Source: UNIV OF ILLINOIS AT CHICAGO submitted to
AN EPIDEMIOLOGIC INVESTIGATION OF RESTAURANT INSPECTION FREQUENCY AND FOOD HANDLER TRAINING WITH FOODBORNE ILLNESS OUTBREAKS IN THE US
Sponsoring Institution
National Institute of Food and Agriculture
Project Status
COMPLETE
Funding Source
AFRI COMPETITIVE GRANT
Reporting Frequency
Annual
Accession No.
0230275
Grant No.
2012-67011-20021
Cumulative Award Amt.
$74,341.00
Proposal No.
2012-01222
Multistate No.
(N/A)
Project Start Date
Sep 1, 2012
Project End Date
Aug 31, 2015
Grant Year
2012
Program Code
[A7101]- AFRI Predoctoral Fellowships
Recipient Organization
UNIV OF ILLINOIS AT CHICAGO
(N/A)
CHICAGO,IL 60680
Performing Department
(N/A)
Non Technical Summary
As there is a substantial foodborne disease burden in the United States with a considerable proportion of outbreaks attributed to restaurants, a reduction in restaurant-related foodborne disease outbreaks is crucial to improve the overall health of Americans. There is great need to further examine the risk factors contributing to restaurant-related foodborne disease outbreaks. Restaurant inspection frequency and food handler training requirements are such factors that deserve attention. Currently, there are no federal-level restaurant food safety training or inspection requirements in the United States. As a result, food handler educational requirements and restaurant inspection frequencies vary throughout the country. Correlation of restaurant-related foodborne disease outbreaks with restaurant inspection frequency and food handler training has not been performed at the national level. If there is indeed an association between frequency of foodborne disease outbreaks and inspection and training requirements when controlling for local factors, there is the potential to improve upon existing restaurant food safety policy. The data from this research may help to inform local and state health authorities about the minimum necessary restaurant inspection frequency and food handler training requirements (and therefore minimum investment of time and money) while maintaining the confidence that they have implemented the best level of intervention to prevent foodborne disease. The results from this study may also impart the push needed to increase standards in localities which are shown to be performing inspections and training at levels lower than are needed for maximum food safety. Furthermore, the results could serve as a means to formulate a list of best practices to be adopted by all health departments. Since there is currently no national regulation for restaurant inspections and food handler training in the United States, this work has the potential to significantly improve food safety on a national level.
Animal Health Component
10%
Research Effort Categories
Basic
90%
Applied
10%
Developmental
(N/A)
Classification

Knowledge Area (KA)Subject of Investigation (SOI)Field of Science (FOS)Percent
7125010117080%
7125010302020%
Knowledge Area
712 - Protect Food from Contamination by Pathogenic Microorganisms, Parasites, and Naturally Occurring Toxins;

Subject Of Investigation
5010 - Food;

Field Of Science
3020 - Education; 1170 - Epidemiology;
Goals / Objectives
Approximately half of the foodborne disease outbreaks reported to the Centers for Disease Control and Prevention (CDC) each year is associated with restaurants or delicatessens. Currently, there are no federal-level restaurant food safety training or inspection requirements in the United States. As a result, food handler educational requirements and restaurant inspection frequencies vary throughout the country. Correlation of restaurant-related foodborne disease outbreaks with restaurant inspection frequency and food handler training has not been performed at the national level. The specific objectives of the proposed project are as follows: 1) to conduct a cross-sectional epidemiologic study at the national level to determine if frequency of restaurant inspection by local health authority and levels of food handler training are associated with restaurant-related foodborne disease outbreaks when controlling for local demographic factors and 2) to conduct a spatial clustering analysis using Geographic Information Systems (GIS) technology to assess clustering of foodborne disease outbreaks with respect to frequency of restaurant inspections and food handler training requirements. A survey will be designed to determine the policies and practices of the two variables of interest (restaurant inspection frequency and food handler training requirements) and the outcome variable (number of restaurant-related foodborne outbreaks on a local health department level for the years 2009, 2010 and 2011). All 2,864 local health departments across the United States will be invited to participate. Data will be collected electronically with progress evaluated by the percentage of completed surveys at specific time points: 25% survey completion by April 2013, 50% completion by August 2013 and 100% completion by December 2013. Following data collection, data will be merged, cleaned and analyzed using SAS, STATA and GIS. The Advisory Committee will be updated quarterly on the progress of the project. Study results will be disseminated using various avenues, including presentation at the UIC weekly seminar, abstract submission for presentation at food safety and public health conferences, and manuscript submission to peer-reviewed journals. Dissemination activities will primarily occur in Year 2 of the study. Education and training activities will be completed throughout the course of the project. The Global Information System (GIS) training course, NEHA Epi-Ready Team Training: Foodborne Illness Response Strategies, ServSafe Certification and one CDC TRAIN online food safety course will be completed by August 2013. The STATA training course and two additional TRAIN online food safety courses will be completed by August 2014.
Project Methods
A local health department survey will be developed to collect the following information; required number of inspections per year for each restaurant type, number of inspections actually performed, number of health inspectors employed by the jurisdiction, number of inspections each sanitarian performed by month each year, type of inspection forms/systems used, required food handler education, number of restaurant-related foodborne outbreaks, number/type of food handler training facilities, number/classification of restaurants, number of restaurants with critical food safety violations, number of restaurant closures due to food safety malpractice. All 2,864 local health departments across the United States will be invited to participate and data will be collected electronically using the secure web survey program SurveyGizmo. Additional variables of interest will be obtained from various sources. Restaurant census information will be obtained from the 2007 Economic Census and will include: the number of restaurants in each US state, county and city, restaurant demographics (including restaurant type, average business income). Population census information will be obtained from the 2010 Census and will include: number of persons in each US state, county and city, population demographics (including median household income, education, racial/ethnic/ characteristics). Outbreak information will be obtained from the 2009 Centers for Disease Control and Prevention (CDC) Foodborne Outbreak Online Database (FOOD) and will include: outbreak location by state, number of persons sick, hospitalized and died, reported and confirmed outbreaks, causative agents and suspected food vehicles. Numbers of restaurant-related outbreaks and outbreak characteristics will be examined at the state-level to assess consistency in outbreak reporting in this study compared to the CDC. Data from the survey, 2009 FOOD, the 2007 US Economic Census dataset and the 2010 US Census population dataset will be merged together for analysis. Data will be analyzed using both SAS and STATA statistical packages. Descriptive information will be provided as the survey data is collected. Regression models will be employed to analyze number of restaurant-related foodborne outbreaks outcome with number of restaurant inspections and food handler education and other potential confounders. Geographic Information System (GIS) analysis will be utilized, and choropleth maps will be prepared to visualize the area outbreak data. Restaurant-related foodborne-illness outbreak prevalence, reported cases, confirmed cases and causative-agent specific cases will be analyzed. Study results will be disseminated using various avenues including presentation at the UIC weekly seminar, abstract submission for presentation at food safety and public health conferences and manuscript submission to peer-reviewed journals. An Advisory Committee of food safety, public health and survey development experts has been established and will serve to evaluate the progress of the study. Members will be updated quarterly to ensure that outputs are being accomplished according to the study timeline and protocol.

Progress 09/01/12 to 08/31/15

Outputs
Target Audience:The target audience for this research includes local public health departments/jurisdictions and food safety policy-makers, specificallythose individuals involved in foodborne illness outbreak investigations and restaurant inspections. Changes/Problems:As the survey data collection phase of this study required more time and effort to accomplish than was originally anticipated, a final manuscript has not yet been submitted for peer-reviewed publication. The manuscript is nearly complete and should be submitted to a peer-reviewed journal by December 2015.? What opportunities for training and professional development has the project provided? Nothing Reported How have the results been disseminated to communities of interest?An abstract titled, "Analysis of restaurant-related foodborne illness outbreaks and restaurant inspections data from local health departments: Are sanitarians having to inspect too many restaurants?" was presented at the International Association for Food Protection (IAFP) Annual Conference on July 27, 2015. What do you plan to do during the next reporting period to accomplish the goals? Nothing Reported

Impacts
What was accomplished under these goals? The accomplishments described in this section reflect the study for Year Three. The study methods and timeline compliance were nearly met in accordance to the research protocol for this third year. Data collection concluded in May 2014 and preliminary analysis of these data began in January 2014. Data analysis concluded in May 2015 and a manuscript for peer-reviewed publication will be submitted by the end of the year 2015. The PI is completing a PhD with this research as one of three main aims of the dissertation and will defend the dissertation early 2016.

Publications

  • Type: Conference Papers and Presentations Status: Published Year Published: 2015 Citation: Manes MR, Dworkin, MS. Analysis of restaurant-related foodborne illness outbreaks and restaurant inspections data from local health departments: Are sanitarians having to inspect too many restaurants? Poster presentation at: 104th Annual Meeting of the International Association of Food Protection; 2015 July 26-28; Portland, OR.


Progress 09/01/13 to 08/31/14

Outputs
Target Audience: The target audience for this research includes local public health departments/jurisdictions and food safety policy-makersand is specifically directed to individuals involved in foodborne illness outbreak investigations andrestaurant inspections. Changes/Problems: Nothing Reported What opportunities for training and professional development has the project provided? To complement the research, educational and training activities were completed in Year Two. The PI attended the National Environmental Health Association (NEHA) annual conference in August 2014. Presentations at NEHA conference included information regarding foodborne illness outbreak investigations, new methods for detecting pathogens in food safety equipment and new food handler training opportunities. The PI also attended a no-cost GIS workshop during the APHA annual conference in November 2013. One CDC TRAIN online course was also completed in June 2014. This course focused on food safety in ethnic food restaurants How have the results been disseminated to communities of interest? An abstract titled, “Preliminary results of a national survey of local health departments designed to examine restaurant-related foodborne illness outbreaks, restaurant inspections and food handler training” has been accepted for presentation at the International Association for Food Protection (IAFP) Annual Conference on August 5, 2014. What do you plan to do during the next reporting period to accomplish the goals? As the survey data collection phase of this study required more time and effort to accomplish than was originally anticipated, some project activities have not yet been completed. A one year no-cost extension will be ample time to complete these activities. To accomplish the goals from Year 2, the following still need to be completed: Data analysis should be complete by November 2014. Manuscript should be written and submitted to a peer-reviewed journal by August 2015. PI should attend/complete the following educational/training activities: Serv-Safe food safety certification, GIS course, STATA course by August 2015.

Impacts
What was accomplished under these goals? The accomplishments described in this section reflect the study for Year Two. The study methods and timeline compliance were nearly met in accordance to the research protocol for this second year. Survey data collection, however, was extended to maximize the number of participating local health departments/jurisdictions. Extensive follow up using phone calls and emails was performed to invite local health departments to participate in the research. Data collection concluded in May 2014 with 171 completed local health department surveys from 39 states. Restaurant census information and local demographic data were obtained from the US Census website for each participating jurisdiction. Datasets were merged and cleaned. Preliminary analysis of these data began in January 2014 and is currently on-going.

Publications


    Progress 09/01/12 to 08/31/13

    Outputs
    Target Audience: Nothing Reported Changes/Problems: Nothing Reported What opportunities for training and professional development has the project provided? To complement the research, educational and training activities were completed in Year One. The PI attended the Epi-Ready Team Training: Foodborne Illness Response Strategies in San Ramon, California in August 2013. The Epi-Ready Training focused on how to efficiently and effectively respond to an outbreak by understanding the roles and responsibilities of the disciplines involved. Two CDC TRAIN online courses were also completed in December 2012. These courses included training on the relevant food safety tools the National Outbreak Reporting System (NORS) and the Foodborne Outbreak Online Database (FOOD). How have the results been disseminated to communities of interest? Dissemination activities also occurred in Year One. The PI was invited to speak at the October 2012 UIC Community Health Sciences Brown Bag Seminar titled, “A panel discussion about successful grant proposals for doctoral students.” Details about completing and submitting pre-doctoral grants were presented and discussed with public health graduate students. What do you plan to do during the next reporting period to accomplish the goals? To accomplish the goals in Year 2, the following activities need to be completed according to the projected timeline: Survey data collection should be completed in December 2013. Local-level data from the CDC Foodborne Outbreak Online Database (FOOD) and the US Census should be obtained and merged with the survey data as surveys are completed for each local health department. Data should be analyzed. Manuscript should be written and submitted to a peer-reviewed journal. PI should attend/complete the following educational/training activities: Serv-Safe food safety certification, GIS course, STATA course, one CDC TRAIN food safety course.

    Impacts
    What was accomplished under these goals? The accomplishments described in this section reflect the study for Year One. The study methods and timeline compliance have been met in accordance to the research protocol for this first year. A database was developed to include contact information for all local health jurisdictions/departments and public health offices throughout the United States. To obtain local restaurant-related data, each of the 2,900 local US health departments were contacted and invited to complete a web-based survey. A 50-question survey instrument was designed to collect jurisdictional demographics, frequency of foodborne illness outbreaks, frequency of restaurant inspections and food handler training requirements for three consecutive years (2010, 2011 and 2012). The survey was reviewed by the research advisory committee, public health researchers, food safety experts and representatives from local health departments and was approved by the UIC IRB. Data collection began in April 2013.

    Publications