Food Protection Trends - March/April 2020 - 81

Food safety, which has been a concern since the time of
early humans (around 50,000 BCE) as a method of selfpreservation (22), refers to the handling, preparation, and
storage of food to prevent foodborne illnesses. With the
relatively recent increase in consumption of raw foods, new
contributors to foodborne illnesses have been discovered (25,
35). However, many mild cases go unreported, as illness may
cause only discomfort. According to the U.S. Department
of Agriculture (46), foodborne illnesses cost more than
$15.6 billion annually in the U.S. alone (39). People at risk
for severe cases include pre-school children, older adults in
health care facilities, and immunocompromised patients,
such as those with cancer (37). According to the Food
and Drug Administration (45) Food Code, five major risk
factors are related to behaviors and preparation practices
that contribute to foodborne illnesses: improper holding
temperatures, inadequate cooking, contaminated equipment,
food from unsafe sources, and poor personal hygiene.
Several articles on trends influencing food safety in retail
foodservice have identified eight trends that can affect food
safety and thus increase the need for education by nutrition
professionals (26, 29, 30, 43, 47). Some are directly associated
with characteristics of consumers, such as increased number
of meals eaten away from home, employees being held more
accountable for food safety practices, and increased number
of people at high risk for foodborne illnesses, while the risk
factors associated with inappropriate handwashing practices,
cross-contamination, and time and temperature control
continue to remain as major concerns. These trends show
the need for increased food safety knowledge and improved
practices among food handlers and consumers.
Food safety in home cooking is very important, as
there are many areas in the home where food can become
contaminated and cause foodborne illnesses. However,
there are currently no studies investigating food safety
knowledge, attitudes, and practices among low-income
households cooking food at home. With foodborne diseases
causing approximately 3,000 deaths each year in the U.S.,
it is important to recognize the need for safe food-handling
behaviors at home.
Food safety issues with home cooking
The home is a multifunctional setting in which various
activities that can influence food safety occur (41).
According to Carlson, Kinsey, and Nadav (12), 72% of
the food that Americans consume comes from the grocery
store and is prepared at home; therefore, it is not surprising
that the home is the last line of defense against foodborne
diseases (41). However, many experts agree that the home
is the primary location where foodborne illness outbreaks
occur (9). Based on the 2018 Surveillance for Foodborne
Disease Outbreaks (13), of 839 reported cases of foodborne
disease outbreaks in 2016, 76 (almost 10%) were associated
with home cooking. Among the food safety factors related

to home cooking, bacterial (e.g., Salmonella, Clostridium
perfringens, and Campylobacter) and chemical (e.g.,
scombroid toxin and ciguatoxin) etiologies were mainly
responsible for the outbreaks (13, 40). In addition, because
most foodborne illness incidents are believed to be sporadic,
mild, and unreported (2), it can be surmised that the actual
number of cases associated with food safety problems in
home cooking is much higher than reported (38).
Numerous factors can contribute to the food safety
problems that occur at home, such as contamination of the
raw food supply, insufficient awareness or knowledge of
food safety, mistakes in food handling or preparation, and
deliberate consumption of raw and undercooked foods of
animal origin (24). Both Campylobacter and Salmonella can
be transferred from raw chicken products to kitchen surfaces
(16, 23). Also, the human and animal occupants of the home
can serve as sources of foodborne pathogens (41). Salmonella
and other enteropathogens have been linked with domestic
pets such as dogs and cats (6).
Food safety issues and practices among low-income
populations
Numerous factors contribute to food safety incidents
among low-income populations, such as a lack of access to
grocery stores and supermarkets, inadequate resources, and
poor food safety practices (15, 31). Among these factors,
food safety practices may be the most important. A study
conducted by Signs et al. (42) found that egg samples from
low-income census tracts were more often unrefrigerated
than eggs from high-income census tracts. In another study,
it was found that for each additional 10% of individuals
below the poverty line in Detroit, there was an increase of
0.6 critical violations in the food store (36). In addition,
studies that focused on the food safety practices of lowincome Puerto Rican families in the U.S. showed that these
consumers did not often utilize thermometers when cooking
meat (3, 17). Furthermore, low-income households' kitchens
are often crowded with items unrelated to food preparation
but lack the paper towels and soap necessary for appropriate
hand washing practices (17). Thus, the purpose of this
study was to evaluate the level of food safety knowledge and
practices among consumers in low-income families in an
area of the U.S. The results of this study are aimed at raising
awareness among the public regarding the food safety risks
associated with home cooking.
METHODOLOGY
Subject selection
Approval to use human subjects in this study was obtained
from the University of Missouri Institutional Review Board
prior to initiating the research. The population consisted of
adults over 18 years of age who had received food or food
stamps from local food banks/pantries in the past year.
Participants were recruited through Qualtrics.com, an online

March/April Food Protection Trends

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Food Protection Trends - March/April 2020

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