Knowledge And Attitude Towards Health And Food Safety .

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J Anal Res Clin Med, 2017, 5(2), 62-8.doi: 10.15171/jarcm.2017.012, http://journals.tbzmed.ac.ir/JARCMKnowledge and attitude towards health and food safety amongstudents of Tabriz University of Medical Sciences, Tabriz, IranParvin Dehghan1, Fatemeh Pournaghi-Azar2, Saber Azami-Aghdash3, Yousef Sohraby-Silabi1,Hassan Dadkhah4, Hossein Mohammadzadeh-Aghdash*11Nutrition Research Center, Department of Food Science and Technology, School of Nutrition and Food Sciences, Tabriz University ofMedical Sciences, Tabriz, Iran2Dental and Periodental Research Centre, Tabriz University of Medical Sciences, Tabriz, Iran3Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran4Department of Management, School of Humanities, Bonab Branch, Islamic Azad University, Bonab, IranKnowledge,Attitude,Health and Food SafetyHealth and food safety is one of the most important issues of nutrition science.The present study aims to examine the knowledge and attitude towards health and food safetyamong students of Tabriz University of Medical Sciences, Tabriz, Iran.This study was conducted through cross-sectional approach on 300 students of TabrizUniversity of Medical Sciences who were selected through stratified random sampling method,using a validated and reliable researcher-made questionnaire. Data were analyzed by SPSS.More than 50% of students had high attitude and knowledge towards health and foodsafety and washing hands before cooking. Further, more than 60% of students had low attitudeon other related items such as unimportance of food additives in food safety. Besides, more than50% of students had low knowledge about best temperature to store cooked food which isbetween 5 to 65 C and the most appropriate plastic containers to keep food healthy. About87.3% of students had good knowledge about diseases that could be transmitted through food.That there was a significant relationship between students' attitude and taking courses related tohealth and food safety (P 0.010). There was also a significant relationship between students'knowledge and their college (P 0.001) and major (P 0.020).Results obtained revealed that students from some colleges and some majors hadlow knowledge of health and food safety. It is therefore necessary to hold training programsthrough workshops or to include courses in the curriculum of majors that lack such credits.Citation: Dehghan P, Pournaghi-Azar F, Azami-Aghdash S, Sohraby-Silabi Y, Dadkhah H,Mohammadzadeh-Aghdash H. Knowledge and attitude towards health and food safety among studentsof Tabriz University of Medical Sciences, Tabriz, Iran. J Anal Res Clin Med 2017; 5(2): 62-8.Doi: 10.15171/jarcm.2017.012Annually millions of people in the worldsuffer from food-borne diseases throughconsumptionofcontaminatedfood.Increasing outbreaks of transmitted diseasesindicate the expansion of public healthproblems in low- and middle-incomecountries which threaten consumers' healthand affect their economy by imposingmedicalexpenses.1Inrecentyearsconsidering the increased prevalence offood-borne diseases, the science of health andfood safety has attracted great attention.2Every year, more than 30% of the populationof high-income countries suffer fromfood-borne diseases.3 According to thereports, for example, food-borne diseaseshave sickened up to 76 million in the United* Corresponding Author: Hossein Mohammadzadeh-Aghdash, Email: [email protected] 2017 The Authors; Tabriz University of Medical SciencesThis is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), whichpermits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Dehghan, et al.States among which 325000 cases have beenhospitalized and 5000 ones have led to death.Although few studies have been done in thisregard in low- and middle-income countries,evidence suggests that they are strugglingwith severe problems caused by spread ofthese diseases.4,5Health and food safety is a science thatprevents humans from being infected withchronic and acute food- and water-bornediseases.6 Cross-contamination, disregardinghand washing, improper food storage andinadequate cooking have an important role infood-borne diseases.7Previous studies on epidemiology offood-borne diseases show that consumersbehavior such as eating raw (uncooked) orlightly cooked foods and poor sanitaryconditions, knowledge and attitude towardshealth and food safety play an important rolein the prevalence of food-borne diseases.8-10According to the Majowicz et al.’s study,11people’s knowledge of health and food safetycan prevent them from being infected withmany diseases and hinder contamination offood and the environment. Young et al.12performed a study in a Canadian universityand reported that more than 53% of studentshad low knowledge about eating raw foodsthat causes food-borne diseases. Unklesbayet al.13 conducted an investigation onknowledge and attitude towards food safetyamong students of Tehran University ofMedical Sciences, Tehran, Iran, and foundthat students who had passed food-relatedcourses had much higher level of knowledgeand attitude than others. According to thestudy done by Askarian et al. in Shiraz, Iran,there was a significant difference betweenknowledge and attitude towards health andfood safety.14Students of medical science universitieshave an important role in Iranian healthsystem in regard to prevention of diseasesespecially food-borne diseases. In this regard,their knowledge and attitude towards healthand food safety must be studied.According to the results of literaturereview, so far there has been no study on theassessment of knowledge and attitude towardhealth and food safety among students ofTabriz University of Medical Sciences, Tabriz,Iran. In this regard, the aim of this study wasto assess the knowledge and attitude ofstudents of Tabriz University of MedicalSciences towards health and food safety.In this cross-sectional study, the populationconsisted of all students studying at TabrizUniversity of Medical Sciences. To carry outthis study, students’ information regardingcollege, field of study, level, year of entry andgender were received from university'seducational department.Morgan table was used to calculate thesample size. According to the population, asample size of 320 students was calculatedwhich was raised up to 20% to increase thestrength of the study and reduce attrition.Thus, finally a sample of 384 was calculated.To select students from each college, quotasampling method was used. Quota samplingis a non-probability sampling techniquewherein a certain proportion is consideredfor each class or subgroup of the population.To this end, available individuals and unitsare selected in proportion to the number ofeach of the classes or groups constituting thepopulation. To collect the data, a self-madequestionnaire was used which was designedthrough literature review and similarstudies.15Questionnaire's validity was confirmed by15 experts of food science and technology aswell as educational authorities. The reliabilityof the questionnaire was calculated throughtest-retest method by 30 students (α 0.80).The questionnaire contained three mainparts. First, demographic and educationinformation (6 items), second, questionsrelated to attitude (9 items) and third,questions on knowledge (13 items).Study was run after questionnaire becameready. Our researchers visited differentschools and distributed the questionnairesamong students and then collected themafter completion.JARCM/ Spring 2017; Vol. 5, No. 263

Students’ knowledge and attitude towards food safetyTable 1. Educational and demographic characteristics of participants (n ed tohealth andfood safetyVariable anagement and medical informationNursingRehabilitationNew SciencePharmacyMaleFemaleYesNotn (%)49 (16.3)29 (9.7)37 (12.3)25 (8.3)30 (10.0)29 (9.7)32 (10.7)19 (6.3)32 (10.7)18 (6.0)172 (57.3)127 (43.7)123 (41.7)172 (58.3)The inclusion criterion for this study washaving passed at least one semester at TabrizUniversity of Medical Sciences and theexclusioncriterionwasstudent'sunwillingness to answer the questionnaire.Informed consent was obtained from allparticipants. They also were given the rightto withdraw from the study at any stage ofthe study. Participants were assured thattheir information and remarks would be keptconfidential and anonymous. Further, anethical approval was obtained from theEthics Committee of the Tabriz University ofMedical Sciences.To analyze the data, descriptive statistics(mean, frequency, percentage) and statisticaltests such as chi-square, one-way analysis ofvariance (ANOVA) and Students’ t-test wereused trough SPSS software (version 16, SPSSVariableSectionField ofstudyYear ofentry to theTabrizUniversity ofMedicalSciencesVariable levelsUndergraduateMastersPhDMedicalHealth Other1389139013911392139313941395n (%)175 (58.3)68 (22.7)54 (18.0)28 (9.3)24 (8.0)32 (10.7)13 (4.3)16 (5.3)12 (4.0)175 (58.3)5 (1.7)9 (3.0)36 (12.0)97 (32.3)76 (25.3)69 (23.0)1 (0.3)Inc., Chicago, IL, USA). A significance levelof 0.05 was considered for the statistical tests.Of 384 questionnaires distributed, 300 oneswere returned and analyzed (response rate78.1%). Male students comprised 53.8% of thesample. In addition, 58.3% of the sample wasundergraduate students. The mean age standard deviation (SD) was 24.0 3.5. Othereducational and demographic features ofparticipants are shown in table 1.Student’s responses to items on attitudeand knowledge of health and food safety arepresented in tables 2 and 3, respectively.According to students’ answers, over 70% ofthem had high attitude towards health andfood safety and more than 50% of them threwaway food bulging cans.Table 2. Results of assessing attitude towards health and food safety among students of Tabriz University of Medical SciencesItemsBeing aware of health and food safety is of great importance.It is essential to wash our hands with soap and water before cooking.Reheating food ensures its safety.Canned foods with bulging lids should be thrown away.Food additives are not much important in safety of foods.Raw foods can be kept next to the cooked foods.Pasteurized milk can be stored for 24 hours at room temperature.Putting bread in recycled bags makes no problem.Drinking raw milk has a high risk of causing food poisoning.64JARCM/ Spring 2017; Vol. 5, No. 2Stronglyagree218 (72.7)192 (64.0)90 (30.0)175 (58.3)25 (8.3)33 (11.0)33 (11.0)28 (9.3)116 (38.7)AgreeDisagree79 (26.3)97 (33.3)98 (32.7)89 (29.7)63 (21.0)65 (21.7)78 (26.0)58 (19.3)121 (40.3)2 (0.7)11 (3.7)95 (31.7)28 (9.3)124 (41.3)135 (45.0)124 (41.3)115 (38.3)44 (14.7)Stronglydisagree1 (0.3)0 (0)17 (5.7)8 (2.7)87 (29.0)65 (21.7)65 (21.7)98 (32.7)19 (6.3)

Dehghan, et al.Table 3. Results of assessing knowledge of health and food safety among students of Tabriz University of Medical SciencesItemsWe check manufacture and expiry date of food products when shopping.Fever and vomiting are of symptoms of food-borne diseases.The proper temperature to keep food in the fridge is 2-5 C.Botulism is transmitted through canned food.There is no need to put pasteurized milk in the refrigerator to keep it safe.Milk and meat spoil quickly.Mince (ground) meat gets spoiled more quickly.Keeping bread in the refrigerator prevents it from going stale.It is more suitable to keep food cans in the fridge at a temperature of below zero.Meat becoming slimy is a sign of its spoilage.The best temperature to store cooked foods is between 5 to 65 C.Plastic containers are much healthier to store foods.Staphylococcus aureus can be transmitted to the food through rashes of hands and faceand nasal discharge.A small percentage of students were awareof the facts that raw foods can be kept next tocooked dishes and pasteurized milk can bestored for 24 hours at room temperature. Theyalso had good attitude towards health andfood safety and low attitude towards the effectof food additives on its safety, and had littleknowledge about suitability of plasticcontainers for food storage. The resultssuggested that over 50% of students had lowknowledge about the best temperature forstoring cooked food which is between 5 to65 C. More than 80% of students had highknowledge of food-borne diseases. Accordingto the results, there was a significantrelationship between students’ attitude onhealth and food safety and passing coursesrelated to this topic (P 0.010). Students'knowledge of health and food safety was alsosignificantly related to their school (P 0.001)and field of study (P 0.020) (Table 4).The results suggested that students had highknowledge of health and food safety in somefactors and low knowledge in some others.True297 (98.7)262 (87.3)242 (80.7)270 (90.0)97 (32.3)268 (89.3)74 (91.3)219 (73.0)159 (53.0)229 (76.3)130 (43.3)82 (27.3)215 (71.7)False3 (1.0)37 (12.3)57 (19.0)30 (10.0)203 (67.7)32 (10.7)26 (8.7)81 (27.0)141 (47.0)71 (23.7)170 (56.7)218 (72.7)85 (28.3)On the other hand, over 50% of students hadhigh attitude towards being informed ofhealth and food safety and washing handsbefore cooking. Moreover, more than 60% ofthem scored low on attitude in other itemssuch as unimportance of food additives infood safety.In this study, we found that 87.3% ofstudents had enough knowledge about foodborne diseases. According to other studiesdone on high school students in the UnitedStates, they had acceptable knowledge ondiseases transmitted through food.13The results of our study revealed that aslevel of education increases, students'knowledge towards health and food safety getshigher which corresponds with the research ofJahed et al. in Tehran.16 Over 95% of studentsthat participated in our study stated that theyalways check food products label whenshopping.16 Marietta et al. conducted aninvestigation on food safety in the University ofMissouri, Columbia, Missouri, US and foundthat 90% of students take a look at productionand expiry date written on the label of foodproducts first when buying their food supply.17Table 4. Results of assessing the relationship between students' demographic and educationalinformation and total scores of their attitude and knowledge of health and food safetyDemographic and educational informationGenderCollegeDegree levelField of studyYear of entryPassing courses related to health and food 0.010*0.5200.001*0.2600.020*0.2700.870*Significant at level of P-value 0.05.JARCM/ Spring 2017; Vol. 5, No. 265

Students’ knowledge and attitude towards food safetyIn the present study, 45% of students hadnegative attitude toward the fact that rawfoods can be kept next to cooked meals and20% of them believed that drinking raw milkhas no risk of causing food poisoning.According to the findings of another surveycarried out in Taif University, Saudi Arabia,more than 50% of students had littleknowledge regarding raw foods that causefood poisoning.18 Raw and contaminatedfoods contain harmful microorganisms whichcan cause food-borne diseases whentransmitted to healthy foods.19Most students participated in this studybelieved that it is vital to wash hands withsoap and water before cooking. Poor handwashing definitely results in the retention ofviral pathogens and bacteria on our handsthrough touching raw materials.20 Further,more than 70% of students believed thatbeing aware of health and safety issues is ofgreat importance. Study performed bySockett illustrated that many people knownothing about the basic rules of foodhygiene.21 According to the survey done byMajowicz et al. in Ontario high schoolstudents of American, there was a significantdifference between students' knowledge andattitude towards health and food safety.22Results obtained in this study imply thatstudents who had passed courses related tohealth and food safety had better knowledgeand attitude in this regard. According to theresults of studies done by Garayoa et al.23among Spanish University students and Linand Sneed24 in Midwestern Iowa StateUniversity showed those who had passedcourses and received training on health andfood safety had higher knowledge andattitude than the rest of the participants. Thestudy carried out by Unklesbay et al. in theUniversity of Missouri illustrated thatstudents who had passed food-related courseshad much higher knowledge and attitude andeven better performance than other students.13The main limitations of current study arethat it was accomplished only in TabrizUniversity of Medical Sciences and on theyoung people and the educated society and66JARCM/ Spring 2017; Vol. 5, No. 2also lack of cooperation by a number ofstudents. Consequently, the results of thisstudy cannot be generalized to the society.According to the results obtained, studentsfrom some colleges have low knowledge ofhealth and food safety. Also considering therelationship between students’ knowledgeand attitude towards health and food safetyand public health enhancement, it isrecommended to include training programsthrough workshops or college courses in thecurriculum of different medicine majors thatlack such credits. These programs need tocontain some practical information regardingmicrobiology of food borne diseases andproper food storage methods. An acceptabletraining program has to include trainingabout protection against food borne diseases,as well as change in bad eating habits.The authors gratefully acknowledge all thestudents of Tabriz University of MedicalSciences who assisted us in carrying out thisresearch.Parvin Dehghan, Fatemeh Pournaghi-Azar,Saber Azami-Aghdash, Yousef ash contributed tostudy concept and design.Data was acquired by Saber AzamiAghdash, Yousef Sohraby Silabi, HassanDadkhah, and Hossein MohammadzadehAghdash. Analysis and interpretation of datawas performed by Parvin Dehghan, FatemehPournaghi-Azar, and Saber zadeh-Aghdashdraftedthemanuscript. Parvin Dehghan and t for important intellectual content.Statistical analysis was performed byParvin Dehghan, Fatemeh Pournaghi-Azar,and Saber Azami-Aghdash. Parvin Dehghan,Fatemeh Pournaghi-Azar, Saber Azami-

Dehghan, et al.Aghdash, Yousef Sohraby Silabi, HassanDadkhah, and Hossein MohammadzadehAghdash provided administrative, technical,and material support. Parvin Dehghanand Hossein Mohammadzadeh-Aghdashsupervised the study.funding for this study.Authors have no conflict of interest.The authors declare that there was noEthical approval was obtained from theregional ethics committee of TabrizUniversity of Medical Sciences.1. Notermans S, Gallhoff G, Zwietering MH, MeadGC. Identification of critical control points in theHACCP system with a quantitative effect on thesafety of food products. Food Microbiology 1995;12: 93-8. DOI: 10.1016/S0740-0020(95)80084-02. Mullan B, Allom V, Sainsbury K, Monds LA.Examining the predictive utility of an extendedtheory of planned behaviour model in the context ofspecific individual safe food-handling. Appetite2015; 90: 91-8. DOI: 10.1016/j.appet.2015.02.0333. Ansari-Lari M, Soodbakhsh S, Lakzadeh L.Knowledge, attitudes and practices of workers onfood hygienic practices in meat processing plants inFars, Iran. Food Control 2010; 21(3): 260-3. DOI:10.1016/j.foodcont.2009.06.0034. Mead PS, Slutsker L, Dietz V, McCaig LF, BreseeJS, Shapiro C, et al. Food-related illness and death inthe United States. Emerg Infect Dis 1999; 5(5):607-25. DOI: 10.3201/eid0505.9905025. Kirby RM, Bartram J, Carr R. Water in foodproduction and processing: quantity and qualityconcerns. Food Control 2003; 14(5): 283-99. DOI:10.1016/S0956-7135(02)00090-76. Parry-Hanson Kunadu A, Ofosu DB, Aboagye E,Tano-Debrah K. Food safety knowledge, attitudesand self-reported practices of food handlers ininstitutional foodservice in Accra, Ghana. FoodControl 2016; 69: 324-30.7. Ababio PF, Lovatt P. A review on food safety andfood hygiene studies in Ghana. Food Control 2015;47: 92-7. DOI: 10.1016/j.foodcont.2014.06.0418. Patil SR, Morales R, Cates S, Anderson D, KendallD. An application of meta-analysis in food safetyconsumer research to evaluate consumer behaviorsand practices. J Food Prot 2004; 67(11): 2587-95.DOI: 10.4315/0362-028X-67.11.25879. Annor G, E. Baiden E. Evaluation of food hygieneknowledge attitudes and practices of food handlers infood businesses in Accra, Ghana. Food and 011.2811410. Viator C, Blitstein J, Brophy JE, Fraser A.Preventing and controlling foodborne disease incommercial and institutional food service settings: asystematic review of published intervention studies. JFood Prot 2015; 78(2): 446-56. DOI:10.4315/0362028X.JFP-14-26611. Majowicz SE, Hammond D, Dubin JA, Diplock KJ,Jones-Bitton A, Rebellato S, et al. A longitudinalevaluation of food safety knowledge and attitudesamong Ontario high school students following a foodhandler training program. Food Control 2017; 76:108-16. DOI: 10.1016/j.foodcont.2017.01.01112. Young I, Hendrick S, Parker S, Rajic A, McClure JT,Sanchez J, et al. Knowledge and attitudes towardsfood safety among Canadian dairy producers. ed.2009.11.01013. Unklesbay N, Sneed J, Toma R. College students'attitudes, practices, and knowledge of food safety. JFood Prot 1998; 61(9): 1175-80. DOI:10.4315/0362-028X-61.9.117514. Askarian M, Kabir G, Aminbaig M, Memish ZA,Jafari P. Knowledge, attitudes, and practices of foodservice staff regarding food hygiene in Shiraz, Iran.Infect Control Hosp Epidemiol 2004; 25(1): 16-20.DOI: 10.1086/50228515. Abdullah Sani N, Siow ON. Knowledge, attitudesand practices of food handlers on food safety in foodservice operations at the Universiti KebangsaanMalaysia. Food Control 2014; 37: 210-7. DOI:10.1016/j.foodcont.2013.09.03616. Jahed G, Golestani Far H, Ghodsi R, MohammadiM. The knowledge and attitude of students inrelation with health and food safety at TehranUniversity of Medical Sciences. J Res Health 2012;2(1): 72-9. [In Persian]17. Marietta AB, Welshimer KJ, Anderson SL.Knowledge, attitudes, and behaviors of collegestudents regarding the 1990 Nutrition LabelingEducation Act food labels. J Am Diet Assoc 1999;99(4): 445-9. DOI: 10.1016/S0002-8223(99)00108-X18. Sharif L, Al-Malki T. Knowledge, attitude andpractice of Taif University students on foodpoisoning. Food Control 2010; 21(1): 55-60. DOI:10.1016/j.foodcont.2009.03.01519. Akabanda F, Hlortsi EH, Owusu-Kwarteng J. Foodsafety knowledge, attitudes and practices ofinstitutional food-handlers in Ghana. BMC PublicHealth 2017; 17(1): 40. DOI: 10.1186/s12889-016-JARCM/ Spring 2017; Vol. 5, No. 267

Students’ knowledge and attitude towards food safety3986-920. Snelling AM, Kerr KG, Heritage J. The survival ofListeria monocytogenes on fingertips and factorsaffecting elimination of the organism by handwashing and disinfection. J Food Prot 1991; 54(5):343-8. DOI: 10.4315/0362-028X-54.5.34321. Sockett PN. The epidemiology and costs of diseasesof public health significance, in relation to meat andmeat products. J Food Saf 1995; 15(2): 91-112. DOI:10.1111/j.1745-4565.1995.tb00126.x22. Majowicz SE, Diplock KJ, Leatherdale ST, BredinCT, Rebellato S, Hammond D, et al. Food safetyknowledge, attitudes and self-reported practices68JARCM/ Spring 2017; Vol. 5, No. 2among Ontario high school students. Can J 06.521323. Garayoa R, Cordoba M, Garcia-Jalon I, SanchezVillegas A, Vitas AI. Relationship betweenconsumer food safety knowledge and reportedbehavior among students from health sciences in oneregion of Spain. J Food Prot 2005; 68(12): 2631-6.DOI: 10.4315/0362-028X-68.12.263124. Lin SY, Sneed J. University foodservice employees'food safety knowledge, attitudes, practices, andtraining. Journal of Foodservice Management andEducation 2005; 1(1): 1-14.

Knowledge, Attitude, Health and Food Safety Health and food safety is one of the most important issues of nutrition science. The present study aims to examine the knowledge and attitude towards health and food safety among student

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