Food safety knowledge, sources thereof and self-reported behaviour among university students in Sweden

Journal Pre-proof Food safety knowledge, sources thereof and self-reported behaviour among university students in Sweden Ingela Marklinder, Roger Ahlgren, Anna Blücher, Stina-Mina Ehn Börjesson, Frida Hellkvist, Madeleine Moazzami, Jenny Schelin, Elin Zetterström, Gustaf Eskhult, Marie-Louise Danielsson-Tham PII:

S0956-7135(20)30046-3

DOI:

https://doi.org/10.1016/j.foodcont.2020.107130

Reference:

JFCO 107130

To appear in:

Food Control

Received Date: 8 November 2019 Revised Date:

17 January 2020

Accepted Date: 18 January 2020

Please cite this article as: Marklinder I., Ahlgren R., Blücher A., Ehn Börjesson S.-M., Hellkvist F., Moazzami M., Schelin J., Zetterström E., Eskhult G. & Danielsson-Tham M.-L., Food safety knowledge, sources thereof and self-reported behaviour among university students in Sweden, Food Control (2020), doi: https://doi.org/10.1016/j.foodcont.2020.107130. This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. © 2020 Published by Elsevier Ltd.

Date 2020-01-20

Title page and author group with affiliations Ingela Marklinder Lektor / FD, docent Senior lecturer / PhD

Reference for article: JFCO 107130, Title:

Institutionen för kostvetenskap Department of food studies, nutrition and dietetics Box 560 SE-751 22 Uppsala Besöksadress/Visiting address: BMC / Husargatan 3 751 22 Uppsala Telefon/Phone: 018-471 23 12 +46 18 471 23 12 Telefax/Fax: 018-471 22 61 +46 18 471 22 61 www.ikv.uu.se [email protected]

Food safety knowledge, sources thereof and self-reported behavour among university students in Sweden Authors and affiliations: Ingela Marklinder, Associate professor Department of Food Studies, Nutrition and Dietetics Uppsala University S-751 22 Uppsala Tel: (+46) 18 471 23 12 E-mail: [email protected] Roger Ahlgren Department of Food, Nutrition and Culinary Science Umeå University SE-901 87 Umeå, Sweden Tel: +46 90 786 6542, +46 70 3956 382 E-mail: [email protected] Anna Blücher Senior lecturer Faculty of Health and Life Science Linnaeus University 391 82 Kalmar [email protected]

Stina-Mina Ehn Börjesson Faculty of Natural Science Kristianstad University, 291 88 Kristianstad, Sweden Tel: (+46) 706239711 E-mail: [email protected]

Frida Hellkvist Department of Food Studies, Nutrition and Dietetics Uppsala University S-751 22 Uppsala Tel: (+46) 707948425 E-mail: [email protected]

Organisationsnr: 202100-2932

2(3)

Madeleine Moazzami Department of Biomedicine and Veterinary Public Health, division Food Safety, Swedish University of Agricultural Sciences, 750 07 Uppsala, Sweden Tel: (+46) 018-67 23 17 E-mail: [email protected] Jenny Schelin Division of Applied Microbiology Department of Chemistry Lund University Lund, Sweden Tel: (+46) 46-2220311 E-mail: [email protected] Elin Zetterström, Uppsala University Department of Food Studies, Nutrition and Dietetics Uppsala University S-751 22 Uppsala Tel: (+46) 737027172 E-mail: [email protected] Gustaf Eskhult Department of statistics, Uppsala University S-751 20, Uppsala Tel: (+46) 706 90 70 63 E-mail: [email protected]

Marie-Louise Danielsson-Tham, Professor School of Hospitality, Culinary Arts and Meal Science Örebro University, Sweden P.O. Box 1, S-712 02 Grythyttan (+46)19302025 E-mail: [email protected]

Organisations/VATnr: 202100-2932

3(3)

Organisations/VATnr: 202100-2932

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1. Introduction

2 3

1.1. Background

4

Internationally, studies have shown shortcomings in food safety knowledge, attitudes and

5

behaviour among consumers (Redmond & Griffith, 2003; Jevsnik, et al., 2008a; Jevsnik, et

6

al., 2008b; Lagendijk, et al., 2008; Ovca & Jevsnik, 2009; Langiano, et al., 2012; Byrd-

7

Bredbenner, et al., 2013 Rössvoll, et al., 2013). According to the statistics from the EU

8

commission, and based on 32 European countries, one in every three foodborne outbreaks

9

occur in private households (EFSA, 2015; Krause, et al., 2007). Thus, improved consumer

10

behaviour in private households might have an important impact on the number of foodborne

11

illnesses. A crucial question is the consumers´ food safety knowledge and sources of their

12

knowledge for learning about safe food handling. According to the European food law

13

everyone working with food in a food company must be trained in food safety (Regulation

14

(EC) No 178/2002). However, when it comes to handling food in the private homes there is

15

no surveillance system and no requirement for food safety knowledge.

16 17

1.2. Foodborne infections and intoxications in Sweden

18

According to the Communicable Diseases Act and the Communicable Diseases Ordinance a

19

number of foodborne diseases are notifiable in Sweden e.g. campylobacteriosis, listeriosis

20

and enterohemorrhagic Escherichia coli (EHEC) infection, also called shiga toxin-producing

21

Escherichia coli (STEC). Another group, the so-called toxin-producing bacteria

22

(Staphylococcus aureus, Bacillus cereus and Clostridium perfringens) are only notified if they

23

are involved in foodborne outbreaks in restaurants and other public eateries. Norovirus

24

occupies an intermediate position as they are voluntarily notifiable (Public Health Agency of

25

Sweden, 2019; Swedish Food Agency, 2019). Many of them are related to consumers

26

behaviours. Based on an assessment of the mean number of foodborne domestic cases per

27

year between 2013 and 2017, Norovirus (168 611 cases), toxin-producing bacteria (57 892

28

cases) and campylobacter (42 838 cases) are associated with the greatest disease burden in

29

terms of the number of domestic cases (Swedish Food Agency, 2019). During 2017 the

30

number of reported cases of STEC was 465, and with respect to underreporting of data the

31

number of cases was 4864 whereof 2918 was related to food (Swedish Food Agency, 2019).

32

Between 2005 and 2017 the number of reported cases of campylobacteriosis has been

33

increasing with a peak during year 2016 to 2017 caused by a large outbreak from Swedish-

34

produced chicken (Swedish Food Agency, 2019). 1

35 36

Campylobacter jejuni is the major reported bacterial cause of foodborne illness worldwide

37

(EFSA, 2018; Kaakoush, et al., 2015). Listeriosis also show a clear trend of increasing

38

incidence in the period between 2015 and 2017 (Swedish Food Agency, 2019). According to

39

Swedish statistics the number of cases has increased from 34 individuals in 2005 to 116 cases

40

during 2017. The trend is similar in other European countries. Every case of listeriosis is

41

important as the mortality is high.

42 43

1.3. Food safety knowledge

44

Food safety knowledge and behavior is crucial. Certain studies have focused on food safety

45

knowledge among young people and students (Byrd Bredbenner, et al., 2007a; Byrd

46

Bredbenner, et al., 2007b; Abbot et al., 2009; Sanlier et al., 2009; Ozilgen, et al., 2011; Lazou

47

et al., 2012; Ovca et al., 2014; Green & Knechtges, 2015). In Sweden a few consumer studies

48

have been undertaken in the food safety area (Marklinder, et al., 2004; Marklinder, et al.,

49

2013; Lange et al., 2016). One of these targeting 529 school students aged 15-16 years old

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revealed that the students’ food safety knowledge and behaviour were inadequate and that

51

some of them might leave elementary school without having learnt even basic food safety

52

principles (Lange et al., 2016). Boys were reported to be significantly more at risk regarding

53

handling of potentially hazardous food, reheating leftovers and cleaning surfaces in the

54

kitchen. The majority (65%) of boys claimed that it was no risk to taste raw minced meat

55

when cooking (Lange et. al., 2016). One of the first studies exploring food safety knowledge,

56

attitudes and practices was performed by Unklesbay et al., (1998). The results revealed

57

perturbing gaps in food safety knowledge. Even at that time, the implications of this survey

58

performed on 824 American students produced the recommendation that all educators in

59

food-related disciplines should communicate the food safety role of consumers and be

60

involved with the food safety education of all future consumers.

61 62

1.4. Food safety sources of knowledge

63

Common sources of food safety knowledge suggested in food safety research are: university

64

studies, the private home, family and friends, personal doctor, media, magazine articles, the

65

Internet, educational settings, governments agencies, cooking classes at school or television

66

shows (Byrd-Bredbenner, et al., 2007a; Lazou et al., 2012; Lange et al., 2016; Maughan et al.,

67

2017). In Sweden, every student attending primary school meets some level of food safety

68

teaching in the compulsory subject, Home and Consumer Studies (HCS). In the HCS 2

69

syllabus´ section on Food, meals and health there is reference to “Hygiene and cleaning when

70

handling, preparing and storing food” (National Agency for Education, 2011). However,

71

when it comes to teaching food safety in Swedish schools, there is no guarantee that all issues

72

will be covered (Lange et al., 2014). Byrd-Bredbenner et al., (2007a) assessed the sources

73

from which 4343 young adults first learned about food safety. When asked to identify where

74

they first learned of food safety the majority named mother and father. Also Lange et al.,

75

(2018) found that mothers remain the most important source of knowledge related to food

76

safety, especially among the girls. Boys reported trusting more heterogeneous sources to a

77

greater extent ─ such as cooking shows in the media ─ and therefore risked being exposed to

78

information that could lead to unnecessary health hazards. Cooking shows do not set the best

79

examples when it comes to preventive food safety behaviour (Borda et al., 2014). Maughan et

80

al., (2017) identified a need for improvement in demonstrated and communicated food safety

81

behaviours among professional chefs and suggested those who produce cooking shows in

82

media should help education by modelling appropriate food safety behaviours. Levine et al.,

83

(2017) suggested popular cookbooks as an underutilized avenue for communicating safe food

84

handling practices. However, current cookbook authors are often risk amplifiers.

85 86

Students in general do not constitute a pronounced risk group as such but in a foreseeable

87

future some of them will become pregnant and a majority will be responsible for feeding

88

small children. Occasionally they will also prepare food to other vulnerable groups such as

89

older relatives or immunocompromised individuals. So far as the authors know there has been

90

no investigation on food safety knowledge and behavior performed on university students in

91

Sweden. Further, we are not sure what the foremost food safety sources of knowledge are in

92

Swedish society when it comes to young consumers, or the quality of these food safety

93

sources. Sources of food safety knowledge among Swedish consumers are rarely investigated.

94

The aim here is to investigate food safety knowledge, sources thereof and self-reported food

95

safety behavior among university students in Sweden.

96 97

2. Materials and methods

98 99

2.1 Design

100

Data on students' food safety knowledge, self-reported behaviours and sources of food safety

101

knowledge were collected via an online questionnaire. Before the questionnaire was sent out,

3

102

a pilot study was performed on 27 students who were then asked not to answer the final

103

version of the questionnaire if it would appear again.

104 105

2.2. Recruitment

106

The study population comprised students at 24 universities in Sweden. The students were

107

conveniently recruited in various ways i.e. via e-mail advertisements given by various

108

university contacts or different Facebook groups. The inclusion criteria were to be registered

109

as a student at a Swedish university, to have mastery of the Swedish language and to agree to

110

participate in the study.

111 112

2.3 Ethical considerations

113

Present study is performed according to the Swedish Research Council´s ethical guidelines,

114

based on the declaration of Helsinki (Swedish Research Council, 2002). Central Ethical

115

Review Board has stated that this kind of research does not require ethical vetting (Central

116

Ethical Review Board, 2019). Present study does not handle any personal data relevant to

117

Section 3 (the handling of sensitive personal data; Ethical Review of research Involving

118

Humans; Swedish Code of Statues, 2003:460; 3-5 §§).

119

The questionnaire was followed by a letter with information regarding the purpose of the

120

investigation and a question regarding consensus to participate. The questions were answered

121

individually and anonymously. It was not possible to track who gave which answer and no

122

comparison has been made between different universities. The students were informed about

123

that the participation was voluntary and that they could withdraw their participation at any

124

time.

125 126

2.4. Method

127

The survey was sent out as an open link via Google Form (Google, 2017).

128

The link was primarily distributed via social media, Facebook and also via e-mail

129

advertisements that were given by various contacts. Those who were reached by the survey

130

were also asked to share it further. The respondents were asked not to seek out the correct

131

answers to the knowledge questions during the execution. If they were unsure of the answers,

132

they were asked to answer "Don't know" instead of guessing. The data were collected during

133

twelve days from the 15 to 26th of Nov 2016.

134 135 4

136

2.5. The questionnaire

137

In total, the questionnaire consisted of 28 questions. However, the analysis of all questions is

138

not presented in this article.

139

The first question was an agreement question to participate related to ethical consideration.

140

One question focused on the frequency of cooking at home. Twelve questions focused on

141

food safety knowledge and comprised eleven statements where the answer alternatives could

142

be “True”, “False” or “Do not know”, and one question with the four answer alternatives:

143

+1─2 °C; +4─5 °C; +7─8 °C or “Do not know” (Table 1). There were also ten questions

144

regarding self-reported food safety behaviour. The questionnaire also contained regular

145

questions regarding whether the respondent had experienced food poisoning in general or if

146

they had been food poisoned by something they have cooked themselves. Two questions

147

focused on sources for food safety knowledge and self-estimated food safety knowledge,

148

respectively. The alternatives for safety sources Family and friends, as a source category for

149

food safety knowledge, was comprised of the alternatives: Mother/other female relative;

150

Father/other male relative and Partner/friend. There were three demographic questions (ages,

151

gender, and the university where they were registered). Following Sandvik, et al., (2014), the

152

age intervals 18─30; 31─44; 45─64 and 65─80 was chosen. One question asked if they had

153

earlier experience of food safety courses and/or microbiology. The response alternatives at

154

secondary school; at university level; at working place/polytechnic school were combined to

155

comprise the category “Food safety education”. All questions were closed with defined

156

response options. It was not relevant to make any response analysis as the contact information

157

to the respondents were never available.

158 159

2.6. Analysis of data

160

The collected data were processed and analysed in the programme IBM SPSS Statistics and

161

Microsoft Office Exel. Chi-2 test, one ways ANOVA and independent t-test with the

162

significant level p< 0.05.

163

Respondents were divided in two groups in order to simplify the analysis of the number of

164

correct answers on the knowledge questions in relation to the behaviour questions: the group

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achieving 0─6 corrects answers and the group with 7─12 correct answers. Differences in the

166

number of correct answers by gender, age, foremost source of food safety knowledge and

167

self-estimated knowledge, were compared using the average values for the number of correct

168

answers in the different categories.

169 5

170

3. Results

171

In total, there were 607 respondents, however, the results from one questionnaire was

172

excluded. Respondents were students from 24 different universities in Sweden with 474

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women (78%), 129 men (21%) and three persons identified themselves as “Another

174

alternative”. Ages were between 18 to 64 years whereof 80 percent were between 18─30

175

years old, 14.7 percent (n=89) were 31─44 years and 5.4 percent (n=33) were 45─64 years

176

old. On the question of whether they had experience on a course in food hygiene/safety and/or

177

microbiology, 35.6 percent (n=216) reported having experienced a course in food hygiene at

178

or after secondary school.

179 180

Twelve percent (n=73) of respondents reported food poisoning during the last year. However,

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a further 8 percent (n=48) did not know whether they had food poisoning or not. A minority,

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2.3 percent (n=14), stated that they were food poisoned by food they had made themselves

183

and 6.3 percent (n=38) chosen the alternative “Do not know”.

184 185

3.1. Cooking routines.

186

In total, 49.5% (n=300) of the respondents stated that they make food from raw food items

187

such as minced meat, fish, chicken several times a week whereas 11.9 percent (n=72) chose

188

the alternative “never”. Further, almost half of the respondents, 49. 8% (n=302), stated that

189

they handled fresh vegetables/roots/leeks /potatoes daily, and 0.2% (n=1) chose the

190

alternative “never”. Fifty-five respondents (9.1%) admitted having been cooking food to

191

someone else, when having temporary diarrhoea.

192 193

3.2. Knowledge questions

194

The average value was 7.61 correct answers on the 12 knowledge questions (63.4 percent)

195

(Table 1). Further, 67.2 percent of respondents (n=407) got correct answers on more than

196

50% of the twelve knowledge questions whereas 32.8 percent (n=199) got 50% or fewer

197

correct answers. Respondents who reported “Family and friends” to be the foremost food

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safety source of knowledge got significantly fewer correct answers.

199 200 201

3.3. Aspects of ages and gender

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Respondents in the age group 18-30 years old (n=484) got, on average, 7.52 correct answers

203

on the knowledge questions whereas those who were 31─64 years old (n=122) averaged 7.97 6

204

correct answers. There were no statistically significant differences on age (p>0.05). Women

205

(n=474) got an average of 7.66 correct answers on the 12 knowledge questions whereas men

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(n=129) averaged 7.44 correct answers. Knowledge differences between men and women

207

were not statistically significant (p> 0.05).

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3.4. The foremost source of knowledge

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Present study investigated the foremost source of food safety knowledge among students. The

211

options were “Family and friends”, “Food safety education”, “Home and consumer studies”,

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“Not able to name any source” or “Others” (Figure 1). It was shown that the foremost source

213

of food safety knowledge was “Family and friends” (45%; n=272). In the analysis the

214

category Family and friends comprised the alternatives Mother/other female relative;

215

Father/other male relative and Partner/friend. The option “Mother” was chosen to 80 percent

216

of the 272 responses in this category.

217 218

The reported primary source of knowledge in relation to the number of correct answers to the

219

knowledge questions is demonstrated in Figure 2. Experience of food safety education

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correlated positively with a higher number of correct answers to the knowledge questions

221

(p<0.05).

222 223

3.5. Knowledge differences in relation to stated knowledge source

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Among respondents who stated "Food safety education" as the foremost source of food safety

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knowledge, the number of correct answers for the knowledge questions was 9.57 out of 12.

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Those who stated "Home and consumer studies" as their foremost source got 7.37 correct

227

answers. The respondents who stated "Others" and "Not able to name any source" got 7.21

228

and 7.17 correct answers, respectively whereas those who stated "Family and friends" got an

229

average value of 6.98 correct answers. There was a statistically significantly difference in the

230

number of correct answers depending on the experience of a food safety course. Those who

231

stated their foremost food safety knowledge source being "Food safety education" got a

232

significantly better result on the twelve knowledge questions (p< 0.05) than alternatives.

233

Respondents who reported “Family and friends” as their foremost food safety source of

234

knowledge got a significantly fewer correct answers. More correct answers were also

235

achieved by those who estimated their knowledge to be good.

7

236

Responses on question 12 regarding the current temperature in a refrigerator, were 58.6%

237

(n=355) stating the correct answer, i.e. +4─5 ºC, whereas 24.65% (n=149) stated 7─8 ºC.

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Further, 2.35 % stated 1─2 ºC and 14.5% (n=88) answered “Do not know”.

239 240

3.6. Self-reported behaviors

241

In the questionnaire there were 12 questions regarding knowledge (Table 1). Results from

242

self-reported food safety behavior in relation to the number of correct answers to knowledge

243

questions is presented in Table 2. Among those respondents who got 7─12 correct answers it

244

was more common to change dish cloths once a week. Further, among the respondents who

245

only scored 0─6 correct answers, dish cloths were changed once a month or less frequently.

246

Regarding routines for cutting boards, 43.5% (n=177) of the respondent group with 7─12

247

corrects answers stated that they used separate cutting boards in comparison with 29.75%

248

(n=59) in the respondent groups with just 0─6 corrects answers. More than double the number

249

of the respondent group with 7─12 correct answers used thermometer when cooking

250

hamburgers or chicken. Among the respondent group with 7─12 correct answers, 19% (n=77)

251

actively chilled food or put it in the refrigerator within 4 hours by comparison with 7% (n=14)

252

in the respondent group with 0─6 correct answers. Thus higher numbers of correct answers

253

correlated with more optimal self-reported behaviors. More respondents with 0─6 correct

254

answers seemed to store their lunch box in room temperature.

255 256

3.7. Self-reported knowledge

257

Among the total number of respondents, 52.6 (n=319) stated that they had rather good food

258

safety knowledge and 9.1% (n=55) stated "very good". Further, 27.6% (n=167 stated either

259

good or bad food safety knowledge, 10.1% (n=61) answered that they had rather or very bad

260

food safety knowledge and 0.7% (n= 4) answered "Do not know".

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3.8. Correct questionnaire answers on food safety knowledge and self-perceived knowledge

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The difference in average values regarding number of correct answers on the knowledge

264

questions and respondent self-perceived knowledge is illustrated in Figure 3. There was a

265

significant difference between the groups (p<0.05). After excluding the group who answered

266

“Do not know” a statistically significant difference in the number of correct answer to the

267

knowledge questions was revealed between those self-reporting “Very bad” or “Rather bad”

268

knowledge.

269 8

270

4. Discussion

271

4.1. Methodological reflections

272

In order to minimize bias, respondents were distributed across 24 different universities in

273

Sweden. Among the 606 respondents, 78% (n=474) were women. According to SCB (2017)

274

the number of registered students at universities in Sweden during the study year 2016/2017

275

was 402 205 (60% women) (SCB, 2017). Other surveys indicate that women have better food

276

safety behaviour than men (Lazou et al., 2012; Rössvoll, et al., 2013). Lange et al., (2016)

277

also got indications of that boys have more risky behaviours than girls. Results from a survey

278

performed by Rössvoll et al., (2013) also showed that women have more food safety

279

knowledge than men. However, in the present study no statistically significant gender

280

difference emerged (p> 0.05).

281

Among respondents, 35.6 percent (n=216) reported having taken a course in food

282

hygiene/safety and/or microbiology at secondary school or at post-secondary school level.

283

However, we were not able to control for the quality of any these food safety educations

284

experiences. Hence, there is a weakness in this investigation as we do not know the content or

285

quality of the stated food safety education. On the question “What is your foremost source of

286

knowledge regarding what you know about food hygiene today?” The answer from 21.1%

287

(n=127) respondents was “Food safety education”. Further, there were three answer

288

alternatives to the question: “Have you taken a course in food hygiene/safety and/or

289

microbiology?: “At secondary school; at university: via a food company/polytechnic school”.

290

However, among the students who stated the alternatives comprising food safety education as

291

their foremost source of knowledge, the average value from the knowledge questions were

292

9.57 correct answers (p<0.05).

293

Twelve percent (n=739) of respondents reported having had food poisoning during the last

294

year. The number is in accordance with earlier studies, however higher (Lindqvist et al., 2001;

295

Marklinder, et al., 2004). According to the Swedish Food Agency, (2019) the number of

296

foodborne illnesses involving certain pathogens has increased.

297

In present study, cooking routines overall were in some way limited as just half of them

298

reported making food from raw items several times a week. Around 15% never cut raw meat

299

or cooked chicken from scratch. In a study by Lange et al., (2016) it was reported that boys

300

who seldom cooked at home had risky behaviour.

301 302 303 9

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4.2. Food safety education as a food safety source of knowledge

305

The present study indicates a positive correlation between food safety education, knowledge

306

and behavior. It was shown that the foremost source of food safety knowledge was “Family

307

and friends” (45%) and among them the option “Mother” was chosen to 80 percent (Figure

308

1). This is in accordance with other studies (Byrd-Bredbenner et al., 2007a; Jevsnik et al.,

309

2008a; Chow & Mullan, 2010; Ovca et. al., 2014 and Lange et al., 2016). The respondents

310

who reported “Family and friends” to be the foremost food safety source of knowledge got

311

significantly fewer correct answers. Results from a survey performed by Lazou, et al., (2012)

312

indicated a lower level of food safety knowledge among those students who stated “Family

313

and friends” as their foremost food safety source of knowledge. We agree with Chow &

314

Mullan, (2010) that parents and friends may not be health experts and that it is important to

315

engage with formal food safety education. In the present study just 6.3 percent of the students

316

stated that “Home and consumer studies” was their foremost food safety source. In Sweden

317

all students get some food safety information in the subject Home and consumer studies,

318

however the quality varies (Lange et al., 2014). In the present study, students might have

319

learned food safety in school but later in life they also might have been attending a food

320

safety course. Therefore, the alternative Home and consumer studies as a food safety source

321

of knowledge might have scored a low number. Teachers´ limited back ground knowledge

322

and lack of resources have also been identified as potential barriers to adequate food safety

323

education in school (Lange et al., 2014; Richards et al., 2008; Diplock et al., 2018).

324

Although 35.6 percent (n=216) of the students reported having taken a course in food

325

hygiene/safety at secondary school or at post-secondary school level, just 21.1 percent stated

326

this course as their foremost source of food safety knowledge. We are not able to control for

327

the quality of any of these food safety educational experiences but it is still interesting that a

328

majority find the category “Family and friends” as their foremost source of food safety

329

knowledge.

330 331

4.3. Food safety knowledge and behaviour

332

In the present study the respondents who got 7─12 correct answers seemed to have more

333

optimal food safety behaviour regarding using dish cloths, routines for cutting boards, using a

334

thermometer, chilling food or storing lunch boxes (Table 1). Thus higher numbers of correct

335

answers positively correlated with more optimal self-reported behaviors.

336

Chow & Mullan, (2010) suggested that food safety behaviour is habitual. This is also in

337

agreement with Redmond & Griffith, (2003). Chow & Mullan, (2010) confirmed using the 10

338

social cognition psychological model Health Action Process Approach (HAPA) to predict

339

food safety behaviour. HAPA is a stage model with one motivational phase and one volitional

340

phase (Schwarzer, 2008). The results of their study indicated that past behaviour is a major

341

predictor of both intention and behaviour (Chow & Mullan, 2010). Past behaviour was shown

342

to be an important predictor of food safety intentions and behaviour. As food safety behaviour

343

was described to be a habitual nature, which means that the habit control how you behave it is

344

therefore important to get optimal food safety behaviour early in life so they become habitual.

345

They also highlighted education about the susceptibility of risks and benefits in order to

346

change behaviour (Chow & Mullan, 2010).

347

Regarding the knowledge questions about cold food storage, about 59% of respondents stated

348

the correct answer 4─5 ºC whereas 25% stated 7─8 ºC and 14.5% the answer “Do not know”

349

(Table 1). Swedish consumers in general have shown to have insufficient knowledge in cold

350

food storage (Marklinder et al., 2004; 2013). Furthermore, a survey targeting 529 Swedish

351

school children in school year 9, aged 15 to 16, the response option +8 ºC had the highest

352

frequency (45%). Under laboratory conditions Listeria has been found to survive and grow at

353

refrigeration temperatures between −0.5 and 9.3 °C (Walker, et al., 1990). Listeriosis have

354

generally been associated with ready-to-eat foods that are held for extended periods at

355

refrigeration or chill temperatures which allow growth to high numbers at the time of

356

consumption (Buchanan, et al., 2017). One case of listeriosis reported by the Swedish Food

357

agency was due to homemade raw spiced salmon, indicating an example of gaps in consumer

358

knowledge about food safety (Swedish Food Agency, 2017).

359

Results from a study performed by Jofré et al., (2019) focusing on the impact of the

360

temperature on the shelf-life of refrigerated cooked meat products. It was shown that

361

temperature fluctuation negatively affects the safety of ready-to-eat foods. The authors

362

highlighted that improvement of household refrigerated storage would be an effective way of

363

increasing food safety of refrigerated ready-to-eat food.

364 365

4.4. Food safety education for younger age groups

366

The present study has illustrated the importance of food safety education and that food safety

367

education in any form will make a change. Rössvol et al., (2013) suggested that food safety

368

education as part of the school curriculum would facilitate an early development of safe

369

habitual food handling practices and enable the dissemination of food safety information.

370

Several studies highlight the need for teaching children food safety in school (Kennedy et al.,

371

2005; Jevsnik et al., 2008a; Nesbitt et al., 2009; Lange et al., 2018). Ovca et al., (2016) 11

372

emphasized the importance of starting food safety education at early ages in order to establish

373

optimal food safety habits. They also highlighted the importance of doing experiments or

374

practical activities to significantly improve an intervention. In that case Home and Consumer

375

studies teaching on food safety would be particularly valuable. Food safety education would

376

hypothetically promote optimal food safety behaviour. Feng et al., (2019) identified six

377

barriers for using food thermometers. The findings in this review study may be useful to

378

facilitate the development of effective strategies to increase thermometer use. Comparisons

379

between social media-based intervention and a food safety lecture are consistent with research

380

suggesting that online food safety education is as effective as lecture and other traditional

381

methods of education (Bramlett Mayer& Harrison, 2012). The literature suggests, therefore,

382

that there are number of potential routes to get the goal of effective early stage familiarisation

383

with food safety practices.

384 385

Present study is unique in focusing on university students in Sweden. As far as the authors

386

know there has not been done any investigation on this category. In Sweden, norovirus, toxin-

387

producing bacteria and Campylobacter are associated with the greatest disease burden in

388

terms of the number of domestic cases, issues related to food handling and consumer

389

behaviour. In addition to that STEC and Listeria are increasing poisoning. Experience of food

390

safety education at secondary school/university/working place/polytechnic school positively

391

correlated with more correct answers on the knowledge questions and safer self-reported food

392

safety behaviour. Those with fewer correct answers also reported more unfavourable

393

behaviours. Respondents in our study who reported “Family and friends” to be the foremost

394

food safety source of knowledge got significantly fewer correct answers and reported more

395

unfavorable behaviours. Indeed, the present study may provide a basis for further examining

396

the need to equip young consumers with food safety knowledge in Sweden.

397 398

5. Conclusion

399

The main findings in this study is that students foremost source of food safety knowledge is

400

the family members and friends. It has also been shown that any kind of food safety education

401

makes a difference. Present study indicates that education provides knowledge and promotes

402

more optimal food safety behaviours. The authors would suggest a more systematic food

403

safety education in younger ages.

404 405

Acknowledgements 12

406

We thank Professor Phil Lyon at Umeå University for spell- and grammar checking of the

407

document. The authors would also like to thank all students who participated, and the contacts

408

on 24 different universities in Sweden who advertised e-mail addresses. This research did not

409

receive any specific grant from funding agencies in the public, commercial, or not-for-profit

410

sectors.

411 412

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Text to tables and figures

Table 1. Twelve questions focusing on food safety knowledge. Eleven of the twelve knowledge questions provided statements categorised as True, False or Do not know. Knowledge question number 12 had four answer alternatives (n=606). The bold answer alternative is optimal.

Table 2. Self-reported food safety behavior in relation to the number of correct answers to the knowledge questions (n=606). The bold text is the optimal behavior alternative.

Figure 1. The foremost sources of food safety knowledge reported by the students (n=606).

Figure 2. The reported primary source of knowledge in relation to the number of correct answers to the knowledge questions (n=606).

Figure 3. The difference in average values regarding number of correct answers on the knowledge questions and respondent self-perceived knowledge.

Table 1. Twelve questions focusing on food safety knowledge. Eleven of the twelve knowledge questions provided statements categorised as True, False or Do not know. Knowledge question number 12 had four answer alternatives (n=606). The bold answer alternative is optimal.

Statements 1. To freeze food items kill all dangerous bacteria 2. Healthy people may carry the bacteria Staphylococcus aureus that can cause foodborne illness 3. To eat a rare/pink hamburger is a risk for foodborne illness 4. Bacteria may grow in vacuum packed food items 5. Pathogen bacteria may cause death among human beings 6. A dish cloth may disseminate bacteria that can cause foodborne illness 7. The bacteria from the specie Listeria is foremost related to raw chicken 8. Food items that are heated to 54 °C are free from pathogen bacteria 9. Food that is heated in a microwave oven is totally free from bacteria 10. To taste the seasoning of raw minced meat is a risk for foodborne illness 11. Correct cold food storage is one way to avoid foodborne illnesses

True

False

Do not know

n (%)

n (%)

n (%)

68 (11)

436 (72)

102(17)

191 (32)

51 (8)

364 (60)

355 (58)

170 (28)

81 (14)

304 (50)

132 (22)

170 (28)

429 (71)

51 (8)

126 (21)

548 (90)

7 (2)

51 (8)

162 (27)

166 (27)

278 (46)

36 (6)

371 (61)

199 (33)

10 (2)

529 (87)

67 (11)

388 (64)

113 (19)

105 (17)

540 (89)

27 (5)

39 (6)

+1─2 °C

+ 4─5 °C

+7─8 °C

Do not know

12. What is an optimal fridge temperature? If uncertain, please answer “Do not know”

n (%)

n (%)

n (%)

n (%)

14 (2)

355 (58)

149 (25)

88 (15)

Table 2. Self-reported food safety behavior in relation to the number of correct answers to the knowledge questions (n=606). The bold text is the optimal behavior alternative. Response alternative

Response

Response

Response

frequency

frequency

frequency

The questions number

Self-reported behavior

0-6 correct

7-12 correct

All respondents

1 to 5.

In relation to food safety

answers

answers

(n=606)

knowledge

to the food

to the food

safety

safety

knowledge

knowledge

questions

questions

(n=199)

(n=407)

n (%)

n (%)

n (%)

Every day

1

1 (0.2)

2 (0.3)

Once a week

27 (13.6)

79 (19.4)

106 (17.6)

Number of times a week

5 (2.5)

24 (5.9)

29 (4.8)

Once a week/every second

71 (35.7)

135 (33.2)

206 (34.0)

Once a month or less often

86 (43.2)

143 (35.1)

229 (37.8)

Do not know

4 (2.0)

8 (2.0)

12 (2.0)

Do not use dish cloths

5 (2.5)

17 (4.2)

22 (3.6)

Rinse it with water

4 (2.0)

8 (2.0)

12 (2.0)

1. How often do you change to a clean dishcloths (boil it/wash it in machine/brand new)? (0.5)

week

2. You are about to clean your cutting board, what do you mostly do?

Hand wash with detergent

148 (74.4)

282 (69.3)

430 (71.0)

Wipe it with paper

0 (0)

1 (0.2)

1 (0.1)

Cleaning with the dishwasher

47 (23.6)

112 (27.5)

159 (26.2)

Other

0 (0)

4 (1.0)

4 (0.7)

Use the same cutting board and

1 (0.5)

1 (0.2)

2 (0.3)

2 (1.0)

0 (0)

2 (0.3)

17 (8.5)

7 (1.7)

24 (4.0)

59 (29.7)

177 (43.5)

236 (38.9)

11 (5.5)

19 (4.7)

30 (5.0)

79 (39.7)

145 (35.6)

224 (37.0)

3. You have cut raw meat and are now about to cut cucumber, tomatoes or salad, what do you do?

knife as they are Wipe the cutting-board and knife with paper/dishcloth/towel Rinse the cutting- board and knife with water Change to a clean cutting board and a clean knife, I always have a separate cutting board for raw meat products Turn the cutting board to the back side and rinse the knife Wash the cutting board and the knife with hot water and detergent

4. How do you clean your hands?

I never cut raw meat

30 (15.1)

58 (14.3)

88 (14.5)

With water

4 (2.0)

4 (1.0)

8 (1.3)

With water and soap and dry

181 (91.0)

369 (90.7)

550 (90.8)

them with paper/towel With water and soap

13 (6.5)

34 (8.3)

47 (7.8)

Other

1 (0.5)

0 (0.0)

1

Cut it and check if the colour is

92 (46.2)

150 (36.9)

242 (39.9)

27 (13.6)

54 (13.3)

81 (13.4)

3 (1.5)

20 (4.9)

23 (3.8)

4 (2.0)

9 (2.2)

13 (2.1)

(0.2)

5. You fry a hamburger, how to decide whether it is done?

grey Check if the juice of the hamburger is clear Measure with a thermometer that the central part it is 72 °C. I check the texture of the chicken I fry it for a certain time

2 (1.0)

5 (1.2)

7 (1.2)

I never cook chicken

32 (16.1)

60 (14.7)

92 (15.2)

Other

1 (0.5)

9 (2.2)

10 (1.7)

Do not know

0 (0.0)

2 (0.5)

2 (0.3)

Response alternative

Response

Response

Response

frequency

frequency

alternative

The questions number

Self-reported behavior

0-6 correct

7-12 correct

All respondents

6 to 9.

In relation to food safety

answers

answers

(n=606)

knowledge

to the food

to the food

safety

safety

knowledge

knowledge

questions

questions

(n=199)

(n=407)

n (%)

n (%)

n (%)

Do not consume the milk

16 (8.0)

29 (7.1)

45 (7.5)

Use the milk if it smells and

172 (86.4)

339 (83.3)

511 (84.3)

2

(1.0)

4 (1.0)

6 (1.0)

I have never milk at home

9

(4.5)

35 (8.5)

44 (7.3)

I put the food directly in the

19 (9.6)

36 (8.8)

55 (9.1)

14 (7.1)

77 (19.1)

91 (15.0)

6. You have a package of milk that has passed the “Best before date”, what do you do?

tastes well Use the milk regardless “Best before date”, smell and taste

7. You cook a large amount of food to eat later, how do you handle food after cooking?

fridge I actively cool the food and thereafter put it in the fridge within 4 hours

I leave the food in room

13 (6.5)

24 (5.9)

37 (6.1)

2 (1.0)

2 (0.5%)

4 (0.7)

151 (75.9)

267 (65.6)

418 (69.0)

0 (0)

1 (0.2)

1 (0.2)

118 (59.3)

201 (49.4)

319 (52.6)

7 (3.5)

32 (7.9)

39 (6.4)

In refrigerator

52 (26.1)

134 (32.9)

186 (30.7)

Other

3 (1.5)

3 (0.7)

6 (1.0)

I never have lunch box with me

19 (9.6)

37 (9.1)

56 (9.2)

Yes

15 (7.5)

40 (9.8)

55 (9.1)

No

158 (79.4)

337 (82.8)

495 (81.7)

Do not know

26 (13.1)

30 (7.4)

56 (9.2)

temperature for 4 hours or longer (but not the entire day/night) and thereafter I put it in the fridge I leave the food in room temperature the entire day/night and thereafter put it in the fridge I leave the food at room temperature for less than 4 hours and thereafter I put it in the fridge I never cook food to be eaten later 8. You keep your lunch box in school while waiting for lunchtime, how? In room temperature, for instance in my bag/cupboard Together with a cooling lamp/in a cooling bag

9. At any time during the past year, have you ever cooked in your home for someone else, when you had temporary diarrhoea?

Figure 1. The foremost sources of food safety knowledge reported by the students (n=606).

Figure 2. The reported primary source of knowledge in relation to the number of correct answers to the knowledge questions (n=606).

Figure 3. The difference in average values regarding number of correct answers on the knowledge questions and respondent self-perceived knowledge.

Date 2020-01-17

Highlights Ingela Marklinder Lektor / FD, docent Senior lecturer / PhD Institutionen för kostvetenskap Department of food studies, nutrition and dietetics Box 560 SE-751 22 Uppsala Besöksadress/Visiting address: BMC / Husargatan 3 751 22 Uppsala Telefon/Phone: 018-471 23 12 +46 18 471 23 12 Telefax/Fax: 018-471 22 61 +46 18 471 22 61 www.ikv.uu.se [email protected]

Organisationsnr: 202100-2932

1. Food safety study targeting university students from 24 Swedish universities 2. Experience of food safety education significantly showed more knowledge 3. Experience of food safety education indicated more optimal behavior 4. The foremost sources of food safety knowledge were family and friends 5. The project is conceptualized and performed by a National food safety network

2(2)

Organisations/VATnr: 202100-2932