumption time were calculated for each subject. RESULTS: Five hundred thirty-six of 869 clients (63%) reported that they ate their meals as soon as they were delivered. Of those clients who did not eat their meals immediately, 234 (82%) stored the cold food in the refrigerator and 142 (58%) stored the hot food in the freezer. More than one-third of the clients (n=277, 35%) reported that they had leftovers and only 34 (15%) ate the leftovers within 2 hours. Significant differences among groups on the basis of a derived food safety knowledge score were observed in terms of whether or not they ate their meal immediately (P

Mitigating the risk of food handling in the home-delivered meal program.

The purpose of this cross-sectional study was to examine the length of time between packing and delivery of home-delivered meals, and the extent of foodborne illness risk to the elderly. Procedures to mitigate that risk were also evaluated. Researchers surveyed 95 drivers from home-delivered meal preparation sites in six states across the United States to determine the average length of time that passed during packing, loading, leaving, and delivery. The efficiency of various risk mitigation methods were evaluated and used to adjust the actual delivery time. Total average delivery time from packing to last delivery was 1.92 hours. This study suggests that the risk associated with the actual 1.92 hours of total delivery time could be mitigated to represent approximately 1.55 hours of effective time with proper packing and holding conditions. This methodology proposes a single measure for evaluating the effectiveness of various handling procedures associated with distributing home-delivered meals, which can be utilized to evaluate overall risk when combined with in-house preparation and client-handling behaviors.