# Assessment of Food Safety and Food Handling Practice Knowledge among College of Basic Education Students, Kuwait

Authors: Fatemah Ashkanani; Wafaa Husain; Maryam A Al Dwairji
Journal: Journal of Food Quality
 (2021)

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## Abstract

The aim of this study is to assess the overall food safety knowledge of students at the College of Basic Education in Kuwait and to explore the relationship between their knowledge and demographic characteristics. A valid questionnaire was used that included 16 food handling practice (FHP) questions and 15 food safety knowledge (FSK) questions. Each question had one correct answer that was awarded a score of one point, while a score of zero was given for all incorrect answers. In addition, a passing percentage was calculated. A passing percentage is the percentage of participants who answered correctly ≥ 50% of the questions. A total of 585 students participated in the study (mean age = 21.3 ± 3.88 years). The results showed that the mean score of FHP was 7.56 ± 1.96 (47.2%), with the highest mean practices being using a paper towel to dry hands and washing hands before cooking or eating (91.5% and 90.1%, resp.). The lowest mean practices (5.3%) were checking the temperature of burgers followed by (6%) the way of defrosting meat. The mean score of FSK was 3.44 ± 2.00 (22.9%), with the highest mean knowledge (63.8%) being related to cleaning the kitchen counter. The lowest mean knowledge (6.8%) was related to the optimum growth temperature for the most disease-causing bacteria. The overall passing percentage of FHP was 55%, while it was 2.9% for FSK. The results obtained showed that the students with the highest FHP scores were generally female, aged ≥ 28 years, and single, and they cook by themselves all the time or sometimes (p<0.001, p<0.001, p<0.001, and p=0.004, resp.). The students with the highest FSK scores were generally male and they cook by themselves all the time or sometimes (p=0.018 and p=0.002, resp.). In conclusion, the study showed that students had insufficient scores for FHP and FSK. Therefore, an effective food safety education programme is urgently needed.


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## Body

## 1. Introduction

Food safety refers to the procedures used in handling, preparing, and storing food in a way that prevents contamination and foodborne diseases [1]. Nowadays, food safety is an international concern [2, 3]. Although governments all over the world are doing their best to improve the safety of food, the occurrence of foodborne disease remains a significant health issue in both developed and developing countries [4].A report conducted by the World Health Organization (WHO) [5] has shown that almost 1 in 10 people in the world fall ill after eating contaminated food and more than 91 million people are affected in developing countries. Moreover, it has been estimated that each year 1.8 million people die as a result of diarrhoeal diseases. This may be due to poor food safety and unhygienic/improper handling practices, cross contamination from food contact surfaces, and inadequate preservation methods [3]. The WHO has developed the Five Keys to Safer Food programme as available guidance to provide basic principles that each individual should know to ensure safer food and prevent foodborne diseases. The basic principles are to keep clean, separate raw and cooked food, cook thoroughly, keep food at a safe temperature, and use safe water and raw materials [6].Unsafe food creates a vicious cycle of disease and poor nutrition, and some age groups may be at higher risk of foodborne disease than vulnerable groups such as infants, young children, the elderly, and pregnant women [7]. For example, young adults (18–29 years old) are more likely to engage in risky food handling than others [8–11]. It was found that, overall, young adults have a lack of food safety knowledge (FSK) and safe food handling practices (FHP), and this may be due to a lack of food safety education, good role models, and/or food handling experience [9]. This becomes more serious when they are responsible for providing care to other family members who are at an increased risk, such as children and the elderly [7, 12].Few studies have been published about FSK and FHP among young adults in universities. Those studies that have been undertaken have shown that FSK appears to be low among university students [11, 13–15]. Such studies have found that FSK, attitudes, and practices differ by gender, age, year of study, major, mother’s education level, psychological factors, and other demographic characteristics [11, 13–18].Food safety education is an important part of foodborne disease prevention and young adults are an important vulnerable group to focus on [8, 12, 19]. Due to changes in the education system and a lack of food safety education, it is important to evaluate this group’s level of food safety awareness and to understand the issues surrounding it. This will help to tailor educational programmes that can improve FSK and FHP for this group. To the best of our knowledge, there is a lack of studies that investigate FSK and FHP among Kuwaiti students. Therefore, this study aims to assess the overall food safety knowledge of students at the College of Basic Education in Kuwait and to explore the relationship between their knowledge and demographic characteristics. This will help to provide valuable information for the planning of effective educational food safety programmes that can improve students’ knowledge and practices.


## 2. Materials and Methods

### 2.1. Study Population

A cross-sectional study was conducted during September and October 2019. The respondents were undergraduate students of different departments, with the aim of obtaining a broad student representation. The respondents are comprised of 600 students enrolled in both male and female campuses of the College of Basic Education (CBE), Kuwait. The CBE is a degree awarding tertiary institute in Kuwait with a population of ∼25,000 students. It is operated by the Government’s Public Authority for Applied Education and Training (PAAET). The college provides teachers for the Ministry of Education [20]. The minimum required sample size was calculated based on a statistical power of 80%, a confidence level of 95%, a margin of error of 5%, and the student body of 25,000; thus, a minimum sample size of 379 was required [21].Before administering the questionnaire, verbal explanations of the study were given to lecturers. The objectives, significance, and protocol of the study were explained and prior approval was obtained from each lecturer.The protocol of the study and its significance were briefly explained on the first page of the questionnaire. After initial approval, a consent form was obtained from each student who was willing to participate in the study. Questionnaires were distributed to all students during regular class times by the researchers. It was stressed that completion of the questionnaire was voluntary and that all responses were anonymous. No extra credit was given to the participating students. Incomplete or inappropriately filled-in questionnaires were excluded. Out of 600 completed questionnaire forms, only 585 (97.5%) were valid.


### 2.2. Questionnaire

A structured questionnaire on overall food safety knowledge, including FHP and FSK related to basic principles, was used. The questionnaire was composed of three sections covering sociodemographic characteristics, FHP questions, and FSK questions. The first part was developed by the researchers to collect information about students’ sociodemographic and academic characteristics, including age, gender, field of study, year of study, marital status, governorate, nationality, mother’s employment, cooking habits, and the person responsible for preparing and cooking food in the family. In addition, a question about the main sources of food safety information was added and multiple answers were allowed.The second and third parts of the questionnaire were developed from a published, reliable, and valid questionnaire created by Byrd-Bredbenner et al. [7] which has been used in similar studies undertaken in Jordan, Greece, Lebanon, and the USA, respectively [10, 14, 18, 22]. The FHP section included 16 questions, whereas the FSK section included 15 questions. Most of the questions were multiple choice questions.The questionnaire was evaluated and assessed by a number of experts to make necessary modifications as appropriate. Then, a pilot study (comprising 50 students) was conducted to ensure initial validation of the questionnaire. The clarity and suitability of wording, in addition to the average time needed for its completion, were assessed. Necessary modifications were made but the pilot study results were not included in the final results of the study. The questionnaire took approximately 9 minutes to complete.Each question in sections two and three had one correct answer that was awarded a score of one point, while a score of zero was given for all incorrect answers, those skipped, and those answered with “I do not know.” The sum of the FHP section and the sum of the FSK section were obtained and the total score was the sum of the two sections. The maximum of possible points was 31, reflecting the participant’s overall knowledge of food safety. In addition, a passing percentage was calculated for each section and a total was calculated as well. A passing percentage is the percentage of participants who answered correctly ≥ 50% of the questions [18].Age groups were divided into ≤ 21, 22–27, and ≥ 28 years old. Students’ self-reported fields of study were divided into six departments: science and technology (science, math, and computer science), humanities and social sciences (English, French, and Arabic languages and Islamic studies), physical education and sport, applied arts and music (art, music, interior design), library and information science, and educational technology. The fields of study “humanities and social sciences,” “educational technology,” and “library and information science” were merged as a statistical requirement under the name of “humanities and others.”


### 2.3. Statistical Analysis

Data were statistically gathered using the Statistical Package for the Social Sciences, version 23 [23]. The cut-off point for statistical significance was p value < 0.05. Descriptive statistics (means and standard deviations or frequencies) were calculated for all variables. Independent analysis of variance (ANOVA) tests were conducted to determine differences in sociodemographic variables and correct scores for FHP and FSK. Tukey’s test was used in conjunction with the ANOVA test to find means that were significantly different from each other. An independent sample t-test was used to show the relationship between gender, nationality, marital status, and correct FHP and FSK scores. The correlation between FSK and FHP was tested with a Pearson correlation.Stepwise multiple regression (bidirectional elimination) was used to model the relationship of each of the response variables with independent variables, withp value < 0.05 considered to be statistically significant. A Cronbach’s alpha reliability coefficient was calculated for the 31 questions. Cronbach’s alpha was 0.70 (note that a reliability coefficient of 0.70 or higher is considered “acceptable” in most social science research situations) [24].


## 2.1. Study Population

A cross-sectional study was conducted during September and October 2019. The respondents were undergraduate students of different departments, with the aim of obtaining a broad student representation. The respondents are comprised of 600 students enrolled in both male and female campuses of the College of Basic Education (CBE), Kuwait. The CBE is a degree awarding tertiary institute in Kuwait with a population of ∼25,000 students. It is operated by the Government’s Public Authority for Applied Education and Training (PAAET). The college provides teachers for the Ministry of Education [20]. The minimum required sample size was calculated based on a statistical power of 80%, a confidence level of 95%, a margin of error of 5%, and the student body of 25,000; thus, a minimum sample size of 379 was required [21].Before administering the questionnaire, verbal explanations of the study were given to lecturers. The objectives, significance, and protocol of the study were explained and prior approval was obtained from each lecturer.The protocol of the study and its significance were briefly explained on the first page of the questionnaire. After initial approval, a consent form was obtained from each student who was willing to participate in the study. Questionnaires were distributed to all students during regular class times by the researchers. It was stressed that completion of the questionnaire was voluntary and that all responses were anonymous. No extra credit was given to the participating students. Incomplete or inappropriately filled-in questionnaires were excluded. Out of 600 completed questionnaire forms, only 585 (97.5%) were valid.


## 2.2. Questionnaire

A structured questionnaire on overall food safety knowledge, including FHP and FSK related to basic principles, was used. The questionnaire was composed of three sections covering sociodemographic characteristics, FHP questions, and FSK questions. The first part was developed by the researchers to collect information about students’ sociodemographic and academic characteristics, including age, gender, field of study, year of study, marital status, governorate, nationality, mother’s employment, cooking habits, and the person responsible for preparing and cooking food in the family. In addition, a question about the main sources of food safety information was added and multiple answers were allowed.The second and third parts of the questionnaire were developed from a published, reliable, and valid questionnaire created by Byrd-Bredbenner et al. [7] which has been used in similar studies undertaken in Jordan, Greece, Lebanon, and the USA, respectively [10, 14, 18, 22]. The FHP section included 16 questions, whereas the FSK section included 15 questions. Most of the questions were multiple choice questions.The questionnaire was evaluated and assessed by a number of experts to make necessary modifications as appropriate. Then, a pilot study (comprising 50 students) was conducted to ensure initial validation of the questionnaire. The clarity and suitability of wording, in addition to the average time needed for its completion, were assessed. Necessary modifications were made but the pilot study results were not included in the final results of the study. The questionnaire took approximately 9 minutes to complete.Each question in sections two and three had one correct answer that was awarded a score of one point, while a score of zero was given for all incorrect answers, those skipped, and those answered with “I do not know.” The sum of the FHP section and the sum of the FSK section were obtained and the total score was the sum of the two sections. The maximum of possible points was 31, reflecting the participant’s overall knowledge of food safety. In addition, a passing percentage was calculated for each section and a total was calculated as well. A passing percentage is the percentage of participants who answered correctly ≥ 50% of the questions [18].Age groups were divided into ≤ 21, 22–27, and ≥ 28 years old. Students’ self-reported fields of study were divided into six departments: science and technology (science, math, and computer science), humanities and social sciences (English, French, and Arabic languages and Islamic studies), physical education and sport, applied arts and music (art, music, interior design), library and information science, and educational technology. The fields of study “humanities and social sciences,” “educational technology,” and “library and information science” were merged as a statistical requirement under the name of “humanities and others.”


## 2.3. Statistical Analysis

Data were statistically gathered using the Statistical Package for the Social Sciences, version 23 [23]. The cut-off point for statistical significance was p value < 0.05. Descriptive statistics (means and standard deviations or frequencies) were calculated for all variables. Independent analysis of variance (ANOVA) tests were conducted to determine differences in sociodemographic variables and correct scores for FHP and FSK. Tukey’s test was used in conjunction with the ANOVA test to find means that were significantly different from each other. An independent sample t-test was used to show the relationship between gender, nationality, marital status, and correct FHP and FSK scores. The correlation between FSK and FHP was tested with a Pearson correlation.Stepwise multiple regression (bidirectional elimination) was used to model the relationship of each of the response variables with independent variables, withp value < 0.05 considered to be statistically significant. A Cronbach’s alpha reliability coefficient was calculated for the 31 questions. Cronbach’s alpha was 0.70 (note that a reliability coefficient of 0.70 or higher is considered “acceptable” in most social science research situations) [24].


## 3. Results

Demographic characteristics of the sample are summarized in Table1. A total of 585 undergraduate students participated in the study with a mean age of 21.3 ± 3.88; 56.2% were females; and 43.8% were males. The majority of respondents were aged less than or equal to 21 years (69.7%). Of the students in the study, 41.5% were studying in the humanities and others category. Around 37.3% of the students were in their second year. Most of the students were single (80%) and the majority were Kuwaiti (89.7%). Only 8.4% (n = 49) of the participants have children, and of these 44.9% have three or more children. Twenty-five percent of the students were from Al Jahra governorate. Only 10% of the students reported that they cook their own meals all the time; 41.7% have mothers who are housewives. Almost half of the students reported that their housekeeper cooks in their homes (47%). Social media/Internet was the main source of food safety information for the students (49.6%, n = 290).Table 1
Demographic characteristics of the study (n = 585).
Demographic characteristics of the studyn%Age≤ 21 years40869.7Between 22 and 27 years14424.6≥ 28 years335.6GenderMale25643.8Female32956.2Field of studyScience and technology10718.3Humanities and others24341.5Physical education and sport6110.4Applied arts and music17429.7Year of studyFirst year12621.5Second year21837.3Third year14825.3Fourth year or more9315.9Marital statusSingle47080.3Married/divorced11519.6Students have childrenYes498.4No53691.6Number of children (n = 49)1-2 children2755.13-4 and more children2244.9Number of childrenAverage (2.69 ± 1.7) minimum 1–maximum 7GovernorateAl Ahmadi12020.5Capital6210.6Farwaniya7512.8Hawali7613.0Jahra14625.0Mubarek Alkabeer10618.1NationalityKuwaiti52589.7Non-Kuwaiti6010.3Mother’s employmentWorks20735.4Retired13422.9Housewife24441.7Cooking habitsAll the time6010.3Sometimes33056.4Rarely15426.3Never417.0Who prepares and cooks in your family?By myself417.0Mother/wife24742.2Housekeeper27547.0Others223.8Sources of food safety informationInternet and social media21949.6Parent21136.1Doctors18632.8Friends6210.6Textbooks233.9I do not know162.7TV152.6Government71.2n: number of respondents.The mean scores of FHP and the significance levels for each demographic characteristic are presented in Table2. The mean ± SD (range) for FHP score was 7.56 ± 1.96 (1 to 13). The result shows that female students scored significantly better than male students (p≤0.001). In addition, students who cook sometimes scored significantly higher than those who cook rarely (p=0.001).Table 2
Mean scores for food handling practices, food safety knowledge, and total scores for each demographic characteristic.
Demographic variableFHPaFSKbTotalcMeanSDMeanSDMeanSDAge≤ 21 years7.471.9393.402.01510.872.911Between 22 and 27 years7.722.0293.601.95911.323.047≥ 28 years7.971.9923.272.18311.243.307p value ∗∗0.1920.5290.260GenderMale7.131.9543.622.14110.743.075Female7.901.9123.301.89311.202.874p value ∗≤ 0.0010.0610.064Field of studyScience and technology7.551.9493.732.01711.282.990Humanities and others7.551.9963.381.93410.932.913Physical education and sport7.261.9663.001.93210.262.892Applied arts and music7.681.9413.512.11711.183.039p value ∗∗0.5670.1360.137Year of studyFirst year7.372.0583.602.02410.973.139Second year7.831.9853.301.95811.132.855Third year7.431.8263.552.03510.992.916Fourth year and more7.391.9733.382.07410.763.112p value ∗∗0.0820.4790.798Marital statusSingle7.571.9733.442.01711.022.981Married/divorced7.501.9483.431.98710.932.934p value ∗0.7000.9700.780Students have childrenYes7.922.0193.491.94911.413.181No7.531.9603.442.01710.962.950p value ∗0.1820.8590.315Number of children1-2 children7.672.0383.371.75711.042.9283-4 and more children8.231.9983.642.19411.863.482p value ∗0.3390.6400.371GovernorateAl Ahmadi7.401.8943.251.86610.652.889Capital7.712.0683.632.10611.343.152Farwaniya7.631.9713.611.85911.242.779Hawali7.881.8183.952.48111.833.113Jahra7.551.9333.131.86910.682.791Mubarek alkabeer7.382.1313.491.96810.873.129p value ∗∗0.5240.0600.056NationalityKuwaiti7.581.9473.482.02411.062.958Non-Kuwaiti7.332.1373.101.85710.433.033p value ∗0.3490.1650.119Mother’s employmentWorks7.611.8133.562.04011.162.822Retired7.591.9283.461.91011.042.820Housewife7.502.1133.342.03910.843.168p value ∗∗0.8260.5110.496Cooking habitsAll the time7.672.2373.771.92511.433.259Sometimes7.801.9263.602.03111.402.917Rarely7.141.8153.161.96110.292.842Never7.022.1152.761.9219.782.669p value ∗∗0.0010.009≤ 0.001Who cooks and prepares food in your family?By myself7.832.1083.831.39511.662.661Mother/wife7.502.0403.642.20911.143.156Housekeeper7.551.8893.221.91310.772.876Others7.771.8753.271.48611.032.319p value ∗∗0.7430.0580.239aFood handling practices; bfood safety knowledge; ctotal of food handling practices and food safety knowledge; ∗independent sample t-test applied; ∗∗independent analysis of variance (ANOVA) tests applied.The mean ± SD (range) score for FSK was 3.44 ± 2.00 (0 to 11). Male students scored higher than female students, although the difference was not significant (p=0.061). Students who cook all the time or sometimes scored significantly higher than students who never cook (p=0.009) (Table 2).Table3 presents the score distribution details for the FHP questions. The highest percentage of correct answers was for the question asking “What is the best way you dry your hands?” (91.5%) and the question asking “What is the best way you wash your hands?” (90.1%). On the other hand, the lowest percentage of correct answers was for the question regarding “how to make sure that a burger is cooked properly” (5.3%) and the question regarding “the most ideal way to defrost frozen meat” (6%).Table 3
Score distribution for food handling practices questions.
Food handling practice questionsResponsesn%The best way to wash vegetables and fresh fruits is usingSoup254.3Hot water25042.7Water and salt539.1Water and vinegar12821.9Cool running water12922.1The best way to reuse a meat/chicken/fish cutting board to cut other foods isUse the board as it is223.8Wipe the board off with a paper towel488.2Use the other side of the board539.1Wash the board with soap and hot water22839.0Use a different cutting board23440.0The best way to reuse a meat/chicken/fish knife isReuse the knife as it is152.6Rinse the knife with cold water9816.8Wash the knife with soap and water44976.8Wipe the knife with a cloth233.9The best way to wash dishes to avoid food poisoning isUse an automatic dishwasher12020.5Soak them then wash in the same water427.6Hand wash them and let them air dry26345.0Hand wash them and then dry them with a towel16027.4What is the best way you wash your hands?Soap and water52790.1Water only478.0Hand sanitizer40.7I do not wash my hands71.2What is the best way you dry your hands?Paper towel53591.5Hand air dryer40.7Dry on their own305.1Using my clothes162.7Do you take off jewellery when preparing food?Yes29850.9No10718.3Not applicable18030.8Do you prepare food if you have a sore on the back of your hand?Yes, if you are putting on a bandage19633.5Yes, if you wear a glove7112.1Yes, if you bandage the sore and wear a glove11920.3No, before the sore heals, you should not make food19934.0You should wash your hands during cooking if you touchYour face19132.6Clean pots and counter21035.9Utensils used in cooking food14524.8None of the above396.7How many times per week is your kitchen sink drain sanitized?Daily37764.4Weekly7112.1Never315.3Only when washing food in the sink10618.1The best place to store raw meat in your fridge isTop shelf38565.8Medium shelf9215.7Lowest shelf10818.5How do you make sure that a burger is cooked properly at home?By its color30251.6By its texture and firmness10117.3By its core temperature315.3By measuring the cooking time6711.5I do not know8414.4The most ideal way to fry eggs isUntil the egg white is solid and egg yellow is semisolid16027.4Until the egg white and yellow are semisolid7913.5Until the egg white and yellow are solid34659.1The most ideal way to defrost frozen meat isUse a microwave274.6Put it under running water for 1 hour41671.1Leave it outside the freezer for 1 hour10718.3Leave it in the fridge for a few hours356.0The most ideal place to store a hot meal is inThe fridge13022.2A cool oven7412.6A warm oven28749.1The best time to take refrigerated items during grocery shopping isOn the counter9416.1At the beginning467.9In the middle488.2At the end31854.4Any time17329.6n: number of respondents. In this table, the best food handling practice is in bold.Response details for the FSK questions are presented in Table4. Students were mostly knowledgeable (63.8%) about the best way to clean a kitchen counter. This was followed by 45% who knew about the microorganisms that are responsible for most foodborne diseases. Students were least knowledgeable (6.8%) about the optimum growth temperature for the most disease-causing bacteria. In addition, only 7% of the students knew the internal temperature that a burger needs to be to avoid food poisoning.Table 4
Right, wrong, and “I do not know” responses to food safety knowledge questions.
Food safety knowledge questionsRightWrongI do not knowN%n%N%The best way to check kitchen counter37363.811820.29416.1Soap, then water, and then sanitizerWashing hands and rubbing them14625.031553.812421.220 secondsHarmful microbes can be killed when frozen11219.114124.133256.8FalseThe least likely food to cause food poisoning6110.416628.435861.2Chocolate cake left on the counter overnightThe recommended temperature for freezers13022.212421.233156.6−18°CThe recommended temperature for fridges8414.415025.635160.04°CFood that does not need to be refrigerated23540.219934.015125.8RaisinsTo avoid food poisoning, what is the period that leftover foods need to be heated?11018.825243.122338.1Until they are boiling hotHow can we protect ourselves from salmonella bacteria in food?8614.715025.634959.7Cook it wellInternal temperature that a burger needs to reach to avoid food poisoning417.07412.647080.371°CWhich microorganisms are responsible for most foodborne diseases?26345.014825.317429.7BacteriaIndividuals that should not prepare food for other people447.538966.515226.0A person with diarrhoeaFoods that should be avoided by pregnant women, infants, and children8714.914524.835360.3Canned vegetablesWhich individuals rarely get food poisoning?19733.713022.225844.1TeenagersThe optimum growth temperature for most disease-causing bacteria406.89716.644876.65–60°Cn: number of respondents. In this table, the correct answer for each question is highlighted in bold.The overall passing percentage was 6.2%. The passing percentage for the FHP questions was 55%, while the passing percentage for the food safety knowledge questions was 2.9%.The relationship between FSK and FHP was investigated using a Pearson product-moment correlation coefficient. Preliminary analysis was performed to ensure no violation of the assumptions of normality, linearity, and homoscedasticity. There was a small, positive correlation between the two variables,r = 0.116, n = 585, and p<0.005, with a high score for FSK associated with a high score for FHP.Since univariable analysis may be affected by other variables that are not included in the analysis each time, multivariable regression analysis was used to obtain final conclusions concerning the variables FHP, FSK, and overall scores. The models included the independent variables when they were either significant or important for control of cofounding.Stepwise multiple regression was used to model the relationship between demographic characteristics and percentages of total correct scores. The results of the linear regression model were significant (F (2,582) = 11.93,p<0.001, and R2 = 0.04), indicating that approximately 4% of the variance in the percentage of total correct scores is explainable by cooking habits and nationality. The mean total correct scores increased significantly for students who cook all the time or sometimes (Table 5).Table 5
Result for linear regression with cooking habits and nationality predicting the percentage of total correct scores.
VariableBSE95% CIΒTp value(Intercept)31.751.96[27.91, 35.60]0.0016.24< 0.001Cooking habits2.420.52[1.39, 3.45]0.194.62< 0.001Nationality−2.531.29[−5.06, −0.01]−0.08−1.970.049Note. results: F (2,582) = 11.93, p<0.001, and R2 = 0.04. Unstandardized regression equation: percentage of total correct scores = 31.75 + 2.42 cooking habits − 2.53∗ nationality. B: unstandardized coefficient; SE: standard error; B: standardized coefficient beta.Linear regression was used to model the relationship between demographic characteristics and FHP. The results of the linear regression model were significant,F (6,578) = 8.49, p<0.00, and adjusted R2 = 0.08. These variables (age, gender, marital status, and cooking habits) and the variables that were not significant but were maintained in the model for control of cofounding explained 8% of the variability in FHP Table (6). The mean FHP increased significantly for students who were in older age, female, single, and cook all the times or sometimes, compared to younger age, male, married, and those who reported to never cook.Table 6
Results for linear regression with gender, cooking habits, age, marital status, maternal employment, and nationality predicting percentage of correct FHP.
VariableBSE95% CIΒTp value(Intercept)38.213.10[32.12, 44.29]0.0012.34< 0.001Gender5.851.06[3.77, 7.93]0.245.52< 0.001Cooking habits1.950.67[0.63, 3.27]0.122.900.004Age3.540.95[1.67, 5.41]0.173.72< 0.001Marital status−4.731.42[−7.51, −1.95]−0.15−3.35< 0.001Maternal employment−0.960.58[−2.09, 0.17]−0.07−1.660.097Nationality−2.301.63[−5.50, 0.91]−0.06−1.410.160Note. Results: F (6,578) = 8.49, p<0.001, and R2 = 0.08. Unstandardized regression equation: percentage of correct FHP = 47.95 + 5.85∗ gender + 1.95∗ cooking habits + 3.54∗ age − 4.73∗ marital status − 0.96∗ maternal employment − 2.30∗ nationality. B: unstandardized coefficient; SE: standard error; B: standardized coefficient beta.Linear regression was used to model the relationship between demographic characteristics and FSK. The results depict that the linear regression model was significant,F (4,580) = 5.88, p<0.001, and adjusted R2 = 0.04. These variables (gender and cooking habits) and the variables that were not significant but were maintained in the model for control of cofounding explained 4% of the variability in FSK (Table 7). The mean FSK increased significantly for students who were male and those who cook all the time or sometimes, compared to females and those who reported never cooking.Table 7
Results for linear regression with cooking habits, gender, nationality, and “who cooks” predicting percentage of correct FSK.
VariableBSE95% CIΒtp value(Intercept)27.964.19[19.73, 36.19]0.006.67< 0.001Cooking habits2.470.78[0.94, 3.99]0.143.180.002Gender−2.661.12[−4.85, −0.47]−0.10−2.380.018Nationality−3.461.82[−7.03, 0.10]−0.08−1.910.057Who cooks−1.500.84[−3.15, 0.16]−0.08−1.780.076Note. Results: F (4,580) = 5.88, p<0.001, and R2 = 0.04. Unstandardized regression equation: percentage of correct FSK = 40.30 + 2.47∗ cooking habits − 2.66∗ gender − 3.46∗ nationality − 1.50∗ who cooks. B: unstandardized coefficient; SE: standard error; B: standardized coefficient beta.


## 4. Discussion

This study offers insight into the overall food safety knowledge among students at the CBE, Kuwait. In general, students have poor overall food safety knowledge (35.5%), including low adherence to appropriate FHP (47.2%) and poor FSK (22.9%). An insufficient level of overall food safety knowledge among university students was also discovered in previous similar studies [14, 18, 22, 25].It was unexpected that Kuwaiti students would exceed other students from previous studies [10, 14, 18, 22] in questions related to cleaning/hygiene practices and questions regarding cross-contamination practices. These results could be related to the fact that Muslims consider cleaning/hygiene to be part of their faith.Regarding FSK questions, it was disappointing that Kuwaiti students were less knowledgeable of food safety than other students in different countries [10, 14, 18, 22]. This outcome may be explained by the fact that only 7% of the students in this study cook by themselves and infrequent cooking has been previously associated with relatively low knowledge [18]. Furthermore, in the current study, it has been found that all students live with their families and rely on their mothers or housekeeper for food preparation and cooking. It seems possible that these students are less interested in playing a role in the kitchen. In addition, changes in the education system, a lack of modules related to food safety, and a lack of food handling and preparation classes in schools cause a low level of food safety awareness. Food preparation classes are often not part of the basic educational curricula [17]. The situation in Kuwait is not dissimilar, as there are still no formal classes covering food safety taught in schools [13] and universities. Furthermore, a study by Slater [26] found that low FHP and FSK may be due to an increase in consumption of ready-to-eat food and fast food. In Kuwait, a previous study observed a high consumption of fast food, in particular among the youth [27].Regarding the relationship between food safety knowledge and demographic characteristics, the results of this study show that age, gender, marital status, and cooking habits have a significant effect (p<0.05) on FHP, while gender and cooking habits have a significant effect (p<0.05) on FSK.In common with previous studies [25, 28], the current study found that older students gave more accurate answers regarding FHP. This interpretation differs from that of Al-Khamees [13], who undertook a study of 510 students at Kuwait University and observed that older students were significantly less knowledgeable, as well a Stratev et al. [29], who studied veterinary medicine students (n = 90) in Bulgaria and found that age and gender did not affect FSK, attitudes, and practices. This may be due to the variation of the study populations and the methods used in these studies, which can influence study results. Another possible explanation is that older students are more interested in and concerned about food safety, and they cook more than younger students [10]. In addition, it may be due to the rise in the number of working mothers, as they have less time to cook and children tend to learn food practices by observing their mothers [16]. Furthermore, cooking classes and electives are becoming rare in schools [9].The findings of this study are consistent with previous research in which female students have significantly higher scores in FHP than male students. Interestingly, the study results revealed that male students had significantly higher scores in terms of FSK. A study of Lebanese university students (n = 1172) found that female students scored higher (53.6%) in knowledge and practice questions than male students (44.7%), but the differences were significant for the practice part only [14]. Similarly, a study by Green and Knechtges [11] found that undergraduate students at an American university (n = 786) had poor knowledge of food safety practices (43% ± 4.13) and that females had higher scores than males (45% and 43%, p<0.05, resp.). In Pakistan, a study of students (n = 311) at the University of Agriculture, Peshawar, found that female students scored considerably better in food handling scores than male students [15]. A study in Kuwait showed that females scored significantly better in both knowledge and reported behaviour than male students [13]. This result may reflect the fact that females are traditionally responsible for food preparation and nutrition for the whole family in Kuwait, as well as in many other countries [13, 30]. However, young girls may gain traditional FHP from their mothers without any scientific knowledge [18]. Courtney et al. [25], in line with the current study, found that there is higher FSK among males than females. This may be influenced by several factors, such as variations in study populations and the statistical method used. In this study, multivariable analysis was used and adjusted for other factors, whereas this may have been unadjusted in previous studies that relied upon univariable analysis.Students identified as single in this study obtained higher FHP scores than married students. This finding is in agreement with data from a previous study, according to which those unmarried are more knowledgeable regarding FHP (53.3% pass rate) than married participants with children or without children (31.1% and 7.8%, resp.) [31]. The reason for this may be due to the small number of participants in the married group. In the current study, most of the students were single (80.3%), so the most likely cause of this result is that there was a small number of participants in the married group. Another possible explanation is that in Kuwait, most of the married girls tend to live in an extended family house where their mother-in-law or housekeeper is responsible for family meal preparation.This study found that students who cook by themselves all the time or sometimes have significantly better handling practices and food safety knowledge than those who never cook. Osaili et al. [18] suggest that students gain knowledge through the experience of preparing their own meals, as infrequent cooking has been associated with relatively lower FSK [25]. In contrast to earlier findings, Hassan and Dimassi [14] found that students who cook all the time had significantly lower food safety knowledge compared to those who cook less frequently.The present study has some limitations. First, the study was carried out among students of the CBE, Kuwait. Therefore, current findings may not represent all university-aged students in Kuwait. Further studies that survey students in different universities are necessary. Second, self-reporting of FHP does not necessarily reflect students’ actual FHP and may lead to overreporting.


## 5. Conclusion

To conclude, this study has shown that students of the CBE, Kuwait, have insufficient scores for overall food safety knowledge. The data obtained from this study have revealed the great need for an effective food safety education programme starting at an early age and continuing through to university. Furthermore, a national multimedia food safety education campaign is needed, as nutrition education from an early age is an important way to gain essential foundational knowledge and skills.



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