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Strange bedfellows: the history of collaboration between the Massachusetts Restaurant Association and the tobacco industry.

OBJECTIVES: This article examines the historical relationship between the tobacco industry and the Massachusetts Restaurant Association, a nonprofit trade association aligned with the food and beverage industry. METHODS: The study analyzed data from Web-based tobacco industry documents, public relations materials, news articles, testimony from public hearings, requests for injunctions, court decisions, economic impact studies, handbooks, and private correspondence. RESULTS: Tobacco industry documents that became public after various state lawsuits reveal that a long history of collaboration exists between the Massachusetts Restaurant Association and the tobacco industry. For more than 20 years, their joint efforts have focused primarily on the battle to defeat state and local laws that would restrict smoking in public places, particularly in beverage and food service establishments. The resources of the tobacco industry, combined with the association's grassroots mobilization of its membership, have fueled their opposition to many state and local smoke-free restaurant, bar, and workplace laws in Massachusetts. CONCLUSIONS: The universal opposition of the Massachusetts Restaurant Association to smoking bans in food and beverage establishments is a reflection of its historic relationship with the tobacco industry.

Cooperative Behavior↗

An assessment of the ability of routine restaurant inspections to predict food-borne outbreaks in Miami-Dade County, Florida.

OBJECTIVES: This study sought to determine the usefulness of restaurant inspections in predicting food-borne outbreaks in Miami-Dade County, Fla. METHODS: Inspection reports of restaurants with outbreaks in 1995 (cases; n = 51) were compared with those of randomly selected restaurants that had no reported outbreaks (controls; n = 76). RESULTS: Cases and controls did not differ by overall inspection outcome or mean number of critical violations. Only 1 critical violation--evidence of vermin--was associated with outbreaks (odds ratio = 3.3; 95% confidence interval = 1.1, 13.1). CONCLUSIONS: Results of restaurant inspections in Miami-Dade County did not predict outbreaks. If these findings are representative of the situation in other jurisdictions, inspection practices may need to be updated.

Analysis of Variance↗

Town-level characteristics and smoking policy adoption in Massachusetts: are local restaurant smoking regulations fostering disparities in health protection?

OBJECTIVES: We identified and quantified differences in sociodemographic characteristics of communities relative to the strength of local restaurant smoking regulations in Massachusetts. METHODS: We examined the relationship between the strength of the 351 local restaurant smoking regulations in Massachusetts and a number of town-level characteristics, using a multinomial logistic regression model. RESULTS: Characteristics important to the adoption of stronger restaurant smoking regulations included higher education and per capita income, geographic region, voter support for a state cigarette tax initiative, board of health funding to promote clean indoor air policy making, and the presence of a bordering town with a strong regulation. CONCLUSIONS: The current pattern of smoke-free restaurant policy enactment fosters socioeconomic and geographic disparities in health protection, undermining an important national health goal.

Financing, Government↗

Restaurant consumer acceptance of beef loin strip steaks tenderized with calcium chloride.

Beef strip loins from either the right or left side of 22 carcasses of Bos indicus-type steers were injected with 200 mM calcium chloride (CaCl2) solution at 5% (wt/wt) to determine its effect on tenderness and other selected quality traits of steaks. Loins from opposite sides of the carcasses were untreated and served as the control. The steaks were evaluated for tenderness, juiciness, flavor intensity, tenderness acceptability, and overall acceptability by 62 restaurant consumers over a 6-wk period. The CaCl2 injection improved (P < .05) tenderness and flavor intensity ratings by the restaurant consumers. Tenderness acceptability and overall acceptability were improved 23 and 17%, respectively, by the CaCl2 injection. Flavor was not compromised by the CaCl2 injection. The CaCl2-treated steaks were rated superior(P < .05) for flavor compared to the control steaks. Restaurant consumers preferred the beef loin strip steaks injected with 200 mM CaCl2 at 5% (wt/wt). The results of this study are interpreted to indicate that, from a restaurant consumer perspective, CaCl2 injection is an acceptable means of making beef a more consistently tender product.

Adolescent↗

Prevalence of high-risk egg-preparation practices in restaurants that prepare breakfast egg entrées: an EHS-Net study.

Salmonella enterica serotype Enteritidis (SE) is a common cause of foodborne illness in the United States. Foods prepared with raw shell eggs have often been associated with SE outbreaks. The federal government published the Egg Safety Action Plan in December 1999 that called for reduction of egg-preparation practices that may contribute to the survival and proliferation of SE. In seven states, an interview and brief site evaluation of 153 restaurants that prepare eggs during all hours of operation was conducted by the Environmental Health Specialists Network to determine the prevalence of such practices. Fifty-four percent (83 of 153) of restaurants pooled raw shell eggs not intended for immediate service. These pooled eggs were held a median of 4 h for scrambled eggs, 5.5 h for omelets, and 6 h for pancakes and French toast. Nearly 26% (39 of 152) of restaurants reported storing eggs at room temperature, and 5% (7 of 152) stored eggs on ice or in cold-water baths before cooking. Generally, eggs were cooked to 72 to 83 degrees C, which is above the recommended final cook temperature of 63 to 68 degrees C. Employees reported sanitizing utensils used to prepare eggs less than once every 4 h in 42% (57 of 136) of restaurants. Several areas were identified in which further emphasis might reduce egg-associated SE infections in accordance with Healthy People 2010 goals.

Consumer Product Safety↗

Control of fine particulate (PM2.5) emissions from restaurant operations.

This paper describes efforts to reduce particulate matter (PM) emissions from restaurant operations, including application of an existing control method to a new equipment type. Commercial charbroiling in the South Coast Air Basin results in emissions of approximately 10 tons/day of fine particulate matter (PM2.5) and 1.3 tons/day of volatile organic compounds (VOCs). Over a seven-year period, the South Coast Air Quality Management District worked with industry to develop test methods for measuring emissions from various cooking operations, evaluate control technologies, and develop a rule to reduce these emissions. Of the two basic types of charbroilers--chain-driven and underfired--underfired produce four times the emissions when equivalent amounts of product are cooked. Cost-effective control technology is currently available only for chain-driven charbroilers. The application of flameless catalytic oxidizers to chain-driven charbroilers was found to effectively reduce emissions by at least 83% and is cost-effective. The catalysts have been used worldwide at restaurants for several years. Research efforts are underway to identify control options for underfired charbroilers. Implementation of Rule 1138, Control of Emissions from Restaurant Operations, adopted November 14, 1997, will result in reductions of 0.5 tons/day of PM2.5 and 0.2 tons/day of VOCs. Future rules will result in reductions from underfired charbroilers and possibly other restaurant equipment when cost-effective solutions are available.

Air Pollution↗

[Application of tobacco smoking regulations in restaurants in Tromsö 1998].

BACKGROUND: Under the Norwegian Environmental Tobacco Smoke Act, a minimum of 50% of tables in restaurants have to be in smoke-free areas. The Ministry of Health and Social Affairs has defined "smoke-free restaurants" as a priority objective in its anti-tobacco strategy. MATERIAL AND METHODS: We have investigated smoking policies in restaurants in the City of Tromsø in Northern Norway, as reported by restaurateurs in 1998. Representatives of all the 85 restaurants, bars and pubs in the city were interviewed and their smoking policies and habits reported. This study was part of the local health authority's evaluation of the degree of compliance with the legislation. RESULTS: In 71% of establishments, at least 50% of tables were smoke-free; in 88%, smoking areas were in compliance with the legislation. 86% of restaurateurs reported a positive or neutral attitude to the legislation, 80% thought that their guests were of the same opinion. 47% smoked every day; however, there was no association between smoking habits and smoking policies. INTERPRETATION: Though the prevalence of smoking was high among restaurateurs, this did not affect their attitudes towards the Environmental Tobacco Smoke Act or their policies on smoking.

Adult↗

Scores and grades: a sampling of how college students and food safety professionals interpret restaurant inspection results.

Controversy surrounds the use of posted restaurant inspection scores and grades. There is much debate about how well a score or grade conveys risks to potential diners, and questions remain about how the public interprets posted scores and grades, regardless of how they are derived. To determine how such scores and grades are perceived, the authors surveyed a sample of Maryland college students and food safety professionals about what a posted inspection score of 86 means and what a letter grade of C means. There was no clear consensus about the meaning of the scores and grades described in the surveys. The majority of respondents felt that a restaurant should be either open or closed, and that the public should not have to decipher the meaning of a posted sign. The response of the sample is especially significant given that many respondents claimed that they would not eat at a restaurant with either a posted letter grade of C or a posted score of 86. Although these results do not come from a random sample, they nevertheless suggest that the public has a limited understanding of such signs and, at the same time, bases dining decisions on them. Thus, environmental health professionals must carefully consider how the public can be better educated about signs, how the signs can be less ambiguous, and whether posted restaurant inspection results are even advisable in their current form.

Adult↗

Hepatitis A outbreak associated with green onions at a restaurant--Monaca, Pennsylvania, 2003.

The Pennsylvania Department of Health and CDC are investigating an outbreak of hepatitis A outbreak among patrons of a restaurant (Restaurant A) in Monaca, Pennsylvania. As of November 20, approximately 555 persons with hepatitis A have been identified, including at least 13 Restaurant A food service workers and 75 residents of six other states who dined at Restaurant A. Three persons have died. Preliminary sequence analysis of a 340 nucleotide region of viral RNA obtained from three patrons who had hepatitis A indicated that all three virus sequences were identical. Preliminary analysis of a case-control study implicated green onions as the source of the outbreak.

Adolescent↗

Impact of a smoking ban on restaurant and bar revenues--El Paso, Texas, 2002.

Smoke-free indoor air ordinances protect employees and customers from secondhand smoke exposure, which is associated with increased risks for heart disease and lung cancer in adults and respiratory disease in children. As of January 2004, five states (California, Connecticut, Delaware, Maine, and New York) and 72 municipalities in the United States had passed laws that prohibit smoking in almost all workplaces, restaurants, and bars. On January 2, 2002, El Paso, Texas (2000 population: 563,662), implemented an ordinance banning smoking in all public places and workplaces, including restaurants and bars. The El Paso smoking ban is the strongest smoke-free indoor air ordinance in Texas and includes stipulations for enforcement of the ban by firefighting and law enforcement agencies, with fines of up to $500 for ordinance violations. To assess whether the El Paso smoking ban affected restaurant and bar revenues, the Texas Department of Health (TDH) and CDC analyzed sales tax and mixed-beverage tax data during the 12 years preceding and 1 year after the smoking ban was implemented. This report summarizes the results of that analysis, which determined that no statistically significant changes in restaurant and bar revenues occurred after the smoking ban took effect. These findings are consistent with those from studies of smoking bans in other U.S. cities. Local public health officials can use these data to support implementation of smokefree environments as recommended by the Task Force on Community Preventive Services.

Humans↗

[Passive smoking in bars, restaurants, and discotheques in Florence, Italy].

BACKGROUND: "Environmental Tobacco Smoke (ETS) exposure in a sample of European cities" is the first European multicentre project intended to measure ETS exposure in public places in a number of European cities. OBJECTIVES: To present results of measurements of nicotine concentration in a number of bars, restaurants and discotheques in Florence, Italy. METHODS: The ETS marker was vapour-phase nicotine sampled by passive monitors. At least two monitors were placed in each of seven bars (five in hospitals; one at an airport; one at a railway station), and seven restaurants (three with smoking and non-smoking sections), and left in place for several days. In each of four discotheques two nicotine passive monitors were used as personal samplers. RESULTS: The average nicotine concentration in discotheques, restaurants and bars was respectively 26.78 micro/m3, 2.32 microg/m3 and 0.83 microg/m3. In the smoking section of restaurants with separated areas for smokers and non-smokers the average nicotine concentration was 2.54 microg/m3, which was similar to that measured in non-smoking sections (2.14 microg/m3).

Air Pollutants↗

Impact of restaurant hygiene grade cards on foodborne-disease hospitalizations in Los Angeles County.

Although health departments routinely inspect restaurants to assess compliance with established hygienic standards, few data are available on the effectiveness of these efforts in preventing foodborne disease. The study reported here assessed the impact on foodborne-disease hospitalizations in Los Angeles County of a restaurant hygiene grading system that utilized publicly posted grade cards. The grading systm was introduced in January 1998. Hospital discharge data on foodborne-disease hospitalizations were analyzed for Los Angeles County and, as a control, for the rest of California during the period 1993-2000. Ordinary least-squares regression analysis was done to measure the effect of the grading progam on these hospitalizations. After baseline temporal and geographic trends were adjusted for, the restaurant hygiene grading program was associated with a 13.1 percent decrease (p < .01) in the number of foodborne-disease hospitalizations in Los Angeles County in the year following implementation the program (1998). This decrease was sustained over the next two years (1999-2000). The results suggest that restaurant hygiene grading with public posting of results is an effective intervention for reducing the burden of foodborne disease.

Bacterial Infections↗

Involuntary smoking in Savannah's restaurants.

A survey of Savannah area restaurants was conducted to determine the frequency with which nonsmoking sections are provided. Only one in five restaurants in Savannah provide nonsmoking sections, and only one in 10 tables available for dining out are reserved for nonsmokers. Restaurants associated with a national corporation are more than four times as likely to reserve space for nonsmokers than those strictly locally owned. Pertinent attitudes of restaurant personnel are presented, as is a brief discussion of the issue of involuntary smoking.

Data Collection↗

The effects of inspection frequency and food handler education on restaurant inspection violations.

The effectiveness of restaurant inspections and food handler education are not known. Consequently, the optimal frequency of neither has been determined. Thirty randomly selected restaurants from seven health units in three provinces were inspected by one of three senior inspectors. A questionnaire was used to collect the data. The violation score worsened when the time since last inspection was greater than 12 months, but did not worsen when the interval was shorter. Those restaurants in which supervisors and food handlers had completed food handler education courses had better inspection scores than those without. Restaurants whose food handlers had food service education had better scores only for time and temperature violations. These outcomes were all significant in a multiple regression model. The duration of most education courses was under five days. The time since the last food service education course was not significant. Routine inspections should be done yearly. Food service education should be offered to both supervisors and food handlers.

Canada↗

Evaluation of the Heart Smart Restaurant Program in Saskatoon and Regina, Saskatchewan.

The consumer-driven Heart Smart Restaurant Program was developed by the Heart and Stroke Foundation of Saskatchewan and the Saskatoon Community Health Unit, with the aim of improving the nutritional quality of food consumed in table-service restaurants. To participate, restaurateurs must agree to provide smoke-free seating and specific more healthful food choices upon request of the customer. The program was evaluated through telephone interviews with 999 individuals in randomly selected households in Saskatoon and Regina. While public awareness of the program was satisfactory, over half of those who knew of the program misunderstood its function, believing that more healthful choices are indicated on the menu. When choosing a restaurant, individuals are not greatly influenced by whether it is Heart Smart, but in Saskatoon, they are more likely to request a more healthful alternative in a Heart Smart restaurant than in others. Implications of these and other findings for future program development and research are discussed.

Adolescent↗

BRFSS-based survey of the Florida public on restaurant smoking.

A total of 2,246 Floridians were randomly surveyed by telephone concerning the Florida Clean Indoor Air Act and smoking in restaurants. Only 28.8% responded correctly that restaurant smoking is prohibited unless a manager's sign specifically permits it. More than 80% of smokers felt free to light up in the absence of such signs and over 45% of nonsmokers did not recognize this as an infringement of their rights. Although about three-quarters of Floridians are nonsmokers, only about half the state's restaurant seating capacity was intended for nonsmokers by managers. Based on their own experience, smoking Floridians were much more likely (67.1%) to be satisfied with their allocation of seating than were nonsmokers (45.9%). Uniquely among states, Florida's law preempts all local ordinances, past and future. The Clean Indoor Air Act is of little practical value because it is understood by so few. It allows no restrictions on smoking in 42% of Florida's restaurants, those with fewer than 51 seats.

Black or African American↗

Objectivity of food-symptomatology surveys. Questionnaire on the "Chinese restaurant syndrome".

The Chinese restaurant syndrome consists of a characteristic symptom complex, with limited times of onset and duration after eating in a Chinese restaurant. There is widespread belief that the C.R.S. is due to monosodium glutamate used in preparing food in Chinese restaurants and that as many as 25 per cent of the general population may be susceptible to the syndrome. Questionnaires were developed to determine the unpleasant symptoms which 530 subjects associated with specific foods, eating places, and "ethnic" styles of preparing food. Over 90 per cent of respondents associated unpleasant symptoms with specific foods, but only 6.6 per cent experienced an event which would "possibly" represent the characteristic C.R.S. Nevertheless, when the phrase "Chinese restaurant syndrome" was introduced in a second questionnaire, 31 per cent of respondents believed that they were personally susceptible to it. Many people do experience unpleasant symptoms after eating, and particularly after eating food associated with a different culture. Although the responses to food symptomatology questionnaires represent an important aspect of the sociology of eating behavior, this procedure should not be considered an objective data collecting system.

Adult↗

An outbreak of Salmonella Hadar associated with roast rabbit in a restaurant.

In August 1997, an outbreak of gastroenteritis from Salmonella Hadar phage type 2 occurred among customers of a restaurant in Rimini (Emilia-Romagna region, Italy). Twenty-nine people who had eaten food prepared in the restaurant on 2 or 3 August had symptoms of acute gastroenteritis. The infection was culture-confirmed in 24 cases and the stool specimens of four healthy people were positive for Salmonella Hadar. Twelve people had to be hospitalized and a 3-year old girl died. The case-control study identified roast rabbit as the likely vehicle of infection (OR: 6.00; CI 95%: 1.65-22.83). The microbiological investigation carried out on food taken from the restaurant confirmed high levels of Salmonella Hadar in a sample of roast rabbit. Since the rabbit was well cooked, the food contamination likely occurred after cooking. Poor hygienic conditions found in the restaurant, together with inappropriate food-handling practices and inadequate storage temperatures may have contributed to spread to other foods and the severity of the outbreak.

Adolescent↗