Youth Perspectives on Food Safety

Introduction

Foodborne illness is a general term often used to describe a disease or illness caused by eating contaminated foods or drinks. A foodborne illness outbreak is an incident when two or more people get sick from the same food. According to data published by the Centers for Disease Control and Prevention (CDC), 76 millions cases of foodborne illness occur each year, resulting in over 500,000 hospitalizations and 5,000 deaths (Mead et al., 1999). This translates into the simple, yet chilling, fact that one in four people in the U.S. contracts a foodborne illness each year.

Another consequence of the high rates of foodborne illness is the staggering medical cost necessary to treat the illnesses. Medical costs related to major foodborne illnesses are estimated to range between $2.3 and $4.3 billion annually (Buzby, Roberts, Lin, & MacDonald, 1996). When you include the loss of productivity and wages, the cost is estimated to be $6.9 billion each year (Buzby, Roberts, Lin, & MacDonald, 1996). When a case of foodborne illness results in death, the combined cost of health care and death expenses is estimated to be $42,300 per death (Marriot, 1999).

In addition to medical costs, food establishments suffer economic losses due to foodborne illness. These costs are in turn passed on to customers in the form of increased prices for food. It is estimated that a foodborne outbreak could cost an establishment up to $75,000 in direct cost for investigation, clean up, re-staffing, restocking, product loss, settlements, and increase in regulatory sanction (Marriot, 1999).

In a chain of food service operations the indirect loss of business could be up to $7 million for one single outbreak of a foodborne illness in a metropolitan area. For a small food business, the cost of a foodborne illness outbreak can be astronomical and challenge business survival. Given the issues related to physical health, medical costs, and direct and indirect business costs, food safety is a serious public health issue in the United States.

Food safety is also a serious issue in Florida. Between the years 1994-2000, over 2,000 outbreaks of foodborne illnesses were reported in Florida. This represents over 15,000 individual cases (Florida Department of Health (FDH), 2000). In the year 2000 alone, 288 foodborne illness outbreaks (representing 2,353 individual cases) were reported (FDH, 2001). Out of all, cases at least 13 deaths resulted from the bacterium Vibrio Vunificus. These outbreaks occur mainly in restaurants (70.8%), grocery stores (8%), homes (4.9%), and others sites (16%), including cafeterias, hospitals, and nursing homes (FDH, 2001).

For many people, foodborne illness results in discomfort or lost time from work. For some, including children, the elderly, those in health care facilities, and those with impaired immune systems, foodborne illness is more serious and may even be life threatening (FDH, 2000). Florida is a unique state in that 18.4% and 18.9% of the population are over 65 and less than 14 years of age, respectively (Census Bureau, 2000). Therefore, the delivery of food safety education in Florida that targets those groups is critical.

In fact, children and youth deserve added attention because the risks of some foodborne illnesses, such as salmonellosis, are relatively higher for children than for any other demographic group (Buzby, 2001). Children are at higher risks for two primary reasons: 1) their immune systems are not fully developed and 2) due to their lower body weight, it takes a smaller quantity of pathogens to make them sick (Buzby, 2001).

According to the Council for Agricultural Science and Technology (CAST), a large number of foodborne illnesses can be attributed to improper food handling, i.e., preparing, storing, cooking, and consuming (Herringshaw & Largo, 2000). CAST also states that appropriate educational materials must be developed and used that will teach consumers how to safely handle food (Herringshaw & Largo, 2000).

Hygiene habits are formed at an early age, affecting food-handling practices for a lifetime (Herringshaw & Largo, 2000). Also, older youth (teens) should be targeted for food safety education because more high school students are employed in restaurants than any other industry, yet they often receive little information about food safety or ways to prevent foodborne illnesses (Endres, Welch, & Perseli, 2001). Therefore, children and youth are at the appropriate teachable moment for food safety education.

Many Extension Food Safety Specialists and county Extension faculty across the nation seek to deliver food safety programs to 4-H and other youth, recognizing that children and youth are among the groups most susceptible to foodborne illness. To effectively educate young people, the education delivery must be innovative and delivered in a manner that is quick and engaging (Endres, Welch, & Perseli, 2001). This still leaves many options available to the 4-H and Family and Consumer Science (FCS) educators, such as traditional classroom style, interactive video, CD, and the list goes on.

But how do youth want to receive this information? Which method will the youth respond to? Also, there are many ways to focus the food safety education. Should the education focus on preparing food at home, eating at restaurants, etc.? Where should the educational session occur to get the most participation?

In short, educational food safety programs, especially for the young learner, should be based on an assessment of needs (Endres, Welch, & Perseli, 2001). The research questions for the exploratory assessment study described here were:

1. Do 4-Hers currently get information on food safety? If so, how?
2. What food safety topics would 4-Hers want to learn more about, if any?
3. How would 4-Hers want to receive information on food safety?
4. Where should the educational session on food safety occur to get the most participation?

Methodology and Data Analysis

A sample of youth attending the statewide Florida 4-H Congress at the University of Florida were asked to complete a survey to provide their perspective on the types of food safety topics of interest and the best methods to deliver the food safety education. The survey was conducted during Congress registration. To ensure a random process, every other 4-Her was given a survey to complete and directed to a separate area to complete the survey.

The survey instrument consisted of 11 items, of which five were demographic questions relating to gender, age, race, number of years in 4-H, and 4-H district in which the 4-Her resides (geographic). The other six questions related directly to the four basic exploratory research questions listed in the introduction. Faculty in the Program Development and Evaluation Center at the University of Florida (UF) reviewed the survey to ensure face validity and check survey design qualities. The survey instrument and the research methodology were approved under the UF Internal Review Board 2001-770 (Project FYC-03960).

Given the sampling methodology employed, the response rate was 100%, of which 99.9 % were usable surveys. The 285 usable surveys are part of this assessment.

Raw data were entered in Excel and analyzed using SPSS.

Results

Two hundred and eighty-five youth currently involved in 4-H programs in Florida participated in the survey, of whom 40% were male and 60% female. Over three-quarters of the respondents were white, non-Hispanic; 10% were African American; 3% Hispanic; 1% Asian; and 9% marked other. Participants from all 10 Extension 4-H districts within the state of Florida were represented in the survey. A nearly equal number of respondents were from urban (54%) and rural (46 %) areas. Respondents indicated that they were between 13 and 19 years of age, with 52% being 14 or 15 years old. Two-thirds of these respondents have been active in 4-H for the past 4 to 9 years (Table 1). This data is consistent with the overall demographics of the Florida 4-H program.

Table 1.
Age of Respondents and Number of Years in 4-H

Number Years in 4-H (N=282)
Age	< 1 year		1 - 3 years	4 - 6 years	7 - 9 years	10 > years
13	1		2	6	0	0
14	4		16	30	24	4
15	3		12	28	22	4
16	1		13	16	20	3
17	1		5	10	16	4
18	4		4	4	6	9
19	1		0	3	2	4
Total	15		52	97	90	28

Teaching Delivery Method

Youth were asked to check their preference from a list of teaching delivery methods. They indicated that field trips/tours (28%) and 4-H club (24%) experiences were how they preferred to learn new things (Figure 1). When asked where they would prefer to receive this information, 58% indicated that they wanted more information in after-school program site.

Figure 1.
Teaching Methods Preferred by 4-H Youth

Learning About Food Safety

Youth were asked to list where most of their information on food safety comes from. One-third of the respondents indicated that information about food safety comes from their parents, and 23% get their information from friends. Surprisingly, nearly one-third of the respondents indicated that they have not received any information or instruction on food safety.

When asked to check from a list of food safety topics they would like to learn more about, 46% indicated that they want to learn more about food safety when they are away from home. More specifically, food safety topics away from home included food safety at picnics and eating out at restaurants and on camping trips. Youth were also interested in food handling practices. Food handling practices listed included proper hand washing, food storage and heating, and cooling food (Figure 2).

Figure 2.
Youth Interest in Food Safety Topics (n=248)

To a lesser extent, youth were interested in learning about genetically modified foods (17%). 4-Hers showed very little interest in learning about dietary supplements. This was a surprise because certain supplements purportedly address some issues that are thought to be of concern to this age group, namely body enhancement (muscle building, weight loss supplements). It could be that the 4-Hers did not perceive dietary supplements as a food safety issue.

Table 2 shows that interest in food safety topics differs by gender. Sixty-four percent of males were interested in learning about food safety away from home, while only 35% of females were interested in the same topic. Twenty-seven percent of the females were also interested in food handling practices.

Regardless of race, rural or urban locale, and number of years in 4-H, the topic of most interest to respondents was food safety while away from home. Again, this includes food safety at picnics, when camping, and at restaurants.

Table 2.
Interest in Food Safety Topics by Gender (n=246)

Food Safety Topic	Male (%)	Female (%)
Food safety away from home	64	35
Food handling	17	27
Genetically modified foods	17	17
Dietary supplements	2	11
Cooking	1	11

Finally, youth were asked if they would actually attend a food safety program on the topic they expressed an interest in learning more about if one were offered. Sixty-two percent indicated that they would attend such a program, 9% were not sure, and 29% indicated that they would not attend such a program.

Implications

First and foremost, food safety is a topic that youth are interested in, as evidenced by a large majority of the 4-Hers indicating that they would attend a food safety education program. The need exists for 4-H and/or FCS educators to deliver food safety education, given that nearly one-third of the 4-Hers in this study have not received such information.

The 4-Hers in this study were clear about their preferred topics, methods, and location for food safety education. Overall, 4-Hers indicated that they want to learn more about how to keep food safe when they are away from home. The food safety away from home topics were listed as food safety at restaurants, picnics, and camping trips. This finding complements data provided by the Florida Department of Health (2001), which states that 70.8% of the foodborne illness outbreaks occur in restaurants.

Gender was the only demographic variable that showed a difference in preference. Boys overwhelmingly were interested in topics related to food safety away from home, as listed above. Girls, on the other hand, were clearly interested in both food safety away from home and food handling practices. The food handling topics listed include storing food, handling food, hand washing, and heating and cooling food. Therefore, the 4-H and/or FCS educators can plan topics that would be of most interest when designing programs for different genders or for groups of 4-Hers consisting of a dominate gender group.

Cutting-edge topics such as genetically modified foods or dietary supplements did not interest the 4-Hers in this study as much as other topics did. Thus, the message to 4-H and/or FCS educators is that it is okay to stick to the basics, at least initially. However, this result could indicate that the 4-Hers were not sure what those topics meant, which is unlikely given how sophisticated many youth in this age group are today. It could simply be that they did not perceive those topics as food safety issues. Or they may want to receive information on those topics through other programs (e.g., athletic or extracurricular programs).

Also, many of the 4-Hers in this study preferred to learn about food safety on field trips or tours, with 4-H club settings following in close second. The third preference was through the computer/CD format. The in-class, camp, and project-delivery methods were the least preferred. This finding speaks to the experiential way in which young people prefer to learn. In planning and designing food safety programs, the 4-H and/or FCS educators must make the education hands-on, interactive, and based in a real situation.

This study provides practical information to Extension 4-H and FCS specialists and county faculty interested in teaching youth about food safety. In instances where it is not possible to conduct such an assessment due to time and/or monetary constraints, the results of this study can be used as a guide for planning and designing food safety programs for 4-Hers in various states/counties.

References

Buzby, J. C. (2001). Children and microbial foodborne illness. FoodReview, 24(2): 32-37.

Buzby, J. C., Roberts, T. P., Lin, T. J., & MacDonold, J. M. (1996). Bacterial foodborne disease: Medical costs and productivity losses. Agricultural Economic Report No. 741, U.S. Department of Agriculture, Economic Research Service.

Endres, J., Welch, T., & Perseli, T. (2001). Use of a computerized kiosk in an assessment of food safety knowledge of high school students and science teachers. Society for Nutrition Education, 33(1): 37-42.

Florida Department of Health, Bureau of Environmental Epidemiology, Division of Environmental Health (2000). Food and waterborne illness surveillance and investigation. Tallahassee, Florida.

Florida Department of Health, Bureau of Environmental Epidemiology, Division of Environmental Health. (2001). Food and waterborne illness surveillance and investigation. Tallahassee, Florida

Herringshaw, D. & Longo, M. (2000). Healthy kids: Germ free. Journal of Nutrition Education, 32(233A):22-23.

Marriott, N. G. (1999). Principles of food sanitation,(4th ed.). Gaithersburg, Maryland: Aspen Publication.

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

US Census Bureau (2000). http://www.census.gov/