key: cord-0866593-crfyndg9
authors: Faour-Klingbeil, Dima; Osaili, Tareq M.; Al-Nabulsi, Anas A.; O.Taybeh, Asma'; Jemni, Monia; Todd, Ewen C.D.
title: How has public perception of food safety and health risks changed a year after the pandemic and vaccines roll out?
date: 2022-05-04
journal: Food Control
DOI: 10.1016/j.foodcont.2022.109073
sha: 1cdca60e57b3aa37f0995317c241878db79e77a8
doc_id: 866593
cord_uid: crfyndg9

The recent coronavirus pandemic (COVID-19) has caused unprecedented turmoil and spurred fears that have profoundly changed the public's social and health behaviours, including the perception of food safety risks. One year after the pandemic and the global vaccination campaign, the public perception of food safety and the changes in their hygiene behaviour, health risks concerns, and trust were studied in Jordan, Lebanon, and Tunisia using a cross-sectional online survey. The results of 538 subjects showed a rise in the frequency of hygiene practices, notably in handwashing. Sixty-four percent of the participants were vaccinated, a proportion made up mainly of the Jordanians and Lebanese. For 66% and 64% of the two population groups, respectively, there were no longer trust concerns about COVID-19 health risks following vaccination, whereas the worries about getting COVID-19 persisted for others. Only 47% of participants trusted eating food prepared by vaccinated food handlers. A great majority of the Tunisians (81%) showed varying degrees of concern about COVID-19 transmission from food and the lowest vaccination rate (33%). The current study demonstrated that the impact of vaccination policy positively affects public perception of food-related risks during the pandemic. On the other hand, 33% of the surveyed Jordanians and Tunisians lost trust in the health authorities' management of the pandemic, and 45% of the Lebanese still don't trust them. Communication strategies on health and food safety with the public still represent a challenge for these and probably other countries in the Middle East and North Africa (MENA). Strategies for building and maintaining public trust are crucial to curb persistent fear of food, hence, avoiding potential stigmatization affecting the food economy by promoting health awareness and positive changes in food safety perceptions for safer practices.

The 21st century witnessed a revolutionary process in the medical field, and biomedical 62 technologies harnessed to identify health issues and diagnose diseases allowing rapid advances Thus, its severe impact on the economy and supply chain vitality and its significant threat to 77 public health is projected to burden many countries for many years to come. 78 Following the official declaration of the pandemic, extreme measures prevailed globally, 79 although at various paces, to contain the virus, which spreads rapidly from person to person There are similarities to the Spanish flu epidemic, which occurred in three waves and infected 89 500 million people in less than one year (Robinson, 2021) . However, the illnesses and deaths control, led to increased violence (Aston et al., 2020; Polo, 2020) , and decreased the need to 97 maintain democratic principles (Moynihan, 2020) . 98 COVID-19 has imposed various challenges to the food supply chain, including considerable 99 concern about food production, processing, distribution, and demand (Aday & Aday, 2020) . 100 For some regions, consumer demand for food and hygienic supplies increased to the extent that 101 some store shelves were temporarily emptied because of excess purchases of essential products 102 in panic buying. However, these concerns go beyond supply and into its safety with the need 103 for the public to accept it is purchasing a safe and reliable food supply worldwide (Aday & 104 Aday, 2020). 105 As waves of more infectious variants became more frequent throughout the world, the cases of 106 infections and deaths soared to put a severe burden on healthcare systems. The latter resulted 107 in extreme anxiety in many countries and constraining food trade in some (Gale, 2021) . Though In 2020, the authors of the current study examined the public perception of food and non-food contaminated surfaces and food packaging and being exposed to infected people during food 126 shopping was even higher. Sixty percent of the surveyed subjects sought their information from 127 social media. However, less than half trusted their local and national authorities' information 128 on COVID-19, risk communication and response to false rumors.

The rapid onset and spread of COVID-19 showed that public health authorities were far from 130 prepared to react to any pandemic as the virus became more embedded in the populations. This The current study was designed to explore whether public trust in local authorities' risk 145 management has strengthened and helped with the vaccination campaigns reducing public 146 concerns related to food safety and changing their hygiene practices and measures taken against 147 COVID-19 or not. consumption of ready-to-eat foods. The frequency scale ranged from "more frequent" to "not 175 anymore" in comparison with the previous year, with the option of "never followed this 176 practice" to avoid selecting any other answer by chance.

The questionnaire was initially designed in English. To ensure the quality of the translation, The survey and the procedure to be followed were approved by the Ethical Approval Before initiating the data collection, the survey was piloted with 32 participants from Lebanon, 188 Jordan, and Tunisia to assess the content readability, examine its reliability and questions flow, 189 and test the functionalities of the survey and its link, and the survey's length. The participants 190 were contacted via social media applications (Facebook Messenger and WhatsApp) and emails.

The authors followed up with the pilot participants for any feedback and comments necessary including the eligibility criteria and the right of participants to discontinue at any time.

Screening questions were used to ensure that participants were over 18 years and resided or 207 lived in one of the three countries. To continue with the survey, informed consent was obtained 208 from participants through a check to the box "Agree" required to confirm reading the consent 209 information for participation and that they are above 18 years and living (residing) in Lebanon, 210 Jordan, or Tunisia".

The authors initiated the data collection by sending an invitation text to their network via (2) Concerned, for responses with varying levels of concerns, i.e., "very concerned", 242 "concerned", and "somewhat concerned".

Results with a p-value < 0.05 were considered statistically significant. The socio-demographic characteristics of the surveyed subjects are shown in Table 1 . More 250 than a third of the total sample were surveyed in Jordan (36%) and Lebanon (36%) and slightly 251 less in Tunisia (28%). More than two-thirds of the respondents (67%) were female, with 17% 252 aged between 45 and 54 years; an equal proportion of the sample was distributed across the 253 age groups from 19 to 44 years. In terms of educational level, 94% of the respondents had 254 higher than a high school diploma. When asked to compare their concerns to a prior year, more than a third of the respondents 281 reported being less concerned (42%) and only 13% were not any more concerned about getting 282 infected with the coronavirus, (Table 2 ). In contrast, only 14% became more worried and less 283 than a third (26%) were still concerned about COVID-19 ( Table 2) (Table 3) . For instance, significantly more 309 J o u r n a l P r e -p r o o f Tunisians (53%) than Lebanese (29%) and Jordanians (38%) were unsure or disagreed with 310 the vaccines' benefits (Table 3) . The difference in people's perception of health risks and 311 vaccination uptake could be attributed to the varying levels of trust in the vaccination benefits. 312 Regression analysis showed that the Jordanian group was 1.8 times (Odds ratio=1.848, 95% 313 CI= 1.208-2.826, p = 0.005) and the Lebanese were 2.7 times (Odds ratio= 2.723, 95% CI= Nevertheless, lower concern levels were particularly reported among unvaccinated participants 332 in Jordan (71%) compared to 46% and 36% in Lebanon and Tunisia, respectively. These 

Kruskal Wallis test showed significant differences between Jordan and Tunisia (p = 0.024), 376 and Tunisia and Lebanon (p = 0.03) ( were more likely to trust eating food prepared by vaccinated food handlers than the Tunisians.

Trust in vaccines may change food-related behaviors among both food workers and consumers. Overall, the proportion of respondents who maintained or increased hygiene measures was 415 higher than those who reduced or abandoned these habits. The results showed that in 416 comparison with the previous year, a higher proportion of respondents (36%) had increased 417 the frequency of disposing of and/or disinfecting food packages before storing them at home 418 than those reporting a reduced frequency (22%) (Table 4 ). However, a remarkably higher 419 number of respondents increased the frequency of handwashing and sanitizing after touching 420 food packages (65%) and returning home (68%) compared to only 10 and 13% who reported a 421 reduced frequency compared to the previous year, for both occasions, respectively (Table 4) . (Table 5) . At a country level, the clarity of information on vaccination was perceived as good 463 to excellent by more than half of the respondents in Jordan (67%) and Lebanon (63%), 464 compared to only 16% in Tunisia (Table 5) . Furthermore, one-way ANOVA showed a 465 significant difference between the countries; for instance, on a scale of 3= excellent/good to Together with the results on public trust in the vaccination benefits (Table 3) 533 In the current study, four other concerns were examined during the pandemic besides food 534 safety, i.e., economic constraint, social distance, lack of clarity about the pandemic and 535 shortage of food supply. Interestingly, the results showed that concerns about food safety and 536 shortage of food supply did not measure up to other sources of concerns, such as economic 537 constraints, which were the primary concern during the pandemic for 56% of surveyed subjects 538 in the current study, followed by the lack of clarity about the disease (Figure 4) . While On the other hand, some considered social distancing an irritating issue during the pandemic. 

There were no statistically significant differences between participants' opinions from Jordan, 555 Tunisia and Lebanon (p > 0.05) on their primary concerns during the pandemic. For instance, 556 the primary concern was the economic constraint for more than half of the respondents in 557 Jordan (59%), Tunisia (52%) and Lebanon (57%) ( Figure 5) . However, the minor concerns 558 differed significantly between the countries (p = 0.022). Concerns from social distance were 559 reported in Jordan and Tunisia, 32% and 27%, respectively (Figure 6 ). High vaccination rates distress ranks the lack of clarity about the pandemic as a minor concern (27%) (Figure 6 ). 565 4. Limitation of the study 566 One limitation of this study is that the online recruited sample is non-representative of the 567 population and largely educated. While the outcomes can not be generalized or their meaning 568 amplified, the data provide new findings and insight into existing issues that might be rooted 569 elsewhere in the communities of the studied countries and not covered in this study. 

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