Factors related to good food-handling practices: a cross-sectional study based on male food handlers in catering establishments

Abstract

Background

Male food handlers in catering service establishments play an important role in food safety issues in China. However, their food-handling practices are not fully understood. This study aimed to assess the level of food-handling practices and identify factors associated with good practices among male food handlers in these establishments.

Methods

A cross-sectional survey was conducted among 648 male food handlers at randomly selected catering service locations in Wuhu City, Anhui Province, China. A self-compiled questionnaire was used to gather data on the food handlers' demographic characteristics and food-handling practices.

Results

The majority of interviewees (648) had good food-handling practices such as washing hands with soap before handling food (91.2%), checking for any deterioration of food (92.6%), infrequently using food additives beyond their scope and usage limits (92.9%), and infrequently using recycled food as a raw material for new food production (93.8%). However, compliance rates for certain food-handling practices remain low. These include using a 3-compartment sink to wash animal-based, plant-based, and seafood-based foods separately (28.1%), storing perishable cooked foods at appropriate temperatures (38.3%), and using dedicated containers or tools for storing and processing different food materials (42.1%). Age 50 years and above was negatively correlated with good practices when compared to those aged 18 to 30. Average monthly incomes ranging from 3,000 to 4,999 (CNY) and 5,000 to 6,999 (CNY), work experience of 3 to 4 years and 9 years or more, as well as having received food safety training, were positively correlated with good practices, in contrast to incomes below 3,000 (CNY), work experience of less than 1 year, and the absence of food safety training, respectively.

Conclusions

Strengthen food safety training for male food handlers in catering service establishments, particularly targeting older and inexperienced ones, to enhance their food handling skills.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-025-23973-w.

Introduction

Food safety (FS) is a critical public health concern around the world. Food-borne disease (FBD) is the predominant FS issue in most countries, particularly in developing countries, including China. FBD has an important impact on morbidity and mortality. According to the World Health Organization (WHO), consuming unsafe foods leads to 600 million cases of FBD globally, resulting in 420,000 deaths annually [1]. In the United States, 5,760 FBD outbreaks caused 1,000,939 outbreak-associated illnesses, 5,699 hospitalizations, and led to 145 deaths during 2009 to 2015 [2]. In the Netherlands, 5,657 FBD outbreaks with 27,711 cases were confirmed during 2006 to 2019 [3]. Similarly, FBD imposes a serious disease burden on Mainland China. The National FBD Surveillance System reported 7,073 FBD outbreaks in 2020, which resulted in 37,454 cases and 143 deaths [4].

Foodborne diseases (FBDs) result from the consumption of food contaminated with infectious agents such as bacteria (e.g., Salmonella, Escherichia coli, Vibrio parahaemolyticus) and bacterial toxins (e.g., enterotoxins produced by Staphylococcus aureus, Shiga toxin produced by certain E. coli strains, and toxins produced by Clostridium botulinum or Bacillus cereus), parasites (Clonorchis sinensis, Tapeworm, Trichinella spiralis, and Amoeba), or toxic substances (e.g., toxins produced by poisonous mushrooms, nitrite, histamine, and tetrodotoxin). Contamination can occur at various stages of food production, including planting, breeding, slaughtering, processing, storage, transportation, cooking, and sales, due to environmental or human factors. The primary factors contributing to food contamination and FBD outbreaks include an imperfect FS standard system, inadequate regulatory oversight, low FS awareness, unhealthy eating habits, cross-contamination, poor processing hygiene, and unsafe food handling practices [5, 6].

Restaurants or food service establishments are key venues for the transmission of FBD. One report by Angelo et al. showed that 56% of the FBD outbreaks reported by United States during 1998 to 2013, were associated with the food prepared in restaurants [7]. Another report by Hull-Jackson et al. indicated that 37.5% of FBD outbreaks occurring in Barbados between 1998 and 2009, were associated with hotels/resorts [8]. Similarly, the report by Xia et al. revealed that catering service units were responsible for 70.59% of cases associated with FBD outbreaks occurring in China during 2011 to 2020 [9]. FBD outbreaks occurring in the restaurants or food service environments are mainly attributed to food worker hygiene habits and food-handling practices. A research on contributing factors to restaurant-associated FBD outbreaks indicated that food worker health and hygiene was responsible for 64% of outbreaks [5]. The other study on surveillance for FBD outbreaks reported that the improper cooking was responsible for 23% FBD outbreaks, cross contamination 22%, and improper storage 13% [10]. Previous research has identified multiple factors (e.g., routine medical check-ups, liquid waste management, food handling knowledge and attitude, FS training, water storage equipment, gender, age, educational status, income, and work experience as a food handler) linked to food worker hygiene habits and food-handling practices [11–15].

The fast-paced lifestyle of modern society makes people more inclined to choose convenient dining options. Dining out has become an important part of daily life. It is estimated that 39% of consumers in China eat at restaurants an average of 1–5 times monthly, 27.5% 6–10 times, 12.7% 11–20 times, and 2.5% more than 20 times [16]. In addition, restaurants are the main venues for family gatherings, friends'dinners, and business banquets in China, particularly during holidays. However, the security of foods provided by Chinese restaurants is becoming increasingly anxious for consumers due to the frequent occurrence of FS incidents. The State Administration for Market Regulation revised the FS Operation Specifications for Catering Services on June 22, 2018 [17], in order to enhance the overall level of FS in catering services and protect consumer health. This document provides clear operational standards for the catering service, aiming to ensure the safety and quality of foods served to consumers. It encompasses various aspects, including food processing procedures, ingredient traceability, hygiene requirements, staff management, and risk control, thereby fostering standardized and high-quality practices within the industry. However, it remains unclear whether the implementation of these standards has influenced the FS practices of catering service providers.

The proportion of male chefs is relatively high in the catering service, particularly in traditional Chinese restaurants (e.g., Cantonese restaurant, Sichuan restaurant, Jiangsu cuisine restaurant, and Shandong cuisine restaurant), hot pot restaurants, barbecue restaurants, collective canteens, and snack shop. A survey report on the survival state of chefs in 2022 reveals a severe gender imbalance in China's culinary industry, with a sample survey of nearly 4,000 chefs identifying 3,673 males, resulting in a male-to-female ratio as high as 10:1 [18]. Most are engaged in arranging food ingredients, pre-processing food (e.g., cleaning, cutting, and matching), cooking hot dishes, food roasting, preparing cold dishes, and maintaining kitchen cleanliness and equipment. The food-handling practices of male food handlers are crucial role in ensuring restaurant FS and the health of consumers. Nevertheless, the food-handling practices of male food handlers have been minimally researched. Consequently, the present study investigated the food-handling practices and demographic factors influencing them among male food handlers in catering services within a Chinese city.

Materials and methods

Study design

A cross-sectional study was conducted between March and December 2022, using a structured questionnaire to collect data from male food handlers recruited from the collective canteens of schools and restaurants in Wuhu City, Anhui Province, China.

Catering locations and samples

Wuhu City is situated in the southeast of Anhui Province, China, along the lower reaches of the Yangtze River. The central geographic coordinates are 118 degrees 21 min east longitude and 31 degrees 20 min north latitude. It was bordered by Hefei to the north, Xuancheng to the south, Ma'anshan to the east, and Tongling and Chizhou to the west. The total area is approximately 6,026 square kilometers. It administers 4 municipal districts (Jinghu, Yijiang, Jiujiang, and Sanshan) and 4 counties (Wuhu, Fanchang, Nangling, and Wuwei). The permanent population is approximately 3.65 million, primarily concentrated in the central districts of Jinghu, Yijiang, and Jiujiang. The current study was carried out in 11 school collective canteens selected from five undergraduate universities and 132 communal restaurants selected from the three most densely populated districts. Participants working for more than three months and engaging in food pre-preparation (i.e., picking out, cleaning, cutting, and matching food), cooking, serving food, cleaning workstations and equipment, and tableware disinfection in these canteens and restaurants were recruited and interviewed. A total of 648 male respondents ultimately participated in and completed the interviews.

Questionnaire design

The questionnaire used in this study was initially designed by the research team members, based on the FS Operation Specifications for Catering Services revised by the State Administration for Market Regulation in June 2018. The preliminary version of the questionnaire was evaluated by a five-expert panel in the field. The questions of the questionnaire were ultimately modified and optimized to meet the required goal after being pretested by 20 food handlers in catering services. The questionnaire's questions were divided into two distinct sections: (A) seven questions to collect demographic information, and (B) 20 questions associated with food-handling. Section A questions requested participants to identify their (1) age (years) (18 ~ 29, 30 ~ 39, 40 ~ 49, or ≥ 50), (2) education (primary school or lower (e.g., almost illiterate), junior high school, high school, junior college degree, or bachelor and above), (3) average monthly income (CNY) (< 3,000, 3,000 ~ 4,999, 5,000 ~ 6,999, or ≥ 7,000), (4) work experience (years) (< 1, 1 ~ 2, 3 ~ 4, 5 ~ 6, 7 ~ 8, or ≥ 9), (5) catering unit type (collective canteens, or restaurants), (6) catering unit scale (small: < 75 seats, medium: 75 ~ 250 seats, or large: ≥ 250 seats), and (7) whether they had or had not had FS training (yes or no). Section B demanded participants to response 20 food-handling questions with 2 possible answers: “yes” and “no” (Table 2, Q1—Q10; Table 3, Q 11—Q20). Practices were regarded as often if they were followed > 70% of the time.

Table 2.

Food-handling practice compliance rates of male food handlers with different demographic characteristics working in catering service establishments (%)

Variable	Age (years)				Average monthly income (CNY)				Work experience (years)						Catering unit type		Catering unit scale			Food safety training
	18 ~ 29	30 ~ 39	40 ~ 49	≥ 50	< 3,000	3,000 ~ 4.999	5,000 ~ 6.999	≥ 7,000	< 1	1 ~ 2	3 ~ 4	5 ~ 6	7 ~ 8	≥ 9	Collective canteens	Restaurants	Small	Medium	Large	No	Yes
Total	176	216	240	16	144	181	267	56	32	120	80	40	112	264	156	492	64	304	280	64	584
Q1. Often wash hands with soap or hand sanitizer before handling food
Yes	77.3	95.8	96.7	100.0**	91.7	96.7	95.1	53.6**	65.6	90.8	86.3	75.0	97.3	95.8**	82.7	93.9**	95.3	88.5	93.2	53.1	95.4**
Q2. Often check for any deterioration of food before handling it
Yes	100.0	96.3	83.3	100.0**	87.5	100.0	88.8	100.0**	100.0	100.0	100.0	100.0	92.9	84.8**	100.0	90.2**	100.0	86.8	97.1**	62.5	95.9**
Q3. Often use a 3-compartment sinks to separately clean different types of raw food materials
Yes	31.8	24.5	29.2	18.8	31.3	24.3	28.5	30.4	28.1	27.5	25.0	37.5	25.0	29.2	25.6	28.9	32.8	27.6	27.5	29.7	27.9
Q4. Often use separate containers/tools to store/process different raw food materials
Yes	39.8	42.1	42.2	37.5	41.0	40.9	46.1	30.4	37.5	42.5	37.5	37.5	42.9	44.3	38.5	43.3	37.5	43.1	42.1	28.1	43.7*
Q5. Often separately refrigerate raw food materials, semi-finished products, and finished products
Yes	79.0	84.3	87.9	56.3*	78.5	87.8	89.9	51.8**	43.8	86.7	87.5	82.5	81.3	86.7**	76.9	85.6*	81.3	84.9	82.5	67.2	85.3**
Q6. Often removing non-edible parts of aquatic products outside a specific room for food processing
Yes	60.2	70.8	65.0	75.0	51.4	76.2	73.0	35.7**	37.5	63.3	83.8	27.5	77.7	65.9**	63.5	66.7	54.7	67.8	66.4	12.5	71.7**
Q7. Often put the disinfected tableware in special airtight cleaning facilities in time
Yes	71.0	80.1	70.4	50.0*	59.0	86.7	81.3	28.6**	37.5	81.7	86.3	65.0	73.2	71.2**	71.2	74.0	76.6	69.7	74.6	35.9	77.4**
Q8. Often disinfect tableware (bowls, dishes, cups, chopsticks, knives, forks, and spoons)
Yes	83.5	94.4	91.7	50.0**	86.8	90.6	96.6	57.1**	59.4	89.2	87.5	82.5	95.5	92.0**	80.8	92.1**	92.2	89.5	88.6	68.8	91.6**
Q9. Often store raw and cooked food in the same container
No	66.5	57.4	59.2	56.3	63.2	55.8	60.7	67.9	53.1	65.0	61.3	72.5	51.8	61.0	60.9	60.4	57.8	58.2	63.6	65.6	59.9
Q10. Often separately refrigerate raw plant food, animal food, and marine products
Yes	77.8	88.9	90.0	93.8**	84.7	87.3	91.4	64.3**	71.9	85.0	78.8	80.0	85.7	92.4*	81.4	88.0*	89.1	83.9	88.6	64.1	88.9**

^* P < 0.05

^** P < 0.001

Table 3.

Food-handling practice compliance rates of male food handlers with different demographic characteristics working in catering service establishments (%)

Variable	Age (years)				Average monthly income (CNY)				Work experience (years)						Catering unit type		Catering unit scale			Food safety training
	18 ~ 29	30 ~ 39	40 ~ 49	≥ 50	< 3,000	3,000 ~ 4,999	5,000 ~ 6,999	≥ 7,000	< 1	1 ~ 2	3 ~ 4	5 ~ 6	7 ~ 8	≥ 9	Collective canteens	Restaurants	Small	Medium	Large	No	Yes
Total	176	216	240	16	144	181	267	56	32	120	80	40	112	264	156	492	64	304	280	64	584
Q11. Often immediately refrigerate cold dishes prepared in advance for later consumers
Yes	47.2	52.8	63.7	50.0*	72.9	47.0	51.3	55.4**	43.8	36.7	56.3	62.5	56.3	63.3**	53.2	55.9	59.4	63.2	45.7**	53.1	55.5
Q12. Often use plastic wrap to cover food before refrigerating them
Yes	72.2	85.2	76.3	75.0*	68.8	86.2	85.8	39.3**	62.5	69.2	90.0	52.5	79.5	83.7**	73.7	79.5	32.8	78.9	87.5**	17.2	84.8**
Q13. Often store perishable foods at 8–60 ℃ in the indoor environment after cooking and before eating
No	34.1	42.6	37.5	37.5	37.5	43.6	37.5	26.8	28.1	36.7	42.5	27.5	40.2	39.8	43.6	36.6	37.5	37.2	39.6	29.7	39.2
Q14. Often thoroughly process foods and cook them well
Yes	72.2	73.6	77.5	68.8	70.8	77.3	75.7	69.6	75.0	71.7	76.3	60.0	78.6	75.8	75.0	74.4	78.1	73.0	75.4	57.8	76.4**
Q15. Often immediately process raw food materials thawed using a microwave oven
Yes	67.6	78.7	78.8	62.5*	79.2	72.4	76.4	69.6	68.8	70.8	73.8	67.5	68.8	82.6*	67.9	77.6*	79.7	74.3	75.4	71.9	75.7
Q16. Often reheat cooked perishable foods stored at 8–60 ℃ for more than 2 h before eating
Yes	61.9	56.0	57.5	25.0*	50.0	61.9	58.8	55.4	53.1	62.5	55.0	42.5	56.3	59.1	57.1	57.5	45.3	51.6	66.4**	48.4	58.4
Q17. Often use packaged food beyond its shelf-life
No	83.5	94.4	86.3	100.0*	79.9	98.3	88.0	82.1**	100.0	89.2	96.3	60.0	98.2	84.8**	92.3	87.4	75.0	87.8	92.5**	34.4	94.5**
Q18. Often use food additives beyond their scope and usage limits
No	89.8	94.9	92.9	100.0	81.9	98.3	97.0	83.9**	75.0	98.3	97.5	75.0	100.0	90.9**	93.6	92.7	100.0	87.8	96.8**	48.4	97.8**
Q19. Often use unlabeled prepackaged food
No	81.8	96.3	86.3	93.8**	86.1	100.0	87.6	62.5**	71.9	90.8	98.8	70.0	100.0	84.5**	89.1	88.4	75.0	87.5	92.9**	25.0	95.5**
Q20. Often using recycled food as a raw material for new food production
No	96.0	91.7	95.0	81.3*	90.3	95.0	94.4	96.4	93.8	98.3	98.8	72.5	96.4	92.4**	93.6	93.9	95.3	93.1	94.3	93.8	93.8

^* P < 0.05

^** P < 0.0Level and associated factors of food-handling practices

Food handling practice level definitions

Each correct response reported was assigned a score of 1, while each incorrect response reported was awarded a score of 0. For food handling practices items in present study, a response of"Yes"is awarded 1 point if it is the correct response, while"No"receives 0 points, or vice versa. The total score for food handling practices ranged from 0 to 20. Each participant's total score was calculated. Food-handling practice levels were divided into two categories: “good” and “poor”. Participants with scores ≥ 70% (≥ 14 points) of the total score were considered to comply with good practices, while those with scores < 70% (< 14 points) of the total score were considered to defer to poor practices [19, 20].

Data collection

Data were collected using a face-to-face interview approach specifically developed for this study (see supplementary file). The interviews for this survey were conducted by three teachers from the Food Hygiene and Nutrition Research Office and two preventive medicine final year students from the School of Public Health, Wannan Medical College, Wuhu City. Each investigator is pre-trained by the questionnaire designer to standardize their interview skills. Investigators contacted the manager or the directors prior to interviewing participants to obtain consent for the interviews. Interviews were performed at participants'workplaces. At the start of each interview, the interviewer posed questions in sequence. Participants provided their answers individually. The interviewer recorded the responses by marking the appropriate check boxes for each question's options.

Statistical analysis

All the questionnaires collected were precisely examined and coded one by one. Data were entered thoroughly using an Excel spreadsheet and exported to SPSS software V.22.0 (SPSS Inc., Chicago, Illinois, USA) for subsequent analysis. Qualitative variables were described using frequencies or percentages. Participant responses to 20 food-handling practice items were compared with demographic characteristics via chi-square tests. Binary logistic regression analysis was performed to examine the demographic variables significantly correlated with food-handling practices at catering service level. The demographic variables with p-values less than 0.20 in the binary regression analysis was treated as candidate independent variables for multivariate logistic regression analysis. The crude odds ratio (COR), adjusted odds ratio (AOR), and 95% confidence intervals (95% CI) were determined after performing binary and multivariate logistic regression analysis. The demographic variable with p-values less than 0.05 in the multivariate logistic regression analysis was identified as a related factor for good food-handling practices.

Results

Demographic characteristics of food handlers

Of the 648 participants who completed the questionnaire, 456 (70.3%) were aged 30—49 years, and 176 (27.2%) aged 18 ~ 29 years. A total of 390 participants (60.2%) had secondary education, 85 (13.1%) had primary school or below (almost illiterate) education, and 173 (26.7%) had completed junior college or above. The average monthly income for 448 (69.1%) of the participants ranged from 3,000 to 6,999 (CNY). More than half (58.0%) of the participants had > 7 years of work experience as a food handler in restaurants. Approximately 75.9% and 90.1% of them worked in restaurants and had attended a FS training course, respectively. Further demographic characteristics are detailed in Table 1.

Table 1.

Demographic characteristics of male food handlers in catering service establishments

Demographic characteristics	Category	Frequency	Percentage %
Age (years)	18 ~ 29	176	27.2
	30 ~ 39	216	33.3
	40 ~ 49	240	37.0
	≥ 50	16	2.5
Education	Primary school and below	85	13.1
	Junior high school	209	32.3
	High school	181	27.9
	Junior college degree	103	15.9
	Bachelor and above	70	10.8
Average monthly income (CNY)	< 3,000	144	22.2
	3,000 ~ 4,999	181	27.9
	5,000 ~ 6,999	267	41.2
	≥ 7,000	56	8.7
Work experience	< 1	32	4.9
	1 ~ 2	120	18.5
	3 ~ 4	80	12.3
	5 ~ 6	40	6.2
	7 ~ 8	112	17.3
	≥ 9	264	40.7
Catering unit type	Collective canteens	156	24.1
	Restaurants	492	75.9
Catering unit scale	Small (< 75 seats)	64	9.9
	Medium (75 ~ 250 seats)	304	46.9
	Large (≥ 250 seats)	280	43.2
Food safety training	Yes	584	90.1
	No	64	9.9

The food-handling practice status of food handlers

A total of 20 food-handling practices were included in this study. There is a significant variation in the food handlers'responses regarding their compliance with these practices. Most food handlers are proficient in food-handling practices such as washing hands with soap before handling food (91.2%), checking for any deterioration of food (92.6%), infrequently using food additives beyond their scope and usage limits (92.9%), and infrequently using recycled food as a raw material for new food production (93.8%). Additionally, only 57.4% of food handlers often reheat cooked perishable foods that were stored at 8–60 ℃ for more than 2 h before consumption, whereas 42.6% replied that they don't do so. Similarly, only 55.2% often refrigerate cold dishes prepared in advance for later consumption, while 44.8% admitted that they don't do. Notably, there was apparently low compliance with the use of containers/tools to store/process different food materials (42.1%), storing cooked perishable foods (38.3%), and cleaning animal-based, plant-based, and seafood products (28.1%). More details on the correct responses of food-handling practices from male food handlers working in catering services can be found in Fig. 1.

Fig. 1.

Food-handling practice statements and responses from male food handlers in catering service establishments (N = 648). * = indicates reverse scoring

Demographic distribution of 20 food-handling practice items

As presented in Table 2, the compliance rates for food handling practice Q1, Q2, Q5, Q8, and Q10 show significant variations across age, average monthly income, work experience, catering unit type, and FS training groups. Untrained food handlers exhibited a markedly lower compliance rate with food-handling practice Q4 (28.1%, 18/64) than their trained counterparts (43.7%, 255/584), with statistical significance (P < 0.001). For food-handling practice Q6, the compliance rate was significantly (P < 0.001) lower in the average monthly income ≥ 7,000 (CNY) (35.7%, 20/56), work experience of 5 ~ 6 years (27.5%, 11/40), and untrained in FS (12.5%, 8/64) groups, compared with other groups in the same categories. For food-handling practice Q7, the compliance rate was significantly (P < 0.05) lower in the ≥ 50 years of age group (50.0%, 8/16), average monthly income ≥ 7,000 (CNY) (28.6%,16/56), work experience < 1 year (37.5%, 12/32), and untrained in FS (35.9%, 23/64), compared with other groups in the same categories.

Table 3 demonstrates that the compliance rates for food-handling practice Q11 were significantly (P < 0.05) lower in individuals aged 18 ~ 29 years (47.2%, 83/176), those with an average monthly income range of 3,000 ~ 4,999 (CNY) (47.0%, 85/181), those with work experience of 1 ~ 2 years (36.7%, 44/120), and in large-sized catering unit groups (45.7%, 128/280), compared with other groups in the same categories. For food-handling practice Q12, the compliance rates were significantly lower (P < 0.05) among food handlers aged 18 ~ 29 years (72.2%, 127/176), with an average monthly income of ≥ 7,000 (CNY) (39.3%, 22/56), having 5 ~ 6 years of work experience (52.5%, 21/40), working in small-sized catering units (32.8%, 21/64), and those untrained in FS (17.2%, 11/64). The compliance rates for food-handling practice Q16 were significantly (P < 0.05) lower in the ≥ 50 years of age (25.0%, 4/16) and small-sized catering unit group (45.3%, 29/64) than other groups in the same categories. More details regarding the demographic distribution of food-handling practices for each food-handler category are provided in Tables 2 and 3.

Among all 648 food handlers, 472 of them (72.8%) had good food-handling practice level, while176 (27.2%) had poor level of food-handling practice. Age (reference group: age 18 ~ 29), education (reference group: primary school and below), average monthly income (reference group: < 3,000), work experience (reference group: < 1), catering unit scale (reference group: small), and FS training (reference group: no) were selected as candidate independent variables after performing binary regression analysis (P < 0.200). Multivariate logistic regression analysis revealed that the age ≥ 50 years (AOR: 0.200, 95% CI 0.055, 0.731), compared with the age 18 ~ 30 years, correlated negatively with good practices. Average monthly income of 3,000 ~ 4,999 (CNY) (AOR: 2.793, 95% CI 1.475, 5.291) and 5,000 ~ 6,999 (CNY) (AOR: 2.228, 95% CI 1.307, 4.004), work experience of 3 ~ 4 years (AOR: 11.492, 95% CI 2.421, 53.548) and ≥ 9 years (AOR: 7.336, 95% CI 1.836, 29.312), and received FS training (AOR: 401.257, 95% CI 51.742, 4055.008) compared with income < 3,000 (CNY), work experience < 1 year, and those without FS training respectively, correlated positively with good practices (Table 4).

Table 4.

Logistic regression analysis of factors associated with good food-handling practices of male food handlers working in catering service establishments in Wuhu City, Anhui Province, China

Variables	Food-handling practices		COR (95%CI)	P	AOR (95%CI)	P
	Good	Poor
Age (years)
18 ~ 29	114	62	1 (reference)		1 (reference)
30 ~ 39	175	41	2.321 (1.466–3.676)	< 0.001	0.969 (0.502–1.870)	0.969
40 ~ 49	175	65	1.466 (0.962–2.229)	0.075	0.508 (0.253–1.023)	0.058
≥ 50	8	8	0.544 (0.195–1.520)	0.245	0.200 (0.055–0.731)	0.015
Education
Primary school and below	57	28	1 (reference)		-
Junior high school	153	56	1.342 (0.777–2.317)	0.291	-
High school	133	48	1.361 (0.778–2.383)	0.280	-
Junior college degree	81	22	1.809 (0.941–3.475)	0.075	-
Bachelor and above	48	22	1.072 (0.544–2.111)	0.841	-
Average monthly income (CNY)
< 3,000	89	55	1 (reference)		1 (reference)
3,000 ~ 4,999	157	24	4.043 (2.343–6.975)	< 0.001	2.793 (1.474–5.291)	0.002
5,000 ~ 6,999	211	56	2.328 (1.489–3.641)	< 0.001	2.288 (1.307–4.004)	0.004
≥ 7,000	15	41	0.226 (0.115–0.446)	< 0.001	2.509 (0.583–10.790)	0.216
Work experience (years)
< 1	13	19	1 (reference)		1 (reference)
1 ~ 2	87	33	3.853 (1.712–8.673)	0.001	2.588 (0.678–9.854)	0.164
3 ~ 4	68	12	8.282 (3.251–21.097)	< 0.001	11.492 (2.421–54.548)	0.002
5 ~ 6	15	25	0.877 (0.338–2.273)	0.787	0.726 (0.168–3.316)	0.668
7 ~ 8	90	22	5.979 (2.567–13.927)	< 0.001	3.183 (0.828–12.232)	0.092
≥ 9	199	65	4.475 (2.095–9.558)	< 0.001	7.336 (1.836–29.312)	0.005
Catering unit type
Collective canteens	112	44	1 (reference)
Restaurants	360	132	1.071 (0.717–1.601)	0.736
Catering unit scale
Small (< 75 seats)	38	26	1 (reference)		-
Medium (75 ~ 250 seats)	212	92	1.577 (0.905–2.748)	0.108	-
Large (≥ 250 seats)	222	58	2.619 (1.471–4.661)	0.001	-
Food safety training
Yes	471	113	262.593 (36.036–1913.526)	< 0.001	401.257 (51.742–4055.008)	< 0.001
No	1	63	1 (reference)		1 (reference)

Discussion

FS risks are closely related to food handling practices. Good food handling practices are crucial for reducing risks and ensuring public health. The present study determines demographic factors connected with good food-handling practices, supplements the current level of food-handling practices, and provides an in-depth analysis specifically targeting male food handlers in catering service establishments, addressing a gap in this field of study. The findings in this study can provide information for developing targeted training programs and management measures to enhance FS awareness and operational standards among male food handlers in catering service establishments.

Male food handlers'compliance rate of good food-handling practices determined in the present study was 72.8% in catering service establishments. This result is higher than a previous study, that is, (45.7%, 21/46) of male food handlers in food and drinking establishments had good levels of FS practices [12]. Existing other literature does not align with this observation. For instance, a study conducted in Gondar City, Northwest Ethiopia, 2021, reported that 45.4% (30/66) of male street vendors are good in food hygiene practice [21]. A further study conducted in Bahir Dar City, Amhara Regional State, Northwest Ethiopia, revealed that 35.1% (78/222) of male food handlers who worked in food industries adhered to good food handling practices [22]. Additionally, an investigation by Yenealem et al. demonstrated that the good food handling practice proportion among male food handlers working at butcher shops at Gondar town was 63.9% [20]. The findings showed significant discrepancies with prior research due to variations in study design, setting selection, geographical coverage of the study population selection, questions covered in the questionnaire, and criteria for defining substandard practices.

In this study, the compliance rates for certain food-handling practices among male food handlers remain low. The food handlers'compliance rate is only 28.1% regarding the separate-sink washing procedures for plant-based foods, animal-based foods, and seafood. Furthermore, less than half (42.1%, 273/648) of food handlers adhere to segregation rules on using different containers/tools for cutting and preparing animal and plant-based foods during the processing of raw materials. According to the General Hygiene Standards for Food Production (GB 14881–2013) issued by the National Health Commission of the People's Republic of China on May 24, 2013 [23] and the FS Operation Specifications for Catering Services released by the State Administration for Market Regulation on June 22, 2018 [17], different category food ingredients (plant-based such as vegetables and fruits, animal-based such as raw meat and poultry, and seafood such as fish and shellfish) must be sorted into different color-coded sinks for washing (i.e., green: plant-based foods; red: animal-based foods; blue: seafood) and must use different containers (i.e., red: raw meat, and yellow: cooked food) and tools (e.g., color-coded knives) for subsequent cutting and preparing, otherwise the risk of food cross-contamination will be increased [24]. Likewise, more than three-fifths (61.7%, 400/648) of food handlers in present study failure to comply with the regulation requiring high-risk perishable foods stored for extended periods (> 2 h) between cooking and consumption to be held either above 60 °C or below 8 °C. The storing foods at proper temperature conditions is beneficial to inhibits microbial proliferation in food, which in turn reduces food microbial risk [25, 26]. Food cross-contamination and improper storage temperature are major reasons for the outbreaks of FBD [27]. Therefore, these findings underscore the necessity of enhancing education for male food handlers regarding improper food handling practices to foster long-term improvements in wholesome practices. Moreover, proving on-the-job and continuous training for food handlers can more effectively improve their overall skills in food handling [28–30].

The influence of demographic factors on food handling practices is crucial for implementing targeted FS supervision, management, and education. In the present work, age was identified as a factor associated with food handling practices. The level of good food handling practice among male food handlers aged 18 ~ 29 years was 64.8% (114/174), which was lower than those with ages 30 ~ 39 years (81.0%, 175/216) and 40 ~ 49 years (72.9%, 175/240), while higher than those aged ≥ 50 years (50.0%, 8/16). The probability of exhibiting proper food handling practices among food handlers aged ≥ 50 years was 80.0% less likely compared to those with ages 18 ~ 29. This result indicates that advanced-age male food handlers (≥ 50 years) are more likely to disregard standardized food handling procedures. The slower rate of knowledge updates and lower training absorption among elderly food handlers (≥ 50 years old) are potential contributing factors to the decreased likelihood of maintaining optimal food handling practices. This finding, however, is inconsistent with prior studies. For instance, a study examining factors related to food handling practices among food handlers (24 males and 264 females) employed in public food and drink service establishments in Woldia town, Northeast Ethiopia, found that food handlers aged 31 ~ 36 years were 10.7 times more likely to adopt good food handling practices compared to those aged 15 ~ 20 years [13]. In contract, another study by da Vitória et al. indicated that there was no significant associated between age and food handling practices among food handlers (6 males and 166 females) working in school kitchens in Espírito Santo, Brazil [31]. Several other studies have also failed to confirm any significant influence of age on food handling practices [32–34]. It is important to emphasize that the observed variations in the association between age and food handling practices in this study, as well as in several others, likely originate from the gender imbalance among the recruited food handlers. For instance, the distribution is 22.3% male versus 77.7% female food handlers in the study by Derso et al. [33]. Hamed et al. [32] reported a participant gender distribution of 81.0% male and 19.0% female, while Teferi et al. [34] documented a gender distribution of 28.4% male and 71.6% female respondents. In contrast, the present study exclusively involved male participants (100%). Moreover, it is crucial to emphasize that the findings require caution in generalization due to the small subgroup (n = 16) of participants aged ≥ 50 years.

The present work reports a higher average monthly income to be related to good food handling practices. The percentage of male food handlers demonstrating good food handling practices, with average monthly incomes below 3,000 (CNY), was 61.8% (89/144), lower than those earning between 3,000 to 4,999 (CNY) at 86.7% (157/181), and those earning between 5,000 to 6,999 (CNY) at 79.0% (211/267). Food handlers earning between 3,000 to 6,999 (CNY) showed a 2.3 to 2.8-fold higher likelihood of adhering to good food handling practices compared to those earning below 3,000 (CNY). These results indicated that food handlers who had a higher income were more likely to practice safe food-handling skills. The result was consistent with studies in Volta Region, Ghana [14], Bahir Dar City, northwest Ethiopia [22], and Dangila town, northwest Ethiopia [11], and Yeka sub city, Addis Ababa, Ethiopia [35]. Compared with lower-income food handlers, those earning more may possess better FS knowledge, which contributes to improved levels of food handling practices [36–38].

Previous studies indicated that a lack of work experience was associated with poor FS practices. For instance, one survey conducted in the student cafeteria at Woldia University, North Eastern Ethiopia demonstrated that food handlers with less than or equal to one year of work experience (vs. food handlers with work experience > 1 year) are three times more likely to be related to poor food hygiene practices [39]. Another survey implemented in Fiche Town, North Shewa Zone, Ethiopia revealed that food handlers with over ten years of work experience were 3.11 times more likely to exhibit good food practices than those with less than one year of work experience [34]. Similarly, the study performed in Mettu and Bedelle towns in Southwest Ethiopia indicated that the odds of engaging in unsafe food practices among food handlers with a service of two to four and five to seven years decreased by 96.8% and 88.5%, respectively (vs. food handlers with less two years of service) [15]. In the current study, the probability of exhibiting good food handling practices was 11.5 times and 7.3 times higher in male food handlers with 3 to 4 years and 9 or more years of work experience, respectively, than in those with less than 1 year of work experience, aligning with previous research findings [13, 15, 34, 39, 40]. However, the notion that extensive work experience correlates with better food handling practices has not been confirmed in other studies. For example, Alemu et al.'s research on FS practice and associated factors among 422 food handlers indicates no significant difference in the likelihood of adhering to good practice standards between those with more than five years of work experience (34.1% good practice levels) and those with five years or less (49.1% good practice levels) [22]. In Al Banna et al.'s research, although meat food handlers with over 10 years of work experience exhibit higher compliance with food handling practice (21.4% good practice levels) compared to those with fewer than 5 years (14.3% good practice levels), multivariate analysis failed to establish work experience (> 10 years) as a statistically significant predictor of superior food handling practices (AOR = 0.18, P > 0.05) [41]. It should be noted, however, that inconsistent regions [e.g., for Alemu et al. (2023), in Bahir Dar City, Amhara Regional State, Northwest Ethiopia, and for Al Banna et al. (2021), in Bangladesh], food handlers [e.g., for Alemu et al. (2023), they were working in food service industries, and for Al Banna et al. (2021), the butcher shop], work experience categories [e.g., for Alemu et al. (2023), these were < 5 and ≥ 5 years; and for Al Banna et al. (2021), < 5, 5—10, and > 10 years], gender distribution [e.g., for Alemu et al. (2023), males accounted for 52.6% and females accounted for 47.4%, and for Al Banna et al. (2021), males accounted for 100.0%], were used in each of these studies [22, 41].

Training can enhance knowledge and alter attitudes toward FS, potentially leading to better FS practices. In the current study, 80.7% of trained food handlers (n = 584/648) met the criteria for optimal food handling practices, whereas among the untrained food handlers (n = 64/648) merely 1 case achieved compliance. Participation in FS training was significantly linked to better food-handling practices. This finding was in line with many previous studies [22, 39, 40, 42].

Limitations

The present work had two study limitations. Firstly, information on food-handler FS practices was collected through self-reports rather than direct observation. Respondents might have reported their expectations rather than their actual practices. This could negatively impact the identification of causal links between financial services practices and demographic factors. Secondly, since respondents were selected from a specific region, the findings may not accurately represent male food handlers working in catering service establishments across China. Further research employing both quantitative and qualitative methods could provide more comprehensive results and validate these findings.

Conclusions

The present study revealed that male food handlers working in catering service establishments demonstrated good food handling practices. However, several operational challenges, such as insufficient cleaning of food ingredients, incorrect use of containers and tools for cutting and preparing foods during the processing of raw materials, and improper storage of high-risk perishable foods, require prioritized intervention. The predominant factors contributing to good food handling practices were age, average monthly income, work experience, and previous FS training. We advise that male food handlers working in catering services, particularly those who are elderly and inexperienced, should receive training in FS to enhance their food handling practices.

Abbreviations

FS

Food safety

FBD

Food-borne disease

WHO

World Health Organization

COR

Crude odds ratio

AOR

Adjusted odds ratio

CI

Confidence intervals

CNY

Chinese Yuan

Authors’ contributions

Yujuan Chen conceptualized and designed the study, authored the original draft, and performed the formal analysis. Jiangen Song conducted the data analysis and revised the article. Jiajia Dai and Wei Shi interpreted the results, contributed to data collection. Yujuan Chen supervised data collection and the final draft.

Funding

This research was supported by the Key Research Program of Humanities and Social Sciences in Anhui Province Education Department (grant no: SK2021A0461).

Data availability

The datasets used and analyzed in this study are available from the corresponding author upon reasonable request. The corresponding authors confirm that any interested reader who contacts Ms. Yujuan Chen will be provided with an identified dataset (Department of Polyclinics, Nanjing Forestry University, Nanjing 210037, Jiangsu Province, China; e-mail: 57903241@qq.com).

Declarations

Ethics approval and consent to participate

The ethical approval was derived from the institutional review board of Wannan Medical College, and this study was conducted in accordance with the Declaration of Helsinki. The permission letters, which granted authorization for the present investigation, were obtained from the managers of each catering institution. All food handlers were informed about the objectives, contents, and participation method about survey, provided informed verbal consent prior to each interview, and had each question explained to them. Participants were clearly informed that they could withdraw from the study at any time without any preconditions. Participants'identities were replaced with unique identification codes to ensure anonymity. All data collectors and investigators committed to strictly maintaining the confidentiality of the information provided by the participants.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.