ADVANCING FOOD RECOVERY IN K-12 SCHOOL CAFETERIAS BY REMOVING FOOD SAFETY AND OPERATIONAL BARRIERS OF SHARE TABLES

• Sponsoring Institution: National Institute of Food and Agriculture
• Project Status: TERMINATED
• Funding Source: AFRI COMPETITIVE GRANT
• Reporting Frequency: Annual
• Accession No.: 1025160
• Grant No.: 2021-68008-34106
• Project No.: ILLU-698-633
• Proposal No.: 2020-04966
• Program Code: A1701
• Project Start Date: Jan 15, 2021
• Project End Date: May 25, 2023
• Grant Year: 2021

Project Director
Prescott, M. P.

Recipient Organization
UNIVERSITY OF ILLINOIS
2001 S. Lincoln Ave.
URBANA,IL 61801

Performing Department
Food Science & Human Nutrition

Non Technical Summary
We will establish much-needed, evidence-based food safety and operational practices to make share tables more feasible and attractive to the nearly 100,000 schools implementing the National School Lunch Program, facilitating systems change to ameliorate child food insecurity and food waste. Share table implementation is currently limited because the existing guidance on share table food safety requirements is fragmented and not specific enough to guide school-level action. Our overall goal is to address the food safety and operational concerns of stakeholders that are hindering share table food recovery. We will conduct qualitative interviews with health inspectors to identify the perceived food safety risks that are informing local health code variation. Next, we will conduct a quantitative microbial risk assessment of foodborne disease risk due to the consumption of share table food items to address stakeholder food safety concerns and identify best food-safety practices. Using these research findings, we will develop and test share table training and implementation resources in schools. Finally, we will provide consistent, evidence-based share table resources across public health, school nutrition, and food pantry sectors through nationally disseminating our research findings and share table resources to key stakeholders while monitoring and evaluating their use. Our project outputs will provide a data-driven plan of action to all key stakeholders that will reduce food waste, increase healthy food donations to non-profits, and create cost savings for school nutrition programs while protecting children's safety and promoting improved nutritional security.

Animal Health Component

0%

Research Effort Categories

Basic

50%

Applied

50%

Developmental

(N/A)

Classification

Knowledge Area (KA)	Subject of Investigation (SOI)	Field of Science (FOS)	Percent
504	6050	1010	50%
703	6050	1010	50%

Knowledge Area
703 - Nutrition Education and Behavior; 504 - Home and Commercial Food Service;

Subject Of Investigation
6050 - Communities, areas, and regions;

Field Of Science
1010 - Nutrition and metabolism;

Keywords

food safety

share tables

school nutrition

food waste reduction

food security

food recovery

Goals / Objectives
Objective 1. Conduct qualitative interviews with health inspectors to identify the perceived food safety risks that are informing restrictive share table policies.Objective 2. Conduct a Quantitative Microbial Risk Assessment (QMRA) of foodborne disease risk due to the consumption of share table food items to address stakeholder food safety concerns and identify best food-safety practices.Objective 3. Develop share table resources in collaboration with key stakeholders and use a train-the-trainer model to pilot them across approximately 60 schools in the FNS Midwest Region.Objective 4. Launch and evaluate a national dissemination of our research findings and share table resources to key stakeholders via social media marketing and online professional development dissemination.

Project Methods
For Objective 1, we will use purposeful sampling to obtain a variation of restrictive and lenient health inspectors by leveraging feedback from the Share Table Advisory Committee and ABCs of School Nutrition Extension staff. A researcher will e-mail potential participants to invite them to participate in the study. We will use purposeful sampling to obtain a variation of restrictive and lenient health inspectors. Consenting participants will participate in an audio-taped 60-minute interview. Interview transcripts will be analyzed for key themes on perceived risks and subsequent mitigation techniques.For Objective 2, we will estimate the actual risk of share table recovery through a Quantitative Microbial Risk Assessment (QMRA). Each parameter of the model will be informed by a literature review. We will determine the most likely value of each input parameter to create a point-estimate of risk for a share table practice. Then, to assess the variability and uncertainty in this complex situation, we will use @Risk software to define inputs as distributions and perform a sensitivity analysis to assess which input parameters have the largest impact on risk outputs by performing uncertainty iterations where we fix the value of a single input parameter at the 2.5th, 25th, 50th, 75th, and 97.5thpercentile of the distribution. Next, we will track the change in, e.g., the predicted median illness; this analysis determines which input parameter ranges have the largest impact on the magnitude of the outputs.For Objective 3, we will use the QMRA results to develop share table standard operating procedures and corresponding HACCP templates, a training module, and tip sheets for working with local health inspectors and safe food donation to local food pantries. We will use a train-the-trainer program where we will train FNS Midwest Region SNAP-Ed educators to provide training and technical assistance to local schools in share table implementation. SNAP-Ed educators will facilitate a pilot study of the share table toolkit. We will evaluate the pilot study using acceptability, feasibility, and cost-effectiveness metrics.For Objective 4, we will scale-up the implementation of share tables from the FNS Midwest Region to the entire country and evaluate the use of the Share Table Toolkit. We will first finalize the share table toolkit, disseminate it online, and use social media to promote the use of the toolkit. We will quantify the reach of the toolkit using website traffic metrics and download frequency. We will evaluate the impact of the training materials using surveys. We will also disseminate our food safety research findings to local health inspectors and public health departments.

Progress 01/15/21 to 05/25/23

Outputs
Target Audience:School nutrition services staff and administrators in K-12 schools, particularly those with high rates of free & reduced-priced lunch eligibility. Local health inspectors: Individuals employed by state and local health departments tasked to assess compliance with health codes SNAP-Ed Educators: Family and Consumer Science (FCS) Extension field staff at the Educator and Program Coordinator levels who have roles in implementing policy, systems, and environmental change interventions. State-Level SNAP-Ed Extension Administrators: Administrators who oversee their state's SNAP-Ed program. Changes/Problems:Due to COVID, we are behind schedule and have not begun our work on Objective 4. In addition, concerns about COVID prevented us from doing an in-person training for SNAP-Ed Educators. It was done on Zoom instead. The PD is changing institutions. What opportunities for training and professional development has the project provided?4 webinar training sessions were provided during the summer of 2022 to SNAP-Ed staff across the Midwest Region. Topics focused on share table policies, food safety, and implementation science. How have the results been disseminated to communities of interest?The findings from Objective One (qualitative study with health inspectors) were shared with key stakeholders at a Share Table Advisory Committee meeting in March of 2021. The Norovirus QMRA results and the Share Table Toolkit were shared with the Share Table Advisory Committee via email on July 12, 2022. The heat transfer model and milk spoilage model resutls were shared via Zoom with the Share Table Advisory Committee on May 8, 2023. July 29, 2021, Examining nutrition and food waste trade-offs using an obesity prevention context. Invited lecture presented at the National Maternal and Child Health Nutrition Annual Meeting (This audience includes some RDN school nutrition staff and administrators, as well as state nutritionists who operate Summer Food Service Programs.) Presented by MP Prescott. Sept 9, 2021, Using qualitative interviews to better understand differences in how local health departments inspect school share tables. Statewide Illinois Extension PSE staff meeting (Urbana, IL) Presented by MP Prescott. April 5, 2023, School Share Tables: Feeding Our Future, Not Landfills. 2023 Pediatric Nutrition Intensive Course hosted by Children's Hospital of Alabama. Presented by MP Prescott. (This audience includes some RDN school nutrition staff and administrators, as well as state nutritionists who operate Summer Food Service Programs.) April 26, 2023, School Share Tables: Feeding Our Future, Not Landfills. Statewide (LA) webinar hosted by Louisianna Department of Education. Presented by MP Prescott. May 11, 2023. Understanding Residual Risk. Food Safety Summit (Chicago IL) https://www.food-safety.com/food-safety-summit/agenda#day-4 Presented by Stasiewicz, MJ. What do you plan to do during the next reporting period to accomplish the goals? Nothing Reported

Impacts
What was accomplished under these goals? Obj 1: The qualitative interview research is complete and published. These findings indicated that hand-to-hand contamination was of primary concern to local health inspectors, as compared to temperature abuse. Further, apples were a major point of disagreement as local health inspectors varied as to how to safely recover apples and other fruits with an inedible peel. Obj 2: The QMRA on whole apple recovery is complete and published. We concluded that share tables do present increased opportunities for Norovirus transmision, but these risks can be mitigated by handwashing or handsanitizing, one-way share tables, and/or washing recovered fruits prior to re-service. Stakeholders have also raised questions about the risk of recovering whole milks without temperature controls during short lunch periods. To address this concern, our team conducted heat transfer and a PPC Organism Challenge Study to determine the potential for the amplification of risk from Pseudomonas poae amplification under varying milk carton conditions likely to occur on a school share table. We concluded that milk's microbial quality is not meaningfully impacted by repeated circulation in a worst-case share table (i.e. when milk is delivered to schools with spoilage organisms present), particularly compared to the effects of overnight refrigeration. Therefore, sharing milk is unlikely to increase spoilage relative to routine school lunch practices. Obj 3: Our interdisciplinary team created a toolkit based on the whole apple QMRA results, which included an online and in person training module for school nutrition services, standard operating procedures, HACCP plans, signage, and school community communications. Due to COVID, we held our SNAP-Ed staff trainings online, broken into four 2-hour sessions. We launched the pilot in August 2023 and have held optional office hours approximately every 3 weeks to support SNAP-Ed staff as they supported the participating schools in share table implementation. Obj 4: No progress yet

Publications

• Type: Conference Papers and Presentations Status: Accepted Year Published: 2023 Citation: Title: Heat transfer model for milk temperature for predicting quality of milk shared in different school lunch service and storage conditions Paola Corea, Gabriella Pinto, Gustavo A. Reyes, Melissa Pflugh Prescott, Kirk Dolan, Matthew J Stasiewicz. Accepted for presentation at the International Association for Food Protection annual meeting July 2023.
• Type: Conference Papers and Presentations Status: Accepted Year Published: 2023 Citation: Time and Temperature Abuse of Milk in Conditions Representing A School Cafeteria Share Table Does Not Meaningfully Reduce Microbial Quality Gabriella Pinto, Paola Corea, Gustavo Reyes, Matthew J. Stasiewicz Accepted for presentation at the International Association for Food Protection annual meeting July 2023.
• Type: Theses/Dissertations Status: Published Year Published: 2023 Citation: Reyes, Gustavo. ADVANCING FOOD SAFETY THROUGH SIMULATION OF SCHOOL CAFETERIA SHARE TABLES AND PRODUCE SYSTEMS
• Type: Journal Articles Status: Published Year Published: 2021 Citation: Zagorski, J., Reyes, G., Stasiewicz, M. and Prescott, M. 2021. Using qualitative interviews to better understand differences in how local health departments inspect school share tables. J. Food Prot. 2021;84(10):1664-1672.
• Type: Journal Articles Status: Published Year Published: 2022 Citation: Reyes, G, Prescott, MP and Stasiewicz, M. 2022. Quantitative modeling of implementing school cafeteria share tables predicts reduced food waste and manageable norovirus-related food safety risk. Microbial Risk Analysis, 22:100229.

Progress 01/15/22 to 01/14/23

Outputs
Target Audience:Target audiences included school nutrition services staff and administrators in California and Illinois and anti-waste advocates in Illinois. Changes/Problems:We had to hold our SNAP-Ed trainings virtually due to concerns with increased COVID rates of transmission last spring. What opportunities for training and professional development has the project provided?PD andCo-PD provided training to SNAP-Ed staff on research ethics, applied food safety, program evaluation, and implementation science. These trainings were held both synchronously and asynchronously via Zoom. Fifty schools participated in share table trainings focused on food safety and regulatory guidance either in person (taught by SNAP-Ed staff) or online through U of I Extension. How have the results been disseminated to communities of interest?Results were presented by PD at the California Academy of Nutrition and Dietetics Conference and Expo April 22, 2022. Results also shared with key stakeholders during the Share Table Advisory Committee Meeting May 2022. What do you plan to do during the next reporting period to accomplish the goals?We will finish the pilot, evaluate the data, and update the toolkit accordingly. After sharing with key stakeholders for feedback and revising accordingly, we will launch our national dissemination (Objective 4).

Impacts
What was accomplished under these goals? Objective 1: The qualitative interview research is complete and published. These findings indicated that hand-to-hand contamination was of primary concern to local health inspectors, as compared to temperature abuse. Further, apples were a major point of disagreement as local health inspectors varied as to how to safely recover apples and other fruits with an inedible peel. Objective 2: The QMRA on whole apple recovery is complete and published. Stakeholders have also raised questions about the risk of recovering whole milks without temperature controls during short lunch periods. To address this concern, our team conducted heat transfer and a PPC Organism Challenge Study to determine the potential for the amplification of risk from Pseudomonas poae amplification under varying milk carton conditions likely to occur on a school share table. Objective 3: Our interdisciplinary team created a toolkit based on the whole apple QMRA results, which included an online and in person training module for school nutrition services, standard operating procedures, HACCP plans, signage, and school community communications. Due to COVID, we held our SNAP-Ed staff trainings online, broken into four two-hour sessions. We launched the pilot in August 2023 and have held optional office hours approximately every threeweeks to support SNAP-Ed staff as they supported the participating schools in share table implementation.

Publications

• Type: Journal Articles Status: Accepted Year Published: 2022 Citation: Reyes, G, Prescott, MP and Stasiewicz, M. 2022. Quantitative modeling of implementing school cafeteria share tables predicts reduced food waste and manageable norovirus-related food safety risk. Microbial Risk Analysis, 22:100229.

Progress 01/15/21 to 01/14/22

Outputs
Target Audience:Illinois Health Inspectors: Individuals employed by county health departments tasked to assess compliance with the health code. Illinois Extension Staff: Family and Consumer Science (FCS) Extension field staff at the Educator and Program Coordinator levels who have roles in implementing policy, systems, and environmental change interventions. State-Level SNAP-Ed Extension Administrators: Administrators who oversee their state's SNAP-Ed program. Changes/Problems: Nothing Reported What opportunities for training and professional development has the project provided?Results were presented at the following: July 29, 2021, Examining nutrition and food waste trade-offs using an obesity prevention context.Invited lecture presented at the National Maternal and Chilld Health Nutrition Annual Meeting (This audience includes some RDN school nutrition staff and administrators attend this meeting, as well as state nutritionists who operate Summer Food Serivce Programs.) Sept 9, 2021, Using qualitative interviews to better understand differences in how local health departments inspect school share tables. Statewide Illinois Extension PSE staff meeting. How have the results been disseminated to communities of interest?The findings from Objective Onewere shared with key stakeholders at a Share Table Advisory Committee meeting in March of 2021. What do you plan to do during the next reporting period to accomplish the goals?In Year Two, we will develop training materials based on the research findings from Objective One and Objective Two as well as a share table tool kit. We will also pilot this tool kit in Year Two.

Impacts
What was accomplished under these goals? Objective One: The qualitative interview research is complete and published. These findings indicated that hand-to-hand contamination was of primary concern to local health inspectors, as compared to temperature abuse. Further, apples were a major point of disagreement as local health inspectors varied as to how to safely recover apples and other fruits with an inedible peel. Objective Two: Our team has finished analyzing the microbial risk assessment data and will be submitting a manuscript on these findings for peer review in Year Two. We learned that systems factors such as encouraging students to stay home when sick and handwashing are important ways to promote safe share table recovery. In addition, "one-way share tables" (when students are allowed to deposit unwanted items in the meal period that are then assessed by food service staff for donation to school backpack programs or used in future meal service) are one of the safest forms of school food recovery. Future research is needed to determine feasible ways to adopt one-way share tables.

Publications

• Type: Journal Articles Status: Published Year Published: 2021 Citation: Zagorski, J., Reyes, G., Stasiewicz, M. and Prescott, M. 2021. Using qualitative interviews to better understand differences in how local health departments inspect school share tables. J. Food Prot. 2021;84(10):1664-1672.