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Perceptions and Practices Related to the Consumption of Unpasteurized Milk Products, Listeriosis and Pregnancy Complications: Voices from a Hispanic/Latino Community. Margie Irizarry-De La Cruz, MPH Mirna Perez-Rodriguez, MSW

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Perceptions and Practices Related to the Consumption of Unpasteurized Milk

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Perceptions and practices related to the consumption of unpasteurized milk

Perceptions and Practices Related to

the Consumption of Unpasteurized Milk

Products, Listeriosis and Pregnancy Complications: Voices from a

Hispanic/Latino Community

Margie Irizarry-De La Cruz, MPH

Mirna Perez-Rodriguez, MSW

Consuelo Beck-Sague, MD

Jeremy Sobel, MD, MPH

Office of the Director, Division of Reproductive Health, NCCD

Foodborne & Diarrheal Disease Branch, NCID

Centers for Disease Control and Prevention

The findings and conclusions in this presentation have not been formally disseminated by the Centers for Disease Control and Prevention and should not be construed to represent any agency determination or policy.


Perceptions and practices related to the consumption of unpasteurized milk

Overview

  • Background

    • Hispanic-Latinos and Reproductive Health

    • Listeriosis and High Risk Foods

    • Listeriosis and Pregnancy

  • Qualitative Study – focus groups

  • Quantitative Study – community survey

  • Discussion and Conclusions

  • Recommendations

  • HL (Hispanic/Latino)


Hispanic latinos reproductive health

Hispanic-Latinos & Reproductive Health

  • HL fastest growing U.S. minority group

    • 14.2% of U.S. population

    • 47% immigrants

  • Pregnancy outcome rates, 1998–2002

    • 93.30/yr Live births

    • 100.30/yr Fetal loss

    • 10.05/yr PTD

    • 5.61/yr LBW

  • Limited research on HL’s health behaviors

    • Listeriosis and pregnancy complications


Listeria monocytogenes

Listeria monocytogenes

  • Gram-positive bacterium

  • Foodborne pathogen

  • Food safety challenge

    • Commonly found in the environment

    • Can persist for months & years

    • Can grow at refrigeration temperatures

      • 1– 45°C

  • Incidence higher in HL

    • Infants

    • Women of childbearing age


Perceptions and practices related to the consumption of unpasteurized milk

Listeriosis Rate by Ethnicity

FoodNet Sites,1996–2003


Latino style homemade cheese high risk of listeriosis

Latino-Style Homemade CheeseHigh risk of Listeriosis

  • Traditional, widely consumed HL food

  • Often prepared from unpasteurized milk

  • Often home-prepared in unsanitary places

    • Buckets

    • Bathtubs

    • Sink

  • Outbreaks linked to unpasteurized HL cheese

    • Los Angeles, CA 1985

      • 81 HL, 20 stillbirths,10 neonates

    • North Carolina, 2000

      • 12 HL, 5 stillbirths,3 PTB,2 neonates


Listeriosis and pregnancy

Listeriosis and Pregnancy

  • Transmission

    • Ingestion of contaminated food

    • Transplacental

  • Clinical features

    • 2–6 weeks incubation period for invasive disease

    • Asymptomatic infections can occur

    • Mild flu-like illness to sepsis, meningitis

  • Infection during pregnancy can cause:

    • Stillbirths/spontaneous miscarriages

    • Preterm labor or systemic infection

    • Early/late-onset sepsis and meningitis in newborn


Futura mam

Futura Mamá

Qualitative and Quantitative

Study on Health Behaviors


Objectives

Objectives

  • Understand participants’ knowledge, attitude and risk perceptions

    • Unpasteurized milk

    • Pregnancy health issues

  • Characterize participants’

    • Preferences seeking/receiving educational material and health education strategies

    • Literacy level to develop culturally and linguistically appropriate educational material

    • Barriers faced in accessing accurate information


Qualitative study focus groups

Qualitative StudyFocus Groups

  • Conducted 8 focus groups in Hall County, GA 8/23-8/28 2003

    • 7 Hispanic women's groups

    • 1 Hispanic men's group

  • Participants recruited at two sites

    • Hall County Health Department, Gainesville

      • Serves 25% of the county’s HL population

    • Catholic Church in Gainesville, GA.

      • Membership of 16,000 HL

  • Participants enrolled by age group and gender

    • 7 Women’s groups (18–25, 26–32, 33–40, >41 years)

    • 1 Men’s group (>18 years)


Perceptions and practices related to the consumption of unpasteurized milk

Focus Group Participants

  • 76 participants (6–16 participants per group)

  • 70 born in Mexico

  • 53 women childbearing age

    (range 18–40 years)

  • 5 pregnant women


Perceptions of focus groups participants n 76

Perceptions of Focus Groups Participants (N=76)

  • Majority believe unpasteurized products are “healthier”

  • Most can distinguish home-made from commercially-made cheese by taste

  • Most can not distinguish between unpasteurized and pasteurized milk or cheese

  • More than half regularly consume home-made cheese

  • None have heard of listeriosis or associated pregnancy complications

  • All believe in usefulness of prenatal care


Focus group findings

Focus Group Findings

  • Compared to older women, women aged <32 (n=35) were more willing to accept:

    • Possibility of health risks related to consumption of

      unpasteurized milk products

    • Advice offered by healthcare providers

  • Men less willing than women to trust physician

  • Women prefer discussing health concerns with mothers or other relatives rather than healthcare provider


Quantitative study community survey hall county ga 19 6 hl

Quantitative StudyCommunity Survey, Hall County, GA19.6% HL


Recruitment of participants

Recruitment of Participants

  • Enrolled by age group and gender

    • Women aged ≥ 18 to 44 years

    • Women aged ≥ 45 years

    • Men aged ≥ 18 years

  • Methodology

    • Predominantly Hispanic residential areas

    • 14 residential areas met criteria

    • Door to door survey in target HL communities

    • 1 eligible participant per household

    • Spanish questionnaire

    • In person interviews

    • Administered by trained interviewers


Study population

Study Population

  • 485 Hispanics invited to participate July 19 - 29 2005

  • 400 (82.0%) accepted

    • 228 (57.0%) female

      • 26 (11.4%) pregnant

      • 183 (80.2%) reproductive age (18-44 years)

  • Approximately half completed elementary or middle school

  • Most participants were Mexican origin

  • Language proficiency

    • 352 (88.0%) read Spanish well

    • 43 (10.8%) read English


Unpasteurized milk products

Unpasteurized Milk Products

  • 206 (51.5%) believed unpasteurized products may be hazardous to health

  • 210 (55.2%) believed gastrointestinal illness could be caused by food that taste and smell good

  • 158 (50.2%) preferred cheese from unpasteurized milk

  • 265 (66.3%) did not realize eating unpasteurized cheeses during pregnancy increases risk miscarriage

  • 279 (69.8%) believed unpasteurized products “healthier” choice during pregnancy


Pregnancy related health issues

Pregnancy-related Health Issues

  • 375 (93.8%) believed in usefulness of prenatal care

  • 347 (86.8%) believed asymptomatic illness during pregnancy can cause infant illness or death

  • 42 (10.5%) had heard of listeriosis or associated pregnancy complications


Health communication channels

Health Communication Channels


Analysis restricted to women

Analysis restricted to women

  • 214 (93.9%) believe birth defects and congenital illness are preventable with prenatal vaccines, vitamins, blood test

  • 147 (64.5%) believe unpasteurized cheeses may cause gastrointestinal illness in mother or infant

  • 150 (65.7%) believe unpasteurized (“raw”) milk have more vitamins, and is “healthier” during pregnancy

  • 113 (49.5%) knew that some foods should not be eaten during pregnancy

  • 201(88.2%) discuss health concerns with physicians or health professionals


Conclusions

Conclusions

  • Limited awareness of risks related to unpasteurized

    milk products among members of HL community

  • High value placed on “healthful” aspects of food and

    on prenatal care

  • Strong preference for specific types of health education


Limitations

Limitations

  • Accuracy of demographic information

    • Immigration issues

    • Mistrust of U.S. government

  • More than one person per household could have participated in focus groups (qualitative study)

  • Difficult settings for recruitment (quantitative study)

    • Not all Hispanics

    • Work multiple jobs


Recommendations

Recommendations

  • Develop an educational intervention approach to promote behavioral changes by means of:

    • Using broadcast to deliver health education messages

      • Telenovelas

      • Radionovelas

      • Fotonovelas

  • Develop an interpersonal reinforcement at the community level

    • “Health Promotoras”

  • Evaluate effectiveness of intervention

  • Adapt the pilot educational intervention in other HL communities


Acknowledgments

Acknowledgments

  • Office of Minority and Women’s Health, NCID, CDC

    • Marian McDonald, PhD

  • Georgia State DOH

    • Susan Lance-Parker,D.V.M., PhD

    • Melissa D’Angelo

  • Foodborne & Diarrheal Disease Branch, NCID,CCID,CDC

  • Division of Reproductive Health/NCCDPHP,CCHP,CDC

The findings and conclusions in this presentation have not been formally disseminated by the Centers for Disease Control and Prevention and should not be construed to represent any agency determination or policy.


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