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The Pennsylvania State University The Graduate School College of Agricultural Sciences A COMPREHENSIVE FOOD SAFETY ASSESSMENT OF FARMERS’ MARKETS IN PENNSYLVANIA A Dissertation in Food Science by Joshua A. Scheinberg © 2016 Joshua A. Scheinberg Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy May 2016 The dissertation of Joshua A. Scheinberg was reviewed and approved* by the following: Catherine N. Cutter Professor of Food Science Dissertation Advisor Chair of Committee Rama Radhakrishna Professor of Agricultural and Extension Education Edward G. Dudley Associate Professor of Food Science Luke LaBorde Associate Professor of Food Science Stephanie Doores Associate Professor of Food Science Jonathan Campbell Assistant Professor of Animal Science Robert F. Roberts Professor of Food Science Head of the Department of Food Science *Signatures are on file in the Graduate School ii Abstract Since the colonial era, farmers in the U. S. have utilized a constantly changing system of markets to barter, sell, and distribute their farmed goods to the local populace. Today, farmers’ markets have replaced old-world style markets providing more than just local produce. Since the late 1970’s, farmers’ markets in the U. S. have experienced an exponential growth with over 8,200 farmers’ markets operating in the U. S. today. As farmers’ markets have increased in size, scope, and complexity in the kinds of foods sold at these venues, so has the potential food safety risks. Today, farmers’ markets provide thousands of farmers in Pennsylvania and hundreds of thousands in the U. S. an economic opportunity to sell their agricultural products outside of the conventional commercial markets, while also allowing them control during harvesting, processing, packaging, transportation, and final sale of their products, from farm to fork. While the economic and social impacts of farmers’ markets are no doubt important and positive, previous observational, survey, and microbiological research of farmers’ markets in various regions of North American have revealed that in many cases, farmers’ market vendors can lack important knowledge and experience in food safety practices and behaviors. These studies have also observed vendors performing high-risk retail food safety behaviors, and identified the presence of both hygiene indicator and pathogenic bacteria on select produce, meat, and dairy products. Throughout the past decade, numerous outbreaks and recalls associated with farmers’ market sold food products also have been reported, further highlighting the food safety implications of farmers’ markets. While these incidents have yet to cause mass public illness or capture national media attention, there is a great potential for a single food safety incident to jeopardize the farmers’ market movement, toppling a billion dollar industry, iii endangering the livelihoods of hundreds of thousands of farmers’ in the U. S., and causing illnesses and potential deaths of consumers. To date, several studies have evaluated specific elements of farmers’ market food safety, such as consumer preferences and vendor behaviors, however no one study has used multiple research tools to identify food safety gaps in the same setting. Training programs for farmers’ market vendors also have been developed, however, current available programs may not be focused specifically on food safety, may not be validated scientifically, and content may not be based on actual farmers’ market vendor needs. To date, no current training program has been developed to address the specific and unique needs of Pennsylvanian farmers’ markets and vendors. Therefore the purpose of this study is to assess the unique food safety issues related to farmers’ markets and vendors in Pennsylvania through a comprehensive food safety needs assessment, and based on the results, develop and pilot-test a new customized food safety training program for farmers’ market vendors in Pennsylvania. The comprehensive food safety assessment was accomplished using five tools: 1) the use of direct concealed observations of farmers’ market vendors in the retail setting; 2) farmers’ market vendor exploratory, knowledge and attitudinal surveys; 3) Pennsylvania Department of Agriculture inspector observational surveys; 4) market manager structured group interviews; and 5) microbiological sampling and analysis of produce, beef, and pork products obtained from Pennsylvania farmers’ markets. An overall comparison and compilation of results from each research tool identified key risk factors and gaps in food safety knowledge, attitudes, and behaviors. Specifically, the microbiological assessment demonstrated that a proportion of select produce and meat obtained from farmers’ markets in Pennsylvania was of questionable microbiological quality, due to the presence of fecal coliforms, E. coli, and Listeria spp. Further iv analysis also suggested that E. coli isolated from meat and produce had unique phylotypic properties and few isolates exhibited potential pathogenic properties. Results of the observational and survey portions of the assessment revealed that a lack of knowledge and improper behaviors performed by vendors related to hand washing, glove use, thermometer use, packaging use, and cross-contamination, were important risk factors which could be addressed through education and training. Based on those results, it was determined that food safety training for farmers’ market vendors in Pennsylvania could address food safety knowledge and behavior gaps, potentially leading to safer foods sold at farmers’ markets. Guided by the preferences collected from vendor surveys, the FDA Food Code, and applicable Pennsylvania food safety regulations, a training program consisting of a comprehensive food safety resource guide and associated interactive 3- hour PowerPoint presentation was developed and piloted in several cities across Pennsylvania. Using a pre- and post-test knowledge and attitudinal assessment, it was determined that the piloted training program produced significant increases in knowledge and positive changes in attitudes among vendor participants. The overall results of this study demonstrated that a customized, in-person training program, specifically designed to address gaps identified through a comprehensive needs assessment, is an effective strategy for improving the food safety knowledge and changing the attitudes of farmers’ market vendors in Pennsylvania. Future use of this training program in Pennsylvania and in neighboring states, could serve to further support and sustain the current farmers’ market movement in the U. S., while ensuring public safety and the success of individual vendors. v TABLE OF CONTENTS List of tables ............................................................................................................................... ix List of figures ............................................................................................................................. xii Acknowledgements .................................................................................................................... xiv Chapter 1: Literature Review .................................................................................................... 1 Farmers’ markets and direct to consumer marketing in the United States .................... 2 A historical perspective...................................................................................... 2 Growth of farmers’ markets in the U.S. (1800-2014) ........................................ 4 Economics and products sold at farmers’ markets ............................................ 5 Food safety implications of farmers’ markets ................................................... 9 Surveillance, outbreaks, and recalls ................................................................... 11 Regulations and laws ......................................................................................... 15 Needs assessments ......................................................................................................... 16 Methods and background ................................................................................... 16 Survey development and methodology .............................................................. 19 Focus groups ...................................................................................................... 21 Direct concealed observations ........................................................................... 23 Food safety training program development and assessments ........................................ 25 Escherichia coli ............................................................................................................. 27 Historical information ........................................................................................ 27 Characteristics of E. coli ................................................................................... 30 Commensal E. coli ............................................................................................ 32 Phylogenetic clustering of commensal E. coli .................................................. 33 E. coli pathotypes ............................................................................................... 35 Escherichia coli infections in humans ........................................................................... 37 Epidemiological significance ............................................................................