Food Protection Trends - September/October 2016 - 373

Symptoms of food allergy reactions range from mild to severe and can be life threatening. One of the most severe allergic responses, anaphylaxis, can result in circulatory collapse, coma, and even death (28). The "Big 8" food allergens-eggs, fish, milk, peanuts, soy, shellfish, tree nuts, and wheat-are major food allergens in the U.S., triggering more than 90% of food allergy reactions (38). For the manufacturing industry, the Food Allergen Labeling and Consumer Protection Act (FALCPA) of 2004 requires food labels on all products regulated by the U.S. Food and Drug Administration (FDA) to clearly identify ingredients or proteins derived from the major eight food allergens. The restaurant industry is not subject to these legislative and regulatory guidelines relating to the management of food allergies. At the federal level, only the FDA Food Code states that the person in charge in restaurants should have knowledge about major food allergens, cross-contacts, and symptoms of food allergy reactions (14, 15). As of 2016, only Massachusetts, Michigan, Rhode Island, and Virginia had established legislation for improving restaurant staffs' awareness of food allergies. Several cities, including New York, NY, and St. Paul, MN, require all restaurants to display food allergy posters in staff areas (11). Despite the various prevention strategies taken by customers with food allergies, some customers have experienced difficulty when dining out because restaurant staff did not know about food allergies, did not understand special requests, or were not aware of the severity of food allergy reactions (20, 21). Researchers found that 33% of the fatal food allergy reactions occurring in the U.S. from 2001 to 2006 were triggered by foods prepared away from home (5, 6). In one study, researchers found that 34% of customers with food allergies had experienced food allergy reactions in restaurants (41). Miscommunication between and among restaurant staff and customers with food allergies, unexpected or hidden food allergens, and cross-contacts in food preparation areas have been recognized by customers with food allergies as major causes of food allergy reactions in restaurants (16, 20, 23). Of these, establishing proper communication may be one of the most important steps in preventing food allergy reactions in restaurants (23). In fact, many food allergy reactions occurred in restaurants because customers failed to inform restaurant staff about their food allergies (27), believing that the foods they were eating were safe (36). Risk perception, which refers to an individual's views of the risks involved in a particular situation, is highly relevant to the safe food-handling behaviors of foodservice employees (37). If a person perceives greater risk in terms of probability and consequence, he or she is more likely to take actions (42). Risk communication, "the process of exchanging information among interested parties about the nature, magnitude, significance, or control of a risk" (10), is a special concern in the food safety context. The way the risk or danger is described, assessed, and managed influences how individuals or groups perceive, process, and act (17) and may prevent negative outcomes (30) such as foodborne illnesses and food allergy reactions. As a part of food safety risk management, food allergy risk communication is important for restaurants in reducing the chance of food allergy reactions when serving customers with food allergies (19). Currently, a few food allergy training programs are available for the restaurant industry, including the ServSafe® food allergen training program and "Welcoming Guests with Food Allergies" developed by Food Allergy Research and Education (FARE) (11). Most target delivering food allergy knowledge, but few focus on improving the risk perceptions and risk communication behaviors of restaurant employees when serving customers with food allergies. The purpose of this research was to identify current food allergy risk communication and related operational practices in restaurants, using a qualitative approach. The specific objectives were to (a) identify restaurant managers' beliefs and perceptions about food allergy risks in their restaurants, (b) explore risk communication procedures or protocols when serving customers with food allergies, and (c) identify food allergy risk communication training needs in the restaurant industry. METHODS Target population and study sample selection The research protocol was approved by the University Institutional Review Board (#7484) at Kansas State University prior to data collection. The target population of this study was managers of full-service restaurants in the U.S. According to previous risk communication researchers (26), new concepts arise rapidly from the first 10 to 15 interviews when conducting risk communication interviews. Therefore the target sample size was determined to be 15. To achieve variation within the sample, a purposive sampling method was employed to recruit managers from different types of restaurants, such as chain-operated and independently-owned restaurants. Contact information of potential participants was obtained through faculty and alumni groups from two major universities and restaurant associations in large metropolitan areas. Upon completion of the interview, each participant was offered a $20 gift card as a token of appreciation for his or her time and effort. Development of interview questions Interview questions were developed based on the literature review following the mental model risk communication interview guidelines (32) and the qualitative interview guidelines (34). A mental model is a person's internal, personalized, contextual understanding of the world and how things work (32). The goal of the mental model interview September/October Food Protection Trends 373

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