Background: Foodborne disease is a significant problem worldwide. Research exploring sources of outbreaks indicates a pronounced role for food workers' improper health and hygiene practice. Objective: To investigate food workers' perceptions of factors that impact proper food safety practice. Method: Interviews with food service workers in Baltimore, MD, USA discussing food safety practices and factors that impact implementation in the workplace. A social ecological model organizes multiple levels of influence on health and hygiene behavior. Results: Issues raised by interviewees include factors across the five levels of the social ecological model, and confirm findings from previous work. Interviews also reveal many factors not highlighted in prior work, including issues with food service policies and procedures, working conditions (e.g., pay and benefits), community resources, and state and federal policies. Conclusion: Food safety interventions should adopt an ecological orientation that accounts for factors at multiple levels, including workers' social and structural context, that impact food safety practice.Keywords: Food workers, Food safety, Health and hygiene practice, Social ecological model, Qualitative methods
IntroductionFoodborne disease is a significant and preventable public health problem in the United States and globally. Each year, an estimated one in six Americans (48 million people) become ill, 128 000 are hospitalized, and 3,000 die from contaminated food or beverages.1 The majority of foodborne disease outbreaks reported to the Centers for Disease Control and Prevention (CDC) originate in food service facilities, such as restaurants and delis. 2,3 Research exploring sources of these outbreaks indicates a pronounced role for food workers, particularly through worker health and hygiene. [2][3][4][5][6] Interventions to prevent foodborne disease in food service establishments are determined at local, state, and tribal government levels. To support this process and achieve consistency with federal food safety policy, the Food and Drug Administration (FDA) publishes and encourages local adoption of the Food Code, a reference document updated every 4 years that provides science-based guidance regarding local food safety rules. 7 This document describes effective management of workers' health and hygiene through a number of practices, including hand washing procedures to reduce and remove foodborne pathogens; requirements for the use and maintenance of gloves and clean outer garments to reduce the transfer of pathogens from workers to food and other objects; and procedures for the identification and restriction of sick workers. 8,9 To ensure that workers follow these practices, restaurants rely predominantly on food safety training. 10,11 While worker training may increase knowledge of proper food safety practices -an important part of food safety control -a number of studies show that food safety training does not ensure that workers actually perform food safety behaviors. [12][13][14][15] These ...