OBJECTIVE:Describe the rationale and design for THIS-WIC, a large, multistate project to integrate telehealth into the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) program for nutrition education and breastfeeding support service delivery. DESIGN:Varied by the WIC state agency (1 group-randomized control trial, 4 quasi-experimental matched comparison designs, and 1 prepost design). Mixed-methods data collection, including surveys, interviews, the WIC Management Information System, telehealth metadata, and process and implementation. SETTING:Special Supplemental Nutrition Program for Women, Infants, and Children local agencies (n = 68) in 7 states, including the District of Columbia, Georgia, Michigan, North Carolina, South Carolina, Vermont, and Wisconsin. PARTICIPANTS:Special Supplemental Nutrition Program for Women, Infants, and Children clients, including pregnant and lactating postpartum women aged ≥ 18 years, infants, and children aged ≤ 5 years at participating agencies. Special Supplemental Nutrition Program for Women, Infants, and Children staff who are responsible for delivering nutrition education/breastfeeding support, and local agency directors at participating intervention agencies. INTERVENTION(S):Telehealth interventions varied by state, including enhanced video conferencing and virtual services provided through customized online platforms and portals. Intervention duration ranged from 7 to 18 months. MAIN OUTCOME MEASURE(S):Special Supplemental Nutrition Program for Women, Infants, and Children client satisfaction with telehealth. ANALYSIS:Mixed-methods analysis.

It is estimated that one in five cases of foodborne illnesses is acquired in the home. However, how pathogens move throughout a kitchen environment when consumers are preparing food is not well characterized. The purpose of this study was to determine the prevalence and degree of cross-contamination across a variety of kitchen surfaces during a consumer meal preparation event. Consumers (n = 371) prepared a meal consisting of turkey patties containing the bacteriophage MS2 as a tracer organism and a ready-to-eat lettuce salad. Half were shown a video on proper thermometer use before the trial. After meal preparation, environmental sampling and detection were performed to assess cross-contamination with MS2. For most surfaces, positivity did not exceed 20%, with the exception of spice containers, for which 48% of the samples showed evidence of MS2 cross-contamination. Spice containers also had the highest MS2 concentrations, at a mean exceeding 6 log viral genome equivalent copies per surface. The high level of MS2 on spice containers drove the significant differences between surfaces, suggesting the significance of spice containers as a vehicle for cross-contamination, despite the absence of previous reports to this effect. The thermometer safety intervention did not affect cross-contamination. The efficiency of MS2 transfer, when expressed as a percentage, was relatively low, ranging from an average of 0.002 to 0.07%. Quantitative risk assessment work using these data would aid in further understanding the significance of cross-contamination frequency and efficiency. Overall, these data will help create more targeted consumer messaging to better influence consumer cross-contamination behaviors.

ABSTRACT:This study was conducted to test the effectiveness of a consumer poultry washing educational intervention that included video observation of meal preparation with participants who self-reported washing poultry. Treatment group participants received three e-mail messages containing information that the U.S. Department of Agriculture has used on social media sites (video and infographics) related to poultry preparation, including advising against washing chicken. Participants were observed cooking chicken thighs (inoculated with traceable nonpathogenic Escherichia coli strain DH5α) and preparing a salad to determine whether they washed the chicken and the extent of cross-contamination to the salad and areas of the kitchen. After meal preparation, participants responded to an interview about food handling behaviors, including questions about the intervention for treatment group participants. Three hundred people participated in the study (158 control, 142 treatment). The intervention effectively encouraged participants not to wash chicken before cooking; 93% of treatment group participants but only 39% of control group participants did not wash the chicken (P < 0.0001). The high levels of E. coli DH5α detected in the sink and on the salad lettuce suggest that microbes transferred to the sink from the chicken, packaging, or contaminated hands are a larger cause for concern than is splashing contaminated chicken fluids onto the counter. Among chicken washers, 26 and 30% of the lettuce from the prepared salad was contaminated for the control and treatment groups, respectively. For nonwashers, 31 and 15% of the lettuce was contaminated for the control and treatment groups, respectively. Hand-facilitated cross-contamination is suspected to be a factor in explaining this resulting lettuce cross-contamination. This study demonstrates the need to change the frame of "don't wash your poultry" messaging to instead focus on preventing contamination of sinks and continuing to emphasize the importance of hand washing and cleaning and sanitizing surfaces. HIGHLIGHTS:

This study developed and evaluated risk communication messages for ready to eat (RTE) foods targeted towards consumer storage practices in a food safety health campaign. Concepts were determined from a fractional factorial design of five categories of attributes potentially present in health promotion: title, message, graphic, slogan, and icon. Consumers viewed a subset of concepts and scored how useful the concept was in remembering to throw away RTE foods that were stored too long. Regression analysis determined which combinations of message attributes were most likely to result in using the information to throw out foods, which could help prevent foodborne illness. Findings showed that for this type of information, a graphic is a critical element for the printed schematic. The slogan (i.e., a short statement similar to a jingle or tag-line in a commercial) may be important to consumers, but the icon was not important.

The purpose of this study was to test the effectiveness of an intervention for consumer thermometer use by using a randomized experimental design and direct observation of meal preparation. The study was conducted in test kitchen facilities in two locations in North Carolina (one urban and one rural). Cameras recorded participants' actions at various locations throughout the kitchen and recorded the meal preparation from beginning to end. Before preparing the meal, a randomized treatment group watched a 3-min U.S. Department of Agriculture (USDA) food safety video "The Importance of Cooking to a Safe Internal Temperature and How to Use a Food Thermometer." Participants in the control and treatment groups were observed while cooking turkey burgers and preparing a salad to determine whether a thermometer was used to check the doneness of the turkey patties. Following meal preparation, all participants responded to a postobservation interview about food handling behaviors. Treatment group participants were also asked about the intervention. A total of 383 people participated in the study (201 in the control group and 182 in the treatment group). Participants who viewed the video were twice as likely to use a thermometer to check the doneness of the turkey patties compared with the participants who were not exposed to the video (75 versus 34%) and twice as likely to place the thermometer in the correct location (52 versus 23%). Sixty-seven percent of participants who watched the video reported that it influenced their behavior in the kitchen. This study demonstrates the importance of timing and framing of a behavioral intervention for thermometer use and highlights considerations for the development of additional messages (e.g., proper insertion).

Salmonella and Campylobacter are among the most common causes of foodborne disease in the United States. Most illnesses are associated with eating raw or undercooked poultry or cross-contamination. Young children and older adults are more susceptible to contracting foodborne illness and have serious infections compared with other age groups. We conducted a Web-based survey of parents of young children ( n = 1,957) and older adults ( n = 1,980) to estimate adherence to recommended food safety practices for raw poultry and to identify differences in practices between the two groups. The findings present adherence rates for 20 practices. In both groups, less than 50% of respondents reported adherence to seven practices; thus, improvements are needed in these areas. Parent respondents were significantly more likely than older adult respondents to report following eight practices, with most related to avoiding cross-contamination and using a food thermometer. For example, parents (39%) were significantly more likely than older adults (31%) to report not rinsing or washing raw poultry ( P < 0.001). Older adult respondents were significantly more likely than parent respondents to report following seven practices, with most related to chilling to proper temperatures and thawing. For example, older adults (87%) were significantly more likely than parents (69%) to report cooking, freezing, or discarding raw poultry within 1 to 2 days of purchase as recommended ( P < 0.001). For the remaining five practices, no differences were found between groups. To motivate behavior change, food safety messages and materials must target specific at-risk populations as their practices are different. Additional research is needed to better understand how parents of young children and older adults like to receive food safety information and how to tailor the information to different generations.

Raw poultry products often are contaminated with Salmonella and Campylobacter, and these bacteria can be transmitted through meat juice on the packages. An observational study was conducted to assess consumer exposure to meat juice during shopping and to quantify the transmission of meat juice from poultry packages to hands and other surfaces. Ninety-six participants completed the shopping study; 402 swabs were collected and analyzed for the presence of meat juice by an immunoassay. Overall, meat juice was detected on 61% of poultry package surfaces, 34% of shoppers' hands, 41% of grocery bags, 60% of kitchen surfaces, and 51% of food item surfaces. When meat juice was detected on the purchased poultry packages, the chance of the meat juice being on the shopper's hands, grocery bags, food items, and kitchen surfaces was significantly higher ( P < 0.005) compared with packages on which meat juice was not present. Shoppers who had poultry wrapped separately during checkout had a significantly lower ( P < 0.05) chance of meat juice on the food items. However, using plastic bags and wrapping poultry separately did not significantly reduce the likelihood of meat juice on kitchen surfaces at home due to consumers' practices of repackaging before storage. Results suggested that the transfer of meat juice through direct contact with the poultry packages is a major concern during shopping and should be prevented.

Background: Edible marijuana products have become extremely popular in states that have legalized marijuana for recreational use. Objectives: The goal of this research was to provide a better understanding of consumer perceptions of edible marijuana products, including why they prefer edibles relative to other forms of marijuana (e.g., smoking) and their concerns regarding the consumption of edibles. Methods: We conducted eight focus groups (four groups in Denver, Colorado, and four groups in Seattle, Washington) in February 2016 with 62 adult consumers of edibles. Focus group transcripts were coded in QSR NVivo 10.0 qualitative analysis software, and coding reports identified trends across participants. Results: Most participants preferred edibles to smoking marijuana because there is no smell from smoke and no secondhand smoke. Other reasons participants like edibles included convenience, discreetness, longer-lasting highs, less intense highs, and edibles' ability to aid in relaxation and reduce anxiety more so than smoking marijuana. Concerns and dislikes about edibles included delayed effects, unexpected highs, the unpredictability of the high, and inconsistency of distribution of marijuana in the product. No participants in either location mentioned harmful health effects from consuming edibles as a concern. Conclusions/Importance: The present study was qualitative in nature and provides a good starting point for further research to quantify through surveys how consumers understand and use edibles. Such information will help guide policy makers and regulators as they establish regulations for edibles. Also, such research can help inform educational campaigns on proper use of edibles for recreational purposes.

Meat slaughter establishments use a multipronged approach to ensure beef and pork products are safe for human consumption. To determine the approaches most commonly used, we conducted a national survey of federally inspected meat slaughter and processing establishments (376 completed surveys, 66% response rate) in 2015. We compared the results with a survey that was conducted in 2005, albeit of potentially different establishments, by using a similar questionnaire and similar data collection methods, thus allowing for an evaluation of trends in food safety practices over time. The use of some food safety practices has increased over the 10-yr time period, whereas others remained the same or decreased. For example, the use of chemical sanitizers or hot water for food contact surfaces and tools increased from 51 to 93%. As another example, microbiological testing of raw meat after fabrication, in addition to that required by regulation, increased from 50 to 72%. However, the use of organic acid rinse on carcasses in the slaughter area remained the same, at 66% of establishments. Written policies and procedures to control the use of hazardous chemicals decreased from 75 to 65% of establishments. The survey findings can be used to characterize food safety practices and technologies in the meat slaughter and processing industry and identify areas for improvement.

Background: Sales of edible marijuana products have been strong in Colorado and Washington State since the legalization of recreational marijuana. Initially, these states did not have comprehensive labelling or packaging requirements in place. In response to increases in marijuana-related emergency room visits and poison control centre calls, additional regulations were implemented. Currently, Alaska, Colorado, Oregon, and Washington each have passed into law various labelling and packaging requirements for edibles.Methods: This article presents the primary legal research findings of relevant statutes and regulations for edibles in Alaska, Colorado, Oregon, and Washington. These laws were identified by using Boolean terms and connectors searches in these states' legal databases in LexisNexis.Results: Alaska, Colorado, Oregon, and Washington vary greatly in how they regulate labelling and packaging. Colorado, Oregon and Washington require a Universal Symbol to be affixed to edibles, but only Oregon and Washington require that the use of pesticides be disclosed on the label. Only Colorado and Oregon require that the packaging for edibles bear a Nutrition Facts Panel on the label. Delta(9)-Tetrahydracannabinol (THC) in a single serving or single edible product as Alaska and Oregon. All four states prohibit the manufacture or packaging of edibles that appeal to youth.Conclusion: State laws governing recreational marijuana edibles have evolved since the first recreational edible products were available for sale. Alaska, Colorado, Oregon, and Washington now require edible product labels to disclose a variety of product information, including risk factors associated with consumption. However, there still remain concerns about the regulatory gaps that exist in each of these states, inherent difficulties in enforcing laws around the labelling, packaging, and manufacturing of edibles, and the outstanding question of whether these edible laws are actually informing consumers and keeping the public safe. (C) 2017 Elsevier B.V. All rights reserved.

Background: In 2014, the states of Colorado and Washington began allowing retail sales of marijuana for recreational use. The regulatory agencies in these states have implemented specific labelling requirements for edible marijuana products sold for recreational use to help address concerns such as delayed activation time, accidental ingestion, and proper dosing.Methods: We conducted 12 focus groups with 94 adult consumers and nonconsumers of edibles in Denver and Seattle to collect information on their use and understanding of labelling information on edible marijuana products sold for recreational use. Specifically, we asked participants about the usefulness, attractiveness, ease of comprehension, relevancy, and acceptability of the label information.Results: Some focus group participants look for and read specific information, such as the potency profile and serving size statement, but do not read or were unfamiliar with other labelling features. The focus groups revealed that participants have some concerns about the current labelling of edibles. In particular, participants were concerned that there is too much information on the labels so consumers may not read the label, there is no obvious indication that the product contains marijuana (e.g., a Universal Symbol), and the information on consumption advice is not clear. Participants in both locations suggested that education in a variety of formats, such as web- and video-based education, would be useful in informing consumers about the possible risks of edibles.Conclusion: The focus group findings suggest that improvements are needed in the labelling of edibles to prevent unintentional ingestion among adult nonusers and help ensure proper dosing and safe consumption among adult users. These findings, along with lessons learned from Colorado and Washington, can help inform the labelling of edibles as additional states allow the sale of edibles for recreational use. (C) 2017 Elsevier B.V. All rights reserved.

In 2006, the Food and Nutrition Service introduced the Value Enhanced Nutrition Assessment (VENA) guidance to aid with participant-centered nutrition education as part of the WIC program. Because local WIC agencies have flexibility in their approach for delivering nutrition education, understanding how current practices align with VENA was an objective of the 2016 WIC Nutrition Education Study: Phase I Report. We conducted surveys with a nationally representative sample of WIC local agencies and sites (893 local agencies, 1,401 sites) and in-depth telephone interviews with site staff from a subset of survey respondents (80). Outcome measures included environment, staffing, and resources for WIC nutrition education; types and frequency of educational approaches; and efforts to incorporate participant-centered approaches. We synthesized data from surveys and interviews. Up to 67% of sites provide staff training on VENA and/or participant-centered education techniques with an average of 5-6 hours of training per staff person annually. Sites reporting more training also reported more changes in their nutrition education approach. More than 80% of sites indicated that discussion topics for one-on-one visits are chosen by the participant or by the participant and WIC staff together. Similar numbers reported that individualized goals are almost always or often set by participants or by the participant and educator together. WIC nutrition education is moving toward a more individualized approach focused on meeting participant needs with a higher level of participant involvement throughout the process which is the primary goal of VENA. Ongoing attention to strengthening nutrition education policy and practice is essential for achieving program goals.

Background: Poultry, eggs, and their products represent a potential food safety hazard. Although consumer practices related to these foods have been studied in various countries, little data exists from Latin America. Objective: The objective of this pilot study was to provide initial data to characterize consumers’ purchase, storage, handling, and preparation of poultry products and eggs in three countries: Argentina, Colombia, and USA. Methods: Consumers (n = 425 total) in each location completed a questionnaire about poultry products and egg purchase locations, storage conditions (i.e. refrigerator or freezer), preparation and handling practices, and managing leftovers. Results: The results indicated that in the USA most surveyed consumers purchased refrigerated eggs, whereas in Argentina (91%) and Colombia (84%) eggs typically were purchased at room temperature. Furthermore, almost all consumers in the USA stored eggs in the refrigerator, but 23% of Argentinian and 45.9% of Colombian consumers stored eggs at room temperature, which is potentially an unsafe practice. Some practices supported possible cross-contamination, for example washing raw eggs and poultry prior to cooking. Conclusions: These results are a first comparison across countries in the Americas of consumer poultry and egg practices and can serve as the basis for further research and development of food safety educational messages.

Previous research has shown that many consumers do not follow recommended food safety practices for cooking poultry and eggs, which can lead to exposure to Salmonella and Campylobacter. Past research has been done primarily through surveys and interviews, rather than observations. The objective of this project was to determine through observations whether consumers follow food safety guidelines. Consumers (n =101) divided among three locations (Manhattan, KS; Kansas City, MO area; and Nashville, TN) were observed as they prepared a baked whole chicken breast, a pan-fried ground turkey patty, a fried egg, and scrambled eggs. The end point temperature for the cooked products was taken (outside the view of consumers) within 30 s after the consumers indicated they were finished cooking. Thermometer use while cooking was low, although marginally higher than that of some previous studies: only 37% of consumers used a thermometer for chicken breasts and only 22% for turkey patties. No one used a thermometer for fried or scrambled eggs. Only 77% of the chicken and 69% of the turkey was cooked to a safe temperature (165°F [74°C]), and 77% of scrambled and 49% of fried eggs reached a safe temperature (160°F [71°C]). Safe hand washing was noted in only 40% of respondents after handling the chicken breast and 44% after handling the ground turkey patty. This value decreased to 15% after handling raw eggs for fried eggs and to 17% for scrambled eggs. These results show that there is a high prevalence of unsafe behaviors (undercooking and poor hand washing technique) when cooking poultry and eggs and a great need for improvement in consumer behavior with poultry and eggs.