Food safety and Ontario high school students: assessing education needs and the utility of existing food handler training in improving behaviours

Foodborne disease poses a significant risk to Canadians, with substantial health and economic burdens. In response, education is a common strategy used to increase food safety knowledge and promote safe food handling behaviours. Although youth are considered an important population for food safety education, the specific needs of high school students, and the ability of food safety education to improve food handling behaviours, are unknown. Thus, this thesis explored: (1) food safety education needs of high school students in Ontario; (2) the suitability of the Ontario Ministry of Health and Long-Term Care’s (MOHLTC’s) Provincial Food Handler Training program for meeting identified education needs; and (3) whether students’ food handling behaviours changed following delivery of the MOHLTC’s program. These objectives were addressed predominantly via two studies with findings reported in four manuscripts. To explore students’ food safety education needs, key informant interviews with 20 food safety and education experts were conducted. Transcripts of the audio-recorded interviews were analysed inductively, uncovering the nuanced food safety needs of students. High school was identified as an ideal time to instil safe food handling habits to meet students’ personal needs and help reduce the burden of foodborne disease. Experts also agreed that students generally need the same food safety education content as other demographic groups, but stressed the importance of focussing on students’ own common food handling experiences, including: the use of microwaves for reheating and cooking; consumption of convenience meals; school events; transportation of food for lunches, school trips and sporting events; and food allergen awareness. These findings demonstrate that food safety education is important for high school students, and suggest that existing food safety education material may be suitable for such education efforts. To assess whether the MOHLTC program could meet the education needs of high school students, the program’s content was mapped against food safety education needs identified by the key informant experts, and relevant objectives of the Ontario high school curriculum. All the education needs identified by the experts were met, except one: preventing injuries during food preparation. Injury prevention, classified under kitchen safety, is not typically included in food safety education, but is an important consideration for youth given their inexperience with food preparation and cooking. All relevant food safety objectives from the high school curriculum were covered by the MOHLTC material. Thus, the MOHTLC’s program appears suitable for meeting the identified food safety education needs of Ontario high school students. To evaluate whether safe food handling behaviours changed following delivery of the MOHLTC’s program, a repeated measures study was conducted with students (n=119) from four Ontario high schools. Students were observed preparing meals at three times during a semester: prior to receiving the food safety education, within two weeks post-education, and approximately three months later at the end of the semester. Prior to receiving the education, on average students only engaged in half of the observed safe food handling behaviours. Post-education, all behaviour scores increased significantly ~2 weeks post intervention and remained unchanged ~3 months later. However, students continued to perform risky behaviours post-education, suggesting that a risk of foodborne disease remained. Future consideration of how psychosocial factors influence behaviours and norms, and how changes in food handling behaviours translates to actual risk of foodborne disease, is needed. This thesis demonstrates – for the first time – the importance of food safety education for high school students, and provides evidence that delivering an existing food handler training program within high school food and nutrition classes may be a feasible way to meet students’ education needs and improve their safe food handling behaviours

A longitudinal evaluation of food safety knowledge and attitudes among Ontario high school students following a food handler training program

The final publication is available at Elsevier via https://doi.org/10.1016/j.foodcont.2017.01.011 © 2017. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/Youth are a unique audience for food safety education, in part due to low food safety knowledge. Although the effectiveness of such education has been explored for primary school and college students, no studies have assessed effectiveness among high school students specifically. We conducted a longitudinal intervention study in Ontario, Canada, between February and May 2015, to measure the baseline food safety knowledge and attitudes of high school students (n=119; from 8 classes in 4 high schools), and determine whether these factors improved following in-class delivery of a provincial standardized food handler training program. Linear mixed effects regression models were used to model within-student changes in knowledge scores and attitudes over time (i.e., circa 2 and 12 weeks post-intervention), and to investigate associations with student characteristics. At baseline, knowledge and attitudes were poor. Following training, overall knowledge was significantly greater than at baseline, although at three months post-intervention only knowledge of safe times and temperatures for cooking and storing food remained significantly higher than baseline. Following training, students were significantly less interested in learning about how to avoid foodborne disease. Other attitudes, as well as knowledge of cross-contamination prevention and disinfection procedures, remained unchanged. These findings suggest that delivering existing food handler training programs within high schools may be a feasible mechanism for food safety educators to improve students’ food safety knowledge, both overall and specific to safe times and temperatures, albeit potentially for short timeframes. Whether knowledge continues to decline beyond three months after training bears further investigation. As well, future research to investigate how students’ actual food safety practices may change following such training, and whether improvements in knowledge translate into reduced foodborne disease risk, is warranted.Ontario Ministry of Agriculture, Food and Rural Affairs' Food Safety Research Program || FS2013-1843 Canadian Institutes of Health Research || OOP-110788 Canadian Institutes of Health Research || MOP-114875 Additional support was provided via CIHR Public Health Agency of Canada Chairs in Applied Public Health (D. Hammond, S. Leatherdale)