Food Control 73 (2017) 681e688

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Food Control
journal homepage: www.elsevier.com/locate/foodcont

Food safety knowledge, optimistic bias and risk perception among

food handlers in institutional food services
Maria de Sousa Carvalho Rossi a, 1, Elke Stedefeldt b, 2, Diogo Thimoteo da Cunha c, 3,
Veridiana Vera de Rosso d, *, 1
a
Programa de Po
s-Graduaça ~o Interdisciplinar em Ci^ ~o Paulo (UNIFESP), Instituto Saúde e Sociedade, Santos,
encias da Saúde, Universidade Federal de Sa
Brazil
b
Centro de Desenvolvimento do Ensino Superior em Saúde, UNIFESP e Universidade Federal de Sa ~o Paulo, Santos, Brazil
c
Faculdade de ci^
encias aplicadas, Universidade Estadual de Campinas, Limeira, Brazil
d
Departamento de Bioci^ encias, UNIFESP e Universidade Federal de Sa ~o Paulo, Santos, Brazil

a r t i c l e i n f o a b s t r a c t

Article history: Food handlers demonstrate an awareness of food safety but generally fail to translate that knowledge
Received 29 June 2016 into safe practices. Optimistic bias can explain this phenomenon. Optimistic bias is a psychological
Received in revised form phenomenon in which people believe they are less likely to experience adverse events than others. In
8 September 2016
this case, optimistic bias can negatively influence food safety. This study aims to verify the existence of
Accepted 9 September 2016
optimistic bias and associated factors in food handlers who work in institutional food services. A total of
Available online 10 September 2016
200 food handlers from 23 establishments in the state of Sao Paulo, Brazil, were recruited for this study.
A structured questionnaire was used to determine the socio-demographic profile of food handlers and
Keywords:
Food handler
their frequency of training, food safety knowledge and risk perception. The food handlers indicated the
Training risk of themselves and their peers causing a foodborne disease. Responses were provided on a structured
Food safety seven-point scale ranging from highly unlikely (1) to extremely likely (7). The difference between their
Optimistic bias levels of risk perception indicated an optimistic bias. Most food handlers were female (73%) and trained
Risk perception (95%). The average knowledge score in food safety was 67%. Optimistic bias was identified in all situa-
tions studied, i.e., regardless of the parameter of comparison (internal or external peer) or the type of
labor (generic or specific practice). Knowledge was higher in the group with a high education level
(p ¼ 0.02) but was not related to training, age or optimistic bias. An overly optimistic food handler can
overlook some protocols and contaminate the food. Foodborne disease in institutional food services can
lead to significant financial losses for the company due to absenteeism and reduced productivity.
© 2016 Elsevier Ltd. All rights reserved.

1. Introduction public policy initiative that encourages companies to provide a

Consuming meals away from the home is motivated by the
pursuit of the speed and convenience of eating (Adams et al., 2015;
Bezerra, Souza Pereira & Sichieri, 2013; Kant & Graubard, 2004). In
Brazil, 62.7% of meals eaten outside of the home are consumed in
the workplace (Carús, França, & Barros, 2014). This high number of
meals, approximately 20 million per day in Brazil (ABERC, 2015), is
due in part to the Worker Food Program (WFP). WFP is a Brazilian
* Corresponding author.
E-mail address: veriderosso@yahoo.com (V.V. de Rosso).
1
Address: Silva Jardim street, 136, Vila Mathias, 11015-020, Santos city, SP, Brazil.
2
Address: Pedro de Toledo Street, 859, Sa ~o Paulo, Brazil.
3 consumption (Griffith, 2006; Jevsnik, Hlebec, & Raspor, 2008).
Address: Pedro Zaccaria Street, 1300, Limeira, SP, Brazil.
balanced diet for workers, with the goal of reducing nutrition-
related diseases and absenteeism and improving productivity. In
return, the companies that join this program receive tax deductions
(Bandoni, Brasil, & Jaime, 2006; Brasil, 1991).
Concern about the quality of meals provided to employees spans
nutritional aspects and food safety, particularly with regard to
preventing foodborne disease (FBD). Promoting food safety in es-
tablishments that produce meals must be based on a food safety
management system that relies on the involvement of leadership,
good communication, team commitment and the promotion of a
safe environment in which everyone understands the risks of each
procedure (Griffith, Livesey, & Clayton, 2010). Properly managing
human resources is an important step in producing safe meals for

http://dx.doi.org/10.1016/j.foodcont.2016.09.016
0956-7135/© 2016 Elsevier Ltd. All rights reserved.
682 M.S.C. Rossi et al. / Food Control 73 (2017) 681e688
Food handlers have an important role in the prevention of
foodborne disease (FBD) (Brasil, 2005a). The inadequate handling
of food is a major cause of foodborne outbreaks in Brazil (Lima,
Loiko, Casarin, & Tondo, 2013) and other countries such as New
Zealand (ESR, 2008, p. 28), the USA (Food and Drug Administration,
2009) and Hong Kong (Chan & Chan, 2007). Training food handlers
in food safety is one of the most effective strategies for preventing
FBD and is mandatory in Brazil (Brasil, 2004b) and other countries
(McIntyre, Vallaster, Wilcott, Henderson, & Kosatsky, 2013;
Regulation EC, 2004).
Studies have shown that training improves the knowledge of
food handlers (Da Cunha, Stedefeldt, & de Rosso, 2014a,b; Liu et al.,
2015; Soares, García-Díez, Esteves, Oliveira, & Saraiva, 2013). A
relationship between knowledge and practice, however, is not al-
ways observed (Da Cunha, Braga, Passos, Stedefeldt, & Rosso, 2015;
Da Cunha, Stedefeldt, & de Rosso, 2014b; Park, Kwak, & Chang,
2010; Soares et al., 2013). Everyday barriers such as time con-
straints, lack of communication, inadequate resources and inef-
fective leadership are considered important limitations (Rowell,
Binkley, Alvarado, Thompson, & Burris, 2013) that lead the food
handler to neglect good practices. One possible explanation for this
is optimistic bias (OB) in food handlers (Da Cunha et al., 2015; Da
Cunha, Stedefeldt, & Rosso, 2014a), whose practices are influ-
enced by the environment in which they work (Da Cunha et al.,
2014b). However, this hypothesis has not been tested for food
handlers working in institutional food services, which can promote
OB when the technical manager is a nutritionist (Brasil, 2005b),
when most requirements for sanitation are met (Akutsu, Botelho,
Camargo, Sa
vio, & Araújo, 2005) and when a large number of
meals are produced (ABERC, 2015).
OB is a psychological phenomenon in which people believe they
are less likely to experience negative events and more likely to
experience positive events than others. For example, consumers
believe that there is no possibility of suffering a FBD by consuming
food in an apparently clean restaurant (Weinstein, 1989). OB ap-
pears as a communication barrier; people ignore risk messages as
they believe that the message is directed to more vulnerable peo-
ple, reducing their cautions to risk (Da Cunha et al., 2014a; Miles &
Scaife, 2003). Weinstein (1989) presents some hypotheses for why
this phenomenon occurs: self-protection; a desire to be better than
others; threatened self-esteem; an illusion of control; and a low
perception of risk. All of these habits are produced by cognitive
errors.
The presence of OB in food handlers can be reflected in their
negligence to good handling practices, jeopardizing the health of
those who eat the meals they produce. In Brazil, the WFP provides
meals for 20 million workers every day during working hours.
Taking into account important aspects about food handler and
worker health, this study aimed to identify the presence of OB in
food handlers working in collective institutional food services and
evaluate the possible associated factors.
2. Methods
2.1. Samples
A pilot test was performed with 20 food handlers to calculate
the sample size and evaluate their understanding of the question-
naire. Calculation of the sample size estimated an expected corre-
lation of 0.75 of OB with training variables (number of trainings and
months since the last training) and knowledge of good handling
practices. Based on this data, it was determined that it would be
necessary to recruit 136 food handlers to obtain a sampling error of
0.15, given a 95% confidence interval.
Two hundred food handlers from 23 small- and medium-sized
institutional food service establishments that serve between 500
and 2000 meals per day, respectively (Pinheiro Sant'Ana, 2012),
participated in this study. The establishments were selected for
convenience and were located in cities in the metropolitan region
~o Paulo, Brazil. The management of these establishments was
of Sa
either self-managed (food service managed by the company itself)
or outsourced (food service managed by an outside company).
Employees of these establishments who came into contact with
food at any stage of processing were invited to participate. No re-
striction of experience was applied.
2.2. Questionnaires
A structured questionnaire collected the food handlers' socio-
demographic information, work experience, information related
to training, knowledge and risk perception related to food safety.
Upon arriving at the establishment, the interviewer invited the
food handlers to answer the questionnaire in the cafeteria during a
break in meal service. The interviewer was present to answer
questions about the questionnaire and supervised the food han-
dlers to make sure that no one exchanged information while
answering the questionnaire. The response time ranged from 10 to
20 min; the interviewer then collected the questionnaire. To reduce
response bias, the interviewer warned the handlers before
answering the questionnaire that anonymity was guaranteed and
that the company would not have access to individual responses.
2.2.1. Evaluation of knowledge
A questionnaire based on the study of Da Cunha et al. (2014b),
with 10 multiple-choice questions and three response options (yes;
no; I do not know), was used to evaluate the food handlers'
knowledge of proper food handling practices. The main issues
addressed included temperature control, cross contamination,
personal hygiene and food safety. The questions were prepared
based on the current legislation of food safety in Sao Paulo, Brazil,
CVS-5 (Sa~o Paulo, 2013). The score for this questionnaire ranged
from 0 to 10 and was subsequently converted to a percentage of
correct responses.
2.2.2. Risk perception of foodborne diseases and OB
The handlers were asked about the risk of FBD caused by their
practices while working. These 11 questions were based on the
Handbook of Good Practices for Foodservice of the National Health
Surveillance Agency (ANVISA in Portuguese) (Brasil, 2004b).
The handlers provided their answers on a structured seven-
point scale ranging from “not at all likely (1), likely not to happen
(2 and 3), 50% chance of happening (4), likely to happen (5 and 6)
and extremely likely (7)”. These questions were based on other
studies on OB (Perloff & Fetzer, 1986; Raats, Sparks, Geekie, &
Shepherd, 1999).
 Question 1 e What is the customer's risk of having stomach ache
and/or vomiting (food poisoning) after eating a meal prepared
by a food handler similar to you (who is a similar age and has
participated in the same amount of training as you), but working
at another company?
 Question 2 e What is the customer's risk of having stomach ache
and/or vomiting (food poisoning) after eating a meal prepared
by you?
 Question 3 e What is the customer's risk of having stomach ache
and/or vomiting (food poisoning) after consuming a meal pre-
pared by a colleague (food handler working in the same place as
you)?
 Question 4 e If a customer consumes contaminated food, what
is the risk of the disease he contracts being severe or lethal?
 M.S.C. Rossi et al. / Food Control 73 (2017) 681e688 683

 Question 5 e If your co-worker does not wash his/her hands, ~o

approved by the Ethics Committee of the Federal University of Sa
what is the customer's risk of having stomach ache and/or Paulo (No. 795,310).
vomiting (food poisoning) after consuming a meal prepared by
him? 3. Results and discussion
 Question 6 e If you do not wash your hands, what is the cus-
tomer's risk of having stomach ache and/or vomiting (food 3.1. Characteristics of the sample
poisoning) after consuming a meal prepared by you?
 Question 7 e If you work while wearing earrings, jewelry, a Of the 200 food handlers who participated in the study, 146
watch or uncovered hair, what is the customer's risk of having were women (73%), and the average age (standard deviation) was
stomach ache and/or vomiting (food poisoning) after consuming 38.8 (18.0) years old. Average experience working in the current
a meal prepared by you? company was 3.03 (4.25) years, and the average experience in the
 Question 8 e What is the customer's risk of having stomach ache catering sector was 7.76 (8.1) years. There was no participation
and/or vomiting (food poisoning) after consuming a hot meal restriction based on the work experience of the food handlers
that did not reach 70  C in the geometric center? (minimum 1, maximum 309 months).
 Question 9 e If you serve your customer a meal prepared with The average age and the prevalence of female food handlers in
an expired ingredient, what is his risk of him having stomach the studied group resemble other food handler groups in different
ache/or vomiting (food poisoning) after consuming this meal? establishments in Brazil (Da Cunha et al., 2015; Ferreira et al., 2013).
 Question 10 e If you do not properly sanitize a utensil, what is Regarding education, 43% of participants had completed sec-
the customer's risk of having stomach ache and/or vomiting ondary education and either some or all higher education; 30% had
(food poisoning) after consuming a meal prepared by food completed primary education and some secondary education; and
handlers from the food service where you work? 25% had completed only some primary education.
 Question 11 e If you prepare meat that has been improperly Food handlers of institutional food services are part of a group
thawed, what is the customer's risk of having stomach ache and/ that has not yet been studied in relation to OB. These handlers have
or vomiting (food poisoning) after consuming the meal? an important role, given the significant number of meals served to
workers in companies (ABERC, 2015) through the WFP (Bandoni
The stomach ache and vomiting are the terms most used in et al., 2006).
Brazil to describe the symptoms of food poisoning.
An indirect method was used to identify OB, in that the indi-
3.2. Training and knowledge of proper handling practices
vidual indicates his risk of causing a FBD and separately indicates
the risk of another individual (peers, friends or others) causing a
Table 1 shows the characteristics of the training courses
FBD (Miles & Scaife, 2003). To observe this phenomenon, the score
completed by the participants regarding proper food handling
that the individual gave himself was compared to the score the
practices. Participants reported that they participated in an average
individual assigned to his partner in a similar situation. Positive
of 19.1 (26.3) training courses and that the last training course was
results with significant differences indicate the tendency of OB,
completed approximately 8.5 (15.6) months ago. The company's
with higher scores indicating a greater magnitude of this trend
training course policy influenced the high standard deviation, with
(Chock, 2011). OB was identified by two standards: first, a com-
52% of companies providing training course more frequently
parison with a similar food handler working at another company
(quarterly, monthly, fortnightly and weekly). In all, 95% of handlers
(Question 2 vs. Question 1) and second, a food handler who works
received training in the workplace.
at the same company (Question 2 vs. Question 3). A third situation
Brazilian law (Brasil, 2004b) does not mandate the frequency of
(Question 5 vs. Question 6) was tested to identify OB in a specific
training courses, explaining only that food handlers should be
practice (hand hygiene), using as a benchmark the food handler
trained regularly and allowing the company to determine this fre-
who works with him. This methodology for identifying OB has been
quency. The semi-annual frequency of training courses led to an
previously described (Da Cunha et al., 2014a; Knox, 2000). To
increase of the knowledge score of food handlers from schools and
evaluate risk perception, the average of the scores related to each
hospitals (Da Cunha et al., 2014b).
question mentioned above was calculated (Da Cunha et al., 2015;
Other studies have also reported a high prevalence of trained
Da Cunha, Stedefeldt, & De Rosso, 2012).
food handlers in several food services in Brazil, such as in hospitals
(92.2%) (Ferreira et al., 2013) and schools (93.2%) (Da Cunha et al.,
2.3. Statistical analysis
2012), where training courses are required by law (Brasil, 2004b).
On the other hand, the proportion of food handlers not trained in
All variables have undergone a compliance test to check the
approach against theoretical curves, using the Kolmogorov-
Smirnov test and Levene test to verify the homoscedasticity. Table 1
The correlation among the variables, including the amount of Characteristics of training courses for food handlers in Good handling practices in
training, knowledge scores, educational level and OB, was calcu- institutional food services.
lated using the Pearson coefficient. To compare means between Training variable n %
two unrelated groups, Student's t-test was used. To compare the
Participation
risk perception, Student's t-test for related samples was used. In all Yes 189 95
tests, the significance level was p < 0.05, and SPSS software version No 11 5
15.0.1 was used. Frequency
Weekly 16 9
Fortnightly 2 1
2.4. Ethical aspects Monthly 35 18
Quarterly 45 24
Those responsible for the survey signed a letter of authorization Biannual 34 18
for data collection. All participants signed a free and informed Annual 29 15
Only once 28 15
consent before participating in the study, and the research was
684 M.S.C. Rossi et al. / Food Control 73 (2017) 681e688

commercial restaurants in Brazil is higher, at 41.5% (Da Cunha et al.,
2014b).
The average score for knowledge related to food safety was 67%.
There was no significant difference in knowledge between trained
food handlers (67.1%) and untrained handlers (61.8%) (p ¼ 0.33).
This result differs from other studies in that it shows a clear rela-
tionship between training and knowledge (Al-Shabib, Mosilhey, &
Husain, 2016; Pichler, Ziegler, Aldrian, & Allerberger, 2014). Un-
like other food services, institutional food services are more likely
to adhere to health legislation (Da Cunha et al., 2015). Thus, the
number of food handlers without training was low (n ¼ 11), not
taking into account the observation of significant differences.
Table 2 shows the percentage of correct answers for each
question of the proper handling practices. The questions that had
high percentages of correct answers were those related to not
wearing jewelry while handling food, not using expired food, not
serving undercooked meat and the need to remove the food
handler from direct contact with food in cases of illness that may
bring some risk of contamination. These results converge with
those obtained by Da Cunha et al. (2014b).
It was observed that food handlers are aware of microbiological
risks, but with some gaps of knowledge of food safety. One question
with a lower percentage of correct answers was related to the
correct way to sanitize hands. The handlers were unable to identify
the necessity of using a bactericidal agent to properly sanitize their
hands as recommended by Brazilian law (Brasil, 2004b). The hand
hygiene frequency is generally low in food service (De Castro
Almeida, Kuaye, Serrano, & Almeida, 1994; Green et al., 2005;
Mello, Gama, Marin, & Colares, 2010). Thus, improper hand hy-
giene combined with the low frequency of this practice increases
the risk of a FBD.
Another question with a low percentage of correct answers
concerned the risk of disease transmission through ice. Microor-
ganisms as Vibrio cholera, whether in food or ice, can recover their
viability when food is thawed (Waturangi, Pradita, Linarta, &
Banerjee, 2012).
According to Byrd-Bredbenner, Berning, Martin-Biggers, and
Quick (2013), knowledge should motivate good practices in food
handling. However, translating knowledge into practice is a com-
plex process (Liu et al., 2015). Knowledge should be positively
correlated with attitudes and practices, but there is some
disagreement on this issue. Some studies show positive correla-
tions among knowledge, attitudes and practices (Abdul-Mutalib
et al., 2012; Vo, Le, Le, Tran Minh, & Nuorti, 2015), whereas
others refute this hypothesis (Annor & Baiden, 2011; Da Cunha
et al., 2014b).
The practical and theoretical training model seems to be the
most effective way of training (Lillquist, McCabe, & Church, 2005),
though when planning the training, the possible barriers that can
interfere with good manufacturing practices should be taken into
account: for example, social pressure (Clayton & Griffith, 2008),
work overload, inadequate facilities, lack of material, lack of
accountability and lack of involvement of managers and coworkers
(Green et al., 2007; Pragle, Harding, & Mack, 2007).
There was a weak positive correlation between the knowledge
score and the length of professional experience (r ¼ 0.17;
p ¼ 0.013). Table 3 shows a difference between the knowledge
score and the group level of education “incomplete primary edu-
cation” (p ¼ 0.02). The level of education can be a prerequisite for
the admission of food handlers, in that the higher the level of ed-
ucation, the better the level of knowledge (Annor & Baiden, 2011;
Pichler et al., 2014.). No significant correlation was found be-
tween knowledge score and amount of training (r ¼ 0.017, p ¼ 0.81)
or age (r ¼ 0.002, p ¼ 0.97).
The positive correlation between knowledge and experience,
despite its weakness, is confirmed. Kraemer and de Aguiar (2009)
report that there is little investment in formal training and in the
development of handlers' skills in food service. In their study they
noted that skills are acquired in learning within food service, i.e., in
this case, the training is informal and takes place on the job.
The type of food service management interfered with the level
of knowledge of food handlers. Those who worked in self-managed
food service institutions showed a better performance (8.11 ± 1.85)
than those who worked in outsourced units (6.53 ± 1.68)
(p < 0.001). It was also verified that employees of self-managed
companies had three times more training in their companies than
employees of outsourced companies. This can possibly be attrib-
uted to the fact that self-managed companies generally invest more
in their workers with structured training programs. However, this
is just a hypothesis that should be tested.

Table 2
Evaluation of knowledge of food handlers about good handling practices.

Questions Correcta %

1. Wearing jewelry such as earrings, rings, watches and others may encourage food contamination? 92
2. Water can be a way of disease transmission, but when transformed into ice, the risk of disease transmission is smaller? 38
3. The way to perform hand hygiene to prevent food contamination is to wet your hands under running water, using a mild detergent and 26
dry them with paper?
4. The contact between raw and cooked food, such as using parsley and chives on top of hot dishes, enables contamination of food? 60
5. Using food one day after its expiration date brings health risks? 94
6. Improper food for consumption always has bad smell and bad taste? 34
7. The consumption of undercooked meat can lead to foodborne disease that can cause vomiting and diarrhea? 93
8. Wash the vegetables and let them soak in water with vinegar is enough so that this food is safe for consumption? 74
9. Thawing food can be done in a bowl with or without water on the sink, table or counter? 67
10. The food handler with diseases such as diarrhea, flu and sore throat represents risk for food contamination? 94
a
Correct answer refers to the Handbook of Good Practices for Foodservice of the National Health Surveillance Agency (Brasil, 2004a,b).

Table 3
Comparison between the level of knowledge and level of education of food handlers.

Variable n Average knowledge score* SD p

Incomplete Primary Education 51 6.2a 1.7 0.02

Complete Primary Education, Incomplete Secondary Education 60 6.5b 1.6
Complete Secondary Education, Complete and Incomplete Higher Education 89 7.0b 1.8

SD ¼ standard deviation; ANOVA test with pos-hoc Tukey test. *Average in the same column followed by different letters differed significantly.
 M.S.C. Rossi et al. / Food Control 73 (2017) 681e688 685

Table 4
Risk perception of food handlers related to good food handling practices.

Issue Averagea SD

Question 1 e What is the customer's risk of presenting stomachache and/or vomiting (food poisoning) after eating a meal prepared by a similar 3.2 1.9
food handler as you (who has similar age and has participated in the same amount of training than you), but working in another company?
Question 2 e What is the customer's risk of presenting stomachache and/or vomiting (food poisoning) after eating a meal prepared by you? 2.1 1.5
Question 3 e What is the customer's risk of presenting stomachache and/or vomiting (food poisoning) after consuming a meal prepared by a 2.7 1.6
colleague (food handler working in the same place as you)?
Question 4 e If a customer consumes a contaminated food, what is the risk of a disease be severe or lethal to him after consuming this food? 5.2 1.6
Question 5 e If your co-worker does not wash his/her hands, what is the customer's risk of presenting stomachache and/or vomiting (food 5.2 1.5
poisoning) after consuming a meal manipulated by him?
Question 6 e If you do not wash your hands what is the customer's risk of presenting stomachache and/or vomiting (food poisoning) after 5.1 1.6
consuming a meal manipulated by you?
Question 7 e If you work with earrings, jewelry, watch and uncovered hair, what is the customer's risk of presenting stomachache and/or 4.7 1.8
vomiting (food poisoning) after consuming a meal manipulated by you?
Question 8 e What is the customer's risk of presenting stomachache and/or vomiting (food poisoning) after consuming a hot meal that did not 4.8 1.5
reach 70  C in the geometric center?
Question 9 e If you use any ingredient with expired date in a meal and serve your customer, what is his risk of presenting stomachache/or 5.6 1.4
vomiting (food poisoning), after consuming this meal?
Question 10 e If you do not properly sanitize any utensil, what is the customer's risk of presenting stomachache and/or vomiting (food 5.2 1.6
poisoning) after consuming a meal prepared by food handlers from the kitchen where you work?
Question 11 e If you prepare a meat that has been thawed incorrectly, what is the customer's risk of presenting stomachache and/or vomiting 5.0 1.5
(food poisoning) after consuming this meal?
a
Correct answer refers to the Handbook of Good Practices for Foodservice of the National Health Surveillance Agency (Brasil, 2004a,b).

3.3. Risk perception
Table 4 shows that food handlers demonstrated moderate risk
perception of food safety (questions 4, 7, 8, 9, 10 and 11), recog-
nizing that food poisoning is possible if handlers are inattentive to
the practices covered in this study. However, for the assessment of
personal risk and risk to their peers, the perception was lower
(questions 1, 2, 3, 5 and 6).
Higher risk perception of FBD was expressed for the use of
expired food, probably because this issue is covered in training
courses targeted to this audience, and everyday consumers also
have access to this information through various media, including
television, newspaper and internet, and information from the
health ministry reports.
Table 5 evaluated whether knowledge influences risk percep-
tion of a given subject. It was observed that knowledge had little
influence on risk perception and was significant for only the
practice of serving hot food that did not reach 70  C in the geo-
metric center, indicating that handlers with more knowledge on
this subject realized that this practice may lead to a higher risk of
FBD. However, knowledge by itself was not able to influence the
risk perception of other subjects (Zanin, DaCunha, Stedefeldt, &
Capriles, 2015). Risk perception seems to be linked to confidence
that changes perceived control (Byrd-Bredbenner et al., 2013;
Redmond & Griffith, 2004) and other factors, such as cognitive
errors, motivation, beliefs and previous experiences (Miles & Scaife,
2003).
Risk perception guides practices (McCarthy et al., 2007; Parra,
Kim, Shapiro, Gravani, & Bradley, 2014); therefore, knowledge is
no guarantee of the implementation of appropriate procedures
(Zanin et al., 2015). For this reason, studies indicate that the best
strategy for improving practices would be improving communica-
tion to increase risk perception and change general behavior (Byrd-
Bredbenner et al., 2013; McCarthy et al., 2007; Parra et al., 2014).
3.4. Optimistic bias
OB was identified in all three cases studied (Table 6): when the
food handler compared himself to an external peer, when the food
handler compared himself to an internal peer, and when the food
handler compared himself with an internal peer for a particular
practice. The OB score was lower when the handler compared
himself with an internal peer, i.e., the comparison target does not
alter the perception of his own vulnerability (Perloff & Fetzer,
1986). When the comparison is made with known people, the in-
dividual has a real target in offering judgment because he has in-
formation about the target behavior, which differs from the
comparison with an unknown person, despite having the same
characteristics (Klar, Medding, & Sarel, 1996; Shepperd, Waters,
Weinstein, & Klein, 2015).

Table 5
Relation of the score of risk perception between food handlers that answered correctly and incorrectly the knowledge questions.

Issue Knowledge n Risk perceptiona SD pb

FBD transmission when there is no proper hygienic cleaning of hands. Incorrect 148 5.0 1.7 0.150
Correct 52 5.4 1.5
Food handling wearing jewelry Incorrect 17 3.9 2.1 0.060
Correct 183 4.7 1.7
Use of expired product in food preparation Incorrect 13 5.4 1.4 0.530
Correct 187 5.6 1.4

Serving food which has not reached 70 C temperature in the geometric center Incorrect 15 3.7 1.3 0.005
Correct 185 4.9 1.5
Thawing meat at ambient temperature Incorrect 67 4.9 1.6 0.490
Correct 133 5.1 1.5

SD ¼ standard deviation.
a
Average of the questions about of risk perception with equivalent issue to the assessed knowledge test.
b
t-Student test.
686 M.S.C. Rossi et al. / Food Control 73 (2017) 681e688
Table 6
Optimistic Bias of food handlers from institutional food service establishments.
Personal risk Peer risk
Average ± SD Average ± SD
Question 2 vs Question1a 2.09 ± 1.51 3.18 ± 1.92
Question 2 vs Question3b 2.09 ± 1.51 2.66 ± 1.64
Question 5 vs Question6c 5.07 ± 1.63 5.23 ± 1.47
a
Comparison between external peer. who works at another company.
b
Comparison between internal peer. who works in the same company.
c
Comparison between internal peer. who works in the same company but for a
particular practice (hand hygiene).
As in this study, OB has already been found in food handlers, but
for other types of food services (Da Cunha et al., 2015; Da Cunha
et al., 2014a,b). Some reasons given as justification for this phe-
nomenon are as follows: a) the tendency to predict that their re-
sults will be more favorable than their peers (Shepperd et al., 2015;
Weinstein, 2011); b) the overestimation of and overconfidence in
their own knowledge and skills (Dunning, Heath, & Suls, 2004); c)
the underestimation of others' control (Shepperd, Klein, Waters, &
Weinstein, 2013); and d) “self-defense” behavior (Wills, 1981) or
egocentric thinking (Shepperd et al., 2013), in which people fail to
recognize their vulnerability to negative events but recognize this
vulnerability for others.
The hypothesis of comparing risk stereotypes and egocentric
thoughts make more sense when observing the third situation
(question 5 vs. question 6), where the risk is the same for the food
handler and his peer. In this situation, neither sanitizes his hands
correctly, though the food handler identifies a lower personal risk
than his internal peer. Comparison of risk stereotypes has already
been reported in food handlers from hospitals and schools,
reflecting lower risk perception, which offers food handlers a
feeling of protection when compared to those who work in com-
mercial restaurants, beach kiosks and street food stands (Da Cunha
et al., 2014a).
The size of the company (small or medium) did not affect the
level of knowledge and the risk perception of food handlers.
However, in institutional food service, when the ratio of the
number of meals produced by the handler is high, the existence of
OB may compromise the safety of food and endanger the health of
workers (Ross, Kemerer, & Taylor, 2006), burdening the health
system (hospitalizations and medical appointments), leading to a
loss of productivity and absenteeism (Hoang, Tran, Ha, & Nguyen,
2015; Voss, 1993), and negatively affecting companies and the na-
tional economy (Hoffmann, Maculloch, & Batz, 2015; Ross et al.,
2006). The productivity loss in the United States due to FBD is
estimated at $856 million (Hoffmann et al., 2015).
There are few studies that assess the impact of FBD on absen-
teeism. In the study by Voss (1993), 61% of individuals affected by a
food outbreak missed an average 8.3 days at work. In a report on an
outbreak of food poisoning, Ross et al. (2006) reported that 70% of
workers who consumed a meal prepared in an institutional food
service unit were sick enough to stop production (Ross et al., 2006).
There was no correlation between the existence of OB with the
knowledge score and amount of training. Dunning et al. (2004)
report the difficulty of finding correlation between competences
and the actual performance of individuals.
Studies have been warning experts about the need for updating
the techniques and strategies used to train food handlers (Da Cunha
et al., 2015; Da Cunha et al., 2014a; Ferreira et al., 2013). However,
training should be not only expanded, but reworked to determine
what strategy would be most likely to increase food handlers'
perception of personal risk and erode their self-confidence and
complacency to attitudes and practices (Brewer, Weinstein, Cuite, &
Med, 2004).
P 4. Conclusion
<0.001
OB was identified in the food handlers of institutional food
<0.001 services, particularly when the food handler compared himself to
<0.030 an external peer. OB occurred in both generic practices (food
preparation) and in specific practices (hand hygiene), reinforcing
the individual's need to be better than the other, regardless of the
event to which he is exposed. An overly optimistic food handler can
overlook some protections and contaminate the food. The amount
of training and the level of knowledge showed no correlation with
OB.
Personal risk perceptions was low. The only variable that
showed a significant correlation with knowledge was the level of
education. Food handlers from self-management companies
demonstrated better knowledge.
The occurrence of FBD in institutional food services can result in
significant financial losses for the company due to absenteeism and
reduced productivity. Understanding the mechanisms that trans-
late knowledge into practice can help in developing new strategies
for training food handlers and ensuring food safety.
Appendix A. Supplementary data
Supplementary data related to this article can be found at http://
dx.doi.org/10.1016/j.foodcont.2016.09.016.
References
Abdul-Mutalib, N.-A., Abdul-Rashid, M.-F., Mustafa, S., Amin-Nordin, S.,
Hamat, R. A., & Osman, M. (2012). Knowledge, attitude and practices regarding
food hygiene and sanitation of food handlers in Kuala Pilah, Malaysia. Food
Control, 27(2), 289e293. http://dx.doi.org/10.1016/j.foodcont.2012.04.001.
ABERC. (2015). Mercado Real. Retrieved November 3, 2015, from m.br/mercadoreal.
asp?IDMenu¼21.
Adams, J., Goffe, L., Brown, T., Lake, A. A., Summerbell, C.,
White, M., … Adamson, A. J. (2015). Frequency and socio-demographic corre-
lates of eating meals out and take-away meals at home: Cross-sectional analysis
of the UK national diet and nutrition survey, waves 1e4 (2008e12). The Inter-
national Journal of Behavioral Nutrition and Physical Activity, 12(1), 51. http://
dx.doi.org/10.1186/s12966-015-0210-8.
Akutsu, R. D., Botelho, R. A., Camargo, R. B., Sa
vio, K. E., & Araújo, W. C. (2005).
Adequacy of good manufecturing procedures. Revista Nutriça ~o, 18(3), 419e427.
Retrieved February 21, 2016, from http://www.scielo.br/scielo.php?script¼sci_
arttext&pid¼S1415-52732005000300013&lng¼en&tlng¼pt.
Al-Shabib, N. A., Mosilhey, S. H., & Husain, F. M. (2016). Cross-sectional study on
food safety knowledge, attitude and practices of male food handlers employed
in restaurants of King Saud University, Saudi Arabia. Food Control, 59, 212e217.
http://dx.doi.org/10.1016/j.foodcont.2015.05.002.
Annor, G. A., & Baiden, E. A. (2011). Evaluation of food hygiene knowledge attitudes
and practices of food handlers in food businesses in Accra, Ghana. Food and
Nutrition Sciences, 02(08), 830e836. http://dx.doi.org/10.4236/fns.2011.28114.
Bandoni, D. H., Brasil, B. G., & Jaime, P. C. (2006). Programa de Alimentaça ~o do
trabalhador: Representaço ~es sociais de gestores locais. Revista de Saude Publica,
40(5), 837e842. http://dx.doi.org/10.1590/S0034-89102006000600013.
Bezerra, I. N., Souza, A. D. M., Pereira, R. A., & Sichieri, R. (2013). Consumption of
foods away from home in Brazil. Revista de Saúde Pública, 47(Suppl. 1),
200Se211S.
Brasil. (2004a). Cartilha sobre Boas pra
ticas para Serviços de alimentaça ~o. Brasília.
Retrieved from http://portal.anvisa.gov.br/wps/wcm/connect/
e56c07004f740596a7e2f79a71dcc661/3þcartilhaboaspraticas_final_baixa_
creditosþPDFþ30þDEþABRIL.pdf?MOD¼AJPERES.
Brasil. (2004b). RDC no216 de 15 de setembro de 2004. dispo
e sobre Regulamento
T
ecnico de Boas Pra
ticas de para Serviços de Alimentaça ~o. Brasília: dia

rio oficial da
República Federativa do Brasil.
Brasil. (2005a). Boletim Vigila ^ncia Sanita
riaVigila
^ncia. Epidemiolo
gica das doenças
transmitidas por alimentos Brasil 1999e2004). Boletim Vigil^ ancia Sanita
ria.
Brasília. Retrieved from http://bvsms.saude.gov.br/bvs/periodicos/boletim_
eletronico_ano05_06.pdf.
Brasil. (2005b). Resoluça ~o CFN no 380/2005. Brasilia: Dispo ~ e sobre a definiç~ ao das

reas de atuaça
a ~o do nutricionista e suas atribuiço ~es, estabelece para ^metros
nume
ricos de refere^ncia, por

area de atuaç~ ao, e da
outras provide ^ncias.
Brasil. DECRETO No 5, DE 14 DE JANEIRO DE 1991. (1991). Brasil: Regulamenta a Lei

N 6.321, de 14 de abril de 1976, que trata do Programa de Alimentaça ~o do
 M.S.C. Rossi et al. / Food Control 73 (2017) 681e688
Trabalhador, revoga o Decreto n 78.676, de 8 de novembro de 1976 e da
outras
provid^encias. Retrieved from http://www.planalto.gov.br/ccivil_03/decreto/
1990-1994/d0005.htm.
Brewer, N. T., Ph, D., Weinstein, N. D., Cuite, C. L., & Med, A. B. (2004). Risk per-
ceptions and their relation to risk behavior. Annals of Behavioral Medicine, 7(2),
125e130. http://dx.doi.org/10.1207/s15324796abm2702.
Byrd-Bredbenner, C., Berning, J., Martin-Biggers, J., & Quick, V. (2013). Food safety in
home kitchens: A synthesis of the literature. International Journal of Environ-
mental Research and Public Health, 10(9), 4060e4085. http://dx.doi.org/10.3390/
ijerph10094060.
Carús, J. P., França, G. V. A., & Barros, A. J. D. (2014). Place and type of meals
consumed by adults in medium sized cities. Revista de Saude Publica, 48(1),
68e74. http://dx.doi.org/10.1590/S0034-8910.2014048004720.
Chan, S. F., & Chan, Z. (2007). A review of foodborne disease outbreaks from 1996 on
food safety promotion. Journal of Food Safety, 28(2008), 276e299.
Chock, T. M. (2011). The Influence of body mass index, sex, and race on college
students' optimistic bias for lifestyle healthfulness. Journal of Nutrition Educa-
tion and Behavior, 43(5), 331e338. http://dx.doi.org/10.1016/j.jneb.2010.09.016.
Clayton, D. A., & Griffith, C. J. (2008). Efficacy of an extended theory of planned
behaviour model for predicting caterers' hand hygiene practices. International
Journal of Environmental Health Research, 18(2), 83e98. http://dx.doi.org/
10.1080/09603120701358424.
Da Cunha, D. T., Braga, A. R. C., Passos, E. D. C., Stedefeldt, E., & de Rosso, V. V. (2015).
The existence of optimistic bias about foodborne disease by food handlers and
its association with training participation and food safety performance. Food
Research International, 75, 27e33. http://dx.doi.org/10.1016/
j.foodres.2015.05.035.
Da Cunha, D. T., Stedefeldt, E., & de Rosso, V. V. (2014a). He is worse than I am: The
positive outlook of food handlers about foodborne disease. Food Quality and
Preference, 35, 95e97. http://dx.doi.org/10.1016/j.foodqual.2014.02.009.
Da Cunha, D. T., Stedefeldt, E., & de Rosso, V. V. (2014b). The role of theoretical food
safety training on Brazilian food handlers' knowledge, attitude and practice.
Food Control, 43, 167e174. http://dx.doi.org/10.1016/j.foodcont.2014.03.012.
Da Cunha, D. T., Stedefelt, E., & De Rosso, V. V. (2012). Perceived risk of foodborne
disease by school food handlers and Principals: The influence of frequent
training. Journal of Food Safety, 32(2), 219e225. http://dx.doi.org/10.1111/j.1745-
4565.2012.00371.x.
De Castro Almeida, R., Yoshiteru Kuaye, A., De Melo Serrano, A., & De Almeida, P. F.
(1994). Avaliaça ~o e controle da qualidade microbiolo
gica de ma ~os de manipu-
ladores de alimentos. Reve Pública Saúd, 29(4), 290e294. http://dx.doi.org/
10.1590/S0034-89101995000400006.
Dunning, D., Heath, C., & Suls, J. M. (2004). Flawed self-assessment implications for
health, education, and the workplace. Psycohological Science in the Public In-
terest, 5(3), 69e106.
ESR. (2008). Annual summary of outbreaks in New Zealand 2007. New Zealand:
Population and Environmental Health Group.
Ferreira, J., Cerqueira, E., Carvalho, J., Oliveira, L., Costa, W., & Almeida, R. (2013).
Conhecimento, atitudes e pra
ticas em segurança alimentar de manipuladores
de alimentos em hospitais públicos de Salvador, Bahia. Revista Baiana de Saúde
Pública, 37, 35e55.
Food and Drug Administration. (2009). Food code. Washington, DC. Retrieved from
http://www.fda.gov/food/guidanceregulation/retailfoodprotection/foodcode/
default.htm.
Green, L. R., Radke, V., Mason, R., Bushnell, L., Reimann, D. W., Mack, J. C.,
Motsinger, M. D., Stigger, T., & Selman, C. A. (2007). Factors related to food
worker hand hygiene practices. Journal of Food Protection, 3(9), 661e666.
Retrieved from http://www.ingentaconnect.com/content/iafp/jfp/2007/
00000070/00000003/art00018?token¼005111dec67232d45232b6d7a73
3838577446543e553568293c62207d673f582f6bd66816ae39dfdb.
Green, L., Selman, C., Banerjee, A., Marcus, R., Medus, C., Angulo, F. J., Angulo, F. J.,
Radke, V., & Buchanan, S. (2005). Food service workers' self-reported food
preparation practices: An EHS-Net study. International Journal Hygiene and
Environmental Health, 208(1e2), 27e35. http://dx.doi.org/10.1016/
j.ijheh.2005.01.005.
Griffith, C. J. (2006). Food safety: Where from and where to? British Food Journal,
108(1), 6e15. http://dx.doi.org/10.1108/00070700610637599.
Griffith, C. J., Livesey, K. M., & Clayton, D. A. (2010). The assessment of food safety
culture. British Food Journal, 112(4), 439e456. http://dx.doi.org/10.1108/
00070701011034448.
Hoang, V. M., Tran, T. A., Ha, A. D., & Nguyen, V. H. (2015). Cost of hospitalization for
foodborne Diarrhea: A case study from Vietnam. Journal Korean Medicine Sci-
ence, 30(Suppl. 2), S178eS182.
Hoffmann, S., Maculloch, B., & Batz, M. (2015). Economic burden of major foodborne
illnesses acquired in the United States. Economic Research Service, 53. EB140.
Jevsnik, M., Hlebec, V., & Raspor, P. (2008). Food safety knowledge and practices
among food handlers in Slovenia. Food Control, 19(12), 1107e1118. http://
dx.doi.org/10.1016/j.foodcont.2007.11.010.
Kant, A. K., & Graubard, B. I. (2004). Eating out in America, 1987e2000: Trends and
nutritional correlates. Preventive Medicine, 38(2), 243e249. http://dx.doi.org/
10.1016/j.ypmed.2003.10.004.
Klar, Y., Medding, A., & Sarel, D. (1996). Nonunique invulnerability: Singular versus
distributional probabilities and unrealistic optimism in comparative risk judg-
ments. Organizational Behavior and Human Decision Processes, 67(2), 229e245.
http://dx.doi.org/10.1006/obhd.1996.0076.
Knox, B. (2000). Consumer perception and understanding of risk from food. British
687
Medical Bulletin, 56(1), 97e109. http://dx.doi.org/10.1258/0007142001903003.
Kraemer, F. B., & de Aguiar, O. B. (2009). Gesta ~o de compete ^ncias e qualificaç~ao
profissional no segmento da alimentaça ~o coletiva. Revista de Nutricao, 22(5),
609e619. http://dx.doi.org/10.1590/S1415-52732009000500002.
Lillquist, D. R., McCabe, M. L., & Church, K. H. (2005). A comparison of traditional
handwashing training with active handwashing training in the food handler
industry. Journal of Environmental Health, 67(6), 13e16, 28. Retrieved from
http://www.ncbi.nlm.nih.gov/pubmed/15690900.
Lima, G. C., Loiko, M. R., Casarin, L. S., & Tondo, E. C. (2013). Assessing the epide-
miological data of Staphylococcus aureus food poisoning occurred in the State
of Rio Grande do Sul, Southern Brazil. Brazilian Journal of Microbiology: [publi-
cation of the Brazilian Society for Microbiology], 44(3), 759e763. http://
dx.doi.org/10.1590/S1517-83822013005000063.
Liu, S., Liu, Z., Zhang, H., Lu, L., Liang, J., & Huang, Q. (2015). Knowledge, attitude and
practices of food safety amongst food handlers in the coastal resort of Guang-
dong, China. Food Control, 47, 457e461. http://dx.doi.org/10.1016/
j.foodcont.2014.07.048.
McCarthy, M., Brennan, M., Kelly, A. L., Ritson, C., de Boer, M., & Thompson, N.
(2007). Who is at risk and what do they know? Segmenting a population on
their food safety knowledge. Food Quality and Preference, 18(2), 205e217. http://
dx.doi.org/10.1016/j.foodqual.2005.10.002.
McIntyre, L., Vallaster, L., Wilcott, L., Henderson, S. B., & Kosatsky, T. (2013). Eval-
uation of food safety knowledge, attitudes and self-reported hand washing
practices in FOODSAFE trained and untrained food handlers in British Columbia,
Canada. Food Control, 30(1), 150e156. http://dx.doi.org/10.1016/
j.foodcont.2012.06.034.
Mello, A. G., Gama, M. de P., Marin, V. A., & Colares, L. G. T. (2010). Conhecimento dos
manipuladores de alimentos sobre boas pr
aticas nos restaurantes públicos
populares do Estado do Rio de Janeiro. Brazilian Journal of Food Technology,
13(1), 60e68. http://dx.doi.org/10.4260/BJFT2010130100008.
Miles, S., & Scaife, V. (2003). Optimistic bias and food. Nutrition Research Reviews,
16(1), 3e19. http://dx.doi.org/10.1079/NRR200249.
Park, S.-H., Kwak, T.-K., & Chang, H.-J. (2010). Evaluation of the food safety training
for food handlers in restaurant operations. Nutrition Research and Practice, 4(1),
58e68. http://dx.doi.org/10.4162/nrp.2010.4.1.58.
Parra, P. A., Kim, H., Shapiro, M. A., Gravani, R. B., & Bradley, S. D. (2014). Home food
safety knowledge, risk perception, and practices among Mexican-Americans.
Food Control, 37, 115e125. http://dx.doi.org/10.1016/j.foodcont.2013.08.016.
Perloff, L. S., & Fetzer, B. K. (1986). Selfeother judgments and perceived vulnera-
bility to victimization. Journal of Personality and Social Psychology, 50(3),
502e510.
Pichler, J., Ziegler, J., Aldrian, U., & Allerberger, F. (2014). Evaluating levels of
knowledge on food safety among food handlers from restaurants and various
catering businesses in Vienna, Austria 2011/2012. Food Control, 35(1), 34e40.
http://dx.doi.org/10.1016/j.foodcont.2013.06.034.
Pinheiro Sant'Ana, H. M. (2012). Planejamento físico-funcional de unidades de
alimentaça ~o e nutriça
~o (1st ed.). Rio de Janeiro: Editora Rubio. Retrieved from
https://books.google.com.br/books?
id¼iMTDAwAAQBAJ&printsec¼frontcover&hl¼pt-BR&source¼gbs_ge_
summary_r&cad¼0#v¼onepage&q&f¼false.
Pragle, A. S., Harding, A. K., & Mack, J. C. (2007). Food workers' perspectives on
handwashing behaviors and barriers in the restaurant environment. Journal of
Environmental Health, 69(June), 27e32.
Raats, M. M., Sparks, P., Geekie, M. A., & Shepherd, R. (1999). The effects of providing
personalized dietary feedback. A semi-computerized approach. Patient Educa-
tion and Counseling, 37(2), 177e189. http://dx.doi.org/10.1016/S0738-3991(98)
00114-1.
Redmond, E. C., & Griffith, C. J. (2004). Consumer perceptions of food safety risk,
control and responsibility. Appetite, 43(3), 309e313. http://dx.doi.org/10.1016/
j.appet.2004.05.003.
Regulation, E. C. (2004). No 852/2004 of the European Parliament and of the
Council of 29 April 2004 on the hygiene of foodstuffs. Official Journal of the
European Communities, 18.
Ross, P., Kemerer, S., & Taylor, L. (2006). Food safety in the workplace: A practical
approach. Aaohn Journal, 54(12), 521e528.
Rowell, A. E., Binkley, M., Alvarado, C., Thompson, L., & Burris, S. (2013). Influence of
food safety training on grocery store employees' performance of food handling
practices. Food Policy, 41, 177e183. http://doi.org/10.1016/j.foodpol.2013.05.007.
S~
ao Paulo. Portaria CVS 5. (2013). Sa ~o Paulo: Aprova o regulamento t
ecnico sobre boas
pra
ticas para estabelecimentos comerciais de alimentos e para serviços de
alimentaça ~o, e o roteiro de inspeça ~o, anexo. Retrieved from http://www.cvs.
saude.sp.gov.br/up/PORTARIA CVS-5_090413.pdf.
Shepperd, J. A., Klein, W. M. P., Waters, E. A., & Weinstein, N. D. (2013). Taking stock
of unrealistic optimism. Perspectives on Psychological Science, 8(4), 395e411.
http://dx.doi.org/10.1177/1745691613485247.
Shepperd, J. A., Waters, E. A., Weinstein, N. D., & Klein, W. M. P. (2015). A primer on
unrealistic optimism. Current Directions in Psychological Science, 24(3), 232e237.
http://dx.doi.org/10.1177/0963721414568341.
Soares, K., García-Díez, J., Esteves, A., Oliveira, I., & Saraiva, C. (2013). Evaluation of
food safety training on hygienic conditions in food establishments. Food Control,
34(2), 613e618. http://dx.doi.org/10.1016/j.foodcont.2013.06.006.
Vo, T. H., Le, N. H., Le, A. T. N., Tran Minh, N. N., & Nuorti, J. P. (2015). Knowledge,
attitudes, practices and training needs of food-handlers in large canteens in
Southern Vietnam. Food Control, 57, 190e194. http://dx.doi.org/10.1016/
j.foodcont.2015.03.042.
688 M.S.C. Rossi et al. / Food Control 73 (2017) 681e688
Voss, S. (1993). Costs to affected individuals following an outbreak of food
poisoning: A pilot study. Public Health, 107, 337e341.
Waturangi, D. E., Pradita, N., Linarta, J., & Banerjee, S. (2012). Prevalence and mo-
lecular characterization of Vibrio cholerae from ice and beverages sold in
Jakarta, Indonesia, using most probable number and multiplex PCR. Journal of
Food Protection, 75(4), 651e659. http://dx.doi.org/10.4315/0362-028X.JFP-11-
504.
Weinstein, N. D. (1989). Optimistic Biases about personal risks. Science, 246(4935),
1232e1233.
Weinstein, N. D. (2011). Unrealistic optimism about future life events: A cautionary
note. Psychological Review, 118(1), 135e154. http://dx.doi.org/10.1037/a0020997.
Wills, T. A. (1981). Downward comparison principles in social psychology. Psyco-
hological Bulletin, 90(2), 245e271. Retrieved from http://psycnet.apa.org/index.
cfm?fa¼buy.optionToBuy&id¼1981-30307-001.
Zanin, L. M., Da Cunha, D. T., Stedefeldt, E., & Capriles, V. D. (2015). Seafood safety:
Knowledge, attitudes, self-reported practices and risk perceptions of seafood
workers. Food Research International, 67(July), 19e24. http://dx.doi.org/10.1016/
j.foodres.2014.10.013.