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Food safety and handling knowledge and practices of Lebanese university students
Food Control 40 (2014) 127e133
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Food safety and handling knowledge and practices of Lebanese university students Hussein F. Hassan a, *, Hani Dimassi b a b
Lebanese American University, Department of Natural Sciences, Beirut, Lebanon Lebanese American University, School of Pharmacy, Byblos, Lebanon
a r t i c l e i n f o
a b s t r a c t
Article history: Received 18 September 2013 Received in revised form 18 November 2013 Accepted 26 November 2013
The aim of this study was to assess the level of food safety handling knowledge and practices among 1172 Lebanese university students (mean age 20.0 1.6 SD) and to explore the association between their knowledge/practices and the socio-demographic and academic characteristics. Participants were undergraduate students enrolled in the Lebanese American University from different majors and years of study, from different areas of residence, living alone or with others, and having working or non-working mothers. They completed a questionnaire of 16 food handling practices and 14 food safety knowledge questions related to preparation, cross-contamination, storage and hygiene. On average, the students scored 53.6 15.8% and 44.7 14.3% on the knowledge and practices parts, respectively. Female students scored higher on both practices and knowledge questions than male students; however, the difference was significant (p < 0.001) for the practices part only. Health-related majors scored significantly (p 0.001) better on both practices and knowledge questions. Senior students scored highest on the knowledge questions, followed by juniors, sophomores and finally freshmen and the difference was borderline significant (p ¼ 0.07). The area of residence had a significant (p ¼ 0.006) effect on the food safety practices questions. Students living with parents scored higher in both knowledge and practices parts than those living alone or with roommates; however, the difference was significant (p ¼ 0.009) in the knowledge part only. Students who cook all the time showed a significant (p ¼ 0.001) lower difference in terms of their food safety knowledge compared to those who cook less frequently. Food handling practices and food safety knowledge scores were significantly (p < 0.001) related with a weak to moderate correlation coefficient (R ¼ 0.231). Our results confirm the need for ongoing educational initiatives to improve the relatively low food awareness among the Lebanese young adults group. Ó 2014 Elsevier Ltd. All rights reserved.
keywords: Food safety Knowledge Practices University students Lebanon Questionnaire
1. Introduction Food-borne diseases or food poisoning represent a growing public health problem of prime interest all over the world (Morris, 2011). Even in societies with highly developed food safety systems, such as the “farm-to-fork” in Europe and the “farm-to-table” in USA, a “weak link” can cause significant morbidity and mortality from foodborne illness (EFSA, 2011; Lazou, Georgiadis, Pentieva, McKevitt, & Iossifidou, 2012). Although this problem has more effect on economy and health of developing countries, reliable data is not widely available (WHO, 2007). The global incidence of foodborne diseases is hard to estimate, but it has been reported that around 1.8 million people die every year from diarrheal diseases, mostly due to food and drinking water contamination (WHO,
* Corresponding author. E-mail address: [email protected] (H.F. Hassan). 0956-7135/$ e see front matter Ó 2014 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.foodcont.2013.11.040
2007). In USA, one person in three may be affected by foodborne illness each year and recently, this percentage is increasing due to significant changes in industrialization of animal production, mass production in food processing and distribution, globalization of food trade, and increase number of tourists around the world (Sharif & Al-Malki, 2010). On the other hand, more than 95% of food poisoning cases are sporadic, their incidences are small and they originate at home (EFSA, 2011), which highlights the fact that domestic food handler is a critical link in the food chain. Without whom, all the regulatory efforts may be ineffective, if they are not complemented by safe food purchase, preparation, cooking and handling in private homes (Kennedy et al., 2005). There are a number of literature reporting that food handlers of all ages think that they know how to handle food safely, but their self-reported food handling behaviors do not support this assumption (Bruhn & Schutz, 1999; Frewer, Shepherd, & Sparks, 1994; Gettings & Kiernan, 2001; Redmond & Griffith, 2003). Food mishandling is more common in some consumer groups than in
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others (Byrd-Bredbenner et al., 2007; Sanlier, 2009). Young adults (18e29 years old), men and individuals with education further than high school are more likely to have risky food handling than others (Li-Cohen & Bruhn, 2002; McArthur, Holbert, & Forsythe, 2007; Medeiros et al., 2004). This age group (18e29 years old) is not considered to be “at risk” for foodborne illness; however, the consequence of their unhygienic food practices becomes serious when they start providing care for other household members who are at risk, such as pregnant women, young children and ageing adults (Abbot, Byrd-Bredbenner, Schaffne, Bruhn, & Blalock, 2009; Byrd-Bredbenner et al., 2008). Few research about food safety handling and practices among young adults in universities has been recently published. A recent study showed that more than 50% of the Saudi college students consumed raw eggs and raw white cheese and 34% believed that there is no risk of food poisoning from eating cooked food kept at room temperature for one day if covered (Sharif & Al-Malki, 2010). About one third of USA college students reported eating fried eggs with soft yolks, and about the half reported eating raw cookie dough, and undercooked chicken and hamburger (ByrdBredbenner et al., 2007; Morrone & Rathburn, 2003). In Turkey, half of young consumers did not know that checking the internal temperature of the food is the safest way to know if the meat was cooked well (Sanlier, 2009). Garayoa, Córdoba, García-Jalón, Sanchez-Villegas, and Vitas (2005) reported that 13.5% only of Spanish university students washed their hands with soap and water before and during food preparation and 38.6% used safe methods. Lazou et al. (2012) reported a 44% score on food safety practices among Greek university students. To the best of our knowledge, information about Lebanese university students in terms of their food safety knowledge and practices has not been studied previously; therefore, this study focused on assessing the self-reported food safety practices and knowledge of university students from health and non-healthrelated fields in the Lebanese American University (LAU). Another focal objective was to explore any relationships between the food safety awareness and demographic characteristics. Such information would be used for health promotion, adoption of legislation and use of appropriate tools to increase knowledge, and changing inaccurate beliefs and wrong practices related to food habits.
inappropriately filled questionnaires were excluded. Out of 1172 filled questionnaire forms, only 932 (79.5%) were valid. 2.2. Questionnaire In order to assess the food safety and handling knowledge and practices of students in both campuses (Beirut and Byblos) of the Lebanese American University (LAU), a questionnaire was developed by including questions selected from an updated, reliable, and valid instrument produced by Byrd-Bredbenner et al. (2007) and used in similar studies done in Jordan (Osaili, Obeidat, Abu Jamous, & Bawadi, 2011) and Greece (Lazou et al., 2012). Necessary modifications were made to some of the selected questions to reflect specific eating habits in Lebanon. A pilot study (35 students) was made to get a preliminary validation of the questionnaire. The clarity and suitability of wording, in addition to the average time needed for its completion were assessed. Then, necessary modifications were made and its results were not included in the data analysis. The questionnaire took around 12 min to be completed. It consisted of four parts: an introduction, demographic characteristics, foodhandling practices, and food safety knowledge questions. The demographic characteristics included gender, age, major and year of study, campus, residential area and status, involvement in cooking and parental employment. Food handling practices section included 16 questions, while the food safety knowledge section included 14 questions. Most of the items were multiple-choice questions. 2.3. Statistical analysis SPSS v18 Statistical computer software was used for all statistical analyses. The demographic characteristics represented the independent variables. Food-safety and handling knowledge and practices outcomes derived from the questionnaire represented the dependent variables. Each multiple-choice item had one correct answer that was assigned the score of 1 point; whereas, 0 point was assigned to all wrong answers. Student t test and Analysis of Variance (ANOVA) was conducted to compare the mean sum of correct responses of every section by gender, age, residential area, major of study, year of study, mother employment, living status and cooking habits. Significance level of 0.05 was used.
2. Materials and methods
3. Results and discussion
2.1. Study population
A total of 1172 undergraduate students participated in the study; 59% females and 41% males. The study sample included 18% of students from health-related majors (nutrition, biology, chemistry, nursing and pharmacy) and 77% from non-health related majors (arts, engineering and business) (Table 1). The mean student age was 20 (SD ¼ 1.7). Four percent of them were freshmen, 39% were sophomores, 30% were juniors, and 26% were seniors. Around 79% of the subjects lived with parents. Only 6% of the students reported that they cook their own meals all the time. 44% of the subjects had a working mother. The overall food-handling practices score was the sum of correct responses in the “food handling practices” section for each student and its mean value was 44.7% (SD ¼ 14.2). The mean score and the significance levels for each variable are presented in Table 2. In terms of food handling, female students scored significantly (p < 0.001) better than male students. Also, subjects majoring in health-related fields scored significantly (p < 0.001) better than non-health related ones. In addition, the residence area had a significant (p ¼ 0.006) effect with Aley/Shouf scoring the highest, while Batroun/Koura the lowest. Moreover, students having working mothers scored better than those whose mothers are housewives and the significance was borderline (p ¼ 0.05). On the
The study was conducted from November until May 2013 and the sample was comprised of 1172 students enrolled in both campuses (Beirut and Byblos) of the Lebanese American University (LAU) and selected randomly from different majors and years of study (sophomore, junior and senior). The Lebanese American University is a leading, non-sectarian, private higher education institution in Lebanon. In the fall 2012 semester, LAU had more than 8100 students enrolled. Before administering the questionnaire, a verbal explanation of the questionnaire and its content were given to the instructors of the selected classes during programmed meetings, and their approval was obtained. The selected classes were NUT201 (Fundamental of Nutrition) and HLT201 (Basic Health) since it was found that students registered in them represent LAU students in terms of the distribution of gender, major and year of study, according to figures obtained from the Registrar Office. Questionnaires were distributed to all students in classrooms to be completed towards the end of the lecture. The completion of the questionnaire was voluntary and anonymous, and no extra credit was given. Approval of the study was granted by the Committee on Human Subjects in Research at LAU. Incomplete or
H.F. Hassan, H. Dimassi / Food Control 40 (2014) 127e133 Table 1 Demographic characteristics of the study population (N ¼ 1172). Demographic variables Gender Age group Field of study Year of study
Campus Residential status
Residential area
Cooking habits
Maternal employment
% Male Female 18e20 21e23 Health-related Non health-related Freshman Sophomore Junior Senior Beirut Byblos Family With a roommate Alone Beirut and suburbs Metn Jbeil and Keserwan Cook all the time Sometimes Rarely Never Works Housewife
40.6 59.2 68.9 28.8 17.8 77.2 3.8 39.2 29.8 26.2 80.0 19.9 78.6 9.6 11.0 70.0 7.3 10.3 5.6 33.4 32.7 28.0 43.9 56.6
Table 2 Mean scores food handling practice and food safety knowledge sections per demographic characteristics. Demographic variable
Age
18 19 20 21 22 23 Gender Male Female Major of study Health-related Engineering Arts & humanities Business Year of study Freshman Sophomore Junior Senior Campus Beirut Byblos Residence area Beirut & suburbs Matn Kesrwan Jbeil Batroun & Koura Tripoli Saida & Tyr Aley & Shouf Residential Parents status Friends/ roommates Alone Cooking All the time habits Sometimes Rarely Never Maternal Works employment Housewife
Food handling practices
Food safety knowledge
Mean SDa Sig.
Mean SD Sig.
45.8 45.9 44.1 42.9 44.6 45.3 42.4 46.4 48.8 42.9 42.8 44.4 41.6 44.8 44.8 45.3 44.5 45.8 44.1 46.2 50.0 47.1 32.3 40.2 44.5 53.1 45.0 44.3
13.2 14.4 14.4 13.6 15.1 15.0 13.8 14.3 13.3 13.8 15.3 14.2 13.7 13.9 14.7 14.1 13.8 15.1 14.1 14.6 14.3 13.1 19.1 15.8 13.3 15.4 14.3 15.1
0.440 55.6 53.8 53.3 54.3 49.6 54.8 <0.001 52.5 54.4 <0.001 57.7 52.8 50.3 53.5 0.655 49.5 52.4 54.1 55.5 0.251 53.3 54.5 0.006 53.0 57.8 55.3 53.4 66.7 54.5 58.0 54.8 0.909 54.4 48.6
13.5 15.1 17.7 14.7 17.0 15.8 16.2 15.4 14.5 16.2 15.0 16.1 18.9 15.5 15.9 15.5 16.0 15.1 15.8 13.8 15.3 15.3 10.8 10.1 17.5 11.9 15.2 20.0
44.6 43.5 45.6 44.9 44.1 46.2 44.1
12.7 15.7 14.3 13.8 14.1 13.9 14.3
53.4 0.605 46.4 53.0 55.7 53.8 0.05 55.0 53.0
14.6 17.9 0.001 16.4 15.1 14.6 14.8 0.09 16.1
0.143
0.106 0.001
0.07
0.316 0.108
0.009
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other hand, age, year of study, campus, residential status and cooking habits were not significantly associated with practice and knowledge scores (p > 0.05). The mean food-safety knowledge score was 53.6% (SD ¼ 15.7). The mean score and the significance levels for each variable are presented in Table 2. Female students scored better than male students; however, the difference was not significant (p ¼ 0.106). Subjects majoring in health-related fields scored significantly (p ¼ 0.001) better than non-health related ones. The higher the year of study, the higher the knowledge score was. Senior students scored the highest, followed by juniors, sophomores and freshmen and the difference was border line significant (p ¼ 0.07). Students living with parents scored significantly (p ¼ 0.09) higher than those living alone or with friends. Subjects who cook all the time scored significantly (p ¼ 0.001) lower than those who cook less frequently or never. Students who have working mothers scored higher than those having non-working mothers; however, the difference was not significant (p > 0.05). On the other hand, the effect of age, campus, residential status and campus was not significant (p > 0.05). Our study presents insights into the self-reported food-handling practices and food safety knowledge among Lebanese university students. The responses of the participants showed low levels of food safety knowledge (53.6%) and poor adherence to the correct food-handling practices (44.8%). This insufficient lack of food safety awareness was also observed in previous similar studies (Abbot et al., 2009; Byrd-Bredbenner et al., 2007; Garayoa et al., 2005; Lazou et al., 2012; Osaili et al., 2011; Sharif & Al-Malki, 2010; Unklesbay, Sneed, & Toma, 1998). For instance, despite methodological differences, Lazou et al. (2012) reported that the mean scores of food safety knowledge and food handling practices among Greek university students were 60% and 44%. On the other hand, Byrd-Bredbenner et al. (2007) found the mean scores of approximately 60% and 50%, respectively, among American students. Students from health-related majors (Nutrition, Chemistry, Biology, Nursing and Pharmacy) reported the highest average food handling practices (48.8%) and food safety knowledge (57.7%) scores (Table 2). The difference between these students and their counterparts in the engineering, arts and humanities, and business majors was significant (p < 0.05) for both food handling practices and food safety knowledge parts. This could be due to the presence of modules and courses relevant to food safety, hygiene and microbiology in the curricula of health-related majors. A similar finding was reported by Byrd-Bredbenner et al., 2007; Garayoa et al., 2005; Lazou et al., 2012; Osaili et al., 2011; Sharif & AlMalki, 2010; Unklesbay et al., 1998. Senior students reported higher food safety knowledge scores (55.5%), followed by junior (54.1%), sophomore (52.4%) and freshman (49.5%) ones and the difference was borderline significant (p ¼ 0.07) (Table 2). Previous surveys reported similar findings in terms of higher scores among senior students. This can be attributed to the fact that as the student, especially in the health-related majors, stays longer in the major; he covers more aspects of food safety (Byrd-Bredbenner et al., 2007; Garayoa et al., 2005; Lazou et al., 2012; Osaili et al., 2011; Sharif & Al-Malki, 2010; Unklesbay et al., 1998). Male and female students were equally (w54%) knowledgeable in terms of food safety knowledge (Table 2); however, female participants responded significantly (p < 0.001) better (46%) than males (42%) in terms of food safety practices. This could be due to the fact that, in Lebanon, females are traditionally in charge of the kitchen hygiene and cleaning. This conforms to the findings from previous studies, in which female outperformed male university students (Byrd-Bredbenner et al., 2007; Lazou et al., 2012; Unklesbay et al., 1998). Students living with their parents scored better (Table 2) than those living alone or with friends or roommates; however, the
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difference was only significant (p ¼ 0.009) for the food safety knowledge questions. This can be attributed to the fact that when the student lives with his parents, someone else, who is more experienced (mother or maid), will handle the food preparation, resulting in a better food handling and an opportunity for the student to observe and learn more about food safety. Participants whose mother is a housewife scored lower in both food handling practices and food safety knowledge questions (Table 2); however, the difference was borderline significant (p ¼ 0.05) for the food handling practices part only. This can be due to the fact that, in Lebanon, working mothers tend to be more
educated than housewives and therefore, they could have acquired the food safety basics from their studies or readings. Detailed scores on the food handling practices and food safety knowledge questions are presented in Tables 3and 4, respectively. In the food handling practices section, the highest score was for the hand washing; 87% of the participants reported that they wash their hands with soap and water before eating or preparing food. On the other hand, the lowest score was for how to check that a burger is enough cooked; only 7% of the participants reported that they use a thermometer to check the temperature at the center. In the food safety knowledge section, students were mostly
Table 3 Score distribution to food handling practices questions. Questions
Multiple-choice responses
Correct responses
(1) At home, what is best practiced after using a cutting board to slice raw meat and needing to cut tomatoes?
You use the board as it is You wipe the board off with a paper towel You wash the board with soap and water You use a different cutting board Paper towel Hot air electrical dryer You leave them to dry on their own Your clothes Top shelf Medium shelf Lowest shelf Yes, but after you put a bandage on it Yes, but after you wear a glove Yes, but after you bandage the sore and wear a glove No, you do not prepare food until the sore heals You reuse the knife as it is You rinse the knife with cold water You wash the knife with soap and water You wipe the knife with a cloth Yes No Not applicable By checking the color By checking the firmness By measuring the temperature at the center By checking the cooking time Egg white is solid and egg yellow is semi-solid Egg white and yellow are semi-solid Egg white and yellow are solid Early in the shopping trip About halfway through the shopping trip At the end of the shopping trip It does not matter You heat it inside a microwave You put it under running water for 1 h You leave it on the kitchen counter for 1 h You leave it in the fridge for few hours Yes No In the fridge In a cool oven In a warm oven On the counter Your face Clean pots and counter Utensils being used in food preparation I do not wash my hands after touching any of the above We dip them in water and salt We wash them with soap We wash them under running water We boil them Daily Weekly Never Only when you wash a food in the sink Soap and water Water only Hand sanitizer I do not wash my hands
7.5% 7.0% 45.6 38.6% 85.9% 7.9% 2.9% 2.1% 56.6% 23.2% 16.2% 33.6% 11.1% 27.4% 26.1% 5.2% 16.0% 74.3% 2.9% 76.3% 21.1% 2.4% 48.9% 34.0% 7.4% 7.0% 29.1% 17.3% 51.7% 7.2% 8.4% 59.7% 22.8% 20.2% 11.3% 38.5% 28.0% 53.5% 45.5% 29.1% 19.2% 37.3% 14.0% 33.9% 10.9% 33.7% 17.9% 26.8% 16.7% 51.4% 3.5% 51.7% 26.9% 7.9% 10.1% 86.7% 4.5% 5.4% 2.5%
(2) On campus, how do you dry your hands after washing them?
(3) In the fridge (not freezer) of your house, where is the raw meat stored? (4) If you have a sore on the back of your hand, do you prepare food?
(5) When you cut raw meat and need to use the knife again, what do you do?
(6) Do you take off the jewelry when preparing the food?
(7) At home, how do you check that a burger is cooked enough?
(8) At home, you fry eggs until the:
(9) During your supermarket shopping, when do you place refrigerated meat in your cart?
(10) At home, how do you defrost frozen meat/chicken?
(11) Do you have a thermometer in your fridge? (12) If your roommate or family member is going to be several hours late for a hot meal, where do you leave the meal? (13) When preparing food, you wash your hands after touching which of these?
(14) At home, how do you treat fresh vegetables?
(15) How often is the kitchen sink drain in your home sanitized?
(16) How do you wash your hands before cooking or eating?
The best practice is highlighted in bold in this Table.
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Table 4 Score distribution to food safety knowledge questions. Questions
Multiple-choice responses
Correct responses
(17) Which of the following scenario for cleaning kitchen counters is the BEST?
Soap, then water, then sanitizer Sanitizer, then water Brush, then sanitizer Water, then drying 10 s 20 s 30 s 40 s True False Baked potato left on the kitchen counter overnight Leftover chicken eaten cold Chocolate cake left on the kitchen counter overnight Slices of pizza left on the counter overnight L18 C 18 C 8 C 0 C 4 C 4 C 12 C 16 C Fruit salad Open can of peas Raisins Chocolate pudding Cook it well Freeze it for 3 days Such food cannot be made safe Don’t know 52 C 71 C 121 C 130 C Bacteria Viruses Parasites Fungi A person with diarrhea A person with severe acne A person with HIV A person with a cold Soft cheeses Raw or undercooked eggs Undercooked hot dogs Canned vegetables Old people Pregnant women Teenagers Cancer patients 5-60 C 20e40 C 40e60 C 30e70 C
78.7% 11.2% 5.9% 3.5% 27.1% 39.0% 24.4% 9.2% 35.0% 64.0% 27.8% 26.3% 32.5% 12.1% 48.5% 4.2% 10.9% 34.2% 17.3% 53.1% 20.4% 6.6% 5.8% 7.5% 78.2% 7.5% 67.6% 7.3% 5.2% 19.3% 19.4% 38.4% 27.3% 8.4% 58.8% 15.7% 8.4% 14.8% 9.4% 18.6% 13.6% 56.0% 36.4% 15.5% 4.6% 41.4% 12.3% 7.3% 66.2% 13.5% 29.0% 40.8% 15.1% 9.2%
(18) While washing your hands, it is enough to rub them for?
(19) Freezing kills harmful germs in food (20) Which food is LEAST likely to cause food poisoning?
(21) What is the recommended temperature for freezers?
(22) What is the recommended temperature for fridges?
(23) Which food does NOT need to be refrigerated?
(24) How can a food be made safe if it has salmonella bacteria in it?
(25) For a burger to be safe to eat, it needs to be cooked until its internal temperature reaches:
(26) The microorganisms that cause most of food-borne illnesses are:
(27) Which of these individuals should NOT prepare food for other people?
(28) Which foods do pregnant women, infants, and children need NOT to avoid?
(29) Which of these individuals are LEAST likely to get food poisoning?
(30) Most disease-causing bacteria can grow within a temperature range between:
The right answer for the knowledge question is highlighted in bold in this Table.
knowledgeable (79%) about the best scenario to clean the kitchen counter; however, only 9% knew that a person with diarrhea should not prepare food for others. A comparison between the findings of our study with those of similar questions used by Lazou et al. (2012) among Greek university students are presented in Table 5. Lebanese university students outperformed the Greeks in the food storage practice questions, cleaning and hygiene practice questions and food cooking knowledge questions; however, the Greeks outperformed in the cross-contamination practice questions and food storage knowledge questions. Overall food handling practices and food safety knowledge scores were almost similar. Same comparison was done with the scores reported by Osaili et al. (2011) among Jordanian university students on similar questions used in our study (Table 6). It was found that Lebanese
students outperformed their Jordanian counterparts in the overall food handling score. The bivariate analysis showed that food handling practices and food safety knowledge scores were significantly (p < 0.001) related; however, the correlation was moderate to weak (R ¼ 0.231). Such findings highlights the importance of including food safety modules within the science courses (Lazou et al., 2012). 4. Concluding remarks The low awareness of food safety reported by Lebanese university studies contributes, at the short term, to higher consumption of risky foods and thus, higher susceptibility to food poisoning. On the other hand, at the long term, this lack of food safety awareness will increase the likelihood of foodborne illnesses in the
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Table 5 Comparison of food handling and safety practices and knowledge between Lebanese and Greek university students. Best answer
Food handling practice question Cross-contamination At home, what is best practiced after using a cutting board to slice raw meat and needing to cut tomatoes? When you cut raw meat and need to use the knife again, what do you do? In the fridge (not freezer) of your house, where is the raw meat stored? If you have a sore on the back of your hand, do you prepare food?
Food storage
Average During your supermarket shopping, when do you place refrigerated meat in your cart? At home, how do you defrost frozen meat/chicken?
Do you have a thermometer in your fridge? If your roommate or family member is going to be several hours late for a hot meal, where do you leave the meal? Average Cleaning and hygiene How do you wash your hands before cooking or eating? How often is the kitchen sink drain in your home sanitized? When preparing food, you wash your hands after touching which of these? Average Food handling practice overall average Food safety knowledge question Food cooking For a burger to be safe to eat, it needs to be cooked until its internal temperature reaches: How can a food be made safe if it has salmonella bacteria in it? Average Food storage Which food is LEAST likely to cause food poisoning?
What is the recommended temperature for fridges? Freezing kills harmful germs in food Average Food safety knowledge overall average
home as this target group will act as a parent and food handler. This study showed that there was strong association between demographic information and the self-reported food handling practices and food safety knowledge among Lebanese university
Scores (%) Lebanon (our study)
Greece
46
61
74
67
16 27
23 20
41 60
43 55
28
25
54 29
42 28
43 87 52 34 58 46
38 97 21 39 52 43
71 C
38
21
Cook it well
68 53 33
53 37 55
53 64 50 51
44 78 59 50
You wash the board with soap and water You wash the knife with soap and water Lowest shelf Yes, but after you bandage the sore and wear a glove At the end of the shopping trip You leave it in the fridge for few hours Yes In the fridge
Soap and water Daily Your face
Chocolate cake left on the kitchen counter overnight 4 C FALSE
students, which conforms to the findings of previous studies. The data gathered from this study have revealed the high need for food safety education among young adults on topics related to food temperature control, proper food preparation practices, prevention
Table 6 Comparison of food handling between Lebanese and Jordanian university students. Question
If you have a sore on the back of your hand, do you prepare food? During your supermarket shopping, when do you place refrigerated meat in your cart? What is the recommended temperature for freezers? At home, how do you check that a burger is cooked enough? Which food does NOT need to be refrigerated? Which of the following scenario for cleaning kitchen counters is the BEST? If your roommate or family member is going to be several hours late for a hot meal, where do you leave the meal? How often is the kitchen sink drain in your home sanitized? Which foods do pregnant women, infants, and children need NOT to avoid? When preparing food, you wash your hands after touching which of these? For a burger to be safe to eat, it needs to be cooked until its internal temperature reaches: How can a food be made safe if it has salmonella bacteria in it? Which food is LEAST likely to cause food poisoning? What is the recommended temperature for fridges? Freezing kills harmful germs in food Average
Best answer
Scores (%) Lebanon (our study)
Jordan
Yes, but after you bandage the sore and wear a glove At the end of the shopping trip
27 60
23 74
18 C By measuring the temperature at the center Raisins Soap, then water, then sanitizer
49 7 78 79
21 8 46 31
In the fridge
29
50
Daily Canned vegetables
52 41
82 26
Your face
34
51
71 C
38
33
Cook it well Chocolate cake left on the kitchen counter overnight 4 C FALSE
68 33 53 64 47
44 33 34 52 41
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of cross contamination, suitable cleaning and hygiene procedures, high risk groups, and other contributing factors to foodborne diseases and prevention strategies. The university setting would be the perfect place to reach out this target group. References Abbot, J. M., Byrd-Bredbenner, C., Schaffne, D., Bruhn, C. M., & Blalock, L. (2009). Comparison of food safety cognitions and self-reported food-handling behaviors with observed food safety behaviors of young adults. European Journal of Clinical Nutrition, 63, 572e579. Bruhn, C. M., & Schutz, H. G. (1999). Consumer food safety knowledge and practices. Journal of Food Safety, 19, 73e87. Byrd-Bredbenner, C., Maurer, J., Wheatley, V., Schaffner, D., Bruhn, C., & Blalock, L. (2007). Food safety self-reported behaviors and cognitions of young adults: results of a national study. Journal of Food Protection, 70, 1917e1926. Byrd-Bredbenner, C., Abbot, J. M., Wheatley, V., Schaffner, D., Bruhn, C., & Blalock, L. (2008). Risky eating behaviours of young adults-implications for food safety education. Journal of the American Dietetic Association, 108, 549e552. EFSA. (2011). The European Union summary report on trends and sources of zoonoses, zoonotic agents and food-borne outbreaks in 2009. EFSA Journal, 9, 2090. Frewer, L. J., Shepherd, R., & Sparks, P. (1994). The interrelationship between perceived knowledge and risk associated with a range of food-related hazards targeted at the individual, other people and society. Journal of Food Safety, 14, 19e40. Garayoa, R., Córdoba, M., García-Jalón, I., Sanchez-Villegas, A., & Vitas, A. I. (2005). Relationship between consumer food safety knowledge and reported behavior among students from health sciences in one region of Spain. Journal of Food Protection, 68, 2631e2636. Gettings, M. A., & Kiernan, N. E. (2001). Practices and perceptions of food safety among seniors who prepare meals at home. Journal of Nutritional Education, 33, 148e154.
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Kennedy, J., Jackson, V., Cowan, C., Blair, I. S., McDowell, D. A., & Bolton, D. J. (2005). Consumer food safety knowledge. Segmentation of Irish home food preparers based on food safety knowledge and practice. British Food Journal, 107, 441e452. Lazou, T., Georgiadis, M., Pentieva, K., McKevitt, A., & Iossifidou, E. (2012). Food safety knowledge and food-handling practices of Greek university students: a questionnaire-based survey. Food Control, 28, 400e411. Li-Cohen, A. E., & Bruhn, C. M. (2002). Safety of consumer handling of fresh produce from the time of purchase to the plate: a comprehensive consumer survey. Journal of Food Protection, 65, 1287e1296. McArthur, L., Holbert, D., & Forsythe, W. (2007). College students and awareness of food safety. Journal of Family and Consumer Sciences, 99, 60e68. Medeiros, L. C., Hillers, V. N., Chen, G., Bergmann, V., Kednall, P., & Schroeder, M. (2004). Design and development of food safety knowledge and attitude scales for consumer food safety education. Journal of the American Dietetic Association, 104, 1671e1677. Morris, J. (2011). How safe is our food? Emerging Infectious Diseases, 17(1). www.cdc. gov/eid. Morrone, M., & Rathburn, A. (2003). Health education and food safety behavior in the university setting. Journal of Environmental Health, 65, 9e15. Osaili, T. M., Obeidat, B. A., Abu Jamous, D. O., & Bawadi, H. A. (2011). Food safety knowledge and practices among college female students in north of Jordan. Food Control, 22, 269e276. Redmond, E. C., & Griffith, C. J. (2003). Consumer food handling in the home: a review of food safety studies. Journal of Food Protection, 66, 130e161. Sanlier, N. (2009). The knowledge and practice of food safety by young and adult consumers. Food Control, 20, 538e542. Sharif, L., & Al-Malki, T. (2010). Knowledge, attitude and practice of Taif University students on food poisoning. Food Control, 21, 55e60. Unklesbay, N., Sneed, J., & Toma, R. (1998). College students’ attitudes, practices, and knowledge of food safety. Journal of Food Protection, 61, 1175e1180. WHO. (2007). Food safety and foodborne illness. Fact sheet No. 237, available from http://www.who.int/mediacentre/factsheets/fs237/en/index.html Accessed 18.04.10.
Contents lists available at ScienceDirect
Food Control journal homepage: www.elsevier.com/locate/foodcont
Food safety and handling knowledge and practices of Lebanese university students Hussein F. Hassan a, *, Hani Dimassi b a b
Lebanese American University, Department of Natural Sciences, Beirut, Lebanon Lebanese American University, School of Pharmacy, Byblos, Lebanon
a r t i c l e i n f o
a b s t r a c t
Article history: Received 18 September 2013 Received in revised form 18 November 2013 Accepted 26 November 2013
The aim of this study was to assess the level of food safety handling knowledge and practices among 1172 Lebanese university students (mean age 20.0 1.6 SD) and to explore the association between their knowledge/practices and the socio-demographic and academic characteristics. Participants were undergraduate students enrolled in the Lebanese American University from different majors and years of study, from different areas of residence, living alone or with others, and having working or non-working mothers. They completed a questionnaire of 16 food handling practices and 14 food safety knowledge questions related to preparation, cross-contamination, storage and hygiene. On average, the students scored 53.6 15.8% and 44.7 14.3% on the knowledge and practices parts, respectively. Female students scored higher on both practices and knowledge questions than male students; however, the difference was significant (p < 0.001) for the practices part only. Health-related majors scored significantly (p 0.001) better on both practices and knowledge questions. Senior students scored highest on the knowledge questions, followed by juniors, sophomores and finally freshmen and the difference was borderline significant (p ¼ 0.07). The area of residence had a significant (p ¼ 0.006) effect on the food safety practices questions. Students living with parents scored higher in both knowledge and practices parts than those living alone or with roommates; however, the difference was significant (p ¼ 0.009) in the knowledge part only. Students who cook all the time showed a significant (p ¼ 0.001) lower difference in terms of their food safety knowledge compared to those who cook less frequently. Food handling practices and food safety knowledge scores were significantly (p < 0.001) related with a weak to moderate correlation coefficient (R ¼ 0.231). Our results confirm the need for ongoing educational initiatives to improve the relatively low food awareness among the Lebanese young adults group. Ó 2014 Elsevier Ltd. All rights reserved.
keywords: Food safety Knowledge Practices University students Lebanon Questionnaire
1. Introduction Food-borne diseases or food poisoning represent a growing public health problem of prime interest all over the world (Morris, 2011). Even in societies with highly developed food safety systems, such as the “farm-to-fork” in Europe and the “farm-to-table” in USA, a “weak link” can cause significant morbidity and mortality from foodborne illness (EFSA, 2011; Lazou, Georgiadis, Pentieva, McKevitt, & Iossifidou, 2012). Although this problem has more effect on economy and health of developing countries, reliable data is not widely available (WHO, 2007). The global incidence of foodborne diseases is hard to estimate, but it has been reported that around 1.8 million people die every year from diarrheal diseases, mostly due to food and drinking water contamination (WHO,
* Corresponding author. E-mail address: [email protected] (H.F. Hassan). 0956-7135/$ e see front matter Ó 2014 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.foodcont.2013.11.040
2007). In USA, one person in three may be affected by foodborne illness each year and recently, this percentage is increasing due to significant changes in industrialization of animal production, mass production in food processing and distribution, globalization of food trade, and increase number of tourists around the world (Sharif & Al-Malki, 2010). On the other hand, more than 95% of food poisoning cases are sporadic, their incidences are small and they originate at home (EFSA, 2011), which highlights the fact that domestic food handler is a critical link in the food chain. Without whom, all the regulatory efforts may be ineffective, if they are not complemented by safe food purchase, preparation, cooking and handling in private homes (Kennedy et al., 2005). There are a number of literature reporting that food handlers of all ages think that they know how to handle food safely, but their self-reported food handling behaviors do not support this assumption (Bruhn & Schutz, 1999; Frewer, Shepherd, & Sparks, 1994; Gettings & Kiernan, 2001; Redmond & Griffith, 2003). Food mishandling is more common in some consumer groups than in
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others (Byrd-Bredbenner et al., 2007; Sanlier, 2009). Young adults (18e29 years old), men and individuals with education further than high school are more likely to have risky food handling than others (Li-Cohen & Bruhn, 2002; McArthur, Holbert, & Forsythe, 2007; Medeiros et al., 2004). This age group (18e29 years old) is not considered to be “at risk” for foodborne illness; however, the consequence of their unhygienic food practices becomes serious when they start providing care for other household members who are at risk, such as pregnant women, young children and ageing adults (Abbot, Byrd-Bredbenner, Schaffne, Bruhn, & Blalock, 2009; Byrd-Bredbenner et al., 2008). Few research about food safety handling and practices among young adults in universities has been recently published. A recent study showed that more than 50% of the Saudi college students consumed raw eggs and raw white cheese and 34% believed that there is no risk of food poisoning from eating cooked food kept at room temperature for one day if covered (Sharif & Al-Malki, 2010). About one third of USA college students reported eating fried eggs with soft yolks, and about the half reported eating raw cookie dough, and undercooked chicken and hamburger (ByrdBredbenner et al., 2007; Morrone & Rathburn, 2003). In Turkey, half of young consumers did not know that checking the internal temperature of the food is the safest way to know if the meat was cooked well (Sanlier, 2009). Garayoa, Córdoba, García-Jalón, Sanchez-Villegas, and Vitas (2005) reported that 13.5% only of Spanish university students washed their hands with soap and water before and during food preparation and 38.6% used safe methods. Lazou et al. (2012) reported a 44% score on food safety practices among Greek university students. To the best of our knowledge, information about Lebanese university students in terms of their food safety knowledge and practices has not been studied previously; therefore, this study focused on assessing the self-reported food safety practices and knowledge of university students from health and non-healthrelated fields in the Lebanese American University (LAU). Another focal objective was to explore any relationships between the food safety awareness and demographic characteristics. Such information would be used for health promotion, adoption of legislation and use of appropriate tools to increase knowledge, and changing inaccurate beliefs and wrong practices related to food habits.
inappropriately filled questionnaires were excluded. Out of 1172 filled questionnaire forms, only 932 (79.5%) were valid. 2.2. Questionnaire In order to assess the food safety and handling knowledge and practices of students in both campuses (Beirut and Byblos) of the Lebanese American University (LAU), a questionnaire was developed by including questions selected from an updated, reliable, and valid instrument produced by Byrd-Bredbenner et al. (2007) and used in similar studies done in Jordan (Osaili, Obeidat, Abu Jamous, & Bawadi, 2011) and Greece (Lazou et al., 2012). Necessary modifications were made to some of the selected questions to reflect specific eating habits in Lebanon. A pilot study (35 students) was made to get a preliminary validation of the questionnaire. The clarity and suitability of wording, in addition to the average time needed for its completion were assessed. Then, necessary modifications were made and its results were not included in the data analysis. The questionnaire took around 12 min to be completed. It consisted of four parts: an introduction, demographic characteristics, foodhandling practices, and food safety knowledge questions. The demographic characteristics included gender, age, major and year of study, campus, residential area and status, involvement in cooking and parental employment. Food handling practices section included 16 questions, while the food safety knowledge section included 14 questions. Most of the items were multiple-choice questions. 2.3. Statistical analysis SPSS v18 Statistical computer software was used for all statistical analyses. The demographic characteristics represented the independent variables. Food-safety and handling knowledge and practices outcomes derived from the questionnaire represented the dependent variables. Each multiple-choice item had one correct answer that was assigned the score of 1 point; whereas, 0 point was assigned to all wrong answers. Student t test and Analysis of Variance (ANOVA) was conducted to compare the mean sum of correct responses of every section by gender, age, residential area, major of study, year of study, mother employment, living status and cooking habits. Significance level of 0.05 was used.
2. Materials and methods
3. Results and discussion
2.1. Study population
A total of 1172 undergraduate students participated in the study; 59% females and 41% males. The study sample included 18% of students from health-related majors (nutrition, biology, chemistry, nursing and pharmacy) and 77% from non-health related majors (arts, engineering and business) (Table 1). The mean student age was 20 (SD ¼ 1.7). Four percent of them were freshmen, 39% were sophomores, 30% were juniors, and 26% were seniors. Around 79% of the subjects lived with parents. Only 6% of the students reported that they cook their own meals all the time. 44% of the subjects had a working mother. The overall food-handling practices score was the sum of correct responses in the “food handling practices” section for each student and its mean value was 44.7% (SD ¼ 14.2). The mean score and the significance levels for each variable are presented in Table 2. In terms of food handling, female students scored significantly (p < 0.001) better than male students. Also, subjects majoring in health-related fields scored significantly (p < 0.001) better than non-health related ones. In addition, the residence area had a significant (p ¼ 0.006) effect with Aley/Shouf scoring the highest, while Batroun/Koura the lowest. Moreover, students having working mothers scored better than those whose mothers are housewives and the significance was borderline (p ¼ 0.05). On the
The study was conducted from November until May 2013 and the sample was comprised of 1172 students enrolled in both campuses (Beirut and Byblos) of the Lebanese American University (LAU) and selected randomly from different majors and years of study (sophomore, junior and senior). The Lebanese American University is a leading, non-sectarian, private higher education institution in Lebanon. In the fall 2012 semester, LAU had more than 8100 students enrolled. Before administering the questionnaire, a verbal explanation of the questionnaire and its content were given to the instructors of the selected classes during programmed meetings, and their approval was obtained. The selected classes were NUT201 (Fundamental of Nutrition) and HLT201 (Basic Health) since it was found that students registered in them represent LAU students in terms of the distribution of gender, major and year of study, according to figures obtained from the Registrar Office. Questionnaires were distributed to all students in classrooms to be completed towards the end of the lecture. The completion of the questionnaire was voluntary and anonymous, and no extra credit was given. Approval of the study was granted by the Committee on Human Subjects in Research at LAU. Incomplete or
H.F. Hassan, H. Dimassi / Food Control 40 (2014) 127e133 Table 1 Demographic characteristics of the study population (N ¼ 1172). Demographic variables Gender Age group Field of study Year of study
Campus Residential status
Residential area
Cooking habits
Maternal employment
% Male Female 18e20 21e23 Health-related Non health-related Freshman Sophomore Junior Senior Beirut Byblos Family With a roommate Alone Beirut and suburbs Metn Jbeil and Keserwan Cook all the time Sometimes Rarely Never Works Housewife
40.6 59.2 68.9 28.8 17.8 77.2 3.8 39.2 29.8 26.2 80.0 19.9 78.6 9.6 11.0 70.0 7.3 10.3 5.6 33.4 32.7 28.0 43.9 56.6
Table 2 Mean scores food handling practice and food safety knowledge sections per demographic characteristics. Demographic variable
Age
18 19 20 21 22 23 Gender Male Female Major of study Health-related Engineering Arts & humanities Business Year of study Freshman Sophomore Junior Senior Campus Beirut Byblos Residence area Beirut & suburbs Matn Kesrwan Jbeil Batroun & Koura Tripoli Saida & Tyr Aley & Shouf Residential Parents status Friends/ roommates Alone Cooking All the time habits Sometimes Rarely Never Maternal Works employment Housewife
Food handling practices
Food safety knowledge
Mean SDa Sig.
Mean SD Sig.
45.8 45.9 44.1 42.9 44.6 45.3 42.4 46.4 48.8 42.9 42.8 44.4 41.6 44.8 44.8 45.3 44.5 45.8 44.1 46.2 50.0 47.1 32.3 40.2 44.5 53.1 45.0 44.3
13.2 14.4 14.4 13.6 15.1 15.0 13.8 14.3 13.3 13.8 15.3 14.2 13.7 13.9 14.7 14.1 13.8 15.1 14.1 14.6 14.3 13.1 19.1 15.8 13.3 15.4 14.3 15.1
0.440 55.6 53.8 53.3 54.3 49.6 54.8 <0.001 52.5 54.4 <0.001 57.7 52.8 50.3 53.5 0.655 49.5 52.4 54.1 55.5 0.251 53.3 54.5 0.006 53.0 57.8 55.3 53.4 66.7 54.5 58.0 54.8 0.909 54.4 48.6
13.5 15.1 17.7 14.7 17.0 15.8 16.2 15.4 14.5 16.2 15.0 16.1 18.9 15.5 15.9 15.5 16.0 15.1 15.8 13.8 15.3 15.3 10.8 10.1 17.5 11.9 15.2 20.0
44.6 43.5 45.6 44.9 44.1 46.2 44.1
12.7 15.7 14.3 13.8 14.1 13.9 14.3
53.4 0.605 46.4 53.0 55.7 53.8 0.05 55.0 53.0
14.6 17.9 0.001 16.4 15.1 14.6 14.8 0.09 16.1
0.143
0.106 0.001
0.07
0.316 0.108
0.009
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other hand, age, year of study, campus, residential status and cooking habits were not significantly associated with practice and knowledge scores (p > 0.05). The mean food-safety knowledge score was 53.6% (SD ¼ 15.7). The mean score and the significance levels for each variable are presented in Table 2. Female students scored better than male students; however, the difference was not significant (p ¼ 0.106). Subjects majoring in health-related fields scored significantly (p ¼ 0.001) better than non-health related ones. The higher the year of study, the higher the knowledge score was. Senior students scored the highest, followed by juniors, sophomores and freshmen and the difference was border line significant (p ¼ 0.07). Students living with parents scored significantly (p ¼ 0.09) higher than those living alone or with friends. Subjects who cook all the time scored significantly (p ¼ 0.001) lower than those who cook less frequently or never. Students who have working mothers scored higher than those having non-working mothers; however, the difference was not significant (p > 0.05). On the other hand, the effect of age, campus, residential status and campus was not significant (p > 0.05). Our study presents insights into the self-reported food-handling practices and food safety knowledge among Lebanese university students. The responses of the participants showed low levels of food safety knowledge (53.6%) and poor adherence to the correct food-handling practices (44.8%). This insufficient lack of food safety awareness was also observed in previous similar studies (Abbot et al., 2009; Byrd-Bredbenner et al., 2007; Garayoa et al., 2005; Lazou et al., 2012; Osaili et al., 2011; Sharif & Al-Malki, 2010; Unklesbay, Sneed, & Toma, 1998). For instance, despite methodological differences, Lazou et al. (2012) reported that the mean scores of food safety knowledge and food handling practices among Greek university students were 60% and 44%. On the other hand, Byrd-Bredbenner et al. (2007) found the mean scores of approximately 60% and 50%, respectively, among American students. Students from health-related majors (Nutrition, Chemistry, Biology, Nursing and Pharmacy) reported the highest average food handling practices (48.8%) and food safety knowledge (57.7%) scores (Table 2). The difference between these students and their counterparts in the engineering, arts and humanities, and business majors was significant (p < 0.05) for both food handling practices and food safety knowledge parts. This could be due to the presence of modules and courses relevant to food safety, hygiene and microbiology in the curricula of health-related majors. A similar finding was reported by Byrd-Bredbenner et al., 2007; Garayoa et al., 2005; Lazou et al., 2012; Osaili et al., 2011; Sharif & AlMalki, 2010; Unklesbay et al., 1998. Senior students reported higher food safety knowledge scores (55.5%), followed by junior (54.1%), sophomore (52.4%) and freshman (49.5%) ones and the difference was borderline significant (p ¼ 0.07) (Table 2). Previous surveys reported similar findings in terms of higher scores among senior students. This can be attributed to the fact that as the student, especially in the health-related majors, stays longer in the major; he covers more aspects of food safety (Byrd-Bredbenner et al., 2007; Garayoa et al., 2005; Lazou et al., 2012; Osaili et al., 2011; Sharif & Al-Malki, 2010; Unklesbay et al., 1998). Male and female students were equally (w54%) knowledgeable in terms of food safety knowledge (Table 2); however, female participants responded significantly (p < 0.001) better (46%) than males (42%) in terms of food safety practices. This could be due to the fact that, in Lebanon, females are traditionally in charge of the kitchen hygiene and cleaning. This conforms to the findings from previous studies, in which female outperformed male university students (Byrd-Bredbenner et al., 2007; Lazou et al., 2012; Unklesbay et al., 1998). Students living with their parents scored better (Table 2) than those living alone or with friends or roommates; however, the
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difference was only significant (p ¼ 0.009) for the food safety knowledge questions. This can be attributed to the fact that when the student lives with his parents, someone else, who is more experienced (mother or maid), will handle the food preparation, resulting in a better food handling and an opportunity for the student to observe and learn more about food safety. Participants whose mother is a housewife scored lower in both food handling practices and food safety knowledge questions (Table 2); however, the difference was borderline significant (p ¼ 0.05) for the food handling practices part only. This can be due to the fact that, in Lebanon, working mothers tend to be more
educated than housewives and therefore, they could have acquired the food safety basics from their studies or readings. Detailed scores on the food handling practices and food safety knowledge questions are presented in Tables 3and 4, respectively. In the food handling practices section, the highest score was for the hand washing; 87% of the participants reported that they wash their hands with soap and water before eating or preparing food. On the other hand, the lowest score was for how to check that a burger is enough cooked; only 7% of the participants reported that they use a thermometer to check the temperature at the center. In the food safety knowledge section, students were mostly
Table 3 Score distribution to food handling practices questions. Questions
Multiple-choice responses
Correct responses
(1) At home, what is best practiced after using a cutting board to slice raw meat and needing to cut tomatoes?
You use the board as it is You wipe the board off with a paper towel You wash the board with soap and water You use a different cutting board Paper towel Hot air electrical dryer You leave them to dry on their own Your clothes Top shelf Medium shelf Lowest shelf Yes, but after you put a bandage on it Yes, but after you wear a glove Yes, but after you bandage the sore and wear a glove No, you do not prepare food until the sore heals You reuse the knife as it is You rinse the knife with cold water You wash the knife with soap and water You wipe the knife with a cloth Yes No Not applicable By checking the color By checking the firmness By measuring the temperature at the center By checking the cooking time Egg white is solid and egg yellow is semi-solid Egg white and yellow are semi-solid Egg white and yellow are solid Early in the shopping trip About halfway through the shopping trip At the end of the shopping trip It does not matter You heat it inside a microwave You put it under running water for 1 h You leave it on the kitchen counter for 1 h You leave it in the fridge for few hours Yes No In the fridge In a cool oven In a warm oven On the counter Your face Clean pots and counter Utensils being used in food preparation I do not wash my hands after touching any of the above We dip them in water and salt We wash them with soap We wash them under running water We boil them Daily Weekly Never Only when you wash a food in the sink Soap and water Water only Hand sanitizer I do not wash my hands
7.5% 7.0% 45.6 38.6% 85.9% 7.9% 2.9% 2.1% 56.6% 23.2% 16.2% 33.6% 11.1% 27.4% 26.1% 5.2% 16.0% 74.3% 2.9% 76.3% 21.1% 2.4% 48.9% 34.0% 7.4% 7.0% 29.1% 17.3% 51.7% 7.2% 8.4% 59.7% 22.8% 20.2% 11.3% 38.5% 28.0% 53.5% 45.5% 29.1% 19.2% 37.3% 14.0% 33.9% 10.9% 33.7% 17.9% 26.8% 16.7% 51.4% 3.5% 51.7% 26.9% 7.9% 10.1% 86.7% 4.5% 5.4% 2.5%
(2) On campus, how do you dry your hands after washing them?
(3) In the fridge (not freezer) of your house, where is the raw meat stored? (4) If you have a sore on the back of your hand, do you prepare food?
(5) When you cut raw meat and need to use the knife again, what do you do?
(6) Do you take off the jewelry when preparing the food?
(7) At home, how do you check that a burger is cooked enough?
(8) At home, you fry eggs until the:
(9) During your supermarket shopping, when do you place refrigerated meat in your cart?
(10) At home, how do you defrost frozen meat/chicken?
(11) Do you have a thermometer in your fridge? (12) If your roommate or family member is going to be several hours late for a hot meal, where do you leave the meal? (13) When preparing food, you wash your hands after touching which of these?
(14) At home, how do you treat fresh vegetables?
(15) How often is the kitchen sink drain in your home sanitized?
(16) How do you wash your hands before cooking or eating?
The best practice is highlighted in bold in this Table.
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Table 4 Score distribution to food safety knowledge questions. Questions
Multiple-choice responses
Correct responses
(17) Which of the following scenario for cleaning kitchen counters is the BEST?
Soap, then water, then sanitizer Sanitizer, then water Brush, then sanitizer Water, then drying 10 s 20 s 30 s 40 s True False Baked potato left on the kitchen counter overnight Leftover chicken eaten cold Chocolate cake left on the kitchen counter overnight Slices of pizza left on the counter overnight L18 C 18 C 8 C 0 C 4 C 4 C 12 C 16 C Fruit salad Open can of peas Raisins Chocolate pudding Cook it well Freeze it for 3 days Such food cannot be made safe Don’t know 52 C 71 C 121 C 130 C Bacteria Viruses Parasites Fungi A person with diarrhea A person with severe acne A person with HIV A person with a cold Soft cheeses Raw or undercooked eggs Undercooked hot dogs Canned vegetables Old people Pregnant women Teenagers Cancer patients 5-60 C 20e40 C 40e60 C 30e70 C
78.7% 11.2% 5.9% 3.5% 27.1% 39.0% 24.4% 9.2% 35.0% 64.0% 27.8% 26.3% 32.5% 12.1% 48.5% 4.2% 10.9% 34.2% 17.3% 53.1% 20.4% 6.6% 5.8% 7.5% 78.2% 7.5% 67.6% 7.3% 5.2% 19.3% 19.4% 38.4% 27.3% 8.4% 58.8% 15.7% 8.4% 14.8% 9.4% 18.6% 13.6% 56.0% 36.4% 15.5% 4.6% 41.4% 12.3% 7.3% 66.2% 13.5% 29.0% 40.8% 15.1% 9.2%
(18) While washing your hands, it is enough to rub them for?
(19) Freezing kills harmful germs in food (20) Which food is LEAST likely to cause food poisoning?
(21) What is the recommended temperature for freezers?
(22) What is the recommended temperature for fridges?
(23) Which food does NOT need to be refrigerated?
(24) How can a food be made safe if it has salmonella bacteria in it?
(25) For a burger to be safe to eat, it needs to be cooked until its internal temperature reaches:
(26) The microorganisms that cause most of food-borne illnesses are:
(27) Which of these individuals should NOT prepare food for other people?
(28) Which foods do pregnant women, infants, and children need NOT to avoid?
(29) Which of these individuals are LEAST likely to get food poisoning?
(30) Most disease-causing bacteria can grow within a temperature range between:
The right answer for the knowledge question is highlighted in bold in this Table.
knowledgeable (79%) about the best scenario to clean the kitchen counter; however, only 9% knew that a person with diarrhea should not prepare food for others. A comparison between the findings of our study with those of similar questions used by Lazou et al. (2012) among Greek university students are presented in Table 5. Lebanese university students outperformed the Greeks in the food storage practice questions, cleaning and hygiene practice questions and food cooking knowledge questions; however, the Greeks outperformed in the cross-contamination practice questions and food storage knowledge questions. Overall food handling practices and food safety knowledge scores were almost similar. Same comparison was done with the scores reported by Osaili et al. (2011) among Jordanian university students on similar questions used in our study (Table 6). It was found that Lebanese
students outperformed their Jordanian counterparts in the overall food handling score. The bivariate analysis showed that food handling practices and food safety knowledge scores were significantly (p < 0.001) related; however, the correlation was moderate to weak (R ¼ 0.231). Such findings highlights the importance of including food safety modules within the science courses (Lazou et al., 2012). 4. Concluding remarks The low awareness of food safety reported by Lebanese university studies contributes, at the short term, to higher consumption of risky foods and thus, higher susceptibility to food poisoning. On the other hand, at the long term, this lack of food safety awareness will increase the likelihood of foodborne illnesses in the
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Table 5 Comparison of food handling and safety practices and knowledge between Lebanese and Greek university students. Best answer
Food handling practice question Cross-contamination At home, what is best practiced after using a cutting board to slice raw meat and needing to cut tomatoes? When you cut raw meat and need to use the knife again, what do you do? In the fridge (not freezer) of your house, where is the raw meat stored? If you have a sore on the back of your hand, do you prepare food?
Food storage
Average During your supermarket shopping, when do you place refrigerated meat in your cart? At home, how do you defrost frozen meat/chicken?
Do you have a thermometer in your fridge? If your roommate or family member is going to be several hours late for a hot meal, where do you leave the meal? Average Cleaning and hygiene How do you wash your hands before cooking or eating? How often is the kitchen sink drain in your home sanitized? When preparing food, you wash your hands after touching which of these? Average Food handling practice overall average Food safety knowledge question Food cooking For a burger to be safe to eat, it needs to be cooked until its internal temperature reaches: How can a food be made safe if it has salmonella bacteria in it? Average Food storage Which food is LEAST likely to cause food poisoning?
What is the recommended temperature for fridges? Freezing kills harmful germs in food Average Food safety knowledge overall average
home as this target group will act as a parent and food handler. This study showed that there was strong association between demographic information and the self-reported food handling practices and food safety knowledge among Lebanese university
Scores (%) Lebanon (our study)
Greece
46
61
74
67
16 27
23 20
41 60
43 55
28
25
54 29
42 28
43 87 52 34 58 46
38 97 21 39 52 43
71 C
38
21
Cook it well
68 53 33
53 37 55
53 64 50 51
44 78 59 50
You wash the board with soap and water You wash the knife with soap and water Lowest shelf Yes, but after you bandage the sore and wear a glove At the end of the shopping trip You leave it in the fridge for few hours Yes In the fridge
Soap and water Daily Your face
Chocolate cake left on the kitchen counter overnight 4 C FALSE
students, which conforms to the findings of previous studies. The data gathered from this study have revealed the high need for food safety education among young adults on topics related to food temperature control, proper food preparation practices, prevention
Table 6 Comparison of food handling between Lebanese and Jordanian university students. Question
If you have a sore on the back of your hand, do you prepare food? During your supermarket shopping, when do you place refrigerated meat in your cart? What is the recommended temperature for freezers? At home, how do you check that a burger is cooked enough? Which food does NOT need to be refrigerated? Which of the following scenario for cleaning kitchen counters is the BEST? If your roommate or family member is going to be several hours late for a hot meal, where do you leave the meal? How often is the kitchen sink drain in your home sanitized? Which foods do pregnant women, infants, and children need NOT to avoid? When preparing food, you wash your hands after touching which of these? For a burger to be safe to eat, it needs to be cooked until its internal temperature reaches: How can a food be made safe if it has salmonella bacteria in it? Which food is LEAST likely to cause food poisoning? What is the recommended temperature for fridges? Freezing kills harmful germs in food Average
Best answer
Scores (%) Lebanon (our study)
Jordan
Yes, but after you bandage the sore and wear a glove At the end of the shopping trip
27 60
23 74
18 C By measuring the temperature at the center Raisins Soap, then water, then sanitizer
49 7 78 79
21 8 46 31
In the fridge
29
50
Daily Canned vegetables
52 41
82 26
Your face
34
51
71 C
38
33
Cook it well Chocolate cake left on the kitchen counter overnight 4 C FALSE
68 33 53 64 47
44 33 34 52 41
H.F. Hassan, H. Dimassi / Food Control 40 (2014) 127e133
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