Perceptions of food hygiene risk in a group of Tamil food handlers living in the UK

Perceptions of food hygiene risk in a group of Tamil foodhandlers living in the UK

Michael Howard and Keerthana Wignarajah

School of Social Science and Public Policy, King’s College London, London, UK

Correspondence:Michael Howard,Department ofGeography, School ofSocial Science and PublicPolicy, King’s CollegeLondon, The Strand,London WC2R 2LS, UK.Tel: 020 7848 4413;E-mail:[email protected]

Keywords:food handlers, foodhygiene, perception,public health risk

Abstract

In this study, two groups of people were asked about their perceptions of thepublic health risks associated with poor food hygiene practices. One groupconsisted of commercial food handlers (n = 60) who had undergone foodhygiene training; the other group consisted of people (n = 60) who onlyhandled food at home. Data were gathered using a self-completed question-naire based upon those parameters commonly believed to determine publicperceptions of risk. It was found that general awareness of the risk offood-borne disease was elevated in the commercial food handlers and opti-mistic bias was reduced. These two factors might be expected to militatetowards positive food hygiene behaviour. However, the respondents alsoreported a marked increase in their perception of the degree of controlavailable concerning their vulnerability and the vulnerability of others tofood-borne disease. This increase in perceived control would be expected toreduce their overall perception of the importance of the risk of food-bornedisease. The relevance of the two potentially conflicting outcomes of training,described previously, is discussed.

Introduction

Food-borne illness continues to be an importantdisease in western countries, with 70 895 casesreported in Great Britain (Health ProtectionAgency 2005), and an estimated 76 million casesin the USA (Mead et al. 1999) each year. One ofthe ways in which the incidence of this disease canbe reduced is by the training of food handlers.This training includes not only formal trainingsessions but also various ongoing informal train-ing interventions designed to produce a climate ofpositive food hygiene behaviour.

The effect of training and the promotion ofpositive hygiene messages might reasonably beexpected to increase food handlers’ perceptions offood-borne illness risk. This paper examines the

perceptions of commercial food handlers whowork in an environment of positive food hygienemessages, i.e. instruction, supervision and trainingintended to encourage and reinforce good foodhygiene practices. These perceptions are consid-ered not only in terms of ‘fear’, but also of ‘control’and ‘self-efficacy’, which Gordon (2003) haspointed out is also vital if interventions to promotesafe food handling practices are to be successful.

Risk perception

People’s perceptions of the importance of var-ious risks depend not only upon the measurableparameters of probability and physical harm butalso upon beliefs and values; they are thereforesocially constructed (Fischoff et al. 1984). People

Original article

© 2008, The Authors

Journal compilation © 2008, Blackwell Publishing Journal of Foodservice, 19, pp. 119–126

119

mailto:[email protected]

respond to risks in ways determined not by‘actual’ or ‘measurable’ parameters but by theirown perceptions of risk (Slovic et al. 1979). Thismeans that if we wish to influence behaviour inrelation to, say, safe food handling, it is people’sperceptions of food-borne disease that we mustaddress.

Fischoff et al. (1984) have listed the variousfactors that have been found to affect people’sperceptions of risk as nine key parameters: volun-tariness of risk; immediacy of effect; knowledgeabout the risk; to what extent the risks are knownto science; personal control over the risk; newnessof the risk; chronic or catastrophic; commonor dreaded; severity of consequences if risk isrealized.

Sandman (1987) has produced a model of riskperception in which the probabilistic aspect ofrisk (hazard) is separated from the value judge-ment (outrage). He found that voluntary, control-lable, familiar threats were less likely to provokeoutrage among lay people. Specifically, he arguesthat food-borne illness represents a high (prob-ability) hazard, which provokes low outrage. Instraightforward terms, food-borne disease is animportant illness but is not perceived as such bymost people. Howard (2003) has examined food-borne disease risk in terms of each of theseparameters and concluded that the risk of thisdisease is not likely to be perceived as highlyimportant when compared with other risks.

In a study of public perceptions of a wide rangeof hazards associated with food production andconsumption, Sparks & Shepherd (1994) foundthat 87% of the variance in their subjects’ reac-tions to food risks was explained by three com-ponents: ‘severity’, ‘unknown’ and ‘number ofpeople exposed’.

Slovic (1998) points out that many of theparameters of risk perception listed above corre-late with each other. For example, things that arejudged to be voluntary are also seen as ‘control-lable’; those whose adverse effects are delayed arealso considered to be posing risks that are not wellknown. Slovic goes on to demonstrate that theseparameters can be condensed to a smaller set ofcharacteristics or factors. One of the major factorsproduced by this grouping are those of ‘dread risk’,which includes lack of control, catastrophic poten-tial, fatal consequences and the inequitable distri-

bution of risks and benefits. Another is ‘unknownrisk’, which includes hazards judged to be unob-servable, unknown, new and delayed in theirmanifestation or harm. A third factor relates to thenumber of people exposed to the risk.

Kirk et al. (2002), in an investigation of publicperceptions of a range of food risks over a 1-yearperiod, found salmonella food poisoning (alongwith bovine spongiform encephalopathy) to bethe most dreaded of the food risks that they askedabout. Incidentally, saturated fat was seen as theleast dreaded.

In considering people’s perceptions of risks, it isalso important to mention optimistic bias orunreal optimism. In this case, a population, ifquestioned individually, reports an estimation ofthe probability of suffering an adverse event, themean of which is lower than the actual meanprobability. That is, people are, on average, unre-alistically optimistic about their own chances ofsuffering an adverse event. There are numerousexamples of optimistic bias in the literature(Bauman & Seigel 1987; Joseph et al. 1987;Weinstein 1987).

A number of researchers have addressed thequestion of whether optimistic bias applies inrelation to people’s attitudes to food risks.

Sparks & Shepherd (1994) found evidence ofoptimistic bias in their study of public perceptionsof food-related hazards. Miles & Scaife (2003)reviewed the literature investigating optimisticbias in ‘the food domain’ and found manyreported examples of optimistic bias relating tofood and nutrition issues. They also examined themethodologies that have been used in optimisticbias studies and concluded that optimistic biasis not constant risk-to-risk and varies with themethodology used.

Redmond & Griffith (2004) examined con-sumer perceptions, specifically in relation to foodsafety risk, and found that judgements of optimis-tic bias and ‘the illusion of control’ concerningfood safety during domestic food preparation wereprevalent in the geographical area that theystudied.

Risk perception and food-borne disease

Since food-borne disease can often be preventedby appropriate food handling behaviour, and

120 Perceptions of food hygiene risk in Tamil food handlers M. Howard & K. Wignarajah



people’s behaviour regarding risks is determinedby their perceptions of those risks, it is reasonableto think that perceptions of food-borne illnessrisks are important in controlling that disease. Anumber of studies have shown that people willchange their behaviour if they perceive healthrisks as being high (Rosenstock 1974; Witte1992; Witte 1994; Witte 1997). Redmond &Griffith (2004) pointed out that their findings,regarding optimistic bias and ‘the illusion ofcontrol’, might have negative implications for theeffectiveness of consumer food-safety educationinitiatives.

Food hygiene training can, among otherthings, raise people’s awareness of the danger offood-borne illness and therefore heighten theirperception of the risk. Even when perception ofthe risk is high, people will not change theirbehaviour unless they think that they personallycan affect the outcome. In fact, Dunwoody &Neuwirth (1991) found that when people per-ceived risks as high but believed that they coulddo little or nothing to reduce the threat, theybecame fatalistic and continued to engage inrisky behaviours.

Bandura (1977) has shown that ‘self-efficacy’,the belief that one can successfully carry out theactions required to achieve a positive outcome, isvitally important in people’s decisions as towhether to alter their behaviour. Gordon (2003)points out that for food hygiene messages to beeffective, it is necessary both to stimulate riskperceptions and to promote self-efficacy.

Food hygiene behaviour, therefore, is deter-mined by people’s perceptions of the risksinvolved and their beliefs in their abilities toreduce those risks. The research presented hereinvestigates risk perception in two groups ofpeople: one working in the food industry, theother simply preparing food at home.

The aims of the research

This research examines the perceptions of foodhandlers regarding a number of characteristicsof the hygiene risks that arise from food han-dling. The characteristics used focused uponthose believed to be important in people’s per-ception of risks generally, but the questions wereposed in terms of food handling risks. By com-

paring the response of two groups, professionaland non-professional food handlers, it was pos-sible to examine elements of the effect of train-ing and a positive food hygiene climate onthese characteristics of risk perception in foodhandlers.

Methods

The study groups

The participants chosen for the study were agroup of skilled food preparation staff from aLondon-based ready meals production firm(n = 60) and a matched sample of skilled workersnot employed in food production (n = 60). Thesetwo groups are referred to here as commercialfood handlers and non-commercial food handlers(rather than food handlers and non-food han-dlers) on the basis that we all handle food to someextent.

The commercial food handlers were mostly(90%) Sri Lankan Tamils. The remainder werefirst-generation British Tamils whose parents werefrom Sri Lanka. The company that they workedfor produced ready meals for large supermarketchains across the UK. The food productionprocess that they undertook involved cookingeach ingredient separately, assembling the mealand then storing it at -18°C after blast freezing.All of these staff were trained to the CharteredInstitute of Environmental Health, Basic FoodHygiene Certificate level. This training was regu-larly reviewed. These people worked in an envi-ronment of positive food hygiene behaviour, i.e.where good hygiene practices were practised andencouraged.

To maintain validity in this research, theresearchers depended upon good access to thecompany and its employees and a high levelof trust between the workers and themselves.The company chosen, therefore, was one wherethe researchers already had established links.Individual employees within the companywere randomly selected from work-shiftlists.

The non-commercial food handlers were chosenas an approximate match for gender, age, ethnicand cultural background, and educational level.There were 60 people in each group.

121Perceptions of food hygiene risk in Tamil food handlers M. Howard & K. Wignarajah



The research questionnaire

The research instrument used was a question-naire, which addressed people’s beliefs on issuesconcerning a number of aspects of risk percep-tion. The questions concentrated on a number ofdimensions of risk that have been found to beimportant by previous researchers (Fischoff et al.1984) and have been described earlier in thispaper. The respondents completed the question-naire themselves, but a researcher was present toexplain the questions and answer queries.

Because many of the respondents’ first lan-guage was not English, and to ensure that ques-tions were fully understood, the questionnairewas issued to people, in groups of up to 15people, in both English and their native lan-guage (Tamil). This was done to enable eachrespondent to experience the questions in boththe language in which the dimensions were origi-nally described (English) and in their native lan-guage. A potential for bias arises here, as somerespondents may have relied on their native lan-guage more than others and, therefore, answeredslightly different questions. This occurs becauseit is not always possible to translate questionsfrom one language to another and preserve theprecise meaning of the original. The researcherwho delivered all of the questionnaires and waspresent to answer the questions of the respon-dents, however, believed that the respondentswere of broadly similar abilities in English andthat this factor was not a significant source ofbias.

All of the questionnaires were completed in aTamil community centre in West London.

In each case, respondents were asked to choosebetween alternative responses or to score theirviews on a particular statement against Likert-style scales. The questions asked the respondents’views on three groups of questions.

The following questions were intended togauge the extent to which respondents ‘feared’food-borne illness:1 The number of people who die from food-borne illness each year in the UK as comparedwith other potentially fatal hazards, such as acci-dents in the home and garden, road traffic acci-dents, water related accidents (drowning) andworkplace accidents.

2 Their fear of personally contracting food-borneillness compared with other hazards, such asgenetically modified food, cancer, terrorism andnuclear accidents.3 Their own absolute level of fear of being per-sonally affected by food-borne illness.4 Their own level of fear of contracting food-borne illness when eating out.5 The degree to which they believed that thecauses of food-borne illness are understood by‘science’.6 The degree to which the victims of food-borneillness suffer (in terms of days of illness).7 The time for which food-borne illness has beenaround in human societies.8 The number of deaths caused by food-borneillness in the UK each year.9 How many people an outbreak of food-borneillness may affect at any one time.

The following question was used to measureoptimistic bias:1 The extent to which respondents believe them-selves to be at risk from food-borne illness ascompared with their peers.

The following two questions were usedto gauge respondents’ perceptions of personalcontrol in protecting themselves from food-borneillness:1 The extent to which respondents believe thatthey can act to avoid contracting food-borneillness themselves.2 The extent to which the victim of food-borneillness is, by his/her actions, personally respon-sible for contracting the disease.

The Likert scales used ranged from 5 to 9points. The numbers on the scale corresponded tostatements that reflected the parameter beingexamined. For example, in the case of questionsinvolving simple statements such as ‘The victimsof food poisoning are partly responsible for theirown illness’, the scale ranged from strongly dis-agree to strongly agree. In the case of questionsabout the number of deaths caused by food poi-soning each year compared with other hazards,respondents were asked to mark their answers ona numerical line that had already marked on it thenumbers of deaths caused by the other hazards. Inthe case of a question asking about the numberof deaths caused by food poisoning in the UKeach year as compared with other hazards,




respondents were asked to rank food poisoningtogether with the other hazards presented in a list.

Analysis

The initial data analysis was conducted by plot-ting the data from the scaled responses as histo-grams and examining the patterns of response.These response patterns were examined using c2

test to detect differences across the whole rangeof responses between the commercial and non-commercial food handlers. Where differenceswere detected, data were grouped and the differ-ences examined for their level of statistical signifi-cance using the Mann–Whitney U distribution.This test was used as it is appropriate for com-paring independent samples where the data arenot normally distributed (the plotted histogramsin the initial data analysis did not indicate that thedata were normally distributed). Levels at orbelow P = 0.05 are described later as ‘significant’.

Results

The levels of fatality from food-borne illness ascompared with other hazards

The commercial food handlers estimated a signifi-cantly higher death rate from food-borne illnessas compared with other fatal hazards than didthe non-commercial food handlers (U = 621,P < 0.001). This indicates that commercial foodhandlers had an elevated perception of the risk offood-borne illness in terms of this parameter.

Fear of food-borne illness compared with fear ofother hazards

The commercial food handlers reported a signifi-cantly greater level of fear of food-borne illnesscompared with other hazards than did the non-commercial food handlers (U = 683, P < 0.001).This indicates that commercial food handlers hadan elevated perception of the risk of food-borneillness in terms of this parameter.

Fear of being personally affected byfood-borne illness

The commercial food handlers reported a signifi-cantly higher level of personal fear of being

affected by food-borne illness than did the non-commercial food handlers (U = 721, P < 0.001).This indicates that commercial food handlers hadan elevated perception of the risk of food-borneillness in terms of this parameter.

Concern regarding the risk of contractingfood-borne illness when eating out ata restaurant

Commercial and non-commercial food handlersreported very similar levels of concern of person-ally contracting food-borne illness when eatingout.

The degree to which the causes of food-borneillness are understood

The commercial food handlers reported a signifi-cantly lower level of confidence that ‘scientists’understood the causes of food-borne illness thandid non-commercial food handlers (U = 826,P < 0.001). This indicates that they had anelevated perception of the risk of food-borneillness in terms of this parameter.

The degree to which the individual victim isaffected by food-borne illness

There were no significant differences reportedbetween commercial and non-commercial foodhandlers concerning their views as to how badlyindividual victims of food-borne illness would beaffected by the disease.

Familiarity with food-borne illness

There were no significant differences reportedbetween the perceptions of commercial and non-commercial food handlers concerning the lengthof time for which food-borne illness has beenaround in our society. Both groups consideredfood-borne illness to be a very long-standingdisease.

Estimation of the number of deaths caused byfood-borne illness in the UK each year

Both commercial and non-commercial food han-dlers slightly overestimated the number of deaths




caused by food-borne illness each year. There wasno significant difference between the two groups.

Beliefs as to how many people food-borneillness outbreaks might affect at any one time

Both commercial and non-commercial food han-dlers reported that they believed that food-borneillness outbreaks could affect very large numbersof people (50+) at any one time. There was nosignificant difference between the two groups.

Optimistic bias

Personal risk of food-borne illness comparedwith similar people

The non-commercial food handlers reported thatthey believed their own personal risk of contract-ing food-borne illness was lower than the risk forthe average person like them, to a greater degreethan the non-commercial food handlers. The dif-ference between the two groups was statisticallysignificant (U = 722, P < 0.001). Optimistic biaswas therefore lower in the commercial foodhandlers.

Control

Respondents’ perceptions of the degree towhich they can control their personal risk offood-borne illness

Commercial food handlers reported a signifi-cantly higher perceived level of personal controlover whether they themselves contracted food-borne illness than did non-commercial food han-dlers (U = 844, P < 0.001). This indicates thatcommercial food handlers felt a higher degree ofself-efficacy.

The responsibility of the victim

The commercial food handlers reported that theybelieved that victims of food-borne illness carrieda high degree of responsibility for their illness, i.e.have a high level of personal control. The non-commercial food handlers tended to believe thatvictims of food-borne illness had little or noresponsibility for suffering the disease. The

difference between the two groups was significant(U = 611, P < 0.001). The results are summarizedin Table 1.

Discussion

The results showed that in four of the nine ques-tions asked to gauge ‘fear’ of food-borne illness,the commercial food handlers reported a signifi-cantly higher perception of risk than the non-commercial food handlers. In the remainingquestions, there were no significant differencesbetween the responses. It appears therefore thatfood hygiene training, or at least exposure to aclimate of hygienic food handling behaviour, isassociated with an increase in the perception offood-borne illness risk. This would be exp-ected to influence hygienic food handling behav-iour positively.

Interestingly, optimistic bias was significantlylower in the commercial food handlers than in thenon-commercial food handlers. This could beinterpreted as deriving from the increased level of‘fear’ or concern in this group. It is also possi-ble that the commercial food handlers, simplybecause they provide food for a greater number ofpeople, are more likely to become aware of inci-dents of food poisoning as they are more likely tohear of individual cases. Parry et al. (2004) foundthat people who had suffered personally fromsalmonella food poisoning exhibited lower levelsof optimistic bias than control subjects who hadnot.

Commercial food handlers also reported theirperceptions of a higher level of personal controlover their own risk of food-borne illness than didnon-commercial food handlers. Similarly, theywere more inclined to see the victims of food-borne illness as being, to some extent, culpablefor their own illness. Again, this indicates a per-ception of control over the likelihood of contract-ing the disease. Interestingly, this sense of controlin commercial food handlers did not seem tooverride their sense of concern about the dis-ease because optimistic bias remained lower asexplained previously.

Wakefield & Durrant (2006) found a similarphenomenon in which youths exposed to televi-sion advertising for nicotine replacement therapycontinued to perceive smoking as a significant




health risk even though the advertisements causedthem to see smoking cessation as easier thanthey had seen it before. Wakefield and Durrantcomment that ‘such appraisals do not underminemore enduring perceptions about smoking’.

There remains, however, the danger that iftraining is seen as suggesting behaviour thatmight effectively provide remedies for food-borne disease, people might take fewer precau-tions in the first place. Bloom et al. (2004) foundthat what they called ‘remedies’, e.g. nicotinereplacement products, tended to reinforce theperception of those outside the problem domain(non-smokers) that the activity (smoking in thiscase) was risky, but that these same ‘remedies’reduced risk perception and increased risky be-haviour within the problem domain (smokers).The problem identified by Bloom et al. relates to‘remedies’ that can be applied after the adverseevent occurs and is clearly different from train-ing, which is designed to produce avoidance orpreventive behaviours. The underlying difficultythat Bloom et al. point out may still, however,be important if the hazard is seen as more

‘controllable’ and therefore likely to induce alower level of dread.

The people who participated in this researchwere from around 19 to 54 years of age. Subjectswere not asked their actual ages, but researchersestimated the age of participants for matchingpurposes. Arnett (2000) found differing levels ofoptimistic bias in adolescent and adult smokers.The adolescent smokers were more confident thatthey could quit ‘after a few years’ than the adults.Optimistic bias among food handlers may there-fore vary between age groups. However, no evi-dence for this was found in the work reported here.

The participants in this study were Sri LankanTamils and first-generation British Tamils whoseparents were from Sri Lanka. The results ofthe study might have been different if peoplefrom other ethnic and/or religious groups hadparticipated.

Conclusions

This limited comparative study of specializedcommercial food handlers and non-commercial

Table 1 Differences between the reported perceptions of food safety risk in commercial and non-commercialfood handlers

Parameter Significant difference between groups (P < 0.05)

The levels of fatality from food-borne illness as comparedwith other hazards.

Yes – elevated perception of risk in commercialfood handlers

Fear of food-borne illness compared with fear of otherhazards


Fear of being personally affected by food-borne illness Yes – elevated perception of risk in commercialfood handlers

The degree to which the causes of food-borne illness areunderstood


Concern regarding the risk of contracting food-borneillness when eating out at a restaurant

No

The degree to which the individual victim is affected byfood-borne illness

No

Familiarity with food-borne illness NoEstimation of the number of deaths caused by food-borne

illness in the UK each yearNo

Beliefs as to how many people food-borne illnessoutbreaks might affect at any one time

No

Optimistic bias Yes – higher in non-commercial food handlers

ControlRespondents’ perceptions of the degree to which they can

control their personal risk of food-borne illnessYes – elevated perception of risk in commercial

food handlersThe responsibility of the victim Yes – elevated perception of risk in commercial

food handlers




food handlers appears to indicate that foodhygiene training and/or working in a positivefood hygiene environment produces both anincreased sense of concern and an increased senseof control over the risk of food-borne illness.As Gordon (2003) has pointed out, both anincreased perception of risk and a feeling of self-efficacy are vital if people are to be motivated tochange their food handling behaviours.

It may be concluded, therefore, that foodhygiene training and/or working in a positivefood hygiene environment appears to promotegood food hygiene behaviour and should be con-sidered a worthwhile intervention in controllingfood-borne disease.

Acknowledgements

The authors would like to thank Peter Milligan,Specialist Statistician, King’s College London, forstatistical advice.

References

Arnett JJ (2000). Optimistic bias in adolescent andadult smokers and non-smokers. Addictive Behav-iours 25:625–32.

Bandura A (1977). Self-efficacy: toward a unifyingtheory of behavioural change. Psychological Review84:193–206.

Bauman LJ, Seigel K (1987). Misperception among gaymen of the risk for AIDS associated with their sexualbehaviour. Journal of Applied Social Psychology17:329–50.

Bloom P, Bolton L, Cohen J (2006). The marketing of‘get out of jail free cards’: how remedies encouragerisky consumption. Journal of Consumer Research33:71–81.

Dunwoody S, Neuwirth K (1991). Coming to termswith the impact of communication on scientific andtechnological risk judgements. In: Risky Business:Communicating Issues of Science, Risk and PublicPolicy (ed. L Wilkins & P Patterson), pp. 11–30.Greenwood: New York.

Fischoff B, Watson SR, Hope C (1984). Defining risk.Policy Sciences 17:123–39.

Gordon J (2003). Risk communication and food borneillness: message sponsorship and attempts to stimu-late perceptions of risk. Risk Analysis 23:1287–96.

Health Protection Agency (2005). Food Borne IllnessNotifications-Annual Totals, England and Wales1982 to 2003. Available at: http://hpa.org.uk/

infections/topics_az/noids/food_poisoning.htm (ac-cessed 9 February 2005).

Howard MT (2003). Food borne illness and percep-tions of risk in the UK. Proceedings of the fourthInternational Conference on Culinary Arts and Sci-ences, University of Orebro, Sweden, July 2003.

Joseph JG et al. (1987). Perceived risk of AIDS: assess-ing the behavioral and psychosocial consequences ina cohort of gay men. Journal of Applied Social Psy-chology 17:231–50.

Kirk SF, Greenwood D, Cade JE, Pearman AD (2002).Public perception of a range of potential food risks inthe United Kingdom. Appetite 38:189–97.

Mead PS et al. (1999). Food-related illness and death inthe United States. Emerging Infectious Diseases5:607–25.

Miles S, Scaife V (2003). Optimistic bias and food.Nutrition Research Reviews 16:3–19.

Parry SM et al. (2004). Differences in perceptions ofrisk between people who have and have not experi-enced Salmonella food poisoning. Risk Analysis24:289–99.

Redmond EC, Griffith CJ (2004). Consumer percep-tions of food safety risk, control and responsibility.Appetite 43:309–13.

Rosenstock IM (1974). Historical origins of the healthbelief model. Health Education Monographs 2:328–53.

Sandman PM (1987). Risk communication: facingpublic outrage. Environmental Protection Assess-ment Journal 13:21–2.

Slovic P (1998). Do adolescent smokers know the risk?Duke Law Journal 47:1133–41.

Slovic P, Fischoff B, Lichtenstein S (1979). Rating therisks. Environment 21:14–20.

Sparks P, Shepherd R (1994). Public perceptions of thepotential hazards associated with food productionand food consumption: an empirical study. RiskAnalysis 14:799–806.

Wakefield M, Durrant R (2006). Exposure of youths atrisk for smoking to television advertising for nicotinereplacement therapy and Zyban: an experimentalstudy. Health Communication 19:253–58.

Weinstein ND (1987). Unrealistic optimism about sus-ceptibility to health problems: conclusions from acommunity wide sample. Journal of BehaviouralMedicine 10:481–500.

Witte K (1992). The role of threat and efficacy in AIDSprevention. International Quarterly of CommunityHealth Education 12:225–49.

Witte K (1994). Fear control and danger control: a testof the extended parallel process model (EPPM).Communication Monographs 61:113–34.

Witte K (1997). Preventing teen pregnancy throughpersuasive communications: realities, myths andthe hard-fact truths. Journal of Community Health22:137–54.




http://hpa.org.uk

Perceptions of food hygiene risk in a group of Tamil food handlers living in the UK

Documents

Transcript of Perceptions of food hygiene risk in a group of Tamil food handlers living in the UK