Relationship between awareness and attitude with health and food safety among students of Urmia University, Urmia, Iran

© 2019 The Authors; Tabriz University of Medical Sciences This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Relationship between awareness and attitude with health and food safety among students of Urmia University, Urmia, Iran

In recent years, numerous food-borne disease outbreaks have occurred worldwide affecting both the public health and the environment. However, the advent of proper sanitation could significantly reduce the risks. Although the public are more aware and sensitive towards food safety and health issues in modern societies, there are still many problems in terms of food contamination and the prevalence of food poisoning in different countries. 1,2 Food poisoning and diarrhea are the most important causes of morbidity and mortality worldwide. 3 The information on health and food safety could prevent the outbreaks of food-borne diseases and protect the environment from contamination. 4  Contaminated food which contains bacteria, viruses, parasites, or chemical substances cause more than 200 diseases from diarrhea to different cancers. 2 In developing countries, food-borne and water-borne diarrheal diseases lead to estimated 2 million deaths, especially among children. 4 Different studies have been conducted worldwide regarding theknowledge and attitude of university students towards health and food safety. [5][6][7][8] Countries around the world are taking steps to improve food safety and decrease the incidence of foodborne illnesses. Studies have shown that people's awareness has an important role in improving nutritional status. Therefore, this study has been accomplished aiming to evaluate the awareness and attitude of students of Urmia University towards health and food safety.
In this cross-sectional study, 30 students from Urmia University were investigated (P = 0.500, d = 0.05), and the sample size was calculated to be 384 using equation 1: The number of samples was determined by stratified random sampling method from different faculties of Urmia University, and finally 384 students were elected. Data were collected by a questionnaire that was previously used in similar studies.
This study was conducted on the basis of previous studies with some modifications. The questionnaire contained 25 core statements with three sections: section 1 on demographic information (such as gender, academic level and passed courses related to health and food safety); section 2 on health and food safety attitude (9 questions); and section 3 on health and food safety awareness (13 questions). The researchers in the present study attended different faculties, distributed the questionnaires among the students, and then collected them after completion. The inclusion criterion for this study was to pass at least one semester at Urmia University and the exclusion criterion was the unwillingness of the students to answer the questionnaire. Besides, informed consent was obtained from all participants and they were also given the right to quit at any stage of the study. Participants were also assured that their information and remarks would be kept confidential and anonymous. To analyze the data, descriptive statistics (mean, frequency, percentage) and statistical tests such as chisquare, one-way analysis of variance (ANOVA), and Students' t-test were used in SPSS software (version 16, SPSS Inc., Chicago, IL, USA).
Demographic characteristics of the participants are presented in table 1. In terms of gender, females and males accounted for 240 (62%) and 144 (38%) of the participants, respectively. Approximately half (49%) of the respondents were undergraduates and 51% were postgraduates. Over 80% of the students did not pass any courses related to health and food safety.  It is more suitable to keep food cans in the fridge at a temperature of below zero. 142 (37) 242 (63) 10 Meat becoming slimy is a sign of its spoilage. 243 (63) 141 (37) 11 The best temperature to store cooked food is between 5 to 65 °C. 140 (36) 244 (64) 12 Plastic containers are much healthier to store foods. 61 (16) 323 (84)  13 Staphylococcus aureus can be transmitted to food through rashes of hands and face and nasal discharge.

(57) 165 (43)
The responses of the students to the questionnaire regarding health and food safety have been summarized in tables 2 and 3, respectively. There was a significant difference between the academic level and the students' attitude (P = 0.008). Nevertheless, no statistically significant difference was observed between the students' attitude, gender, (P = 0.058) and their attendance in food safety courses (P = 0.102) (P ≥ 0.050).
Based on the questionnaires, almost 68% of the students were aware of different causes of meat spoilage and 71% of them were not familiar with how to refrigerate meat. Foodborne diseases are accompanied by more risks in vulnerable groups, i.e. children, older people, and pregnant women. In this study, it was discovered that 76% of the students were well knowledged on food-borne diseases. According to a study by Byrd-Bredbenner et al. 9  In the present study, the majority of the students (91%) checked the products label when shopping. Kim and Lee 11 reported that most consumers pay attention to the production and expiration date of food products. In addition, 36% of the respondents mentioned that they were unaware of the correct temperature to store the cooked food, which is between 5 to 65 °C, and 64% of them did not answer it correctly. Regarding food poisoning, 74% of the students knew about the botulism from canned food.
In a study by Tavakoli et al. 12 on the state of botulism poisoning in Iran during 2003-2007, they have showed that considerations such as public health education, not applying Drinking raw milk has a high risk of causing food poisoning. 48 33 9 10 traditional and insanitary methods in food processing, adequate heating during consumption, lack of using non-pasteurized dairy products, and regular health monitoring and supervision could prevent the occurrence of this hazardous food poisoning.
Over 80% of the students have positive attitude (correct answering) on their first statements, and were aware of the importance of health and safety issues. Hassan and Dimassi 13 have assessed the knowledge and attitude towards food safety at a Lebanese American University, in which the students knew a little about food safety. About question number 2 regarding ''Washing hands with soap and water before cooking food is necessary", 71% of people had positive attitude. Garayoa et al. 14 reported that 13.5% of pre-graduate students in Spain washed their hands with soap and water before food preparation.
Almost 36% of the students disagree with keeping raw and cooked food together. In a study conducted in Shiraz, Iran, by Askarian et al., 15 almost all of (99.1%) the respondents had an opinion about keeping raw foods separate from cooked foods. Many viral and bacterial infections are caused by lack of washing the hands, specially when working with raw materials. 16 Less than 20% of the respondents believed that drinking raw milk is risk-free. Raw and contaminated foods contain noxious microorganisms which can cause food-borne illnesses.
The findings of this study suggested that more educated students had an increased attitude level towards food safety, which was in are agreement with the results of different studies. [17][18][19] Public awareness towards health and food safety issues can prevent many food-borne diseases. The results of the study showed that there is a significant difference between the awareness and attitude towards food safety and human health among students. It is therefore suggested considering training programs and courses related to health and food safety for the students.
The authors gratefully acknowledge all the students of Urmia University who assisted us in carrying out this research.
There was no funding support.
Authors have no conflict of interest.
This study was conducted at Tabriz University of Medical Sciences, Tabriz, Iran. Participants in the plan were assured that their information would be confidential and written informed consent was obtained from each subject.