[Emerging Infectious Diseases * Volume 3 * Number 4 * October - December 1997]

Special Issue

Impact of Changing Consumer Lifestyles on the Emergence/Reemergence of
Foodborne Pathogens

Janet E. Collins
American Meat Institute, Arlington, Virginia, USA
---------------------------------------------------------------------------

      Foodborne illness of microbial origin is the most serious food
      safety problem in the United States. The Centers for Disease
      Control and Prevention reports that 79% of outbreaks between
      1987 and 1992 were bacterial; improper holding temperature and
      poor personal hygiene of food handlers contributed most to
      disease incidence. Some microbes have demonstrated resistance
      to standard methods of preparation and storage of foods.
      Nonetheless, food safety and public health officials attribute
      a rise in incidence of foodborne illness to changes in
      demographics and consumer lifestyles that affect the way food
      is prepared and stored. Food editors report that fewer than 50%
      of consumers are concerned about food safety. An American Meat
      Institute (1996) study details lifestyle changes affecting food
      behavior, including an increasing number of women in the
      workforce, limited commitment to food preparation, and a
      greater number of single heads of households. Consumers appear
      to be more interested in convenience and saving time than in
      proper food handling and preparation.

Reporting of foodborne and waterborne diseases in the United States began
more than 50 years ago (1). At that time, state and territorial health
offices were concerned about the levels of morbidity and mortality caused
by typhoid fever and infantile diarrhea; cases were to be investigated and
reported. The underlying purpose of reporting was to obtain information
regarding the role of food, milk, and water in outbreaks of intestinal
illness to provide a basis for public health action.

In 1923, the Public Health Service began publishing summaries of outbreaks
of gastrointestinal illness attributed to milk; in 1938, it added summaries
of outbreaks due to any foods. In 1966, the present system of surveillance
of foodborne and waterborne diseases began to incorporate into an annual
summary all reports of enteric disease outbreaks attributed to microbial or
chemical contamination of food or water. Comprehensive surveillance should
result in greater awareness of the most important food-protection methods.

Between 1983 and 1987, the etiologic agent in foodborne disease outbreaks
was not determined in 62% of the outbreaks (2); between 1988 and 1992, the
foodborne disease was of unknown etiology in 59% of the outbreaks (1).
Bacterial pathogens caused the largest percentage of outbreaks (79%) when
etiology was knownSalmonella caused 69% of bacterial outbreaks. For each
year from 1983 through 1992, the most commonly reported food preparation
practice that contributed to foodborne disease concerned improper holding
or storage temperatures. The second most common practice was poor personal
hygiene of the food handler. Food from unsafe sources was the least
commonly reported factor in each of the 10 years of reporting. It is now
time to examine food handling and determine how to reverse the trend.

Foodborne disease surveillance has traditionally served three purposes. The
first is disease prevention and control. Prevention and control measures
include early identification and removal of contaminated products from the
commercial market and correction of faulty food-preparation practices in
both food-service establishments and the home. Surveillance also provides
knowledge of disease causation. The responsible pathogen is not identified
in more than half of the foodborne disease outbreaks for various reasons,
including late initiation of laboratory investigation, inability of
available technology to identify the pathogen, and lack of identification
of the pathogen with a particular food. Finally, surveillance assists in
administrative guidance. Information enables assessment of trends in
prevalence of outbreaks caused by specific etiologic agents and in vehicles
of transmission. This information assists in identifying common errors in
food handling. In July 1995, the Centers for Disease Control and Prevention
(CDC), Food and Drug Administration (FDA), and Food Safety and Inspection
Service (FSIS) began a comprehensive effort to track major bacterial
pathogens that cause foodborne illnesses (3). CDC provides the overall
management and coordination with state health departments in the five
survey sites of the FSIS/CDC/FDA Sentinel Site Study. The program actively
seeks out specific cases of foodborne illness to identify whether a food
was of concern and to better establish frequency and source of foodborne
disease outbreaks and cases. CDC will use the data to identify emerging
foodborne pathogens and monitor incidence of foodborne illness; FSIS will
use the data to evaluate the effectiveness of new food-safety programs and
regulations to reduce foodborne pathogens in meat and poultry; FDA will use
the data to evaluate its efforts to reduce foodborne pathogens in seafood,
dairy products, fruits, and vegetables.

According to a recent report to Congressional committees (4), experts
believe that the risk for foodborne illness is increasing. The food supply
is changing in ways that can promote foodborne illness, and there are no
comprehensive data to explain at what point pathogens are introduced into
food. Further, because of demographic changes, more people are at a greater
risk of contracting a foodborne illness.

According to Ollinger-Snyder and Matthews (5), changes in agricultural
practices, a growing population susceptible to infectious diseases,
lifestyle changes, the emergence of new foodborne pathogens, and the high
turnover rate reported for workers in the food-service industry indicate
that new approaches are needed to allay consumers' fears and to prevent the
spread of foodborne disease in the United States. They recommend
implementation of Hazard Analysis and Critical Control Points (HACCP)
systems and certification of food-service managers.

The food processing industries are developing and implementing HACCP
systems; the meat and poultry industries are mandated to do so beginning in
January 1998 (6). Hazard analysis has been defined as the identification of
sensitive ingredients, critical processing points, and human factors that
affect product safety. Critical control points have been described as
processing determinants whose loss of control would result in an
unacceptable food-safety risk.

Most contend that the HACCP system approach must be implemented at each
stage of the farm-to-family continuum. Where are the critical control
points and the HACCP system development in the home, food-service or retail
establishments, or the car when food is carried from one location to
another? The consumer is a complex and critical control point in the
process.

Take the case of the barbecued chicken served to 260 guests at an outdoor
barbecue in 1983. Guests were served chicken that was parboiled in the
morning by one set of cooks and then placed in a large container and
refrigerated. The evening cooks assumed the chicken had been adequately
cooked, so they basted it in barbecue sauce and warmed it over the fire.
Some 71% of the guests got sick from the chicken that was insufficiently
cooked and improperly held (5). What of the infected bakery worker who
stirred a vat full of buttercream frosting with a bare hand and arm? Some
5,000 cases of viral gastroenteritis were caused by the infected worker who
claimed he had washed his hands. Other more recent outbreaks (7) appear in
Table 1.

Table 1. Foodborne illness reports from restaurants, 1996
------------------------------------------------------------
     Date      Description                  Cause

------------------------------------------------------------
                                            Employees
                                            did not
     6/96      Salmonella-contaminated      wash hands
               food, 38 cases               before
                                            handling
                                            food

               Escherichia                  Raw food
     9/95      coli O157:H7                  cross-contaminated
               "beef," 11 cases             other

               Salmonella Newport           Raw meat on
     8/95      "chicken," >850              cuting
               cases                        board with
                                            vegetables

               Hepatitis A,                 Human fecal
     1/95      contaminated food,           matter from
               95 cases                     handling-handwashing

               Salmonella,                  Holding
     8/94      hollandaise sauce,           temperature
               56 cases                     too low for
                                            9 hours

               Clostridium                  Unrefrigerated
     1/93      botulinum, canned            storage of
               cheese sauce, 7              opened
               cases, 1 death               container

------------------------------------------------------------

Source: Center for Science in the Public Interest, 1996

Recent data (1) indicate that 80% of reported foodborne illness outbreaks
occur outside the home. Even though illnesses would be expected to be
reported more often when they occur as a result of eating in restaurants,
the numbers are large. National standards for restaurant safety are
contained in the Food Code (8). FDA has the legal authority to impose the
standards on state and local jurisdictions. The Food Code, which is updated
every 2 years, includes temperatures for cooking, cooling, refrigeration,
reheating, and holding food in food-service establishments. County or city
employees are generally charged with responsibility for inspecting
restaurants; each state or locality has its own laws governing restaurant
safety.

Food service outside the home is big business, with sales of more than $300
billion (9) and nearly 10 million employees. The restaurant industry's
share of the food dollar is 43%, and the typical consumer more than 8 years
of age had more than four meals per week away from home in 1996. Given
those statistics, it is clear that food-service establishments play a
critical role in food safety. The Center for Science in the Public Interest
(7) conducted a survey of 45 agencies across the country to determine if
state and local agencies were enforcing 12 key food-safety standards in the
FDA Food Code. The standards chosen for the study affect consumer health
and safety and include such areas as food cooking and refrigeration
temperatures, frequency of inspections, and consumer warnings for raw
foods. Not one of the 45 agencies surveyed was following all of the Food
Code recommendations.

In the survey, only 13% of agencies enforced the Food Code and recommended
cooking temperatures for pork, eggs, fish, and poultry; only 64% of
agencies required hamburgers to be cooked to 155F. Recommendations for
cooling cooked food were followed by only 20% of the agencies, and only 11%
required refrigeration of food at FDA-recommended temperatures.

Every restaurant can take steps to ensure the safety of the food it
prepares and serves to its customers. Continuous employee training and
institution of HACCP-type systems should assist restaurants and other
food-service institutions in improving their food-safety records. Programs
available through the national restaurant trade organization could assist
even the smallest establishments in achieving food-safety goals.

For more than 25 years, the Food Marketing Institute (10) has surveyed
consumers about their changing needs and priorities in food attitudes and
behavior. The 1996 trends report has an expanded focus on the primary
grocery store or supermarket, including questions to help retailers learn
more about take-out foods (Table 2). In 1996, nearly 40% of the 2,000
shoppers surveyed purchased fresh deli items from their primary supermarket
at least once per week, and more than 10% reported purchasing ready-to-eat
take-out foods as frequently. Three-fourths of these shoppers purchased
food from the deli at least once per month, and half bought take-out food
from the supermarket as often.

Table 2. Sources of take-out food (%)

---------------------------------------------------------------------------
Source                            86 87  88  89 90 91  92 93 94 95 96

---------------------------------------------------------------------------
Fast-food restaurant              43 44  41  41 46 51  55 46 46 41 48
Restaurant                        38 33  38  33 27 23  24 27 25 22 25
Supermarket                       10 9   11  12 14 14  12 15 15 17 12
Deli/pizza parlor/bagel
shop/coffee shop/ donut shop      *  *   *   *  *  *   *  *  *  8  4
Gourmet or specialty shop         *  *   *   *  *  *   *  *  *  *  3
Convenience store                 *  *   *   *  2  2   2  2  2  2  1
Some other place                  2  7   3   6  2  1   *  1  1  1  2
It varies                         1  1   1   3  4  5   3  5  3  2  0
Don't eat out                     *  *   *   7  6  4   4  4  4  3  2
Not sure                          3  3   4   1  *  1   1  1  2  3  2
---------------------------------------------------------------------------

*Data not collected for this year.
Source: Food Marketing Institute, 1996

According to the survey, fast-food restaurants dominate (48%) all food
outlets as the primary source of take-out food; only 12% purchase take-out
foods from the supermarket. A recent article in Food Processing Magazine
(11) states, "Somewhere on their way to the supermarket, consumers have
been getting lost." Home-meal replacement, ready-made meals approximating
what Mom used to make, have begun to rapidly compete for the food dollars
of time-pressed consumers. According to Hollingsworth (12), consumers are
eating more meals at home, but they are not cooking more. Consumers want to
get food in a take-out location and go home to eat it (Figure).

[Figure not available in ASCII]

These take-out or eat-at-home foods have built-in food-safety hazards.
Consumers are time-pressed, and they are buying these foods. Are they
treating them as perishable? The U.S. Department of Agriculture (13) has
expressed concerns about these foods; they say that take-out foods need to
be handled with care. Hot foods need to be picked up or received hot and
eaten within 2 hours. If eaten later, hot foods should be divided into
shallow containers, covered loosely, and refrigerated immediately.

Are consumers ready for all of this food handling? Most consumers are
confident that the food they purchase is safe to eat (10). Spoilage of
foods is considered the greatest threat to food safety by the largest group
(49%) of respondents. They count on freshness and expiration dates (22%)
and increasingly see bacteria and contamination as threats (17%). It is
interesting to note, however, that between 1992 and 1996 these shoppers
were less likely (15% vs. 7%) to see spoilage as a threat; similarly,
processing and preparation of foods was less an issue in 1996 than in 1992
(8% vs. 10%).

Consumers are concerned about handling of foods by other shoppers and by
supermarket employees. Consumers rely increasingly on food stores (16%),
manufacturers (21%), government (21%), and themselves (25%) for food-safety
protection. Consumers apparently are willing to share responsibility for
food safety with others, but they want to know that steps are taken during
the processing and distribution of foods to reduce the likelihood of
pathogen or other bacterial contamination.

According to Technomics (14), these supermarket issues noted in the Food
Market Institute trends data (10) will be shared with food-servic

e
operators as the share of consumer food expenditures changes from 51% vs.
49%, 48% vs. 52%, and 45% vs. 55% (projected) for retail expenditures
versus food-service expenditures in 1991, 1996, and 2001, respectively.

The number of households earning more than $75,000 annually continues to
grow, and these households exhibit the highest levels of spending on food
service. Consumer demands are changing the way that food-service operators
and suppliers of food services must react. The area of convenience, highly
prized by consumers today, has profound implications for food. Consumers
want fast service with easy-to-eat foods and no stress, which means a far
greater emphasis on portable foods.

Technology has conditioned us to demand and receive near-immediate
satisfaction. There will be even greater emphasis on faster service,
meaning more emphasis on convenient food formats to expedite preparation.
Packaging and storage will greatly affect product quality and safety.
According to Technomics (14) packaging will need to be temperature-tolerant
and breathable. Preparation and processing technologies will need to have
greater ability to rapidly cool and chill. And then there is the
food-safety concern associated with dispensing equipment. Food will be
required to have an extended shelflife. The safety factors associated with
these new formats will also change.

Consumers want easy access to portable foods. Accessibility to variety in
food options translates to a proliferation in nontraditional locations.
These smaller sites may include back-of-house preparation facilities. This
easy access to smaller operations also suggests a need for more of such
operations and more variety in menu options. While to the consumer this may
translate to upscale menus with indulgence foods such as new and different
bakery items, microbrewery beverages, and gourmet coffees, to the
food-service operator it may mean greater cross-contamination with cream
fillings, unpasteurized fermented drinks, and spoiled milk. New menu
options create new challenges for service and for safety.

According to Steve Harrison, brewmaster of the Sierra Nevada Brewing
Company (Chico, CA), "The concept that a beer will automatically go bad in
`X' number of days is a very untrue one." Consumers do not know that. What
is "skunky beer"? Starting in late 1996, Anheuser-Busch began a freshness
strategy in their advertising. Other large brewers are catching on, so
freshness is associated with quality and safety. Imagine freshness dating,
"born-on dating," as a quality parameter in brewing.

Consumers' increased emphasis on food-safety issues directly affects food
service. The perceived healthfulness and quality of foods affects food
sales; the increasing considerations of cleanliness as healthfulness and
quality as safety become even greater shared responsibilities as
food-service operators take over the roles historically associated with
home kitchens. "On-the-spot exhibition" cooking is of increasing interest
to today's consumers.

In June 1996, the Food Marketing Institute (15) published a review of
foodborne illness. They note that the organisms that cause foodborne
illnesses are found throughout nature and that mishandling and poor
refrigeration are responsible for most contamination. The most common
causes are cross-contamination of cooked foods with raw foods, contaminated
utensils or serving plates, poor hygiene of food handlers, and time or
temperature abuse.

Agreement is widespread that the most serious food-safety problem is
foodborne illness of microbial origin (Table 3). Foodborne pathogens
include a wide array of microorganisms, which have various physiologic
effects on people, ranging from mild to severe, and are associated with a
wide array of foods. Cross-contamination and association of foods within
mixed dishes complicate environmental control. Further, some of the
microbes have evolved and become more resistant to food preparation and
storage techniques. Several industry and government publications
(1,2,8,15,16) summarize biologic hazards associated with foodborne illness.

Table 3. Sources of reported outbreaks with confirmed causes (%)
----------------------------------------------------
                      Restaurant   Other Known  Place
                      1983-  1988- 1983- 1988-  1996
                      87     92    87    92
----------------------------------------------------
Salmonella            50     60    46    58     30
Escherichia coli      <1     <1    2     1      5
Hepatitis A virus     6      7     3     4
Staphyloccus aureus   2      3     10    5
Campylobacter         1      2     6     3      45
Shigella              8      2     6     2      17
----------------------------------------------------

Sources: Centers for Disease Control and Prevention and U.S. Department of
Agriculture for 1996, the 1996 Sentinel Site Study

Mishandling can occur at any point in the food chainin processing, at
supermarkets or restaurants, or in homes. Many food manufacturers and
retailers have HACCP plans in place, and over the next few years that
number will increase. Consumers, however, must assume responsibility for
the safety of food in the home. Proper preparation and sanitation methods
are key to preventing foodborne illness in the home as in other areas of
food handling. The messages for each of the segments of the food chain are
the samekeep it clean (e.g., wash your hands) and control the temperatures
(keep hot things hot and cold things cold) (Table 4).

Table 4. Pathogen control in foods to reduce foodborne illness
----------------------------------------------------
Pathogen                  Control mechanism
----------------------------------------------------

Campylobacter             Heat foods >= 140F
                          Proper handling

                          Rapid chilling <40F
Salmonella                Hot storage >140F
                          Cooking >165F

Escherichia coli O157:H7  Heat foods >155F
                          Avoid cross-contamination

Staphylococcus aureus     Rapid cooling <40F
                          Personal hygiene

Clostridium botulinum     Boil food 10-15 minutes

Clostridium perfringens   Refrigerate <40F
                          Proper handling

Listeria                  Pasteurization of milk
                          Adequate cooking

----------------------------------------------------

Source: Food Marketing Institute, 1996

For the food-service industry, a number of programs have been developed to
educate food handlers about food-related and personal behaviors that affect
the safety of foods. For example, the Food Marketing Institute (17) has a
Food Protection Certification Program for supermarket personnel to learn
about the FDA Food Code requirements regarding food handling and hygiene.
Similarly, the National Restaurant Association has developed a food-safety
program called Serve Safe, intended to educate food-service workers about
safe food handling.

Who or what teaches the average consumer about food safety? Common sense?
Family? Health and fitness magazines? In May 1996, the Food Marketing
Institute (17) conducted a series of consumer focus groups to establish the
importance of food safety to consumers and to identify barriers to
consumers' safe food purchase, handling, and preparation. They report that
how consumers manage food safety reflects years of conditioning,
observation, and reinforcement from mothers and grandmothers. In some
cases, the more often consumers shop, the less concerned they seem to be
about food safety when it comes to shopping, storage, and handling.
Consumers link safety to fresh food, and they assume that when they shop
more often, they purchase food in smaller quantities and food safety is
less an issue. Respondents in the study also tended to think that cooked
food was generally "safer" than raw food. For example, they believed that
recontamination of unrefrigerated food was less a problem with cooked than
with raw food.

Some safe food practices are observed for convenience, esthetics, or taste
rather than for food safety. Thawing meat is messy; covering food prevents
it from drying out; separating foods in the refrigerator is tidier. These
kinds of behavior improve safety, but consumers may not understand the
food-safety implications.

Overall, the consumers in the Food Marketing Institute study (17) find
food-safety messages generally are "common sense," "basic," "practical,"
and "believable." Messages about such subjects as the order in which to
choose foods in the supermarket, sell-by dates, storage and freezing of
products, ways of keeping hot foods hot and cold foods cold are not
considered too elementary. They also believe that storage times for food
safety do not apply equally across food groups; they do not understand
hazards from vegetables or fruits. Barriers to safe food-handling behavior
in this study included historical (and cultural) practices, feeling of
invulnerability, taste preferences, timing and planning, and space and
convenience.

A 1992 survey conducted at Cornell University and designed to assess
consumer food-safety awareness documented a substantial lack of knowledge
about safe home food preparation practices. Seventy-five percent of those
surveyed knew that Salmonella is associated with meat, poultry, and eggs,
but only 65% would refrigerate a roasted chicken breast immediately; 29%
would leave it on the kitchen counter until it reached room temperature.
Further, 18% said they would not be concerned or were not sure about the
safety of cooked meat left unrefrigerated for more than 4 hours; 14% said
the same for cooked poultry.

In April 1996, the American Meat Institute (16) commissioned a study of
1,000 adults in the United States. Compared with 98% of respondents in the
study who know that harmful bacteria can be present on meat and poultry
products, only 74% made the link to dairy products and eggs; two in five
respondents (43%) recognized that fruits and vegetables may contain harmful
bacteria. These conclusions could be drawn for consumers who responded to
the American Meat Institute (1996) questions. While the U.S. population is
growing (up 10% since 1980), households are becoming smaller. In the 1980s,
the number of households grew 17%, while the average household size
decreased from 2.8 to 2.6 persons. This shift in family size and the
increase in single heads of households has resulted in increased stress in
the family with less time for shopping and food preparation. In addition,
more women are in the workforce. Today, 70% of women ages 25 to 44 years
are in the workforce; 75% work full time. Therefore, no adult is likely to
be in the home for 70% of American households, and many children are
preparing food for themselves. Finally, consumers spend less time on food
preparation. More than 85% of employed women shop and cook, but most spend
less than 30 minutes preparing every meal and 20% spend less than 15
minutes. Consumers are using convenience foods and quick methods of food
preparation, including partially cooked foods that may require special
handling.

The study results provided further documentation that the risk for
foodborne illness is increasing, largely because of societal changes that
affect the way consumers purchase and prepare food. Contributing to this
are changes in the family structure, more women in the workforce, and less
available time for food preparation. Consumers in this study were not able
to correctly separate home preparation issues from food service, nor did
they know correct cooking temperatures to use in their own homes.

The ways in which consumers spread microorganisms to one another and to
themselves include more than just coughing and sneezing. Not washing hands
before, during, and after handling foods clearly contributes to the spread
of foodborne infections and intoxication. Hands can spread disease-causing
microbes to foods from other foods and from infected persons.

In a comprehensive review of 91 scientific articles published after 1986,
Bryan et al.(18) attempted to link hand washing and infections. They report
that hand washing has become an integral component of the tradition and
ritual of prevention practice for the spread of infection, but several
factors confound the ability to establish the effectiveness of hand washing
for reducing infectious disease. Hand-washing practices were shown to
significantly reduce infections transmitted by the fecal-oral route and in
situations of poor personal hygiene. Hand washing is clearly a critical
step in reducing personal contamination of food and cross-contamination
between foods. Hand washing is but one practice that could dramatically
affect risk, if not incidence, of foodborne disease.

According to data provided by the American Society for Microbiology (19),
people do not wash their hands as often as they think they do (Table 5). In
telephone surveys, 94% of respondents claim they always wash up after using
the rest room; however, researchers contend that almost one-third of people
do not wash their hands after using the bathroom. Of the more than 7,000
people nationwide who participated in the study, 81% said they wash their
hands before handling or eating food. However, most say they do not wash up
after petting an animal (48%), coughing or sneezing (33%), or handling
money (22%).

Table 5. American Society for Microbiology/Bayer handwashing survey, 1996
--------------------------------------------------------
                               What they    What they
Behavior/Location:             say(a) (%)     do(b) (%)

--------------------------------------------------------
Wash hands:
After using public restroom         94           68
     Women
                                                 74

     Men
                                                 61

New York (Penn Station)                          60
Chicago (Navy Pier)                              78
New Orleans (casino)                             71
San Francisco (Golden Gate
Park)                                            69
Atlanta (Braves game)                            64
     Women
                                                 89

     Men
                                                 46

--------------------------------------------------------

(a)1,004 adults; (b)6,330 adults
Source: American Society for Microbiology

In early 1997 (8), the U.S. Departments of Agriculture and Health and Human
Services and the U.S. Environmental Protection Agency developed a program
intended to coordinate a food-safety initiative among federal agencies,
immediately after an announcement by U.S. President Clinton (January 1997)
to promote an initiative designed to improve the safety of the nation's
food supply. The president charged the federal agencies to work with
consumers, producers, industry, states, tribes, universities, and the
public to identify ways to improve food safety through government and
private sector action, including public-private partnerships. The
interagency response is a multifaceted program designed to include
surveillance, coordination of activities within the various programs and
agencies, risk assessment, research, inspections, and education. The
underlying premise upon which this program was developed is that foodborne
infections remain a major public health problem. Further, sources of food
contamination are said to be almost as numerous and varied as the
contaminants; bacteria and other infectious organisms are pervasive in the
environment.

The current systems for protecting food in the United States include a
broad range of government agencies and industries, many of which have been
discussed in this paper. Responsibilities are shared among the U.S.
Department of Agriculture (Food Safety and Inspection Service and Animal
and Plant Health Inspection Service), the U.S. Department of Health and
Human Services (FDA and CDC), and the U.S. Environmental Protection Agency.
These respo
n
sibilities include oversight on the farm, in the processing
facilities, during transportation and distribution (including food from
foreign countries), and in food marketing channels including restaurants,
supermarkets, and institutional food services (such as schools and
hospitals).

Surveillance of foodborne illness outbreaks and their causes is a
responsibility of FDA and CDC. Education is shared among the agencies and
is not the primary concern or responsibility of any one of the agencies.
Pivotal to this new initiative is the element of education. Specifically,
the program is intended to reinvigorate education of all those involved in
food preparation, focusing on the use of safe practices. According to USDA
et al. (8), educating people about steps they must take to prevent and
control foodborne illness is a vital link in the food preparation chain. In
spite of the education efforts of the government, both state and federal,
consumer groups, and industry, which have occurred historically, foodborne
illness occurs from a lack of knowledge of the risks involved at all stages
of food preparation. Choices consumers make about how they handle food at
home and about eating food that increases the risk for illness can have an
important effect on foodborne disease incidence.

USDA et al. (8) will develop a program to improve consumer education;
retail, food service, and institutional education; veterinary and producer
education; and industry education in the transportation area. They propose
developing an alliance among industry, consumer groups, and governmental
agencies to mount a comprehensive food-safety awareness campaign for
consumers. Highly focused messages and tactics for the general public and
consumers at high risk will be developed. This thrust is in perfect harmony
with the strategies and tactics proposed by the American Meat Institute
(16) as an outcome to a series of studies and roundtable discussions held
with medical doctors, dietitians, educators, and others. The ability of
industry and consumer groups to work with the government in a program with
common themes and elements is critical to the positive outcome of the
effort. As one of the focus group members in the Food Marketing Institute
(17) said, the more often the message is repeated, the more likely is the
listener to hear it.

The broad-based approach to education, which includes data from
surveillance and inspections, should provide the foundation for changes in
consumer behavior. It is critical that consumers not only take
responsibility for their actions regarding food safety, but that they also
take seriously the learning that must occur for consumers of all ages to
prevent contamination, cross-contamination, and mishandling of foods at
home and in restaurants. Convenience, taste, and variety are welcome
qualities in foods that we enjoy; safety in foods is critical to the public
health and safety of consumers and to the government and businesses that
support those consumers.

Address for correspondence: Janet E. Collins, American Meat Institute 1700
N. Moore Street, Suite 1600, Arlington, VA 22209, USA; fax: 703-527-0938;
e-mail: ami@interramp.com.

References

  1. Centers for Disease Control and Prevention. Surveillance for foodborne
     disease outbreaks, United States, 19881992. MMWR CDC Surveill Summ
     1996;45:1-66.
  2. Centers for Disease Control. Foodborne disease outbreaks, 5-year
     summary, 19831987. MMWR CDC Surveill Summ 1990;39:15-57.
  3. Food Safety and Inspection Service. FSIS/CDC/FDA sentinel site study:
     the establishment and implementation of an active surveillance system
     for bacterial foodborne diseases in the United States. Washington
     (DC): USDA Report to Congress; 1997.
  4. United States General Accounting Office. Food safety: information on
     foodborne illnesses. Report to Congressional Committees. Washington
     (DC): GAO/RCED-96-96; 1996.
  5. Ollinger-Snyder P, Matthews ME. Food safety issues: press reports
     heighten consumer awareness of microbiological safety. Dairy, Food and
     Environmental Sanitation 1994;14:580.
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Emerging Infectious Diseases
National Center for Infectious Diseases
Centers for Disease Control and Prevention
Atlanta, GA

URL: ftp://ftp.cdc.gov/pub/EID/vol3no4/ascii/collins.txt