Source: OHIO STATE UNIVERSITY submitted to
RISK EDUCATION FOR FOODBORNE ILLNESSES IN PREGNANT POPULATIONS
Sponsoring Institution
National Institute of Food and Agriculture
Project Status
TERMINATED
Funding Source
Reporting Frequency
Annual
Accession No.
0217375
Grant No.
(N/A)
Project No.
OHO01214
Proposal No.
(N/A)
Multistate No.
(N/A)
Program Code
(N/A)
Project Start Date
Jan 1, 2009
Project End Date
Sep 30, 2014
Grant Year
(N/A)
Project Director
Medeiros, LY, CL.
Recipient Organization
OHIO STATE UNIVERSITY
1680 MADISON AVENUE
WOOSTER,OH 44691
Performing Department
College of Human Ecology
Non Technical Summary
This study focuses on a highly vulnerable group, pregnant women and their unborn children. An intervention is developed and implemented with two specific target audiences: low income English speaking pregnant women and low income Spanish speaking pregnant women. Educational outcomes will be verified by microbiological assessment for general sanitation (aerobic and coliform counts) and presence of foodborne pathogens in the environment (Listeria monocytogenes (LM) and Salmonella spp.). Research findings and educational materials are then communicated to consumers and health professionals using a variety of outreach educational methods. Despite marked reductions in the incidence of illnesses from many foodborne pathogens, there remains a concern that the most vulnerable population groups continue to suffer foodborne illnesses disproportionately to the general population. My research has focused on educational needs of consumers for the last 10 years, and more recently on population groups at greatest risk of foodborne illnesses due to suppressed or compromised immune function. Although we who conduct research in food safety have sharpened our understanding of the educational needs of consumers, there are still many unknowns. We have yet to prove the efficacy of our work through educational intervention. We have yet to document improved health because of food safety education. And, we have yet to focus our work on the food safety issues of a high risk group who is highly susceptible to the consequences of foodborne illnesses - pregnant women. In these proposed studies, pregnant women are the beneficiaries of the formative studies, educational interventions and outreach education.
Animal Health Component
(N/A)
Research Effort Categories
Basic
(N/A)
Applied
(N/A)
Developmental
(N/A)
Classification

Knowledge Area (KA)Subject of Investigation (SOI)Field of Science (FOS)Percent
7036010302060%
9036010302020%
7126010110020%
Goals / Objectives
Overall Study Objectives. This study focuses on a highly vulnerable group, pregnant women and their unborn children. An intervention is developed and implemented with two specific target audiences: low income English speaking pregnant women and low income Spanish speaking pregnant women. Educational outcomes will be verified by microbiological assessment for general sanitation (aerobic and coliform counts) and presence of foodborne pathogens in the environment (Listeria monocytogenes (LM) and Salmonella spp.). Research findings and educational materials are then communicated to consumers and health professionals using a variety of outreach educational methods. Specific Aim 1. Development, implementation and evaluation of a food safety education intervention among pregnant women. (Research Aim) Objective 1.1. Development of intervention phase Objective 1.2. Educational intervention Expected Outputs. It is expected that a method and plan will be developed that will provide the validity and precision needed to detect changes that result after the educational intervention. These studies are further expected to demonstrate that intensive food safety education can result in 1) improved knowledge and attitudes, 2) improved food consumption and handling behaviors related to risk of exposure to LM, 3) improved general food and environmental hygiene, and 4) decreased exposure to LM among Spanish-and English-speaking pregnant women. Specific Aim 2. Formal and outreach education, publications. (Education, Extension and Outreach Aim) Objective 2.1: Revise, publish and disseminate the materials developed through this study to targeted audiences Objective 2.2: Incorporate research findings into academic courses Objective 2.3: Develop manuscripts for health professionals and educators that serve pregnant women and mothers of young infants Expected Outputs: Pregnant women, undergraduate and graduate students, and continuing education participants will demonstrate knowledge of foodborne pathogen contamination and control after reading the publications developed for this study. This will enable participants to institute or promote changes in their food handling habits for themselves or their clients. Even though it is beyond the procedures of these studies, the ultimate outcome of these studies is decreased incidence of infections of listeriosis and salmonellosis, which will be evident in public health statistical data in future years.
Project Methods
Specific aim 1. Low income English- and Spanish-speaking pregnant women will be recruited for participation in this phase of the study (n=300). The control and will receive a low-contact education treatment consisting of typical food safety education. The experimental group will receive high-contact food safety education. A peer educator will schedule a home visit with each participant to conduct the pre-assessment, assessment of refrigerator temperature, and collection of environmental and food samples. Two food items prepared or stored in the home (ready-to-eat and home-prepared) and two environmental samples (refrigerators, kitchen sink) will be collected from the homes. Pre-moistened sterile sponges will be used to swab surfaces. For foods, 25 g samples will be collected. Specimens will be transported to the Wooster campus lab on ice. The education evaluation will be repeated with both treatment groups at 2 months post intervention. Two sets of food safety educational materials and related curricula will be developed and will be evaluated for content and face validity by 6-8 key informants. Evaluation instruments will be developed based on food safety attitude and knowledge surveys, food behaviors surveys, and survey questions used by the FDA to assess trends in risky food handling and consumption practices. Specific aim 2. The materials developed in this project will be revised as needed and published in print and web-based form for dissemination to pregnant women. These materials will include consumer publications in English and Spanish targeting pregnant women with food safety information, 2 sets of curricula specifically tailored for food safety educators to use with low-income English and Spanish speaking audiences, one targeting food safety educators and paraprofessionals and the other targeting clients of USDA-funded programs such as WIC, EFNEP, and FSNE. The availability of these materials will be marketed through trade publications and web sites, mailings to memberships of professional organizations, and through health clinics and physician's offices. Printed materials will be made available for cost; free materials will be available for download from the research study web site. Lesson plans and educational materials based on research findings will be developed to incorporate into undergraduate and graduate academic courses in colleges and universities. Lesson plans will be made available to other educators through a web site established to communicate the progress and findings of this research project. Research manuscripts will be developed for dissemination to health professionals based on the findings of these studies. The manuscripts will be submitted to journals offering continuing education opportunities to health professionals.

Progress 01/01/09 to 09/30/14

Outputs
Target Audience: Nothing Reported Changes/Problems: Nothing Reported What opportunities for training and professional development has the project provided? Nothing Reported How have the results been disseminated to communities of interest? Publications were disseminated to the scientific community. What do you plan to do during the next reporting period to accomplish the goals? Nothing Reported

Impacts
What was accomplished under these goals? In this final year, data was analyzed and publications published or were in preparation. One rejected publication is in process of revision and resubmission.

Publications

  • Type: Journal Articles Status: Published Year Published: 2013 Citation: Buffer JL, Kendall PA, Medeiros LC, Schroeder M, Sofos J. 2013. Nurses and Dietitians Differ in Food Safety Information Provided to Highly Susceptible Clients. Journal of Nutrition Education and Behavior, 45: 102-108 (doi:10.1016/j.jneb.2012.03.001).


Progress 01/01/13 to 09/30/13

Outputs
Target Audience: There was no active data collection this reporting year. Data analysis continues with information collected from low-income pregnant women who either spoke English or Spanish as their first language. Additionally, the secondary target group was health professionals (specifically dietitians and nurses) who serve pregnant women. Changes/Problems: Nothing Reported What opportunities for training and professional development has the project provided? Nothing Reported How have the results been disseminated to communities of interest? One journal publication in Journal of Nutrition Education and Behavior. Journal read by dietitians and nurses, which are one of the target audiences for this project. Additionally, the curriculum Healthy Baby, Healthy Me is available to the public via foodsafety.osu.edu. What do you plan to do during the next reporting period to accomplish the goals? Complete data analysis, complete manuscript preparation, and submit 3 manuscripts for review to journals. One manuscript is currently in review.

Impacts
What was accomplished under these goals? Outputs: The Healthy Baby-Healthy Me program assesses the food safety knowledge, skills and behaviors of pregnant women who speak either English or Spanish. Pregnant women largely learn of food safety risks from educational efforts of their health professionals. The quality of that education will affect the proficiency that pregnant women demonstrate in their daily use of food safety information. This year we focused on the food safety knowledge of registered dietitians (Study 1, n=267; Study 2=327) and registered nurses (Study 1, n=232), two health care team members who have primary responsibility for food safety education in pre-natal clinics. Study 1 outputs: Both dietitians and nurses were providing food safety education to patients but education emphasis differed. Dietitians were more likely to provide information about specific foods and food storage behaviors, whereas nurses mainly emphasized handwashing. Information specifically about Listeria monocytogenes, that can cause spontaneous abortion, if delivered was taught by dietitians rather than nurses. Food safety training was more extensive among dietitians than nurses. Study 2: Further study of dietitians as the more trained health professional providing pregnant women food safety education was initiated to discover the food safety knowledge and information sources of dietitians. Food safety knowledge was measured via methods developed and published by this research group; it was found that dietitians were only moderately knowledgeable (70% score on examination) and relied on easily available information sources on the internet, or professional literature not known for emphasis in food safety. Post-graduate education in food safety was significantly associated with greater likelihood of providing food safety education to patient populations. Impacts: Active data collection has been completed. Publications were published (n=1), are in review (n=1), or are in preparation (n=3), with anticipated publication or in press status for all publications by the end of 2014. Additionally, a major revision of the online version of the Healthy Baby, Healthy Me curriculum is underway. The publication that is in review is dedicated to the development of the curriculum and will increase traffic to the website to view and download all of the materials developed under this project. One of the publications in the final phases of preparation (waiting on statistical review and final revision) was the culmination analysis of data supporting the mental model of dietitians who teach pregnant women (and other groups who are at-high risk for foodborne illnesses). The submission and subsequent review of this manuscript will be the conclusion of this project’s redirection toward health professions who serve pregnant population.

Publications

  • Type: Journal Articles Status: Published Year Published: 2013 Citation: Buffer JL, Kendall PA, Medeiros LC, Schroeder M, Sofos J. 2013. Nurses and dietitians differ in food safety information provided to highly susceptible clients. Journal of Nutrition Education and Behavior (doi:`0.1016/j.jneb.2012.03.001) 45(2);102-108.


Progress 01/01/12 to 12/31/12

Outputs
OUTPUTS: The Healthy Baby-Healthy Me program assesses the food safety knowledge, skills and behaviors of pregnant women who speak either English or Spanish. Pregnant women largely learn of food safety risks from educational efforts of their health professionals. The quality of that education will affect the proficiency that pregnant women demonstrate in their daily use of food safety information. This year we focused on the food safety knowledge of registered dietitians (Study 1, n=267; Study 2=327) and registered nurses (Study 1, n=232), two health care team members who have primary responsibility for food safety education in pre-natal clinics. Study 1 outputs: Both dietitians and nurses were providing food safety education to patients but education emphasis differed. Dietitians were more likely to provide information about specific foods and food storage behaviors, whereas nurses mainly emphasized handwashing. Information specifically about Listeria monocytogenes, that can cause spontaneous abortion, if delivered was taught by dietitians rather than nurses. Food safety training was more extensive among dietitians than nurses. Study 2: Further study of dietitians as the more trained health professional providing pregnant women food safety education was initiated to discover the food safety knowledge and information sources of dietitians. Food safety knowledge was measured via methods developed and published by this research group; it was found that dietitians were only moderately knowledgeable (70% score on examination) and relied on easily available information sources on the internet, or professional literature not known for emphasis in food safety. Post-graduate education in food safety was significantly associated with greater likelihood of providing food safety education to patient populations. PARTICIPANTS: Study 1: Collaboration for this study was with Colorado State University. Directly involved in the study was Patricia Kendall (Co-PI, CSU) and Lydia Medeiros (C0-PI, OSU), and research associates, Mary Schroeder (CSU) and Janet Buffer (OSU). Cooperation gained to aid implementation of the study was obtained from the Ohio Nurses Association (with national reciprocity to all states) and the American Dietetic Association. Respondents to the survey were given free access to an online continuing education program developed by the Co-PI's of this study. C0-PI's Sofos and LeJeune served as reviewers and/or co-authors. Study 2: Collaboration for this study was between the Department of Human Nutrition (Medeiros) and Food Animal Health Research Program (LeJeune). Results were reported by Medeiros and Research Associate, Janet Buffer. LeJeune served as reviewer and PI of the funding source. The study was implemented with cooperation of the American Dietetic Association. TARGET AUDIENCES: Providers of food safety education to pregnant women were surveyed in two studies. Target audiences were Registered Dietitians and Registered Nurses. Respondents to study 1 were given free access (60$ value) to an online, in-depth food safety education program that could earn the respondent up to 6 hours of continuing education credit awarded by either the Ohio Nursing Association (reciprocity of all states) or the American Dietetic Association. PROJECT MODIFICATIONS: The major change in the approach was the re-direction to providers of food safety education for pregnant women. The reason for this change was to gain greater insight into the quality of food safety information that provides pregnant women received through their pre-natal care. The change helped to inform the researchers of possible strategies to strengthen future educational efforts for both consumer audiences, as well as health professional audiences.

Impacts
Both Study 1 and Study 2 point to the need for more emphasis and greater depth in food safety education with students in dietetics and nursing. Professionally, these studies call for a review of curriculum and post-graduate continuing education policies to adopt evidence-based practice standards for teaching food safety to highly susceptible patients; that includes pregnant women. There is a need to ensure that health professionals who are primary educators of patients have the depth of understanding of the causes, sources, prevention methods and health consequences of highly invasive foodborne pathogens such as Listeria monocytogenes. Academics who prepare educational materials to train the health professionals also need to include in-depth information so that clinical health professionals do not need to refer to superficial information readily available to the public via the internet.

Publications

  • Buffer JL, Kendall PA, Medeiros LC, Schroeder M, Sofos J. 2012. Nurses and Dietitians Differ in Food Safety Information Provided to Highly Susceptible Clients. Journal of Nutrition Education and Behavior, in press (doi:10.1016/j.jneb.2012.03.001).
  • Medeiros, LC, Buffer J. Current food safety knowledge of registered dietitians. Food Protection Trends, 2012;32:688-696.
  • Buffer JL, Medeiros LC, Kendall P, Schroeder M. 2012. Health professionals' knowledge and understanding about Listeria monocytogenes indicates a need for improved professional training. Journal of Food Protection, 2012;75:1310-1316


Progress 01/01/11 to 12/31/11

Outputs
OUTPUTS: The Healthy Baby-Healthy Me curriculum to consist of four 30-minute lessons, each focusing on one of 4 pathogens of special importance to pregnant women: Listeria monocytogenes, Toxoplasma gondii, Salmonella and Campylobacter. All materials are available for free download at http://foodsafety.osu.edu/curriculum/hbhm/. Social media pieces were added this year. A YouTube 2.5 min video on cleaning and sanitizing the home kitchen has been publically viewed over 800 times. The Healthy Baby Healthy Me materials currently are being promoted on the Sharing Center of the USDA WIC-Works website as well as through SNAP-ED Connections and Snap-Ed Talk listserv. A copy is also on file at the Nutrition Information Center at the National Agricultural Library of the USDA. Additionally, with the information learned from the research conducted for this Hatch project, we are 50% complete on a review, revise and expand process on foodborne illness pathogen factsheets that are publically available through the OhioLine web site. We are currently in the process of developing manuscripts for health professionals and educators that serve pregnant women and mothers of young infants. PARTICIPANTS: The research reported in this narrative was completed by researcher, Medeiros and the research coordinator. TARGET AUDIENCES: The educational intervention was completed with low-income pregnant women who spoke either English or Spanish PROJECT MODIFICATIONS: Nothing significant to report during this reporting period.

Impacts
A total of 546 pregnant women completed the Healthy Baby Healthy Me program; 238 (43.6%) controls and 308 (56.4%) enhanced. Of those in the two treatments; 296 (54.2%) were English-speaking and 250 (45.8%) were Spanish-speaking. Language groups were randomly assigned to either the control (basic food safety) or enhanced (enhanced food safety) experimental treatment groups. Educational outcomes were grouped into categories of awareness, knowledge, and behavior. Participants in the enhanced group showed improvement in all three categories (p<0.001). Mean scores between control and enhanced were: Awareness (0 to 4 scale range), Control=0.8, Enhanced=2.3; Knowledge (0 to 4 scale range), Control=0.6, Enhanced=1.1; Behavior (0 to 4 scale range), Control=0.1, Enhanced=0.3. Language (English/Spanish) had an effect on knowledge scores (P<0.05) and there was an interaction between language and group for awareness (p<0.01) and knowledge (p<0.05) scores. Mean differences were found between control and enhanced groups in all 3 categories: Spanish-speaking participants showed greater changes then the English-speaking participants. The overall average changes in scores were for the Spanish group (mean difference=0.91) and English group (mean difference=0.57). All changes were in the positive or educationally desirable direction. We continue to analyze microbiological data collected from the participants' homes.

Publications

  • Casagrande G, LeJeune J, Belury MA, Medeiros LC. Registered dietitians personal beliefs and characteristics predict their teaching or intention to teach fresh vegetable food safety. Appetite 2011;56:469-475.
  • Buffer J, Medeiros LC, Schroeder M, Kendall P, LeJeune J, Sofos J. 2010. Cleaning and Sanitizing the Kitchen Using Inexpensive Household Food-Safe Products. Available at foodsafety.osu.edu.
  • Shiga-Toxin E. coli. 2011. OhioLine Factsheet no. 5561-11. Available at ohioline.osu.edu/hyg-fact/5000/pdf/5561.pdf.
  • Listeria monocytogenes. 2011. OhioLine Factsheet no. 5562-11. Available at ohioline.osu.edu/hyg-fact/5000/pdf/5562.pdf.
  • Staphylococcus aureus. 2011. OhioLine Factsheet no. 5564-11. Available at ohioline.osu.edu/hyg-fact/5000/pdf/5564.pdf.
  • Botulism. 2011. OhioLine Factsheet no. 5567-11. Available at ohioline.osu.edu/hyg-fact/5000/pdf/5567.pdf.


Progress 01/01/10 to 12/31/10

Outputs
OUTPUTS: The project has completed Specific Aim 1 of the protocol and has begun Specific Aim 2. An 8-session education curriculum based on "Eating Smart, Being Active" was adapted for use with low-income English- and Spanish-speaking pregnant women (control curriculum). Five 30-minute lessons on food safety issues of importance during pregnancy were added to the curriculum to create the food safety enhanced (experimental) version. Low income English- and Spanish- speaking pregnant women were recruited in this educational intervention to foster behaviors that lower risk of foodborne illness. There were 269 (56 percent) English and 206 (44 percent) Spanish speaking subjects who completed the curriculum, indicating a 40 percent increase in the number of participants since December of 2008. Of those subjects 215 (45 percent) received the control curriculum and 260 (56 percent) received the experimental curriculum. We requested a year no-cost extension to this grant to complete additional subjects. Additionally, a web site was developed (Specific Aim 2) to serve as a repository for curriculum products developed for pregnant women, as well as educational resources developed in other OARDC HATCH projects. Curriculum and supporting materials are being revised to post as PDF copy for public distribution. A photo gallery to support the web site and print materials was completed. Two consumer fact sheets on Listeria monocytogenes and Cleaning and Sanitizing in the Kitchen (based on research studies) were posted to the web site. Four webinars based on the cleaning and sanitizing research and consumer fact sheet were presented to the Ohio EFNEP and SNAP-Ed program educators for distribution to the public through county Extension offices. A sixty slide PowerPoint set to educate farm families about Listeria monocytogenes and zoonotic disease were added to the web site. PARTICIPANTS: In addition to Medeiros and staff Buffer, others participating in this project were Jeffery LeJeune and Robert Scharff from OARDC and John Sofos, Patricia Kendall and Susan Baker from Colorado State University. Additionally, the project was a collaboration with Joyce McDowell and the Ohio Extension EFNEP program. TARGET AUDIENCES: The target audience was low-income English- and Spanish-speaking pregnant women. PROJECT MODIFICATIONS: Nothing significant to report during this reporting period.

Impacts
Overall preliminary results suggest that intensive food safety education has an overall positive change in behaviors in pregnant women regarding food consumption, handling, and knowledge. As was identified earlier in the study it remains true that Latina women are willing to eat risky foods possibly based on long held beliefs about the food item.

Publications

  • Kendall, P.A., Baker, S., Scharff, R.L., LeJune, J., Sofos, J., Medeiros, L. 2010. Impact of education on food safety knowledge and behavior among low-income English- and Spanish-speaking pregnant women. 2010. National Food Safety Education Conference, March 23-26, Atlanta, GA.


Progress 01/01/09 to 12/31/09

Outputs
OUTPUTS: The project has completed Specific Aim 1 of the protocol. An 8-session education curriculum based on "Eating Smart, Being Active" was adapted for use with low-income English- and Spanish-speaking pregnant women (control curriculum). Five 30-minute lessons on food safety issues of importance during pregnancy were added to the curriculum to create the food safety enhanced (experimental) version. Low income English- and Spanish- speaking pregnant women were recruited in this educational intervention to foster behaviors that lower risk of foodborne illness. There were 185 (56 percent) English and 145 (44 percent) Spanish speaking subjects who completed the curriculum, indicating a 40 percent increase in the number of participants since December of 2008. Of those subjects 144 (44 percent) received the control curriculum and 186 (56 percent) received the experimental curriculum. PARTICIPANTS: This project partnered with Colorado State University, John Sofos and Pat Kendall collaborators. In Ohio, the project partnered with the Expanded Food and Nutrition Education Program, Joyce McDowell director TARGET AUDIENCES: This project targeted low-income, pregnant women whose primary language was either English or Spanish. PROJECT MODIFICATIONS: Nothing significant to report during this reporting period.

Impacts
Educational outcomes were measured using validated survey instruments, observed kitchen sanitation, and microbiological assessment of pathogens in the environment. Findings show that improvement in knowledge was predictive of improved behavior (P less than .001), especially among Spanish-speaking participants. Regression coefficients for pre/post education change in knowledge of bacterial risk (P less than 0.001, R2=0.32) were positive and higher in the experimental group. Younger age, living with partner, and college education were significant (P less than0.05) control variables. Spanish-speakers had reduced consumption of risky foods (P less than 0.001, R2=0.31) and increased handwashing after education (P less than 0.001, R2=0.24), regardless of treatment group. Coliform in sinks were lower in experimental than control groups post education, except in Spanish-subject households (P less than 0.001, R2=0.74). Consistent with economic theory, women who had quit smoking during pregnancy and revealed a low rate of time preference lived in environments with lower microbial counts (P less than 0.05). Significant beneficial changes were detected in food safety knowledge and behaviors. Microbiological findings were less robust, possibly due to the high variability in microbial counts; a problem that may be remedied as more observations are recorded. Overall preliminary results are suggesting that intensive food safety education is having an overall positive change in behaviors in pregnant women regarding food consumption, handling, and knowledge. As was identified earlier in the study it remains true that review of responses and comments provided to the program assistants by the subjects suggest that Latina women are willing to eat risky foods possibly based on long held beliefs about the food item.

Publications

  • What Should Consumers Do to Protect Their Family from Foodborne Illnesses 2009 International Conference on Food, Environment and Health, June 2009, Xian, China. Published abstract.
  • Nutrition or Safety: Which One is More Important for Health 2009 International Conference on Health Promotion: From Bench to Bed, June 2009, Taipei, Taiwan. Published abstract.
  • Medeiros, LC., Kendall, PA., LeJeune, JT., Scharff, RL., Sofos, JN., Baker, S. Risk factors for foodborne illness and pregnant populations. IAFP annual conference, July 12, 2009. Published abstract.
  • Scharff , RL,. Kendall, PA., Sofos JN., LeJeune, JT., Baker, S., Medeiros, LC., Education influences food safety knowledge and behavior of pregnant, low-income English-and Spanish speaking women. IAFP annual conference, July 12, 2009. . Published abstract.
  • Medeiros LC, Buffer J, McDowell J, Lambea MC, Kendall P. Pregnant women improve awareness and food handling behaviors related to listeriosis and salmonellosis after participation in an educational intervention. American Dietetic Association Food and Nutrition Conference, Denver, CO, 2009 . Published abstract.