Variation in food safety inspections associated with local health department and food service establishment structural, social, and demographic characteristics

Purpose: To describe variations in food safety inspections based on Local Health Department (LHD) and Food Service Establishment (FSE) structural, social, and demographic characteristics. Foodborne outbreaks affect roughly 1 in 6 Americans (or 48 million people) each year; 128,000 are hospitalized; 3,000 die. Methods: Comparative case study design utilizing mixed methods. Original data is collected utilizing an innovative direct observation methodology, utilizing trained student observers and a validated observational protocol. Pre and post inspection interviews with sanitarians further inform process. A convenience sample of approximately 30 Ohio LHDs and 60 geographically and demographically diverse Ohio Registered Sanitarians (RS) with more than 600 observed inspections is utilized. Analysis includes multivariable data integration between original data utilizing qualitative field notes, quantitative direct observation, and interview; with statewide public health performance standards and LHD Annual Financial reports with variables including workforce size and composition, public health spending, and funding sources; and census tract level demographic data. Results: Citations were issued in 67% of inspections (2.19/FSE inspection); and verbal corrections given in 80% of inspections (1.93/inspection). In most instances (54%), violations were dealt with during the inspection. Sanitarians offered clear feedback and assessment (98.5%), discussed improvement plan (87%), offered food safety education (69%), elicited questions (77.5%). FSE Employees were cooperative (97.5%) and engaged (88%) and expressed gratitude to the Sanitarian 91% of the time. Patterns of variation related to LHD characteristics including structure, jurisdictional demographics, workforce size, and per capita public health spending; and to FSE characteristics including area level poverty; transportation and household structure by census tract; and size and type of establishment will be described. Conclusion: Sanitarians discovered frequent food safety violations, while offering consistent information to prevent future foodborne outbreaks. Variations in the approach to inspection based on LHD and FSE characteristics should inform policy and education.