Abstract
Public health authorities rely on the timely flow of laboratory results to detect and control food-borne illnesses. At times, social and economic barriers limit individuals’ ability to get needed tests. We demonstrate a simple behavioral approach to assess the cost-effectiveness of interventions designed to remove three social and economic barriers to testing individuals with acute diarrheal illness: testing costs, income loss, and inconvenience. We use readily available statistics to rank programs by their cost effectiveness to identify those most worthy of studying in greater detail.
Similar content being viewed by others
References
Mead, P.S. et al (1999) Food-related illness and death in the United States. Emerging Infectious Disease 5: 607–625.
Dupont, H.L. (2009) Bacterial diarrhea. New England Journal of Medicine 361: 1560–1569.
Abbot, J.M., Byrd-Bredbenner, C., Schaffner, D., Bruhn, C.M. and Blalock, L. (2009) Comparison of food safety cognitions and self-reported food-handling behaviors with observed food safety behaviors of young adults. European Journal of Clinical Nutrition 63: 572–579.
Lee, M.B. and Middleton, D. (2003) Enteric illness in Ontario, Canada from 1997 to 2001. Journal of Food Protection 66: 953–961.
Redmond, E.C. and Griffith, C.J. (2003) Consumer food handling in the home: A review of food safety studies. Journal of Food Protection 66: 130–161.
Desousa, C.P. (2008) The impact of food manufacturing practices on foodborne diseases. Brazilian Archives of Biology and Technology 51 (4): 815–823.
Khan, A.S., Swerdlow, D.L. and Juranek, D.D. (2001) Precautions against biological and chemical terrorism directed at food and water supplies. Public Health Report 116: 3–14.
New York Times. (2010) Egg producer says his business grew too quickly, 22 September, http://www.nytimes.com/2010/09/23/business/23eggs.html?ref=austin_j_decoster, accessed 14 October 2010.
Allos, B.M., Moore, M.R., Griffin, P.M. and Tauxe, R.V. (2004) Surveillance for sporadic foodborne disease in the 21st century: The foodnet perspective. Clinical Infectious Diseases 38 (S3): 115–120.
Swaminathan, B., Barret, T.J. and Fields, P. (2006) Surveillance for human Salmonella infections in the United States. Journal of AOAC 89 (2): 553–559.
Toronto Public Health. (2009) Foodborne illness in Toronto, http://www.toronto.ca/health/moh/pdf/staffreport_april15_2009_appx_a.pdf, accessed 14 June 2010.
Scallan, E. et al (2006) Factors associated with seeking medical care and submitting a stool sample in estimating the burden of foodborne illness. Foodborne Pathogen and Disease 3: 432–438.
Imhoff, B. et al (2004) Emerging burden of self-reported acute diarrheal illness in FoodNet surveillance areas, 1998–1999. Clinical Infectious Diseases 38: S219–S226.
Jones, T.F. et al (2007) A population-based estimate of the substantial burden of diarrhoeal disease in the United States; FoodNet, 1996–2003. Epidemiology and Infection 135: 293–301.
Herikstad, H. et al (2002) A population-based estimate of the burden of diarrhoeal illness in the United States: FoodNet, 1996–1997. Epidemiology and Infection 129: 9–17.
US Census Bureau. (2008) Income, poverty, and health insurance coverage in the United States: 2007, http://www.census.gov/prod/2008pubs/p60-235.pdf, accessed 14 June 2010.
US Bureau of Labor Statistics. (2008) Occupational employment and wages: Food preparation and serving related occupations, http://www.bls.gov/oes/2008/may/oes350000.htm, accessed 14 June 2010.
Guerrant, R.L. et al (2001) Practice guidelines for the management of infectious diarrhea. Clinical Infectious Diseases 32: 331–351.
Todd, E.C.D., Greig, J.D., Bartleson, C.A. and Michaels, B.S. (2007) Outbreaks where food workers have been implicated in the spread of foodborne disease. Part 2. Description of outbreaks by size, severity, and settings. Journal of Food Protection 70: 1975–1993.
Toronto Public Health. (2009) Food safety in Toronto, http://www.toronto.ca/health/moh/pdf/staffreport_april15_2009_appx_b.pdf, accessed 14 June 2010.
Todd, E.C.D., Greig, J.D., Bartleson, C.A. and Michaels, B.S. (2007) Outbreaks where food workers have been implicated in the spread of foodborne disease. Part 3. Factors contributing to outbreaks and description of outbreak categories. Journal of Food Protection 70: 2199–2217.
DuPont, H.L. (1997) Guidelines on acute infectious diarrhea in adults. American Journal of Gastroenterology 92: 1962–1975.
James, L. et al (2008) Emergency care physicians’ knowledge, attitudes and practices related to surveillance for foodborne disease in the United States. Clinical Infectious Diseases 46: 1264–1270.
MacDonald, P.D.M., Torok, M.R., Salyers, M., Wolf, L. and Nelson, A.L. (2004) Practices around acute diarrheal illness diagnosis, counseling, and reporting: Laboratory and health-care practitioners in North Carolina, 2004. Foodborne Pathogens and Disease 4: 359–365.
Talan, D. et al (2001) Etiology of bloody diarrhea among patients presenting to United States emergency departments: prevalence of Escherichia coli O157:H7 and other enteropathogens. Clinical Infectious Disease 32: 573–580.
Centers for Disease Control and Prevention. (2008) Preliminary foodnet data on the incidence of infection with pathogens transmitted commonly through food – 10 States. Morbidity and Mortality Weekly Report 58: 333–337.
Cimolai, N. (2001) Laboratory Diagnosis of Bacterial Infections. New York: Marcel Dekker.
Minnesota Department of Health. (2004) Clinical laboratory guide to services. 4 November, http://www.health.state.mn.us/divs/phl/clin/mdhgts04.pdf, accessed 14 June 2010.
US Department of Agriculture Economic Research Service. (2009) Foodborne illness cost calculator 2008, http://www.ers.usda.gov/data/FoodBorneIllness/salmAssumptions2.asp?Pathogen=Salmonella&p=1&s=203&y=2008&n=2794374, accessed 14 June 2010.
Montana Department of Public Health and Human Services. (2009) Public health laboratory test fees, http://www.dphhs.mt.gov/labfees/proposedlabfees2009.pdf, accessed 14 June 2010.
Arie, H.H. et al (2009) Immunity to Campylobacter: its role in risk assessment and epidemiology. Critical Reviews in Microbiology 35 (1): 1–22.
Commonwealth Fund. (2009) Out of options: why so many workers in small businesses lack affordable health insurance, and how health care reform can help, http://www.commonwealthfund.org/~/media/Files/Publications/Issue%20Brief/2009/Sep/1316_Doty_out_of_options_ib_FINAL_v2.pdf, accessed 14 June 2009.
Cera Products Online Store. (2010) https://www.ceraproductsinc.com/cerastore/index.cfm, accessed 14 June 2010.
Jones, T.F. et al (2004) Use of stool collection kits delivered to patients can improve confirmation of etiology in foodborne disease outbreaks. Clinical Infectious Disease 39: 1454–1459.
US Bureau of Labor Statistics. (2008) Occupational employment and wages: Pharmacy aides, http://www.bls.gov/oes/2008/may/oes319095.htm, accessed 14 June 2010.
King, C.K., Glass, R., Bresee, J.S. and Duggan, C. (2003) Managing acute gastroenteritis among children. Morbidity and Mortality Weekly Report 52: 1–16.
Acknowledgements
The research reported here was supported by a European Community Marie Curie International Outgoing Fellowship within the seventh European Community Framework Program to the first author. The European Community is not liable for any use that may be made of the information contained therein. The views expressed are those of the authors.
Author information
Authors and Affiliations
Corresponding author
Additional information
How can laboratory tests for diarrheal illnesses, critical for public health, be encouraged? The authors have shown how to compare the cost effectiveness of various approaches.
Rights and permissions
About this article
Cite this article
Kaptan, G., Fischhoff, B. Diagnosing food-borne illness: A behavioral analysis of barriers to testing. J Public Health Pol 32, 60–72 (2011). https://doi.org/10.1057/jphp.2010.42
Published:
Issue Date:
DOI: https://doi.org/10.1057/jphp.2010.42