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PubMed1993

A large salmonellosis outbreak associated with a frequently penalized restaurant.

Between January and June 1990, Restaurant A in Greenville, South Carolina repeatedly failed local health department inspection and was repeatedly sanctioned. In September 1990, two persons, hospitalized with salmonellosis after attending a convention catered by Restaurant A, contacted the South Carolina Department of Health and Environmental Control. We inspected Restaurant A, interviewed food handlers, and surveyed by telephone persons from every sixth business attending the convention. Of 398 persons interviewed, 135 (34%) reported gastroenteritis. Nine had culture-confirmed salmonella infection. People who ate turkey were 4.6 times more likely to become ill than those who did not eat turkey (95% confidence interval 2.0, 10.6). We estimate that of 2430 attendees, 824 became ill. Sanitarians judged Restaurant A's kitchen too small to prepare over 500 meals safely. The cooked turkey was unrefrigerated for several hours, incompletely rewarmed, and rinsed with water to reduce its offensive odour prior to serving. Stronger sanctions may be needed against restaurants that repeatedly fail local health department inspection.

Animals↗
PubMed1999

A Mexican restaurant-associated outbreak of Salmonella Enteritidis type 34 infections traced to a contaminated egg farm.

In May 1996, the Georgia Division of Public Health was notified about a cluster of persons with Salmonella Enteritidis (SE) infections in Waycross, Georgia. A matched pair case-control study to determine risk factors for illness found a statistically significant association of SE infection with a history of having eaten at Restaurant A during the 5 days before onset of illness (relative risk = 13 [95% confidence interval (CI) = 3-62, P < 0.01]). In a second case-control study, to determine specific food exposures, consumption of a deep-fried Mexican dish (chile relleno) (4 of 21 cases vs. 0 of 26 controls, odds ratio undefined, 95% CI > 1.46, P = 0.034) was found to be significantly associated with SE infection. An environmental investigation found evidence of suboptimal food storage and cooking temperatures at Restaurant A; cross contamination of foods may have contributed to the low attributable risk identified for chile rellenos. Five of 37 Restaurant A food and environment specimens yielded SE strains. All five positive specimens were from chiles rellenos. Of the seven outbreak-associated strains (six patient isolates and one food isolate from Restaurant A) for which phage typing was conducted, all were phage type 34. A FDA traceback investigation through Restaurant A's single-egg supplier identified the potential source as three interrelated farms in South Carolina. Environmental culture from one of these farms yielded SE phage type 34. As a result of this outbreak, FDA helped institute a statewide egg quality-assurance programme in South Carolina to minimize SE contamination of eggs.

Animal Husbandry↗
PubMed2004

Increased portion size leads to increased energy intake in a restaurant meal.

OBJECTIVE: Eating frequently in restaurants is one of the behaviors associated with obesity. This study examined whether increasing the portion size of an entrée affected energy intake at a restaurant meal. RESEARCH METHODS AND PROCEDURES: In a cafeteria-style restaurant on different days, the size of a pasta entrée was varied from a standard portion (248 g) to a large portion (377 g). The entrée price was not changed. Intake of the entrée was determined by covertly weighing each dish before and after the meal; intake of all other foods was determined by estimating the percent consumed. The 180 adult customers who purchased the entrée also completed a survey in which they rated characteristics of the meal, including the appropriateness of the entrée portion size and the amount that they ate compared with their usual meal. RESULTS: Portion size had a significant effect on intake of the entrée (p < 0.0001). Compared with customers who purchased the standard portion, those who purchased the larger portion increased their energy intake of the entrée by 43% (719 kJ; 172 kcal) and of the entire meal by 25% (664 kJ; 159 kcal). There was no difference between the two groups of customers in ratings of the appropriateness of the portion size or of the amount that was eaten in relation to their usual meal. DISCUSSION: In a restaurant setting, increasing the size of an entrée results in increased energy intake. These results support the suggestion that large restaurant portions may be contributing to the obesity epidemic.

Adolescent↗
PubMed2001

Peanut and tree nut allergic reactions in restaurants and other food establishments.

BACKGROUND: The clinical features of food-allergic reactions in restaurants and other food establishments have not been studied. Of the registrants in the United States Peanut and Tree Nut Allergy Registry (PAR), 13.7% have reported reactions associated with such establishments. OBJECTIVE: The purpose of this study was to determine the features of allergic reactions to peanut and tree nut in restaurant foods and foods purchased at other private establishments (eg, ice cream shops and bakeries). METHODS: Telephone interviews were conducted through use of a structured questionnaire. Subjects/parental surrogates were randomly selected from among the 706 PAR registrants who reported a reaction in a restaurant or other food establishment. RESULTS: Details were obtained for 156 episodes (29 first-time reactions) from 129 subjects/parental surrogates. Most reactions were caused by peanut (67%) or tree nut (24%); for some reactions (9%), the cause was a combination of peanut and another nut or was unknown. Symptoms began at a median of 5 minutes after exposure and were severe in 27% of reactions. Overall, 86% of reactions were treated (antihistamines, 86%; epinephrine, 40%). Establishments commonly cited were Asian food restaurants (19%), ice cream shops (14%), and bakeries/doughnut shops (13%). Among meal courses, desserts were a common cause (43%). Of 106 registrants with previously diagnosed allergy who ordered food specifically for ingestion by the allergic individual, only 45% gave prior notification about the allergy to the establishment. For 83 (78%) of these 106 reactions, someone in the establishment knew that the food contained peanut or tree nut as an ingredient; in 50% of these incidents, the food item was "hidden" (in sauces, dressings, egg rolls, etc), visual identification being prevented. In 23 (22%) of the 106 cases, exposures were reported from contamination caused primarily by shared cooking/serving supplies. In the remaining 21 subjects with previously diagnosed allergy, reactions resulted from ingestion of food not intended for them, ingestion of food selected from buffet/food bars, or skin contact/inhalation (residual food on tables, 2; peanut shells covering floors, 2; being within 2 feet of the cooking of the food, 1). CONCLUSIONS: Restaurants and other food establishments pose a number of dangers for peanut- and tree nut-allergic individuals, particularly with respect to cross-contamination and unexpected ingredients in desserts and Asian food. Failure to establish a clear line of communication between patron and establishment is a frequent cause of errors.

Humans↗
PubMed2004

Effectiveness of clean indoor air ordinances in controlling environmental tobacco smoke in restaurants.

Clean indoor air (CIA) ordinances in Toledo, Ohio, and Bowling Green, Ohio, regulate smoking in restaurants to protect patrons and employees. Yet complete protection is questionable because the ordinances allow for smoking in certain dining sections. Two restaurants were studied in each city, one smoking and one nonsmoking. Levels of contaminants related to environmental tobacco smoke (ETS)--determined by personal and area air monitoring-in the nonsmoking restaurants were comparable to levels in a control environment. However, levels of ETS-related contaminants in the smoking restaurants, including designated nonsmoking sections, were significantly higher than levels in the control environment. ETS-related contamination of the nonsmoking sections in the smoking restaurants is attributable to direct openings between the smoking and nonsmoking sections. Reasonable protection of employees and patrons against ETS-related contaminants requires strict enforcement of CIA ordinances. Full protection is achievable only with 100% smoke-free policies.

Air Pollutants↗
PubMed2002

Hospitalizations among employees in the Danish hotel and restaurant industry.

BACKGROUND: The aim of the present study was to provide a broad picture of the morbidity among employees in the Danish hotel and restaurant industry. METHODS: Cohorts of all 20-59-year-old employees in the Danish hotel and restaurant industry in the years 1981, 1986, 1991 and 1994 were formed to calculate age-standardized hospitalization ratios (SHR) and time trends (1981-1997) for many different diagnoses. RESULTS: Both for women and men, significantly higher SHRs were found for infectious and parasitic diseases, neoplasms, diseases in the nervous system and sense organs, diseases of the circulatory system, diseases of the respiratory system, diseases of the digestive system and diseases of the musculoskeletal system among employees in hotels and restaurants than in the digestive system and diseases of the musculoskeletal system among employees in hotels and restaurants than in the working population at large. Furthermore, among women a significantly elevated risk was found for injuries in the lower extremities, injuries in the upper extremities and head injuries, and among men a high risk was found for head injuries and a low risk for ruptures in ligaments and muscles. The trend assessments did not detect any significant changes in SHRs over time. CONCLUSION: Employment in the Danish hotel and restaurant industry is associated with an elevated hospitalization risk due to many diseases, which may be related to occupation and lifestyle. In line with the official policy of reducing inequality in health, focus should be placed on the health problems in this group.

Adult↗
PubMedDate not supplied

An assessment of burn prevention knowledge in a high burn-risk environment: restaurants.

Our facility has seen an increase in the number of cases of children burned in restaurants. Fieldwork has revealed many unsafe serving practices in restaurants in our tristate area. The current research targets what appears to be an underexamined burn-risk environment, restaurants, to examine server knowledge about burn prevention and burn care with customers. Participants included 71 local restaurant servers and 53 servers from various restaurants who were recruited from undergraduate courses. All participants completed a brief demographic form as well as a Burn Knowledge Questionnaire. It was found that server knowledge was low (ie, less than 50% accuracy). Yet, most servers reported that they felt customer burn safety was important enough to change the way that they serve. Additionally, it was found that length of time employed as a server was a significant predictor of servers' burn knowledge (ie, more years serving associated with higher knowledge). Finally, individual items were examined to identify potential targets for developing prevention programs.

Adolescent↗
PubMed1999

Restaurant employment before and after the New York City Smoke-Free Air Act.

The purpose of this study was to observe trends in the number of restaurants and restaurant employees two years before and two years after the New York City Smoke-Free Air Act took effect in April, 1995. Between April 1993 and April 1997, New York City added 19,347 new restaurant jobs (18% increase) while the rest of the state outside the immediate metropolitan area added 7,423 new jobs (5% increase). The rate of growth in the number of restaurants was comparable among New York City, neighboring counties, and the rest of the state. The data suggest that the New York City Smoke-Free Air Act did not result in job losses for the city's restaurant industry.

Employment↗
PubMed2005

Effect of local restaurant smoking regulations on progression to established smoking among youths.

BACKGROUND: While smoke-free restaurant laws are intended to protect the public from secondhand smoke exposure, they may also discourage smoking among adolescents. There is no evidence from longitudinal studies to test this hypothesis. OBJECTIVE: To examine the effect of local restaurant smoking regulations on progression to established smoking among adolescents. DESIGN, SETTING, AND SUBJECTS: A cohort of 2623 Massachusetts youths, ages 12-17 years at baseline, was interviewed via random digit dial telephone survey in 2001-2002 and followed up two years later. A generalised estimating equations (GEE) logistic regression analysis was used and controlled for potential individual, household, and town level confounding factors. MAIN OUTCOME MEASURE: Progression to established smoking during the two year follow up period (defined as having smoked 100 or more cigarettes in one's life). RESULTS: Compared to youths living in towns with weak regulations, those living in towns with strong regulations (complete restaurant smoking bans) had less than half the odds of progression to established smoking (odds ratio (OR) 0.39, 95% confidence interval (CI) 0.24 to 0.66). The association was stronger for youths in towns with strong regulations in effect for two or more years (OR 0.11, 95% CI 0.03 to 0.37), although it was still present for those in towns with strong regulations in effect for less than two years (OR 0.55, 95% CI 0.33 to 0.90). No relationship was found between living in a town with a medium restaurant smoking regulation (restriction of smoking to enclosed, separately ventilated areas) and rates of progression to established smoking. CONCLUSIONS: Local restaurant smoking bans may be an effective intervention to prevent youth smoking.

Adolescent↗
PubMed2005

African Americans' access to healthy food options in South Los Angeles restaurants.

OBJECTIVES: We examined availability and food options at restaurants in less affluent (target area) and more affluent (comparison area) areas of Los Angeles County to compare residents' access to healthy meals prepared and purchased away from home. We also considered environmental prompts that encourage the purchase of various foods. METHODS: We designed an instrument to assess the availability, quality, and preparation of food in restaurants. We also assessed advertisements and promotions, cleanliness, and service for each restaurant. We assessed 659 restaurants: 348 in the target area and 311 in the comparison area. RESULTS: The nutritional resource environment in our target area makes it challenging for residents to eat healthy away from home. Poorer neighborhoods with a higher proportion of African American residents have fewer healthy options available, both in food selections and in food preparation; restaurants in these neighborhoods heavily promote unhealthy food options to residents. CONCLUSIONS: Environment is important in understanding health status: support for the healthy lifestyle associated with lower risks for disease is difficult in poorer communities with a higher proportion of African American residents.

Black or African American↗
PubMed1998

Restaurant smoking restrictions and environmental tobacco smoke exposure.

OBJECTIVES: This study evaluated the effectiveness of smoking restrictions. METHODS: We measured particulate concentrations in restaurants with different levels of allowable smoking. RESULTS: Mean particulate concentrations were 70% higher in establishments without smoking restrictions compared with those with partial smoking restrictions. Concentrations in nonsmoking restaurants were reduced by an additional 20% to 30%. Measurements of cadmium, an environmental tobacco smoke (ETS) marker, implicated ETS as the major source of particulate in restaurants that allowed smoking. CONCLUSIONS: Partial smoking restrictions substantially reduce, but do not eliminate, ETS exposure in restaurants. Occupants of nonsmoking restaurants avoid ETS exposure but may experience substantial particulate exposures from cooking emissions.

Air Pollution, Indoor↗
PubMed2004

Effect of local restaurant smoking regulations on environmental tobacco smoke exposure among youths.

OBJECTIVES: We examined the effect of local restaurant smoking regulations on restaurant environmental tobacco smoke exposure among youths. METHODS: We interviewed 3863 Massachusetts youths aged 12-17 years and ascertained how often they saw smokers in restaurants in their town. We assessed the effect of local restaurant smoking regulation strength on nonexposure to environmental tobacco smoke (seeing smokers never or only rarely). RESULTS: Compared with youths from towns with weak regulations, youths from towns with medium-strength regulations had 1.4 times the odds (odds ratio = 1.36; 95% confidence interval = 1.12, 1.65) and youths from towns with strong regulations had twice the odds (odds ratio = 2.03; 95% confidence interval = 1.64, 2.52) of reporting nonexposure. CONCLUSIONS: Strong local restaurant smoking regulations are associated with reduced environmental tobacco smoke exposure among youths

Adolescent↗
PubMed2005

SARS-CoV infection in a restaurant from palm civet.

Epidemiologic investigations showed that 2 of 4 patients with severe acute respiratory syndrome (SARS) identified in the winter of 2003-2004 were a waitresss at a restaurant in Guangzhou, China, that served palm civets as food and a customer who ate in the restaurant ashort distance from animal cages. All 6 palm civets at the restaurant were positive for SARS-associated coronavirus (SARS-CoV). Partial spike (S) gene sequences of SARS-CoV from the 2 patients were identical to 4 of 5 Sgene viral sequences from palm civets. Phylogenetic analysis showed that SARS-CoV from palm civets in the restaurant was most closely related to animal isolates. SARS cases at the restaurant were the result of recent interspecies transfer from the putative palm civet reservoir, and not the result of continued circulation of SARS-CoV in the human population.

Adult↗
PubMedDate not supplied

Measuring cues for healthy choices on restaurant menus: development and testing of a measurement instrument.

PURPOSE: To develop and test the Menu Checklist, an instrument to be used by community members to assess cues for healthy choices in restaurants. DESIGN: Menus from 14 restaurants were coded independently by two trained community reviewers to test the interrater reliability of the instrument. SETTING: A low-income, urban, African-American community in Los Angeles, California. SUBJECTS: Restaurants were selected based on community perceptions of their potential to be included in a nutrition education and advocacy program to improve the availability of healthy foods. MEASURES: The Menu Checklist was adapted from previously tested measurement tools developed by the Prevention Research Center at Saint Louis University. Intraclass correlation coefficients (ICCs), kappa statistics, and percent agreements were calculated to assess interrater reliability. Descriptive statistics were calculated to show the availability of cues for healthy foods. RESULTS: The interrater reliability coefficients for the majority of items were high (.93-1.0). Labeling on restaurant menus was rare, as were low-fat choices. Fruits and vegetables were readily available: 31% of all entrees included one serving and 39% of all appetizers were primarily fruits and vegetables. CONCLUSIONS: The Menu Checklist is a reliable, low-cost means for community members to collect data on influences on food choices in restaurants.

Black or African American↗
PubMed1993

Involuntary smoking in the restaurant workplace. A review of employee exposure and health effects.

OBJECTIVE: To determine the relative exposure to environmental tobacco smoke for bar and restaurant employees compared with office employees and with nonsmokers exposed in the home (part 1) and to determine whether this exposure is contributing to an elevated lung cancer risk in these employees (part 2). DATA SOURCES: MEDLINE and bibliographies from identified publications. STUDY SELECTION: In part 1, published studies of indoor air quality were included if they reported a mean concentration of carbon monoxide, nicotine, or particulate matter from measurements taken in one or more bars, restaurants, offices, or residences with at least one smoker. In part 2, published epidemiologic studies that reported a risk estimate for lung cancer incidence or mortality in food-service workers were included if they controlled, directly or indirectly, for active smoking. DATA EXTRACTION: In part 1, a weighted average of the mean concentration of carbon monoxide, nicotine, and respirable suspended particulates reported in studies was calculated for bars, restaurants, offices, and residences. In part 2, the relative lung cancer risk for food-service workers compared with that for the general population was examined in the six identified studies. DATA SYNTHESIS: Levels of environmental tobacco smoke in restaurants were approximately 1.6 to 2.0 times higher than in office workplaces of other businesses and 1.5 times higher than in residences with at least one smoker. Levels in bars were 3.9 to 6.1 times higher than in offices and 4.4 to 4.5 times higher than in residences. The epidemiologic evidence suggested that there may be a 50% increase in lung cancer risk among food-service workers that is in part attributable to tobacco smoke exposure in the workplace. CONCLUSIONS: Environmental tobacco smoke is a significant occupational health hazard for food-service workers. To protect these workers, smoking in bars and restaurants should be prohibited.

Air Pollution, Indoor↗
PubMedDate not supplied

Effect of a manager training program on sanitary conditions in restaurants.

OBJECTIVE: To evaluate the effectiveness of a food manager training and certification program in increasing compliance with restaurant sanitary codes. METHODS: Using routine sanitary inspection records, the authors compared pre- and post-training inspection scores for 94 restaurants falling into three groups: a "mandatory" group (managers' attendance was mandated for these restaurants); a "voluntary" group (managers attended the training voluntarily); and a control group (no staff attended the training program). RESULTS: Restaurants for which managers were mandated to attend a training and certification program demonstrated a significant improvement in inspection scores, an improvement that was sustained over a two-year follow-up period. The mean inspection scores for a control group did not change significantly over time. However, improvements were not noted in all areas of food safety. CONCLUSIONS: Food manager training and certification programs may be an effective way to improve the sanitary conditions of restaurants and reduce the spread of foodborne illnesses.

Boston↗
PubMed1999

Evaluation of the Heart Smart(tm) Heart Beat Restaurant Program.

The Ottawa-Carleton Heart Beat Restaurant Program is intended to encourage restaurateurs to provide lower-fat and higher-fibre choices. Restaurants participating in this program are promoted through a dining guide and a newspaper supplement. In addition, all participating restaurants receive promotional materials - decal, certificate, menu inserts, table tents, and staff poster - for display. To determine restaurateurs' awareness of the program, provision of healthy food choices, and use of promotional materials, a survey was administered to 142 of the 222 participating restaurants. Results show that 92% of the restaurateurs were aware they were participating in this program, most restaurants could provide the healthy food choices, and 75% of restaurateurs recalled receiving the promotional materials. However, fewer than 33% used the table tents and menu inserts. Slightly more used the staff poster, and 45% or more used the decal and the certificate. These results indicate future directions for such programs.

Journal Article↗
PubMed1994

Effects of adding an Italian theme to a restaurant on the perceived ethnicity, acceptability, and selection of foods.

We investigated whether a change in the perceived ethnicity of a food can be produced without manipulating the food item itself, and if that change in ethnic perception is accompanied by a change in acceptability and food selection behavior. Italian and British foods were offered in a British restaurant for four days. Foods were offered for 2 days under control conditions, when the restaurant was decorated as usual. The identical foods then were offered in the restaurant for 2 more days under experimental conditions, when ethnic names were used on the menu to describe foods, and the restaurant was decorated with an Italian theme. Perceived ethnicity and acceptability of items were rated by customers each day, and item selection was tracked. The Italian theme increased selection of pasta and dessert items, and decreased the selection of fish. The Italian theme also increased the perceived Italian ethnicity of British pasta items, fish and veal, and increased the perceived Italian ethnicity of the meal overall. These findings show that changes in perceived ethnicity and food selection can be accomplished without altering food items, but merely by manipulating the environment, and may imply a unique strategy for increasing perceived menu variety.

Culture↗