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The structure and systems of state health departments (SHD) may affect reporting of foodborne disease outbreak (FBDO) hospitalizations. Evaluation of SHD by investigating the contributions of structural capacity elements (SCE) will provide an accurate measure of performance and highlight areas for development of effective strategies for improvement. This study investigated the relationship between organizational and structural characteristics of SHD and systems for FBDO reporting, and included three manuscripts designed to address seven hypotheses, as well as a conclusion chapter interpreting the findings as they relate to the overall research question. Study findings identified consistently higher reports of hospitalization due to foodborne illness from third party payers compared to SHDs between 2006 and 2009 in 30 of the 31 states analyzed. Furthermore, significantly different rates of reporting among states with mixed governance classification were seen when compared to those with centralized and decentralized governance; associations between total laboratory expenditures and total food-related hospitalizations reported were also identified when analyzing healthcare claims data. This dissertation contributes to the current knowledge base for public health services and systems research, as well as food safety surveillance and reporting, and provides an innovative approach to using secondary databases to investigate food safety issues. Findings support the conclusion that collaboration between public and private agencies would support improvements in data collection and foodborne illness surveillance. / Public Health

Bacterial contamination of food is a global concern. Methods of treating bacterial contamination are limited. Bacteriophages, bacterial viruses, offer a promising solution. However, bacteriophages may have limited application for foods that undergo sterilization processing, are inhospitable to organisms, or must be maintained in a dry state. This thesis focused on methods to expand the application of bacteriophages. First, bacteriophages were subjected to generalized stresses of desiccation, heat, and acidity, under laboratory conditions to propagate new populations with improved stress resistance. However, testing of these stress-resistant populations under real-world conditions failed to produce results comparable to generalized laboratory conditions. Success in the application of selected bacteriophages may require high situational specificity during selection, including in terms of food matrix and stress mechanics. The focus of our research shifted from the modification of bacteriophage populations themselves to the development of food-safe protective matrices. Designed matrices encapsulate bacteriophage for integration with modern food production and even the food products themselves. A pullulan-trehalose sugar powder was developed for the protection of a model bacteriophage from pasteurization. Microparticles were engineered such that the majority of the particle would be composed of trehalose as a stabilizer and polysaccharide pullulan was designed to accumulate at the particle surface to slow dissolution. This structure resulted in a bacteriophage powder that remained intact and protective over short-term high-temperature pasteurization, whereas unprotected bacteriophage experienced significant loss in titer. Leucine-lactose and leucine-lactose-maltodextrin microparticles were engineered for the inclusion of bacteriophage in powdered infant formula. The bacteriophage powder was designed as a dormant protection system that could activate upon reconstitution. The excipient system was formulated to not significantly affect the pH, composition, and dissolution of commercial infant formula. The bacteriophage powder was also engineered to match the shelf life and secondary shelf life of infant formula. Altogether, this thesis demonstrates that bacteriophage application in different foods can be expanded through particle engineering. / Thesis / Doctor of Philosophy (PhD) / Bacterial contamination of food can lead to widespread outbreaks and subsequent preventable deaths. Our best tool against bacteria, antibiotics, cannot be widely applied to food for risk to the natural human biome and creation of resistant bacteria. Bacteriophages, viruses that infect bacteria, are a naturally occurring bactericide that offer an alternative solution. This thesis focuses on improving the application of bacteriophages in food. First, bacteriophages are selected for resistance to common food processing stresses, such as heat, drying, and acidity, to prepare future generations that are stress-resistant. Second, a protective sugar powder was designed that could be used to add bacteriophages to milk before pasteurization. Post-pasteurization, the sugar would dissolve and release bacteriophage into the milk to deal with any post-processing contamination. Lastly, an infant-safe bacteriophage powder was developed that could be intermixed with powdered infant formula in an effort to reduce infant death due to the ingestion of bacteria.

New food processing technologies are needed to create safe, high-quality food products that are still considered "fresh" by consumers. Despite the numerous benefits attributed to 'food processing', consumers continue to perceive the term negatively. Consumer acceptance of foods processed with different technologies generally increases when factual information is provided to the consumer. Educators working within Cooperative Extension are a resource for public dissemination of food information. By working directly in the community, Extension educators often cultivate positive relationships with local clientele. Therefore, Extension educators can dispel myths related to food processing technologies and deliver science-supported information to the general public. Consumer knowledge, perceptions, and purchasing intentions associated with both conventional and emerging food processing technologies were assessed through a nationwide telephone survey administered by Virginia Tech's Center for Survey Research Center. A similar version of the telephone survey was disseminated in an online format to Virginia Extension agents. An additional section of the online survey served as a needs assessment for educational materials related to food processing technologies. A grounded theory methodology was used for qualitative coding in both surveys. Approximately 67% of consumers expressed concerns towards the term "processed foods." The majority of Extension agents (67.4%) expressed concerns about foods that had been processed, citing additional ingredients, preservatives, and additives; safety; and health implications. Both the consumer and Extension agent groups were more likely to be supportive of light-exposed foods to enhance food safety and quality, in comparison to gas-exposed foods. Although agents may be familiar with some food processing technologies, they may not have the resources to understand the scientific mechanisms for which a technology is able to increase food safety. Consumer education regarding emerging technologies is necessary to anticipate potential consumer concerns; however, agents still lack resources and information about existing and frequently used food processing technologies. Educational interventions are needed to provide information to consumers and increase their acceptance of new and currently used processing technologies so that the food industry can effectively target emerging issues related to food. / Doctor of Philosophy

Farmers markets (FM) have become increasingly popular almost tripling over the past two decades due to the rising interest in local and/or organic foods. Within this same time period, notable farmers market foodborne illness outbreaks; such as E. coli O157:H7 and strawberries and Salmonella and peas; have occurred, and emphasize the importance of food safety practices at farmers markets. Some farmers may be encouraged to follow Good Agricultural Practices (GAPs) to limit the contamination of fresh produce; however, GAPs programs are complex and also very driven by wholesale buyers. Furthermore, many FM growers are unfamiliar with GAPs or do not believe it is applicable to them. The Food Safety Modernization Act (FSMA) was passed in 2011, and shifted the food safety paradigm from a reactive to proactive approach introducing seven different rules including the Preventive Controls for Human Foods (PCHFR) and the Produce Safety Rule (PSR). Each FSMA rule does contain exemptions for smaller-scale operations (e.g., farms, facilities) that allows them to be excluded from the rule, or excluded from certain aspects of the rule. Generally, most FM vendors may satisfy exemptions from the FSMA regulations (e.g., be exempt from the FSMA Produce Safety Rule because of commodities); however, to our knowledge, no studies have assessed the regulatory compliance requirements of FM vendors to the FSMA regulations. This dissertation explored the regulatory requirements of FM vendors, and the accessibility of FSMA materials for these audiences. Additionally, due to the sudden and unprecedented global COVID-19 pandemic, an objective was added that explored how COVID-19 influenced behavior changes among this audience. Interviews were conducted and found that all vendors (100%) were exempt from the PCHFR and that most vendors (67%) were exempt from the PSR, some were qualified exempt (28%), and a few (5%) were covered. This study also found that farmers market vendors received information mainly from University Cooperative Extension sources. The COVID-19 pandemic greatly impacted hygiene and health practices at FMs. Market personnel (managers and vendors) implemented many different hygiene and health practices at their markets. The major source of COVID-19 food safety information for market personnel was local and federal government; as well as University Cooperative Extension. Accessibility analyses showed that many FM or COVID-19 resources were not accessible due to populations that rely on produce safety resources generated by Cooperative Extension due to (i) navigation or web accessibility errors, (ii) high literacy level requirements, and (iii) lack of keep (i.e., resources were not up-to-date, or continuously managed or monitored). These findings will inform the development of FM targeted resources, that are also, accessible to a more diverse and inclusive audience. One example is a produce safety resource on the updated agricultural water requirements that is developed to an 8th grade reading level, with no broken links or additional navigations errors, and if a PDF version is available, proper headers and titles. / Doctor of Philosophy / Farmers markets (FMs) have increased in popularity over the two decades with because of interest by consumers to support local agriculture, buy organic products, or because they believe these foods to be safer from bacteria and viruses. Shopping at a FMs does not necessarily make the products any safer compared to buying it from a grocery store. It is important that farmers markets follow proper food safety practices during the growing, harvesting, and preparation of produce for sale. One example is the prevention of animal feces from getting on the produce or in a water source that would be used. Another would be to follow proper hygiene practices such as handwashing after using the bathroom. These two examples and others are detailed in a law passed by President Obama in 2011 called the Food Safety Modernization Act (FSMA), which allows the Food and Drug Administration to begin its proactive instead of reactive food safety approach. FSMA does not have to be followed by all food entities. Depending on how much a farm makes in revenue (<$25,000) or if they grow products deemed as "not risky,", they may be exempt. These types of products such as potatoes, beets, and corn are safer because they will be cooked before consumption killing any bacteria or viruses that may exist. Other products such as romaine lettuce and tomatoes are usually consumed fresh without cooking and are thus riskier if there are any bacteria or viruses on it. Interviews were conducted to understand if farmers market vendors need to comply with FSMA. Most vendors are not required to follow FSMA because they gross less than $25,000 or their products were already covered by other food safety regulations such as meat being covered by the USDA. Additionally, how the COVID-19 pandemic influenced FMs was explored. Two surveys, one for vendors and one for managers, were distributed to stakeholders. FMs adapted really well to the challenging COVID-19 landscape and implemented COVID-19 preventive measures such as social distancing, mask wearing, and providing hand sanitizer and handwashing stations to continue to operate and keep their customers and employees safe. After understanding the characteristics and the unique challenges to food safety implementation that these market personnel may face, additional research was done to understand if currently available resources were accessible. Accessibility was evaluated using website and PDF accessibility checkers and a readability level checker. Resources should be easy to navigate and written to around a 8th grade level to make it easy to understand. There is a lack of well-crafted, accessible resources that address the unique challenges that farmers market personnel may face. These considerations should be considered when creating these materials.

Public health costs of foodborne campylobacteriosis are estimated to cost more than a billion dollars in the United States annually. This pathogen has been primarily associated with chicken production and processing which is a ~$33 billion industry. To further identify practices that could reduce Campylobacter presence, concentration, and persistence in chicken prior to consumption a quantitative microbial risk assessment (QMRA) was conducted for boneless, skinless chicken breast meals prepared and consumed domestically in the contiguous United States. This QMRA model was developed with @RISK software (Palisade Corp., Ithaca, NY) and data inputs can be easily modified and updated. QMRA is a powerful analytic method that can be utilized to model the dynamics between the food pathogen, food commodity, and ingestion. It provides insight into the impacts of the process in its interaction and its surrounding environment. The baseline model determined that consumption of this product resulted in annual means of infections: 328,257, illnesses: 108,174, hospitalizations: 27,754, deaths: 37, cases of Campylobacter-associated Guillain-Barré Syndrome (GBS): 1,373, and cases of Campylobacter-associated Irritable Bowel Syndrome (IBS): 9,501. The associated annual economic burdens were ~$192 million for acute campylobacteriosis, ~$77 million for GBS, and ~$96 million for IBS. The effects of targeting and modifying the baseline model's inputs within the farm-to-fork process were studied as follows: Post grow-out (1) prevalence and (2) concentration of Campylobacter on chickens at the farm prior to transport, (3) transport crate cleaning frequency prior to loading, (4) temperature storage conditions at post processing/ pre-retail, (5) the frequency of handwashing in the preparation and handling of a chicken meal, and (6) the combination Campylobacter mitigation models using the inputs from (2) and (4). Mean yearly illnesses are estimated to decrease by approximately half if on-farm Campylobacter prevalence was lowered to 35-50% from the baseline level of 76%. An additional ~50,000 illnesses can be expected if the proportion of home preparers who do not wash their hands increases from 8.3% (baseline) to 20%. The combined effects of reducing on-farm Campylobacter concentrations and increasing the proportion of product frozen in-plant have greater impacts on reducing yearly campylobacteriosis and associated costs than either intervention alone. / Doctor of Philosophy / Campylobacter is a major foodborne bacterial pathogen that is not well known by the general public, although public health costs are estimated to cost more than a billion dollars in the United States annually. Chicken production is a ~$33 billion industry that is affected by the contamination of this pathogen. In this study, a quantitative microbial risk assessment (QMRA) was performed to study the impact of Campylobacter on chicken meals prepared in the home. Societal and economic burdens were evaluated as well. The models developed provide comprehensive simulations that describe the spread, persistence, and the concentration of Campylobacter throughout the farm to fork process in the annual consumption of boneless, skinless chicken breast meals prepared and consumed domestically in the contiguous United States. Additional simulation models were created to compare methods for reducing Campylobacter along the food chain that could lead to fewer cases of campylobacteriosis in the United States, or what could happen if there was a breakdown in a hygiene step in the preparation of the chicken meal.