PR/HACCP RULE EVALUATION REPORT

Listeriosis Food Safety Messages and Delivery Mechanisms

for Pregnant Women

Final Report 2/23/01

1

Purpose

The Research Triangle Institute (RTI) is

conducting a multi-year evaluation of the

Pathogen Reduction; Hazard Analysis and

Critical Control Point (PR/HACCP) Systems;

Final Rule for the U.S. Department of

Agriculture, Food Safety and Inspection

Service (USDA, FSIS). As part of the

evaluation study, RTI is conducting an

evaluation of consumer education

programs.

RTI conducted focus groups with

consumers in spring 2000 to test food safety

messages and to identify effective delivery

mechanisms for these messages.1

 This

study found that consumers are not aware

that pregnant women are a high-risk group

for foodborne illness and are unfamiliar with

the bacterium Listeria monocytogenes (Lm).

To help FSIS determine how to effectively

reach pregnant women with food safety

messages on listeriosis, RTI conducted

eight focus groups with pregnant women in

four different locations.2

 The objectives of

the focus group study were to (1) test and

refine existing FSIS food safety messages

on listeriosis and (2) identify effective

delivery mechanisms for the refined

messages. In addition, we collected

information on participants’ concerns about

foodborne illness; their general food safety

knowledge; their use of safe handling

practices; their food safety concerns during

pregnancy; and how participants prepare

and store hot dogs, luncheon/deli meats,

 1

See “PR/HACCP Rule Evaluation Report,

Focus Group Study on Food Safety Messages

and Delivery Mechanisms,” 12/14/00. 2

The PR/HACCP evaluation study provided

funding for two of the focus groups, and FSIS’s

Food Safety Education Staff (FSES) provided

funding for six of the focus groups.

and deli salads, deli spreads, and pâtés

containing meat or poultry.3

This report presents our key findings and

recommendations, describes the study

design, discusses the results of the PreDiscussion Survey4

 and the focus group

discussions, and presents recommendations for educating pregnant women about

Lm and listeriosis. The Final Report

notebook contains detailed summaries of

each focus group and an analysis of the

Pre-Discussion Survey data.

Key Findings

The key findings from the Pre-Discussion

Survey and the focus group discussions are

summarized below.

Concerns about Foodborne Illness,

Food Safety Knowledge, Safe

Handling Practices, and Food Safety

during Pregnancy

• Participants expressed confidence in

their ability to safely handle and prepare

food at home. However, many

participants do not always follow safe

practices when cooking at home (e.g.,

do not refrigerate leftovers immediately

or do not use a food thermometer).

• Participants were unfamiliar with the

bacteria Lm and Campylobacter.

However, they were aware of E. coli and

Salmonella.

 3

Because only a small number of participants

eat deli salads, deli spreads, and pâtés, we only

report results for hot dogs and luncheon meats.

4

Participants completed the Pre-Discussion

Survey—a 39-item questionnaire that collects

information on safe handling practices,

preparation and storage of the targeted

products, and participant demographics—prior

to the focus group discussion.
PR/HACCP RULE EVALUATION REPORT

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for Pregnant Women

Final Report 2/23/01

2

• Participants were not aware that

pregnant women are a population at

high-risk for foodborne illness.

• Participants reported that their

obstetrician or other health care provider

does not generally provide information

on food safety.

• Most participants said that they have not

made any changes in how they handle

food since becoming pregnant because

they were careful before becoming

pregnant.

Preparation and Storage of Hot Dogs

and Luncheon Meats

• Since becoming pregnant, no

participants always reheat their

luncheon meats to steaming hot.5

• Since becoming pregnant, some

participants eat hot dogs cold or do not

use a cover when microwaving them.6

• Since becoming pregnant, many

participants do not observe the USDA

recommended storage times for some

products (opened prepackaged

luncheon meats and luncheon meats

purchased freshly sliced from the deli).

Evaluation of Listeriosis Educational

Materials

Participants evaluated the two-color, fourpanel brochure, “Listeriosis and Food Safety

Tips,” developed by USDA, FSIS (Figure 1).

Participants generally liked the brochure on

listeriosis.

 5

USDA recommends that pregnant women

reheat hot dogs and luncheon meats to

steaming hot and use a cover when

microwaving these products.

6

Ibid.

• Participants

X found the brochure easy to

understand and very informative,

and

X described the brochure as “to the

point” and did not think that it was

too long.

• Participants were not familiar with the

information on Lm and listeriosis and

seemed concerned and surprised by the

information presented.

• Participants wanted more information on

listeriosis.

• Participants identified the following as

effective messages to include in

educational materials:

X statistics on the number of illnesses

and deaths attributed to Lm

annually, and

X words like “miscarriage” and

“stillbirth.”

• Participants suggested changes to

improve the brochure. These

suggestions are summarized in the

Results section.

Delivery Mechanisms for Listeriosis

Educational Materials

• Participants agreed that the best way to

inform pregnant women about listeriosis

is through obstetricians.

• Participants also suggested disseminating information on listeriosis through

books, magazines, and web sites on

prenatal care.

• Participants identified the need to

increase awareness of Lm and

listeriosis among the general population

through the media.
PR/HACCP RULE EVALUATION REPORT

Listeriosis Food Safety Messages and Delivery Mechanisms

for Pregnant Women

Final Report 2/23/01

3

Figure 1. Listeriosis Brochure

Page 5 Page 6 Back Cover Front Cover

Page 1 Page 2 Page 3 Page 4
PR/HACCP RULE EVALUATION REPORT

Listeriosis Food Safety Messages and Delivery Mechanisms

for Pregnant Women

Final Report 2/23/01

4

Main Recommendations

Our main recommendations are listed below

and discussed in the Recommendations

section of this report:

• Educate pregnant women on steps they

and people who prepare food for them

can take to prevent listeriosis.

• Revise the brochure and target it

specifically to pregnant women.

• Educate obstetricians so they can

inform their patients.

• Disseminate information on Lm to

pregnant women using prenatal care

information sources.

• Increase awareness of Lm in the

general population via the media.

• Educate the general population on

USDA recommended storage times for

foods.

Study Design

RTI conducted a total of eight focus

groups—two groups in each of four different

locations (Manchester, New Hampshire;

Cedar Rapids, Iowa; Salt Lake City, Utah;

and Raleigh, North Carolina). We selected

these locations because they are small-tomedium sized cities. For each location, we

conducted one focus group with individuals

who have a high school education or less

and one focus group with individuals who

are college graduates.

We recruited participants to reflect the racial

diversity of the area in which the focus

groups were conducted. Participants had to

meet the following eligibility criteria: are at

least 12 weeks pregnant; have primary

responsibility or share responsibility for

cooking in their household; prepare meals

at least three times a week; are not

vegetarian; and often or sometimes eat

luncheon meats, hot dogs, deli salads, or

deli spreads/pâtés. Participants included

women who have other children as well as

those in their first pregnancy. Each group

included seven or eight participants, for a

total of 63 participants.

Results

Findings from the Pre-Discussion Survey

are highlighted below, along with the

qualitative information gathered in the focus

group discussions.

Concerns about Foodborne Illness

• Participants were somewhat or not very

concerned about getting foodborne

illness from food they prepare at home.

Participants discussed precautions they

take at home to keep food safe, such as

cleanliness, proper handling, and

cooking foods thoroughly. Over 90

percent of participants said that they are

completely confident that the meat and

poultry products they prepare at home

are safe to eat.

• Participants were more concerned about

getting foodborne illness from eating out

than from eating food prepared at home.

They expressed concern about

cleanliness, improper food handling, and

undercooked meat in restaurants.

Food Safety Knowledge

• Despite their confidence in how they

prepare food at home, most participants

described themselves as being

somewhat knowledgeable about food

safety and safe handling practices.

• Participants were familiar with the

bacteria E. coli and Salmonella but were

unfamiliar with Lm and Campylobacter.
PR/HACCP RULE EVALUATION REPORT

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for Pregnant Women

Final Report 2/23/01

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• Participants correctly identified meat

and poultry as high-risk foods for

foodborne illness.

• Some participants correctly identified

children, seniors, and the immunocompromised as high-risk populations

for foodborne illness, but were not

aware that pregnant women are also at

risk.

Safe Handling Practices

Participants discussed measures they take

at home to protect their families from

foodborne illness. The Pre-Discussion

Survey also collected information on the

prevalence of certain safe handling

practices. The Pre-Discussion Survey

findings on participants’ use of safe

handling practices are summarized below.7

• Ninety-two percent of participants wash

cutting boards used for cutting meat or

poultry with soap and/or bleach water

before using it again, or they use a

different cutting board.

• Eighty-seven percent of participants

wash their hands with soap after

handling raw meat or poultry.

• Forty-four percent of participants own a

food thermometer; most own a dial

thermometer.

• Thirty-nine percent of participants

immediately refrigerate leftovers like

soup or stew containing meat or poultry.

• Over 20 percent of participants always

or often use a food thermometer when

cooking large cuts of meat, like roasts or

turkeys.

 7

Because a probability-based sample was not

used, the results from the Pre-Discussion

Survey should not be generalized to the

population of pregnant women in any statistical

sense.

• Only three percent of participants

always or often use a food thermometer

when cooking hamburgers.

These findings are generally consistent with

the results of the 1998 Food and Drug

Administration (FDA)/FSIS Food Safety

Survey.8

 While the majority of participants

follow proper cleaning practices, many do

not refrigerate leftovers immediately or use

a food thermometer to check for the safe

internal temperature of meat and poultry.

Food Safety during Pregnancy

• Only 8 of the 63 participants had

received information on food safety from

their obstetrician or physician since

becoming pregnant. No participants had

received information specifically on

listeriosis.

• Several participants recalled reading

about food safety and safe handling

practices in books or magazines on

prenatal care (e.g., pregnant women

should not eat soft cheeses, sushi, or

rare meat). A few participants had

received information on food safety from

Women, Infants, and Children (WIC)

nutritionists. Only one participant had

heard that pregnant women should

reheat luncheon meats.

• Most participants said that they have not

made any changes in how they handle

food since becoming pregnant because

they were careful before becoming

pregnant. Some participants said that

they have become more cautious about

food preparation since having children.

• Some participants reported eating highrisk foods during their pregnancy (37

 8

The FDA/FSIS Food Safety Survey is

conducted every 5 years and collects

information on consumer food safety

perceptions, knowledge, and behavior.
PR/HACCP RULE EVALUATION REPORT

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for Pregnant Women

Final Report 2/23/01

6

percent eat raw homemade cookie

dough, 27 percent eat soft cheeses, and

24 percent eat dishes containing raw or

uncooked eggs, like Caesar salad).

Preparation of Hot Dogs and

Luncheon Meats

Table 1 summarizes participants’ responses

on how they prepare and store hot dogs and

luncheon meats.

• Most participants reported that they are

eating hot dogs and luncheon meats

during their pregnancy. Of participants

eating these products, about two-thirds

eat hot dogs at least once a month and

luncheon meats three or more times a

month.

• Some participants recalled reading or

hearing that hot dogs should not be

consumed “raw” or cold, but did not

relate this specifically to pregnant

women.

• Most participants boil, microwave, or

grill their hot dogs. One participant

sometimes eats hot dogs cold out of the

package.

• Participants who microwave their hot

dogs usually do so without a cover.

• Only one participant occasionally

reheats luncheon meats as a food

safety precaution.

• Most participants do not currently eat

deli salads, deli spreads, or pâtés and

did not eat these products before their

pregnancy.

Storage of Hot Dogs and Luncheon

Meats

• Over 80 percent of participants observe

the USDA recommended storage times

for hot dogs for both unopened and

opened packages.

• Over 80 percent of participants observe

the USDA recommended storage time

for unopened packages of prepackaged

luncheon meats. However, over 50

percent of participants eat luncheon

meats after the package has been

opened for longer than 5 days, which is

not recommended.

• About two-thirds of participants observe

the USDA recommended storage time

for luncheon meat purchased sliced

from the deli.

• Many participants refer to expiration

dates to decide whether a product is

safe to eat or should be discarded.

• Some participants knew the meanings

of and understood the difference

between the “sell-by” (guideline to the

store) and “use-by” (guideline to the

consumer) dates. Other participants

said that they do not distinguish

between the “sell-by” and “use-by” dates

and, as a rule, do not use a product past

the “sell-by” or “use-by” date.

• Some participants continue to refer to

the “sell-by” and “use-by” dates after

opening the package, which could

potentially be an unsafe practice

because storage times change after

opening the packaging.

Evaluation of Listeriosis Educational

Materials

Participants generally liked the brochure.

Participants

• found the brochure easy to understand

and very informative,

• described the brochure as “to the point”

and did not think it was too long,
Final Report 2/23/01

7

Table 1. Participants’ Responses on Consumption, Preparation, and Storage of Hot Dogs and

Luncheon Meats (n=63)a

Percentage of

Participants (%)

Hot Dogs

Eat hot dogs during pregnancy 81

Frequency of eating hot dogs

Less than once a month 35

1 to 2 times a month 55

3 or more times a month 10

Usual method for preparing hot dogs

Cold out of the package 2

Boil 35

Microwave 31

Grill 26

Other (e.g., panfry or combination of methods) 6

Store unopened packages and then eat

2 weeks or lessb 80

Longer than 2 weeks 10

Until expiration date 4

Don’t know/no answer 6

Store opened packages and then eat

7 days or less or freeze after openingb 88

Longer than 7 days 6

Until expiration date 2

Don’t know/no answer 4

Luncheon Meats

Eat luncheon meats during pregnancy 95

Frequency of eating luncheon meats

Less than once a month 7

1 to 2 times a month 25

3 or more times a month 68

Usual method for preparing luncheon meats

Eat them cold 98

Heat them so they are warm 2

Store unopened luncheon meat packages (prepackaged) and then eat

2 weeks or lessb 82

Longer than 2 weeks 11

Until expiration date 5

Don’t know/no answer 2

Store opened luncheon meat packages (prepackaged) and then eat

5 days or lessb 45

Longer than 5 days 53

Until expiration date 2

Store luncheon meats purchased freshly sliced from the deli and then eat

5 days or lessb 65

Longer than 5 days 35

aBecause a probability-based sample was not used, the results from the Pre-Discussion Survey should not be

generalized to the population of pregnant women in any statistical sense.

bParticipants storing products for this time period are following the USDA recommended guidelines.
PR/HACCP RULE EVALUATION REPORT

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for Pregnant Women

Final Report 2/23/01

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• liked the flow of the brochure and the

ordering of the information, and

• liked that phone numbers and web site

addresses were provided if one wanted

more information.

Participants were not familiar with the

information on Lm and listeriosis and most

seemed surprised and concerned by the

information presented.

• Participants were very surprised to learn

that pregnant women should reheat

luncheon meats to prevent foodborne

illness. One participant stated, “I was

thinking I was doing everything (right)

except that.”

• Most participants found the statistics on

the number of illnesses and deaths

attributed to Lm concerning. One

participant stated, “Three hundred

people dying from it kind of seems high

to me anyway.” Only a few participants

did not find these statistics alarming and

said that the risk of contracting listeriosis

was not that great.

• Participants were concerned that it

might take as long as 3 weeks to get

sick and that the symptoms of listeriosis

are common conditions during

pregnancy and are similar to the flu.

• Participants wanted more information on

the illness.

Participants identified the following as

effective messages to include in educational

materials:

• Statistics on the number of illnesses

and deaths attributed to Lm annually.

The vast majority of participants said

that the statistics help to illustrate the

seriousness of the illness. Participants

said that having the statistics at the front

of the brochure encourages you to read

the rest of it. Some participants wanted

more information, specifically, the

number of illnesses and deaths

associated with fetuses and newborns.

• Words like “miscarriage” and

“stillbirth.” Participants said that

although these are scary words for

pregnant women, it is important to know

the possible outcomes of the illness.

Participants said that the use of such

words helps to get pregnant women’s

attention and illustrate the seriousness

of the illness.

Participants suggested the following

changes to improve the brochure:

• Change the title so it gets people’s

attention.

X Drop the phrase “Food Safety Tips”

from the title. This phrase suggests

that the brochure is on safe handling

practices in general, with which

many people are already familiar.

X Add the at-risk populations to the

title, so those people will be more

likely to read it.

X Use a title that has a “warning” tone

(e.g., “Listeria: The Deadly Bacteria,”

“Dangers of Listeriosis,” “Listeriosis

and the Pregnant Woman: You are

at Risk,” or “Listeriosis...Is it Harmful

to You?”).

• Develop a brochure specific to each

high-risk population. Participants said

that they would be more likely to read a

brochure that was specifically targeted

to pregnant women. Participants said

that they seek out information on

prenatal care during their pregnancy.

• Add more information on listeriosis

to the brochure, but do not make it

too long. Participants wanted to know

more about the illness (e.g., how to test
PR/HACCP RULE EVALUATION REPORT

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for Pregnant Women

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for it, the number of illnesses and

deaths attributed to fetuses and

newborns, and if it is transmitted

through breastmilk).

• Clarify how Lm contamination

occurs. Several participants were

confused by the statement in the first

paragraph that Lm is “often found in soil

and water.” Participants suggested

stating early in the brochure that one

gets listeriosis from eating certain foods.

• Present the statistics on the mortality

rate for listeriosis in simpler terms.

For example, say “1 in 4 die” from

listeriosis instead of “25 percent die.”

• Provide more information on the

reheating guidelines for hot dogs and

luncheon meats. Although most

participants understood what it means to

“reheat until steaming hot,” they

questioned how one should do this.

Participants wanted to know if you could

reheat luncheon meats by holding them

under hot running water, and if it was

safe to reheat luncheon meats then let

them cool in the refrigerator before

eating.

• Emphasize that hot dogs and

luncheon meats should not be eaten

if they are not reheated. Some

participants did not think it was

sufficiently emphasized that those at risk

should not eat hot dogs or luncheon

meats without reheating them.

• Drop the section on recalls.

Participants said that they know not to

eat recalled products.

Participants in two focus groups evaluated

the video news release (VNR), “Preventing

Illness from Listeria Monocytogenes,”

developed by FSIS.9

 This 2-minute VNR

 9

The original study design specified that four

groups would evaluate the brochure and four

identifies the populations at risk for

listeriosis and provides guidelines for at-risk

populations. Participants liked the VNR and

said that it would be useful for generating

awareness of listeriosis. Participants

suggested that the VNR provide more

information on the bacterium (Lm) itself

(what it is, where it comes from, and how it

gets into food), and more information on the

illness (statistics on the number of illnesses

and deaths attributed to Lm and the effects

of listeriosis on the fetus and mother).

At the end of the discussion, we asked

participants if they plan to make any

changes based on what they learned in the

focus group discussion. Some participants

said that they plan to make changes, while

others do not.

• Some participants said that they would

start reheating or stop eating luncheon

meats during their pregnancy. In two of

the college-educated groups, most of

the participants enthusiastically agreed

that they plan to follow the

recommended guidelines.

• Some participants said that they would

likely eat luncheon meats less often

during their pregnancy. Participants did

not think heated luncheon meats would

be very appetizing.

• Several participants were not inclined to

start reheating or stop eating luncheon

meats during their pregnancy. These

participants said that they would be

more likely to follow the recommended

guidelines if their doctor discussed this

 

groups would evaluate the VNR. After evaluating

the VNR in two groups, we revised the study

design and evaluated only the brochure in the

remainder of the groups. FSIS decided that

evaluating the VNR in two groups would be

sufficient and wanted to get more feedback on

the brochure.
PR/HACCP RULE EVALUATION REPORT

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for Pregnant Women

Final Report 2/23/01

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information with them on a one-on-one

basis.

Delivery Mechanisms for Listeriosis

Educational Materials

Participants agreed that it is important for

pregnant women to be educated about the

risk of listeriosis. Participants’ suggestions

on how to inform pregnant women about

listeriosis are summarized below.

Participants agreed that the best way to

inform pregnant women about listeriosis

is through obstetricians.

• Most participants suggested including a

brochure on listeriosis in the package of

information received at the first prenatal

care visit. One participant said, “Every

pregnant woman needs to get this

brochure at her first visit.” Participants

said that they read everything included

in the prenatal information package

even though it may contain numerous

brochures.

• Additionally, some participants

suggested that obstetricians personally

give the brochure to patients and

discuss it with them. These participants

said that the seriousness of the illness

demanded special attention by the

doctor. One participant stated, “I think

it’s the doctor’s responsibility to say

something because it is such a risk,

specifically for pregnant women.”

Participants also suggested disseminating information on listeriosis to

pregnant women through books,

magazines, and web sites on prenatal

care.

Most participants said that they read books

and magazines on prenatal care during their

pregnancy. Some participants also get

information on prenatal care from the

Internet. Some participants said that they

get more prenatal care information from

books and other sources than from their

doctors.

Table 2 identifies participants’ favorite

books, magazines, and web sites for

prenatal care information. The most popular

prenatal book is What to Expect When

You’re Expecting. Referred to as, “the Bible

for first-time mothers,” this book is

distributed by some doctors and insurance

companies.

Table 2. Most Popular Books, Magazines,

and Web Sites on Prenatal Care

Books

What to Expect When You’re Expecting

Arlene Eisenberg, Heidi E. Murkoff, Sandee E.

Hathaway, BSN. Workman Publishing, New

York, NY, 1996.

While Waiting

George E. Verrilli, MD, FACOG, Anne Marie

Mueser, Ed.D. St. Martin’s Griffin, New York,

NY, 1998.

Your Pregnancy: Week by Week

Glade B. Curtis, MD, OB/GYN.

Fisher Books, Tucson, AZ, 1997.

Magazines

American Baby, Primedia, Inc.

Parenting, The Parenting Group, Inc.

Parents, G&J USA Publishing

Web Sites

http://www.babycenter.com/

http://www.pregnancyweekly.com/

http://www.pregnancycalendar.com/

Other approaches for delivering information

on listeriosis to pregnant women include the

following:

• Display brochures in doctors’ offices

(obstetricians/gynecologists,
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pediatricians, and general family

practice); daycares; and grocery stores.

• Display posters in obstetricians’ and

pediatricians’ offices.

• Include information on listeriosis with

prenatal nutritional information.

• Provide information on listeriosis in

prenatal care classes.

• Develop a video on food safety and

listeriosis that obstetricians can show in

their waiting rooms.

• Disseminate information through WIC

clinics.

Participants were divided as to whether

displaying warning statements on

packaging for hot dogs and luncheon

meats would be effective.

Some participants said that it was

appropriate to display warning messages on

product packaging given the seriousness of

the illness, although some wondered if

people would actually notice warning

messages. Some participants did not think

warning messages are necessary and

suggested that it would be more effective to

increase general awareness of Lm.

Participants identified the need to

increase awareness of Lm and listeriosis

among the general population through

the media.

Participants were very surprised that they

had not heard of Lm prior to the discussion.

Participants said that people need to

become aware of Lm just like they are

aware of E. coli and Salmonella.

Participants thought media coverage would

be effective in getting consumers’ attention

and increasing awareness of Lm. One

participant stated, “If I see it on TV ... then it

sticks in my mind better than if I just quickly

read over a brochure on it.”

Participants suggested the following

approaches for delivering information on

listeriosis to the general population:

• television news

• television news shows (e.g., Dateline,

20/20)

• commercials and public service

announcements (PSAs)

• newspapers

• cooking shows

• billboards

• schools

Recommendations

Recommendations based on the focus

group findings are summarized below.

Educate pregnant women on steps they

and people who prepare food for them

can take to prevent listeriosis.

Nearly all participants were not aware that

pregnant women and other high-risk groups

should reheat luncheon meats. We

recommend that USDA educate pregnant

women and those who prepare food for

them on the guidelines for preparing hot

dogs and luncheon meats, the USDA

recommended storage times for these

products, and to not eat foods that have a

greater risk of containing Lm as specified in

the Listeria Action Plan recently released by

FSIS and the FDA. Recommended delivery

mechanisms for these messages are

identified below.

Revise the brochure and target it

specifically to pregnant women.

Participants suggested developing a

brochure targeted to each high-risk

population. Participants also suggested
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changes to improve the brochure. We

recommend that FSIS develop a brochure

for pregnant women incorporating the

following changes:

• Emphasize the risk of listeriosis to

pregnant women and fetuses (include

statistics and discuss the possible

outcomes).

• Change the title (drop “Food Safety

Tips,” use a title with a warning tone).

• Add more information on listeriosis, but

do not make the brochure too long.

• Clarify how Lm contamination occurs.

• Provide more information on the

reheating guidelines for hot dogs and

luncheon meats.

• Emphasize the message, “If you can’t

reheat it, don’t eat it” for hot dogs and

luncheon meats.

• Provide information on USDA

recommended storage times.

Educate obstetricians so they can inform

their patients.

Participants agreed that the best way to

inform pregnant women about Lm and

listeriosis is through obstetricians.

Participants suggested including a brochure

on listeriosis in the package of information

provided at the first prenatal visit. Some

participants suggested going a step further

and having physicians give the brochure to

their patients and discuss it with them.

Research with physicians suggests that it

may be difficult to encourage obstetricians

to provide their patients with information on

listeriosis. Focus group research sponsored

by the International Food Information

Council found that physicians who treat

patients at high risk for foodborne illness do

not provide them with preventative

information on food safety.10 They believe

that foodborne illness is less important than

other topics, such as heart health, smoking,

and drug/alcohol use.

We recommend that FSIS work with the

American Medical Association (AMA) and

the American College of Obstetricians and

Gynecologists (ACOG) to educate

obstetricians so they can inform their

patients. An important first step toward

educating physicians is the document,

“Diagnosis and Management of Foodborne

Illnesses: A Primer for Physicians.”

11 The

primer was developed in response to AMA

member requests for guidance on

foodborne illness. The primer includes a

patient scenario on Lm. The AMA is

distributing copies of the publication on

request and it is also accessible through the

AMA’s web site.

Disseminate information on Lm to

pregnant women using prenatal care

information sources.

Participants said that they seek out

information on prenatal care during their

pregnancy. Participants rely on books,

magazines, and the Internet for prenatal

care information. Although some sources

discuss food safety during pregnancy (e.g.,

do not eat soft cheeses), they do not include

preparation guidelines for hot dogs and

luncheon meats. We recommend that FSIS

work with the prenatal care information

 10“Physicians’ Attitudes Toward Food Safety

Education.” September 2000. Final report

prepared for International Food Information

Council. Prepared by Axiom Research

Company.

11“Diagnosis and Management of Foodborne

Illnesses: A Primer for Physicians.” January

2001. Produced collaboratively by the AMA, the

Centers for Disease Control and Prevention,

FDA, and FSIS. <http://www.ama-assn.org/

foodborne>.
PR/HACCP RULE EVALUATION REPORT

Listeriosis Food Safety Messages and Delivery Mechanisms

for Pregnant Women

Final Report 2/23/01

13

sources identified in Table 2 to inform them

about Lm and encourage them to report on

Lm when discussing food safety.

Increase awareness of Lm in the general

population via the media.

Participants were surprised that they were

unaware of Lm and listeriosis given the

seriousness of the illness. Participants said

that for at-risk individuals to make behavior

changes, awareness of Lm needs to be

increased in the general population.

Participants likened it to E. coli and how

most consumers now know not to eat rare

meat. Participants discussed the need to

increase awareness of Lm via the media.

Possible approaches for delivering

information on Lm to the general population

were identified in the Results section.

Further analysis is required to determine

which approaches would be most costeffective.

Educate the general population on USDA

recommended storage times for foods.

Findings from the Pre-Discussion Survey

indicate that many participants do not

observe the USDA recommended storage

times for some products. Also, some

participants refer to expiration dates after

opening the package, which could

potentially be an unsafe practice. Because

Lm can grow at refrigerated temperatures,

we recommend that FSIS educate

consumers on the recommended storage

times for meat and poultry products in future

education efforts.