Food handlers and foodborne diseases: knowledge, attitudes, and reported behavior in Italy

The purpose of this study was to evaluate knowledge, attitudes, and behavior concerning foodborne diseases and food safety issues among food handlers in Italy. Face-to-face interviews were conducted within a random sample using a structured questionnaire. Of the 411 food handlers responding, 48.7% knew the main foodborne pathogens (Salmonella spp., Staphylococcus aureus, Vibrio cholerae or other Vibrio spp., Clostridium botulinum, hepatitis A virus), and this knowledge was significantly greater among those with a higher education level, in practice from a longer period of time, and who had attended education courses (P < 0.05). A vast majority (90.4%) correctly indicated those foods classified as common vehicles for foodborne diseases, and only 7.1% of food handlers were able to name five different food vehicles, each of which transmit one of the five pathogens. The proportion of those who were able to specify a food vehicle that transmitted hepatitis A virus was significantly higher for those with a higher educational level and with a longer food-handling activity. A positive attitude toward foodborne diseases control and preventive measures was reported by the great majority of food handlers, and it was more likely achieved by those who had attended education courses. This attitude was not supported by some of the self-reported safe practices observed for hygienic principles, because only 20.8% used gloves when touching unwrapped raw food, and predictors of their use were educational level and attending education courses. Results strongly emphasize the need for educational programs for improving knowledge and control foodborne diseases.     

Relationship between consumer food safety knowledge and reported behavior among students from health sciences in one region of Spain

A survey was conducted to investigate the relationship between knowledge about food safety and actual food handling practices among Spanish university students (mainly from the health sciences disciplines) who usually prepare meals at home. Based on level of education in food safety topics, students were divided in three groups: high, which included students from Food Science and Nutrition; medium, which included students from other health sciences; and low, which included students from non-health-related studies. More than two thirds of the 562 people selected had an accurate knowledge of the eight foodborne pathogens included in the survey, but only 5.2% were able to identify Staphylococcus aureus as a foodborne pathogen. Significant differences in responses were found depending on educational level concerning the food safety topic. For food handling, up to 60% of the responses reflected accurate knowledge of proper storage of prepared meals and washing of hands and materials to avoid cross-contamination. However, with the exception of questions related to storage temperature, there was considerable difference between knowledge and reported behavior. Although 98.6% of the participants recognized the importance of hand washing before and during food preparation, only one quarter (24.4%) affirmed that they washed their hands with soap and water. On questions concerning food practices, more accurate answers were given by the older students. Women answered questions regarding cross-contamination more accurately, whereas men were more accurate in response to questions concerning temperature and food preservation. In general, students with more knowledge of food hygiene had better reported practices, but even these students reported some high-risk behaviors. These results confirm the need to improve educational programs, ensuring that the acquired knowledge actually modifies consumer behavior.     

Validation of guidelines for investigating foodborne disease outbreaks: the experience of the Lazio region, Italy

Information about risk ratios, exposures, and vehicles for foodborne diseases tends to be more reliable when it is obtained from outbreak surveillance than when it is obtained from disease notifications. In 1997, guidelines for methods of investigating foodborne disease outbreaks (FBDOs) were implemented in the Lazio region. To evaluate the impact of these guidelines, we analyzed information about 410 FBDOs from 1996 to 2000. Under these guidelines, the delay in the reporting of outbreaks decreased from 10 to 2 days. An analysis of 82 large FBDOs (in which > 30 people were exposed) showed increases in the calculation of attack rates with a cohort approach (up to 83%), correctly drawn epidemic curves (up to 79%), and the calculation of food-specific relative risk (up to 60%). On the other hand, the level of the determination of etiology remained low: tests were performed on patients in 57% of the cases considered, resulting in an agent identification rate of 38%; for 22 outbreaks, tests were performed on food, resulting in three positive identifications. Analysis of the contamination route with the use of hazard analysis critical control point criteria a posteriori was carried out for 15 outbreaks, and nine of these analyses were successful. The implementation of the 1997 guidelines was successful with regard to epidemiological and statistical methods but did not improve etiological diagnosis for FBDOs. These guidelines improved surveillance for outbreaks in which > 30 people were exposed in well-defined exposure situations; however, the guidelines did not significantly improve epidemiological investigations of small household outbreaks.     

Smoking in Ecuador: prevalence, knowledge, and attitudes

OBJECTIVE: To evaluate the prevalence of, attitudes towards, and knowledge about cigarette smoking in Ecuador in 1991. DESIGN: Survey using in-person interviews; stratified and multiple regression analyses. SUBJECTS AND SETTING: Eight hundred people (> or = 18 years old) representative of the adult populations in the cities of Quito and Guayaquil, Ecuador. MAIN OUTCOME MEASURES: Smoking prevalence, daily cigarette consumption, reasons for smoking, desire to quit smoking, knowledge about the health effects of smoking. RESULTS: About a third of the population in the two major cities of Ecuador are cigarette smokers. Men are not only more likely to be smokers than women (45% vs 17%, respectively), but when they do smoke, they also smoke significantly more cigarettes per day (60% more) than women. Cigarette smoking appears to be more common among younger populations, and among more educated people. Housekeepers are significantly less likely to be smokers compared with people in other occupations. About 80% of smokers consume fewer than 10 cigarettes per day. In Quito, a 40% increase in the number of cigarettes smoked per day on weekdays compared with weekends suggests an effect of the environment on smoking patterns. About 60% of smokers stated their desire to quit smoking, and there was almost universal knowledge about the harmful effects of cigarette smoking on the health of active and passive smokers. CONCLUSIONS: About a third of the population in the two major cities of Ecuador reported smoking cigarettes. Smoking is more common among men, those of younger age, and the more educated. The findings in this study should help the development of antismoking policies in Ecuador and other countries in the region.




     

Incidence of foodborne illnesses reported by the foodborne diseases active surveillance network (FoodNet)-1997. FoodNet Working Group

In 1997, the Foodborne Diseases Active Surveillance Program (FoodNet) conducted active surveillance for culture-confirmed cases of Campylobacter, Escherichia coli O157, Listeria, Salmonella, Shigella, Vibrio, Yersinia, Cyclospora, and Cryptosporidium in five Emerging Infections Program sites. FoodNet is a collaborative effort of the Centers for Disease Control and Prevention's National Center for Infectious Diseases, the United States Department of Agriculture's Food Safety and Inspection Service, the Food and Drug Administration's Center for Food Safety and Applied Nutrition, and state health departments in California, Connecticut, Georgia, Minnesota, and Oregon. The population under active surveillance for foodborne infections was approximately 16.1 million persons or roughly 6% of the United States Population. Through weekly or monthly contact with all clinical laboratories in these sites, 8,576 total isolations were recorded: 2,205 cases of salmonellosis, 1,273 cases of shigellosis, 468 cases of cryptosporidiosis, 340 of E. coli O157:H7 infections, 139 of yersiniosis, 77 of listeriosis, 51 of Vibrio infections, and 49 of cyclosporiasis. Results from 1997 demonstrate that while there are regional and seasonal differences in reported incidence rates of certain bacterial and parasitic diseases, and that some pathogens showed a change in incidence from 1996, the overall incidence of illness caused by pathogens under surveillance was stable. More data over more years are needed to assess if observed variations in incidence reflect yearly fluctuations or true changes in the burden of foodborne illness.     

Waterpipe tobacco smoking: knowledge, attitudes, beliefs, and behavior in two U.S. samples.

Despite evidence of increasing waterpipe tobacco smoking prevalence among U.S. young adults, little is known about the knowledge, attitudes, beliefs, and smoking patterns of waterpipe users in this population. To address this lack of knowledge, two convenience samples of U.S. waterpipe users were surveyed--one from a Richmond, Virginia, waterpipe café (n=101), the other from an Internet forum called HookahForum.com (n=100). Sixty percent reported first-time waterpipe use at or before age 18. Daily waterpipe use was reported by 19%, weekly use by 41%, and monthly use by 29%. Waterpipe use was more common during the weekend (75%) than during weekdays (43%). Forty-four percent reported spending >or=60 min smoking tobacco during a waterpipe session. The majority of waterpipe users owned a waterpipe (57%) and purchased it on the Internet (71%). Many waterpipe users smoked the sweetened and flavored tobacco (i.e., maassel), and fruit flavors were the most popular (54%). Past month use of cigarettes, tobacco products other than cigarettes or waterpipe, and alcohol was 54%, 33%, and 80% respectively, and 36% reported past-month marijuana use. Most waterpipe users were confident about their ability to quit (96%), but only a minority (32%) intended to quit. Most waterpipe users believed waterpipe tobacco smoking was less harmful and addictive than cigarettes. These results are from small convenience samples; more detailed study of a larger group of randomly sampled U.S. waterpipe tobacco smokers will be valuable in understanding this behavior and developing effective strategies to prevent it.     

A summary of reported foodborne disease incidents in Sweden, 1992 to 1997

Reports of foodborne disease incidents in Sweden from 1992 to 1997 are summarized. The results are based on reports from the municipal environmental and public health authorities to the National Food Administration and from medical authorities to the Swedish Institute for Infectious Diseases Control. A total of 555 incidents, of which 84% were outbreaks, were reported, involving 11,076 ill people. In 66% of the incidents, no disease agent was determined. Bacterial agents were implicated in 25% and viruses in 8% of the incidents. Calicivirus was the most reported agent both in terms of incidents and cases. Mixed dishes was the food category most often implicated in outbreaks, and smorgasbord and casserole or stews were the subcategories that caused the most cases. The place of consumption was unknown in 8% of the incidents. In about 60% of the incidents, the implicated food was consumed in commercial food establishments; in approximately 20% of incidents, it was consumed at home. The average annual incidence of reported foodborne disease in Sweden was estimated to be 21 cases per 100,000. The average annual incidence of reported foodborne salmonellosis and campylobacteriosis was estimated to be 2.0 and 0.6 cases per 100,000, respectively. The awareness and motivation to report foodborne diseases need to be improved, but additional sources of information are needed to counteract some of the limitations of reporting discussed in this work.     

Smoking behavior, knowledge, attitudes and practice among health care providers in Changsha city, China.

With the smoking epidemic in China, the role that health care providers (HCPs) could play in tobacco control will be critical. As a preliminary step, this study identified smoking behavior, knowledge, attitudes, and practice (KAP) regarding smoking and smoking control among HCPs in Changsha city, China. The study design was cross-sectional. The instruments - Demographic Information Scale and KAP Scale - were distributed to 420 physicians and 400 nurses in four hospitals in Changsha city. The effective response rate was 77.56% (636/820). Among the respondents, 20.8% were current smokers, which represented 35.7% of the physicians and 1.4% of the nurses, and 43.0% of the males and 1.2% of the females. The mean knowledge score was 22.3+/-4.4 (n = 30). Knowledge regarding smoking's harmful effects and smoking-related respiratory system diseases was high. Nonetheless, tobacco addiction was underestimated. The mean attitudes and practice score was 17.7+/-2.3, 15.1+/-3.4 (n = 20). Eighty-seven percent approved their role in smoking control, but only 45% HCPs practically informed patients about methods of smoking cessation. Smoking behavior was negatively associated with KAP, and 59.7% of the HCPs thought that inadequate knowledge affected their practice. In conclusion, HCPs had some knowledge and positive attitudes regarding the cessation of smoking, but were relatively unoptimistic regarding putting smoking control into practice. The high smoking rate among male HCPs and knowledge insufficiency about smoking may pose barriers in tobacco control efforts for HCPs. As such, interventions for the cessation of smoking, and continual education on smoking control for HCPs, are indicated in China.     

Clinical pathology of foodborne diseases: notes on the patient with foodborne gastrointestinal illness

The symptoms and signs in persons with food- or waterborne infections provide clues to the nature of the infecting microbe. Proper treatment of the affected individual, and protection of those exposed to the same source, is dependent on time-honored methods of diagnosis: exposure history, and physical examination. Laboratory testing may help to identify the responsible agent. Spontaneous recovery is the most likely outcome once supportive measures such as fluid and electrolyte replacement are addressed. Antibiotics are often unnecessary and may prolong fecal excretion of certain microorganisms. In immunosuppressed persons or those weakened by marginal nutrition, foodborne infection can be more severe, mandating more specific therapy. Management requires knowing the level of tissue invasion and organ infected by each of the commonly encountered microbes. Some of the most life-threatening infections (cholera, for example) are associated with no visible tissue injury, yet they have a profound impact on gut function. In contrast, salmonellosis and shigellosis can cause severe gut injury, and when foodborne infections extend beyond the confines of the gut, skilled care is essential. Examples are hemolytic uremic syndrome of Escherichia coli infections, or listeriosis, both of which require urgent attention. Long-term consequences of gut infections such as the paralytic Guillain-Barre syndrome following Campylobacter infections illustrates the long-term problems sometimes encountered. Because it is unlikely that all infectious agents will ever be removed from food and water in any country, sound medical intervention tailored to the extent of illness will be the mainstay of handling such illnesses.     

The effect of a national mastitis control program on the attitudes, knowledge, and behavior of farmers in the Netherlands

Over the years, much effort has been put into implementing mastitis control programs in herds. To further improve utilization of such programs, there needs to be an understanding of the attitudes, knowledge, and behavior of farmers regarding udder health, and the way this can be influenced by mastitis control programs. This study aimed to explore the effect of a national mastitis control program on Dutch farmers' attitudes, knowledge, and behavior regarding mastitis. A total of 378 dairy farmers completed a survey on attitudes, knowledge, and behavior regarding mastitis before the start of a national mastitis control program in 2004, and 204 completed a similar survey in the final year of the program (2009). Although the average annual bulk milk somatic cell count (BMSCC) remained the same, the farmers' self-reported attitudes, knowledge, and behavior changed significantly. The problem level of BMSCC decreased from 285,000 cells/mL in 2004 to 271,000 cells/mL in 2009. More farmers perceived that they had sufficient knowledge about the prevention of mastitis (34% in 2004 vs. 53% in 2009) and they more often perceived that they knew the cause of a mastitis problem (25% in 2004 vs. 37% in 2009). The use of gloves for milking increased from 15 to 46%, the use of a standardized mastitis treatment protocol increased from 7 to 34%, and freestalls were cleaned more often (2.28 vs. 2.51 times/d) in 2009 compared with 2004. Most changes in attitudes, knowledge, and behavior did not differ between groups of dairy farmers whose herds had an initially low (≤ 162,000 cells/mL), medium (163,000 to 205,000 cells/mL), or high (>206,000 cells/mL) BMSCC. The high BMSCC group significantly decreased their annual BMSCC level by 15,000 cells/mL. Regression analysis showed that the decrease in BMSCC was associated with a change in farmers' perceptions (e.g., increased perceived knowledge about the effect of the milking machine on mastitis) and with a change in certain management practices (e.g., disinfecting all teats after milking). The results showed that a national mastitis control program affected the attitudes, knowledge, and behavior of farmers regarding mastitis and could contribute to udder health improvement in the long term.     

Consumer knowledge of foodborne microbial hazards and food-handling practices.

A national telephone survey was conducted of 1,620 randomly selected U.S. residents who spoke English, were at least 18 years old, and resided in households with kitchen facilities. Respondents were interviewed about their recognition of foodborne pathogens, foods at risk for transmitting infection, knowledge of safe food handling, and food-handling practices. One-third of the respondents who prepared meals reported unsafe food hygiene practices: e.g., they did not wash hands or take precautions to prevent cross-contamination from raw meat. Unsafe practices were reported more often by men, adults 18 to 29 years of age, and occasional food preparers than by women, persons 30 years old or older, and frequent food preparers. Respondents who identified a food vehicle for Salmonella spp. were more likely to report washing their hands and cleaning cutting boards after preparing raw meat and poultry. The results raise concerns about consumer food-handling practices. The influence of food safety training, food-handling experience, and age on food-handling practices should be studied further. Awareness of a food vehicle for Salmonella spp., for example, may indicate knowledge of the etiology of foodborne disease that promotes safe food handling. Understanding the factors associated with safe food handling will assist in development of effective safe-food instruction programs.     

Spices and herbs as source of Salmonella-related foodborne diseases

Salmonella is a leading cause of foodborne diseases and the role of ready-to-eat products including plant-derived food is increasingly recognized. The present survey reviewed recent literature on Salmonella-related outbreaks caused by spices and herbs and on the occurrence of Salmonella in these food matrices. Spices and herbs contaminated with Salmonella were responsible for a variety of foodborne outbreaks in Europe and North America. Identified serovars did often not belong to those predominating in human illness. Moreover, in different survey studies, Salmonella belonging to a broad diversity of serovars were found in a variety of spices and herbs. The proportion of Salmonella-positive samples ranged from 0% to 8.4%, albeit detection rates were rather low in most studies. Higher prevalence rates were often obtained with regard to a specific spice or herb type. Due to high desiccation tolerance, Salmonella can survive for an extended period of time in spices and dried herbs. Thus, by the use of untreated spices and herbs for production of foods not subjected to a heat treatment or for seasoning of ready-to-eat products, Salmonella might be introduced and in this way might pose a threat to consumers.     

Strain variability of the behavior of foodborne bacterial pathogens: A review

Differences in phenotypic responses among strains of the same microbial species constitute an important source of variability in microbiological studies, and as such they need to be assessed, characterized and taken into account. This review provides a compilation of available research data on the strain variability of four basic behavioral aspects of foodborne bacterial pathogens including: (i) virulence; (ii) growth; (iii) inactivation; and (iv) biofilm formation. A particular emphasis is placed on the foodborne pathogens Listeria monocytogenes and Salmonella enterica. The implications of strain variability for food safety challenge studies and microbial risk assessment are discussed also. The information provided indicates that the variability among strains of foodborne bacterial pathogens with respect to their behavior can be significant and should not be overlooked. However, in order for the mechanisms underlying the observed strain variability to be elucidated and understood, phenotypic variability data, such as those reviewed here, should be evaluated in conjunction with corresponding findings of studies assessing the molecular/physiological basis of this variability.     

The use of plasmid profiles and nucleic acid probes in epidemiologic investigations of foodborne, diarrheal diseases

The application of nucleic acid analyses to investigations of infectious disease outbreaks has resulted in useful molecular strain markers that distinguish the epidemic clone of a particular pathogen and help identify specific vehicles of infection. We have successfully used plasmid profile analysis, restriction endonuclease digestion of plasmid and whole-cell DNAs, and nucleic acid hybridization to investigate recent outbreaks of foodborne diarrheal illness. Plasmid analysis has been important in identifying epidemic strains of Salmonella enteritidis and Escherichia coli O157:H7. In a culture survey of S. enteritidis isolates from humans and a variety of animals, including chickens and chicken eggs, we identified 16 distinct plasmid profiles and used these to differentiate strains, especially within commonly occurring phage types (Colindale 8 and 13a). HindIII digests of plasmid DNA were useful in distinguishing plasmids of similar mass but dissimilar enzyme target sequences; they clearly distinguished S. enteritidis strains causing systemic infections in children in parts of Africa from U.S. isolates. Investigations of outbreaks of hemorrhagic colitis have also been assisted by plasmid analysis. Restriction endonuclease digests of whole-cell DNA and Southern blot analysis, hybridizing with E. coli 16S and 23S rRNA (ribotyping), have been effective subtyping techniques, especially for plasmidless isolates of Campylobacter jejuni. In five outbreaks of C. jejuni infections, ribotyping of PvuII and ClaI digests distinguished individual epidemic strains within one commonly occurring C. jejuni serotype (Penner 2, Lior 4). Preliminary data show that ribotyping of NcoI digests can also distinguish individual epidemic strains of E. coli O157:H7 and may provide a more stable marker than plasmid profiles. Specific DNA probes derived from cloned virulence genes of E. coli have been invaluable in epidemic investigations and surveys. Using colony hybridization, we found in one survey of stool specimens from 174 dairy cattle that 11% of animals were asymptomatically carrying Shiga-like toxigenic E. coli other than O157:H7. We also found that newly synthesized oligonucleotide probes for the Shiga-like toxins I and II agreed 100% with cloned gene probes in a study of 613 E. coli strains. Future studies of these organisms will include the use of additional synthetic oligonucleotides as primers to amplify the toxin genes directly in patient and animal specimens by the polymerase chain reaction. There is a continuing and expanding role for molecular approaches in epidemiological investigations. The DNA methods described above are not based on the often complex expression of phenotypic characteristics, and, unlike sensitive and specific techniques such as phage typing, a single method can be used to study a variety of Gram-positive and negative bacterial pathogens.     

Food safety knowledge, attitudes, and behaviors among Puerto Rican caretakers living in Hartford, Connecticut

Household food safety education is needed to minimize the risk of exposure to foodborne pathogens. The Latino population in the United States is growing at a fast rate and has become the largest minority group in this country. However, little research has been done to identify the food safety behavioral risks faced by Puerto Ricans. Ten in-depth household observations and a quantitative survey on food safety knowledge, attitudes, and behaviors (n = 100) were conducted to understand food-handling techniques among Puerto Rican caretakers of young children. This was followed by two focus groups (n = 12) to further characterize food safety knowledge, attitudes, and behaviors and the proper media channels for the delivery of food safety education. Even though 97% of survey participants reported washing their hands with soap and water before preparing foods, only 1 of the 10 participants in the household observations actually did it. About 60% of the household participants washed the cutting boards with soap and water compared with 89% of survey participants who claimed to do it. In the survey, 5% reported to know the meaning of cross-contamination, and 71% (n = 80) to use the same cutting board for meats and vegetables. Overall, 96% of survey participants did not use a thermometer to check if meats were cooked properly and only 10% defrosted their meats in the refrigerator. Statistically significant relationships (P < 0.05) were found between speaking English and knowing the meaning of cross-contamination and how to use a meat thermometer. Employed individuals and those with higher education were also more likely to be familiar with the term pasteurization. These results fully justify the delivery of culturally appropriate food safety education in this community.     

Smoking-related knowledge and attitudes of senior Australian medical students

OBJECTIVE: To assess the smoking-related knowledge and attitudes of senior medical students and to compare knowledge and attitude changes in students exposed to four different smoking cessation skills training interventions. DESIGN: A survey questionnaire, assessing knowledge and attitudes, was administered pre- and post-intervention for each of the four intervention conditions. SUBJECTS: A cohort of 219 fifth-year medical students at the University of Sydney. INTERVENTIONS: Students were randomised into one of four intervention conditions: (1) a traditional didactic lecture mode (control group); (2) the use of role plays and audiotaped feedback; (3) role plays with peer feedback; and (4) video feedback. MAIN OUTCOME MEASURES: Knowledge on morbidity and mortality associated with smoking, intervention strategies, intervention effectiveness, and cessation practices; anticipated clinical behaviour related to smoking; and attitudes towards medical practitioner involvement in smoking cessation. RESULTS: Smoking knowledge was significantly greater at post-test (mean unweighted scores of 69% before and 74% after intervention). All groups had improved knowledge levels at post-test. However, after controlling for pre-test differences, the control group, video feedback, and peer feedback groups were found to have improved significantly over the audio feedback group. Scores were higher on items related to morbidity and mortality and intervention effectiveness than for items on intervention strategies and cessation practices. Positive student attitudes towards their role in smoking cessation were also found. There was an almost universally held view that doctors can have a significant impact on reducing smoking levels. Although most students perceived smoking intervention to be a worthwhile activity, they remained pessimistic about the ease with which patients' smoking behaviour could be changed. CONCLUSIONS: Positive smoking cessation knowledge changes can be readily achieved through training. However, specific smoking cessation training is needed for medical trainees to develop appropriate skills and strategies. Attention to particular weaknesses related to specific intervention strategies and cessation practices is required to develop competence in this area and to maximise the chances of new medical graduates fully using the opportunities available to them.


     

U.K. general practitioners' beliefs, attitudes, and reported prescribing of nicotine replacement therapy in pregnancy.

Clinical guidelines recommend that U.K. health professionals prescribe NRT in pregnancy. The present study was conducted to determine (a) general practitioners' confidence in their ability to deliver a range of smoking cessation interventions, including NRT, in pregnancy, (b) the frequency with which general practitioners recall prescribing NRT in pregnancy, and (c) the factors that influence general practitioners to prescribe NRT in pregnancy. We conducted a mail survey of 368 general practitioners (family physicians) working in four districts of Nottingham, England (response rate = 68.6%). Some 27.1% of respondents recalled prescribing NRT to pregnant women (9.2% were unsure). General practitioners were less confident about their ability to prescribe NRT in pregnancy than they were of their ability to deliver other simple smoking cessation interventions in pregnancy. Most general practitioners (62%) believed NRT to be effective in pregnancy and safer than smoking (70%), but fewer (45%) believed NRT to be safe in pregnancy per se. Multiple logistic regression demonstrated that general practitioners who believed NRT use in pregnancy was safer than smoking were most likely to recall having prescribed it, OR = 4.94, 95% CI = 1.31-18.71. Many general practitioners were unsure about the safety of NRT in pregnancy, which may explain their relatively low confidence in their ability to prescribe NRT in pregnancy, compared with other interventions. The key factor influencing general practitioners' prescribing decisions was a belief that NRT use in pregnancy was likely to be safer than smoking. Empirical evidence about the safety and efficacy of NRT use in pregnancy is required to inform general practitioners' decisions about prescribing NRT to pregnant women who smoke.     

Pork producers' attitudes, knowledge, and production practices that relate to on-farm food safety.

A survey was distributed by mail to a random selection of Illinois pig farmers marketing 1,000 or more pigs in 1998 to assess their knowledge, attitude and behavior regarding on-farm food safety. Valid responses were received from 353 of the 946 surveys mailed (37.3%). Pork production accounted for more than 50% of gross agricultural revenues among 65.0% of respondents, and 91.2% were classified as "owner-operators." Knowledge of food-borne pathogens was mixed, with correct responses to questions as follows: Trichina, 80.4%; Salmonella, 58.5%; Toxoplasma, 19.9%; and Campylobacter, 12.8%. Producers strongly agreed that food safety was a shared responsibility at every level of the food chain, including the farm level, with an average score for all steps in the pork chain of 4.5 on a scale from 1 (not important) to 5 (very important). When asked whether third party verification of on-farm practices was important, 51.2% agreed and 48.8% either disagreed or neither agreed nor disagreed. Associations between demographic categories and knowledge of and attitudes toward food safety were detected for herd size, proportion of agricultural receipts from pig production, grower versus birth-to-market production, age categories, and whether the respondent owned the pigs or facilities. Many (53.4%) were willing to apply a suggested food safety practice, even if there was no net profit for the practice. Findings suggest that Illinois pork producers accept an important role in pork food safety and express a willingness to participate but have knowledge gaps that should be filled.