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Leafy vegetables are often consumed raw and typically
require no heat treatment (e.g., cooking) before consumption, which puts consumers at microbiological risk if pathogens are present. Pathogenic microorganisms have been
associated with fresh produce in several countries (4, 9,
23, 38). A review of Brazilian foodborne disease outbreaks
associated with fruits and vegetables and reported between
2008 and 2014 was conducted on the basis of data of the
National Sanitary Surveillance Agency (ANVISA) from
the Ministry of Health (16). This review, which indicated
that 30 produce-linked outbreaks resulted in 2926 cases,
347 hospitalizations and no deaths, represented only 0.6%
of the total number of outbreaks in the period (n = 5,138).
Only bacterial pathogens were identified as etiological
agents, with Salmonella being the most frequent (30%),
followed by Staphylococcus aureus (23.3%) (16).
Quantitative microbial risk assessment (QMRA) has
become an important tool in food safety, providing a
structured way to estimate the probability of exposure to a
microbial hazard in one or more foods as well as the health
impact from that exposure. A QMRA traditionally involves
four components: hazard identification, exposure assessment,
hazard characterization and risk characterization. Hazard
identification involves the determination of biological,
chemical, and physical agents present in a food or group of
foods and possibly causing adverse health effects. Exposure
assessment is the evaluation of the likely intake of those
agents via food or other sources. Hazard characterization
estimates the relationship between the exposure level
(dose) and the probability of an adverse health effect and its
severity (response). Last, risk characterization is the process
of estimating the probability of occurrence and severity of
known or potential adverse health effects in a population,
based on hazard identification, hazard characterization and
exposure assessment (11, 19).
Several studies using QMRA models have been conducted
over the past decade to estimate the risk of foodborne illnesses
due to the consumption of contaminated fresh produce (5,
15, 20, 30, 32, 34, 37). Some studies addressed the impacts
of cross-contamination during the washing step of these
foods (13, 28). Although these studies showed that fresh
produce may pose a measurable risk of foodborne illnesses to
consumers, they all also emphasized that more data are needed
to improve the accuracy of future QMRA models and to
support mitigation strategies to reduce the risks.
Characterization of the risk of foodborne illness from
exposure to a microbiological hazard in a specific food (or
group of foods) requires information on the frequency of
consumption and amounts consumed, as well as the forms
in which they are prepared and consumed. Most food
consumption surveys are conducted to assess the nutritional
status of a population rather than addressing consumer
behavior, leading to a significant degree of uncertainty in
QMRA models (2, 3). The aim of this study was therefore

to gather information on the consumption and handling
practices regarding leafy greens of a sample drawn from the
population of the city of São Paulo, Brazil, for use in future
QMRA models.
MATERIAL AND METHODS
Sampling and survey instrument
A face-to-face cross-sectional questionnaire-based study was
conducted by a team of interviewers in December, 2017, at
two large supermarkets located in the metropolitan area of the
city of São Paulo, Brazil. Approval for the study was obtained
from the Faculty of Pharmaceutical Sciences Research Ethics
Committee (CAAE n° 66179517.2.0000.0067). The São Paulo
Supermarket Association (APAS) also provided authorization
to conduct the survey in the selected supermarkets.
A two-part questionnaire was prepared to obtain data on
participants' demographic characteristics as well as their
consumption and handling practices of leafy greens. Part A
collected data on reported gender, age, marital status and
educational level, while Part B gathered data on consumption
behavior and handling practices regarding leafy greens,
addressing the type, frequency and amount consumed,
preferred shopping location, home storage conditions and
washing procedures. The amount of leafy greens consumed
at each meal was determined based on kitchen measurement
utensils and was converted into grams as follows: small leaf
= 5.0 g, medium leaf = 10 g, large leaf = 15 g, full soup spoon
= 8.0 g, full dessert plate = 30 g, and full shallow plate =
80 g. The socioeconomic status of the participants was not
assessed.
The questionnaire was validated in a pilot study conducted
with a group of 30 participants to assess clarity and suitability
of the survey items. The questionnaire was adjusted according to the pilot study results, and the final version was applied
to 225 randomly selected adults (age above 18 years), who
voluntarily agreed to reply to the questions. Volunteers were
approached by the interviewers at the exit of the supermarket
after they had finished their shopping.
Data analyses
Descriptive analyses were performed to assess response
rates. Pearson's chi-square test was used to observe
possible associations of demographic characteristics of the
participants (i.e., gender, age, marital status and educational
level) to consumption behaviors and handling practices with
regard to leafy greens. Statistical analyses were performed
using the Minitab software, version 17 (2013 Minitab Inc.),
and statistical significance was assumed for P-values ≤ 0.05.
RESULTS
The numbers of participants were similar between the two
supermarkets with, 110 (49%) and 115 (51%) individuals
participating. The demographic characteristics of the
respondents are shown in Table 1. Participants were largely

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