Food Safety Knowledge, Attitudes, and Behaviors of Native American Families with Young Children: A Mixed Methods Study.

Children are at increased risk for foodborne illness due to underdeveloped immune system. Limited research has been reported on food safety knowledge of Native American families with children 10 years of age and younger. This study was conducted to determine the food safety knowledge, attitudes, and behaviors of the main food preparer in these families by collecting quantitative and qualitative data simultaneously in a mixed method approach. A food safety knowledge survey created using FightBAC!™ concepts was administered prior to focus groups discussions held in Native American communities using a script based upon the Health Belief Model. Quantitative data were analyzed using SPSS. Qualitative data were coded by three reviewers independently and then compared jointly for themes. Over three fourths of participants (n = 102) were female with an average age of 38.3 years. Over one half of participants were unemployed (54 %), lived on reservations (54 %), and 86 % had a high school degree or higher level of education. The following four themes emerged from the eight focus groups (n = 66): food can make one sick, I am not in control when others handle food, I know how to safely prepare foods for my family, and I do not have time or best equipment (for food safety). Mixed method analysis revealed that participants were aware of the severity and susceptibility for foodborne illness but were confident in preparing foods safely for their family. A food safety education program for Native American food preparers with young children is needed to prevent foodborne illness (FBI) in this population and promote safe food handling practice.

A Qualitative Phenomenological Exploration of Teachers' Experience With Nutrition Education.

Background: Nutrition education delivered by classroom teachers has become a popular intervention designed to combat childhood obesity. However, few qualitative studies have explored nutrition education with teachers Purpose: The purpose of this study was to explore how elementary teachers describe their experience with nutrition education. Methods: A qualitative phenomenological approach was used. Semistructured interviews, observations, and document analysis were conducted with 10 teachers who delivered nutrition education in their classrooms. Inductive coding was used to determine invariant constituents, reduce constituents to categories, and cluster categories into themes. Reliability and validity were accomplished through intercoder agreement, audio recording, triangulation, bracketing, and member checking. Results: Results identified 5 core themes related to roles teachers play in nutrition education, the importance placed upon nutrition, motivation for supplementary activities, barriers, and a triadic relationship between students, teachers, and curriculum. Discussion: Findings reveal interactions within the nutrition education experience in which teachers balance barriers with their value of nutrition education and motivation to help students make healthy choices. Translation to Health Education Practice: Health educators should work with classroom teachers at the program design, implementation, and evaluation stages of curriculum development to better address needs and facilitate the delivery of high-quality nutrition education for students.

Understanding fruit and vegetable intake of Native American children: A mixed methods study.

Native American children experience greater rates of obesity and risk for chronic diseases in comparison to their counterparts in other ethnic groups. Contributing to this risk may be inadequate consumption of fruits and vegetables. The objective of this study was to investigate the fruit and vegetable consumption of Native American children between the ages of 2 and 5 by using an exploratory sequential mixed methods research design. This study first collected qualitative data from caregivers of Native American children (n = 45) and stakeholders in Native American communities (n = 10) to gain perspectives of fruit and vegetable consumption. Data was then utilized to develop a fruit and vegetable survey which was administered with a fruit and vegetable food frequency questionnaire. These quantitative assessments were administered to caregivers of Native American children (n = 92) to gain an understanding of predictors of fruit and vegetable intake among this population. This study was guided by the Information-Motivation-Behavioral Skills (IMB) model of health behavior. Findings from the mixed methods analysis demonstrate that, while the IMB model may be a useful tool to utilize in explaining the complex relationship between factors that impact fruit and vegetable consumption among Native American children, a revised model may be appropriate to use in future intervention development.

Relationships between nutrition-related knowledge, self-efficacy, and behavior for fifth grade students attending Title I and non-Title I schools.

The Social Cognitive Theory (SCT) is a widely used theory for nutrition education programming. Better understanding the relationships between knowledge, self-efficacy, and behavior among children of various income levels can help to form and improve nutrition programs, particularly for socioeconomically disadvantaged youth. The purpose of this study was to determine the relationships between knowledge, self-efficacy, and behavior among fifth grade students attending Title I (≥40% of students receiving free or reduced school meals) and non-Title I schools (<40% of students receiving free or reduced school meals). A validated survey was completed by 55 fifth grade students from Title I and 122 from non-Title I schools. Differences in knowledge, self-efficacy, and behavior scores between groups were assessed using t test and adjusted for variations between participating schools. Regression analysis was used to determine the relationships between knowledge, self-efficacy, and behavior. In adjusted models, the Title I group had significantly lower scores on several knowledge items and summary knowledge (P = 0.04). The Title I group had significantly lower scores on several behavior variables including intakes of fruits (P = 0.02), vegetables (P = 0.0005), whole grains (P = 0.0003), and lean protein (P = 0.047), physical activity (P = 0.002) and summary behavior (P = 0.001). However the Title I group scored higher on self-efficacy for meal planning (P = 0.04) and choosing healthy snacks (P = 0.036). Both self-efficacy (ß = 0.70, P < 0.0001) and knowledge (ß = 0.35, P = 0.002) strongly predicted behavior; however, only self-efficacy remained significant in the Title I group (self-efficacy, ß = 0.82, P = 0.0003; knowledge, ß = 0.11, P = 0.59). Results demonstrate disparities in nutrition knowledge and behavior outcomes between students surveyed from Title I and non-Title I schools, suggesting more resources may be necessary for lower income populations. Findings suggest that future nutrition interventions should focus on facilitating the improvement of children's self-efficacy.

Fruit and Vegetable Perceptions Among Caregivers of American Indian Toddlers and Community Stakeholders: a Qualitative Study.

American Indians experience higher rates of obesity than any other ethnic group living in the USA. This disparity begins to develop in early childhood, and the excess weight carried by American Indian children contributes to health conditions that can affect their quality of life by the time they enter preschool. These children consume less than recommended amounts of fruits and vegetables, a dietary pattern that may be related to the development of obesity and other health conditions. This qualitative study explored the fruit and vegetable intake of American Indian toddlers through use of the information-motivation-behavioral skills (IMB) model. Focus groups with caregivers of American Indian toddlers and interviews with stakeholders in American Indian communities were conducted to investigate perceptions of knowledge, motivational, and behavioral skills related to the fruit and vegetable intake of American Indian toddlers. Study participants communicated that peer support, food insecurities, cultural norms, self-efficacy, and skills to prepare fruits and vegetables impact their ability to provide fruits and vegetables to toddlers. Study participants expressed a desire to increase their knowledge regarding fruits and vegetables, including variety, benefits, and recommendations for consumption. Findings from this qualitative study provide essential insights into perceptions of fruits and vegetables among caregivers of American Indian toddlers and stakeholders in American Indian communities. Future research will utilize these findings to develop a culturally appropriate IMB-model-based fruit and vegetable-focused nutrition education program for American Indian families.

A mixed methods study of food safety knowledge, practices and beliefs in Hispanic families with young children.

Children are at a higher risk for foodborne illness. The objective of this study was to explore food safety knowledge, beliefs and practices among Hispanic families with young children (≤10 years of age) living within a Midwestern state. A convergent mixed methods design collected qualitative and quantitative data in parallel. Food safety knowledge surveys were administered (n = 90) prior to exploration of beliefs and practices among six focus groups (n = 52) conducted by bilingual interpreters in community sites in five cities/towns. Descriptive statistics determined knowledge scores and thematic coding unveiled beliefs and practices. Data sets were merged to assess concordance. Participants were female (96%), 35.7 (±7.6) years of age, from Mexico (69%), with the majority having a low education level. Food safety knowledge was low (56% ± 11). Focus group themes were: Ethnic dishes popular, Relating food to illness, Fresh food in home country, Food safety practices, and Face to face learning. Mixed method analysis revealed high self confidence in preparing food safely with low safe food handling knowledge and the presence of some cultural beliefs. On-site Spanish classes and materials were preferred venues for food safety education. Bilingual food safety messaging targeting common ethnic foods and cultural beliefs and practices is indicated to lower the risk of foodborne illness in Hispanic families with young children.

Race/ethnicity and income in relation to the home food environment in US youth aged 6 to 19 years.

BACKGROUND: The home food environment is complex and has the potential to influence dietary habit development in young people. Several factors may influence the home food environment, including income and race/ethnicity. OBJECTIVE: To examine the relationship of income and race/ethnicity with three home food environment factors (ie, food availability frequency, family meal patterns [frequency of family and home cooked meals], and family food expenditures). DESIGN: A cross-sectional analysis of the National Health and Nutrition Examination Survey (NHANES). PARTICIPANTS: A total of 5,096 youth aged 6 to 19 years from a nationally representative sample of US individuals participating in NHANES 2007-10. STATISTICAL ANALYSES PERFORMED: Prevalence of food availability frequency was assessed for the entire sample, race/ethnicity, poverty income ratio (PIR), and race/ethnicity stratified by PIR. Mean values of family meal patterns and food expenditures were calculated based on race/ethnicity, PIR, and race/ethnicity stratified by PIR using analysis of variance and least squares means. Tests of main effects were used to assess differences in food availability prevalence and mean values of family meal patterns and food expenditures. RESULTS: Non-Hispanic whites had the highest prevalence of salty snacks (51.1%±1.5%) and fat-free/low-fat milk (39.2%±1.7%) always available. High-income homes had the highest prevalence of fruits (75.4%±2.4%) and fat-free/low-fat milk (38.4%±2.1%) always available. Differences were found for prevalence of food availability when race/ethnicity was stratified by PIR. Non-Hispanic blacks had the lowest prevalence of fat-free/low-fat milk always available across PIR groups. Differences in mean levels of family meal patterns and food expenditures were found for race/ethnicity, PIR, and race/ethnicity stratified by PIR. CONCLUSIONS: Race/ethnicity and PIR appear to influence food availability, family meal patterns, and family food expenditures in homes of youth. Knowledge of factors that influence the home food environment could assist in developing effective strategies to improve food environments for young people.

Food safety knowledge, practices and beliefs of primary food preparers in families with young children. A mixed methods study.

Food preparers in families with young children are responsible for safe food preparation and handling to prevent foodborne illness. To explore the food safety perceptions, beliefs, and practices of primary food preparers in families with children 10 years of age and younger, a mixed methods convergent parallel design and constructs of the Health Belief Model were used. A random sampling of 72 primary food handlers (36.2±8.6 years of age, 88% female) within young families in urban and rural areas of two Midwestern states completed a knowledge survey and participated in ten focus groups. Quantitative data were analyzed using SPSS. Transcribed interviews were analyzed for codes and common themes. Forty-four percent scored less than the average knowledge score of 73%. Participants believe children are susceptible to foodborne illness but perceive its severity to be low with gastrointestinal discomfort as the primary outcome. Using safe food handling practices and avoiding inconveniences were benefits of preventing foodborne illness. Childcare duties, time and knowledge were barriers to practicing food safety. Confidence in preventing foodborne illness was high, especially when personal control over food handling is present. The low knowledge scores and reported practices revealed a false sense of confidence despite parental concern to protect their child from harm. Food safety messages that emphasize the susceptibility and severity of foodborne illness in children are needed to reach this audience for adoption of safe food handling practices.

Position of the American Dietetic Association: Food and water safety.

It is the position of the American Dietetic Association that the public has the right to a safe food and water supply. The Association supports collaboration among food and nutrition professionals, academics, representatives of the agricultural and food industries, and appropriate government agencies to ensure the safety of the food and water supply by providing education to the public and industry, promoting technological innovation and applications, and supporting further research. New food and water safety issues evolve as the environment changes. Food and nutrition professionals should collaborate with food and agriculture industries and members of the medical community in a joint effort to address these issues. Recent food- and waterborne illnesses have occurred in new settings and/or unique foods not traditionally associated with foodborne illness outbreaks. New issues associated with food safety and security that have emerged support the need for continued education and research. Government programs have developed powerful tools such as FoodNet and PulseNet to detect food- and waterborne illness outbreaks in the United States. These government programs have provided the data to enhance public policy and educational programs such as FightBac! Mandatory and voluntary adoption of Hazard Analysis Critical Control Points in the foodservice and processing industries have contributed to a decrease in foodborne illness outbreaks from traditional foods and some microorganisms usually associated with foodborne illnesses. Food and nutrition professionals are positioned to provide food and water safety education in community, clinical settings, and foodservice operations and food industries. With an aging population and an increased number of people at risk due to medical conditions for food- and waterborne illness, food and nutrition professionals should be involved in collaborative food and water safety issues in educational, research, and policy agenda settings. As the food and nutrition experts, food and nutrition professionals must assume a major role in food and water safety education and research.

Evaluation of the microbial quality of Tajik sambusa and control of Clostridium perfringens germination and outgrowth by buffered sodium citrate and potassium lactate.

Clostridium perfringens spore destruction, aerobic plate counts (APCs), and counts of Enterobacteriaceae, coliforms, and Escherichia coli during baking of sambusa (a traditional Tajik food) were evaluated. Control of germination and outgrowth of C. perfringens spores in sambusa during cooling at room or refrigerated temperatures was evaluated using organic acid salts (buffered sodium citrate [Ional] and 1 and 2% potassium lactate, wt/wt). Sambusa were prepared with 40 g of either inoculated or noninoculated meat and baked for 45 min at 180 degrees C. For evaluation of destruction of C. perfringens spores during heating and germination and outgrowth of spores during cooling, ground beef was inoculated and mixed with a three-strain cocktail of C. perfringens spores. Aerobic bacteria, Enterobacteriaceae, coliforms, and E. coli were enumerated in noninoculated sambusa before and after baking and after cooling at room or refrigeration temperatures. After baking, APCs and Enterobacteriaceae and coliform counts were reduced by 4.32, 2.55, and 1.96 log CFU/g, respectively. E. coli counts were below detectable levels in ground beef and sambusa samples. Enterobacteriaceae, coliform, and E. coli counts were below detectable levels (< 0.04 log CFU/g) in sambusa after cooling by both methods. Total C. perfringens populations increased (4.67 log CFU/g) during cooling at room temperature, but minimal increases (0.31 log CFU/g) were observed during cooling under refrigeration. Incorporation of 2% (wt/wt) buffered sodium citrate controlled C. perfringens spore germination and outgrowth (0.25 log CFU/g), whereas incorporation of up to 2% (wt/wt) potassium lactate did not prevent C. perfringens spore germination and outgrowth. Incorporation of organic acid salts at appropriate concentrations can prevent germination and outgrowth of C. perfringens in improperly cooled sambusa.

Microbial Evaluation of Vegetable Ingredients in Salad Bars †.

Vegetable salad ingredients (lettuce, tomatoes, broccoli, and cauliflower) purchased from three grocery-store deli operations were analyzed for total plate count, coliforms, yeasts, and molds. The temperature of the vegetable ingredients was measured at the time of purchase and the pH was measured on all samples within one-half hour after purchase. In the second phase, fresh broccoli was processed into florets, inoculated with E. coli ATCC 23742, and subjected to three washing treatments. The temperature of the salad ingredients ranged from 5.1°C to 18.9°C. The pH ranges for the vegetables were broccoli, 5.46 to 6.39; cauliflower, 5.82 to 6.65; lettuce, 4.92 to 6.38; and tomatoes, 3.30 to 4.47. The total aerobic count for the vegetables ranged from 5.51 to 6.63 log CFU/g. Coliforms on the vegetables ranged from 4.89 to 6.30 log CFU/g. Yeasts and molds were found on all vegetables. The results of the study indicate that the temperature conditions and pH ranges for the broccoli, cauliflower, and lettuce could support microbial growth. The pH range of the tomatoes was below 4.6, but if contaminated and added to low acid foods, the tomatoes may also act as a vehicle for microbial contamination. When a chlorine wash solution was used, it slightly reduced the aerobic microbial load on previously inoculated broccoli and reduced the coliform population of the broccoli by approximately one log unit.

Occurrence of Enterotoxigenic Strains of Staphylococcus aureus and Enterotoxin Production in Bakery Products.

Bakery items were surveyed for the presence of Staphylococcus aureus . Items analyzed were oatmeal raisin cookies, apple muffins, cream puffs, and long Johns. S. aureus were isolated from 21 (9.8%) of 214 bakery items surveyed. Enterotoxin was produced by seven of these isolates. An enterotoxin producing S. aureus was found in one apple muffin and one long John and in five of the cream puffs. The pH and water activity ranges for the bakery items would support S. aureus growth except the water activity for the cookies. An enterotoxin A-producing strain of S. aureus was also inoculated in or on the surface of the bakery items. The bakery items were held at 25°C for 48 h to simulate consumer handling. Total S. aureus was determined by plate count on Baird-Parker agar. S. aureus survived on all the bakery items. After 24 h, total cell number decreased on surface inoculated bakery items; however, S. aureus grew well in the inoculated fillings of cream puffs and long Johns increasing to 105 CFU/g.