In recent years, a dramatic increase in the demand for ethnic foods in the United States has been observed. Interestingly, with their rise in popularity, more foodborne illness outbreaks associated with ethnic foods have also been reported. Despite a more than 200-y history of ethnic foods in the United States, there is a paucity of information about them. Furthermore, there is also a lack of research on food safety issues involving ethnic foods. Therefore, this paper provides a comprehensive overview of ethnic foods, including the history, types, popularity, characteristics, ingredients, and consumer attitudes toward them. Importantly, this review provides an analysis of the statistics of foodborne illness outbreaks associated with ethnic foods based on data from the Centers for Disease Control and Prevention (CDC). The breakdown of etiology of ethnic foods identified the number of total outbreaks, the causative microorganisms, the food vectors, and the locations where foodborne disease outbreaks have occurred. Also covered is a review of the Hazard Analysis Critical Control Point (HACCP) system implementation, food safety training, and inspection score systems related to ethnic foods and how these can serve as effective tools for the prevention of foodborne illness outbreaks. This study contributes to the body of food safety literature by providing helpful information about ethnic foods in the United States.
As immigration, tourism, and international trade have increased worldwide, the role of ethnicity has become more important not only in business and consumer behavior (Rossiter and Chan 2004), but also in food culture and the food industry. Consumers who enjoy ethnic foods have increased in number and ethnic restaurants have become mainstream in the United States (Po 2007). In 2011, the ethnic food market continued to grow with $3 billion in sales and 5% to 6% annual growth and it is expected that sales will reach $3.9 billion in 2016 (Mintel 2012). U.S. Census Bureau projections (2010) showed that the U.S. population has become more diverse, and the number of Asian and Hispanic citizens have grown, with the Asian population currently at 4.6% and the Hispanic population at 16.0%. Meanwhile, other ethnic groups are reported as follows: Caucasian at 64.7% and African American at 12.9%. “Ethnic Restaurants 2012,” a report published by the research company Mintel showed that the diverse U.S. population strongly encouraged the growth of the ethnic restaurant industry in this country. In addition to diversity in the U.S. population, international travel may also be a cause for increased ethnic food sales. International travel increased 3% in 2011 (Mintel 2012) and the experience of international travel often brings greater interest in ethnic cuisines, which may have added to the current increase in ethnic food sales.
Interestingly, as ethnic restaurants become more accessible, a greater number of foodborne illness outbreaks have been linked to ethnic foods. A 7% increase in foodborne disease outbreaks related to ethnic foods was reported from 1990 to 2000, and 135 outbreaks with 2593 cases of illness were linked to contaminated multi-ingredient ethnic foods, including Italian, Mexican, and Chinese foods between 1990 and 2003 (Simonne and others 2004; Fraser and Alani 2009). As the number and variety of ethnic foods increase in food facilities in the United States, food safety issues related to ethnic foods have become more realized and understood (Simonne and others 2004). Food handlers are often not familiar with ethnic foods and ethnic food ingredients, therefore a science-based approach including inspection, training, introduction to the potentially hazardous foods (PHF) criteria, and implementation of a Hazard Analysis and Critical Control Point (HACCP) program may be a way to address food safety issues related to these foods.
Despite the importance and popularity of ethnic restaurants in the foodservice industry, few researchers have discussed ethnic cuisines in depth (Qu 1997; George 2001; Ebster and Guist 2004; Josiam and Monteiro 2004; Sukalakamala and Boyce 2007). Furthermore, relatively little research has been carried out on exploring how ethnic food safety issues can be tackled. This present review provides a comprehensive summary on ethnic cuisines, with particular focus on ethnic food safety issues.
Types, Popularity, and Characteristics of Major Ethnic Cuisines in the United States
Various types of ethnic foods, including Mexican, Italian, Chinese, Japanese, Korean, Vietnamese, Thai, Greek, Indian, French, have been introduced in the United States. The ethnic foods market is still growing amid an economic recession. Among Asian cuisines, specifically, this study focuses on 2, based on their high popularity: Chinese and Japanese. The following section describes some details of Mexican, Italian, Chinese, and Japanese cuisine and points out the characteristics of each.
The largest segment of the ethnic foods market in the United States appears to be Mexican, comprising 62% of the FDMx (food, drug, mass index), excluding Wal-Mart sales. However, growth of the Mexican food market slowed down in 2009–2010 (Mintel 2010). Mexican foods can be categorized by the regional area from which they originate: 1) Northern cuisine includes items from north Mexico that use beef, cheese, and wheat (popular dishes are machaca, arrachera, and cabrito); 2) Oaxaca cuisine are dishes from the city of Oaxaca emphasizing staples such as corn, beans, and chili peppers (popular dishes are triques, chapulines, and 7 moles); 3) Yucatan cuisine are specialties from the Yucatan peninsula that are based on Mayan food (the cuisine is often reddish in color, and a popular dish is cochinita pibil); 4) Mexican city cuisine (popular dishes are barbacoa, birria, cabrito, carnitas, and various moles); 5) Western Mexican cuisine (items from west of Mexico City that incorporates a great deal of fish); and 6) Veracruz cuisines (preparations from the Gulf of Mexico that use various tropical fruits) (Perez 2009; Kenyon and Alpers 2010; Tornavuelta 2010; Mexconnect 2013). Ground beef tacos, enchiladas, burritos, and tostadas, as well as beans are popular Mexican foods among non-Hispanic Americans in the United States. Mexican food is perceived as having a great value for the price, good for carry-out, hot and spicy, and also good for children to eat (Natl. Restaurant Assn. 2000).
Italian restaurants are also popular in the United States, and regardless of age, gender, income, education level, or geographic location, consumers are known to enjoy Italian foods (Natl. Restaurant Assn. 2000). Local cuisines vary by region, such as Lombardy cuisine (polenta, pizzoccheri, risotto, ossobuco, cotoletta, and cassoelua), Emilia-Romagna cuisine (parmigiano reggiano and tortellini), Tuscany cuisine (steak alla fiorentina and ribollita with panzanella), Lazio cuisine (spaghetti alla carbonara and artichokes alla Romana), Campania cuisine (pizza, water buffalo mozzarella, calzone, casatiello, and tortano), and Sicily cuisine (caponata and veal Marsala) (Academia Barilla 2013). According to CNBC, the pizza industry earns $32 billion and comprises 8% of the restaurant operation market (PMQ 2008). The number of Italian restaurants in the 10 most popular U.S. cities was around 16783 operations. This number is higher than Mexican (7102) and Chinese (8493) restaurants. Consumers’ image of Italian food is indulgence, good for celebrations, ample in portions, full of variety, and irresistible in dessert selection (Natl. Restaurant Assn. 2000).
There are 43139 Chinese restaurants in the United States, which is more than any other domestic fast food restaurants, such as McDonalds, Wendy's, and Burger King (Liu and Jang 2009). China has a large terrain and is composed of various races, so Chinese cuisine is one of the richest and boasts the most diverse culinary tradition in the world (Halvorsen 1999). Chinese foods can be categorized by the regional area from which they originate, in particular Canton, Shanghai, Beijing, and Hunan/Szechuan.
Canton cuisine is cuisine from the southern area that emphasizes frying, roasting, steaming, and poaching. Traditional dishes are Cantonese chow mein, sweet and sour chicken, roast duck, dumplings and egg rolls, also stewed fried pork, Chinese steamed eggs, congee with lean pork and century eggs, stewed beef brisket, steamed frog legs on lotus leaves, blanched vegetables with oyster sauce, and stir-fried hairy gourd with dried shrimp and cellophane noodles. Shanghai cuisine is from the eastern part of China. It is delicate, sweet in flavor, and not oily or greasy. Traditional dishes are Yang Chow fried rice, Shanghai noodles, spare ribs with sweet and sour sauce, fish ball soup, shrimp in egg whites, hairy crabs, light broth, paper-wrapped foods, and shredded pears with crystal fruit. Beijing cuisine is from the northern part of China featuring elegant dishes that are strong, spicy, and generous in the use of garlic. Traditional dishes are Peking duck, hot and sour soup, beggar's chicken, cold pig's ear in sauce, fish cooked with 5-spice powder, Peking wonton, sea cucumber with quail eggs, abalone with peas and fish paste, soft-fried tenderloin, meatball soup, fried sesame egg cake, lard with flour wrapping glazed in honey, stewed pig's organs, goat's or sheep's intestine filled with blood, Peking ribs, sautéed clams, orange beef, lamb in tea sauce, shaomai, and sweet and sour recipes. Hunan/Szechuan cuisine is cuisine from the western part of China that uses hot, strong and spicy flavors involving chili, peppers, spices, and herbs. The traditional dishes are hot and sour soup, Szechuan chicken, twice-cooked pork, Kung Pao chicken, stewed sharks’ fin, spiced beef, tea-smoked duck, Mapo tofu, Sichuan hotpot, Fuqifeipian, spicy deep-fried chicken, water-cooked dishes, dandan noodles, and bon-bon chicken (Po 2007).
The characteristics of traditional Chinese food culture are liberal and extensive in the choice of ingredients, with diverse and abundant flavors, common use of oil in the cooking process, rich appearance, and plentiful use of spices and seasonings. However, Chinese cuisine in the United States differs from the original because “Americanized” Chinese food is usually less pungent than the authentic recipes, with higher levels of monosodium glutamate (MSG) to enhance the flavor, and involving more deep frying (Mosby 2009). Some characteristics of Chinese cuisine which consumers like include being handy for carry-out, good for vegetarians, and characterized by highly varied flavors (Natl. Restaurant Assn. 2000). However, some American consumers suffer from “Chinese Restaurant Syndrome,” which is manifested in symptoms ranging from mild headaches to depression caused by the use of high levels of MSG, characteristics of “Americanized” Chinese food (Mosby 2009).
There are approximately 9000 Japanese restaurants operating in the United States, and Japanese food, both ready-made and cooking ingredients, are available at conventional grocery stores, including Wal-Mart (Japan External Trade Organization 2011). The increase in food imports from Japan to the United States reflects the popularity of Japanese foods. An article from Japan's External Trade Organization (2011) pointed out that the key factor for the success of Japanese foods is that they contain less sugar, less fat, and fewer calories. Japanese foods use various crops, fish, and marine ingredients, due to the fact that Japan is an island country (Ashkenazi and Jacob 2003). Using fresh fish, such as sashimi and sushi, is a unique characteristic of Japanese cuisine. Traditional Japanese dishes are tempura, sushi, sashimi, sukiyaki, kaisekiryori, yakitori, tonkatsu, shabu-shabu, soba, and udon. Local cuisines vary depending on the regional area, including Hokkaido cuisine (with specialties such as ishikari-nabe and genghis khan), Tohoku cuisine (sasakamaboko, wanko-soba, and kiritanpo), Kanto cuisine (namerou, monja-yaki, and fukagawa-meshi), Hokuriku cuisine (hotaruika and jibu-ni), Kansai cuisine (funazushi, yudofu, koyadofu, and takoyaki), Chugoku cuisine (okonomiyaki, fugu, and izumo soba), Shikoku cuisine (bonito, tai, and sanuki-udon), and Kyushu cuisine (mizutaki, shochu, sara-udon, and hiyajiru) (Japan Natl. Tourism Organization 2013).
The Japanese regard food preparation as a type of art (Barer-Stein 1999) in that an artistic sense and beauty of the display, the proper arrangement of food, and the choice of receptacles are important (Ha 2006). Characteristics of Japanese food culture are rice as a dietary staple in a traditional menu composition (1 soup and 3 dishes), light seasoning, and an emphasis on the natural flavor of the ingredients (Barer-Stein 1999; Gu and others 2006). According to a survey by the Natl. Restaurant Assn. (2000), consumers like Japanese food because the food is “beautifully presented,” “good for a formal or special occasion,” “difficult to prepare at home,” has “mild, pleasant flavors,” and the “décor and atmosphere are important.” Japanese foods are especially loved by consumers with higher incomes and people who live in the Western United States or in large metropolitan areas.
The History of Ethnic Cuisines in the United States
The history of the introduction of ethnic cuisine varies by types and is closely tied to the history of immigration. U.S. immigration goes back to the 18th century. Five million immigrants from England, Ireland, Germany, and Scandinavia entered the country from 1815 to 1860. Ten million immigrants arrived from northwestern Europe from 1865 to 1890, and 15 million immigrants from central, eastern, and southern Europe came to the United States from 1890 to 1914. During the 19th century, Chinese, Japanese, Italians, and Mexicans affected American's eating patterns and already in the 1920s and 1930s popular ethnic foods were chow mein, spaghetti, pastrami, and tamales (Gabaccia 1998). The developments of these 4 ethnic cuisines are described in detail below.
In the 1930s, Mexican immigrants were a small minority and Mexican cuisine was a minority's food. In 1943 in San Antonio, Texas, chili powder was imported from Mexico (Gabaccia 1998). Mexican food was mainstream among the lower classes, but later became universalized as working-class dishes around 1980. In the year 1879, wine (4 million gallons), sparkling wine (140000 cases), brandy (500000 gallons), and olive oil (300000 gallons) were imported from Mexico into California (Hittell 1982).
In 1987, Italian cuisine expanded based on the strong network between Italian immigrants and other communities (Camillo and others 2010). Ettore Boiardi produced a large quantity of canned Italian food (spaghetti in tomato sauce) targeting the children of the baby boom generation and their suburban mothers, and created various types of products through the Chef Boyardee Food Products Co. (DiStasi 1989). However, in the 1920s, the American middle class was not familiar with the Italian food culture (Janni and McLean 2002). By the 1930s, Italian restaurant owners promoted Italian dining as an “experience,” not just food, and modified their foods to suit the American palate (Gabaccia 1998). Around 10000 Italian restaurants were established in New York City by the 1930s, and most of these restaurants were simple and undecorated (Federal Writers’ Project 1983). It was only after the 1970s that Italian dishes became quite popular in the United States (Cinotto 2011).
Chinese migration, starting in 1848 to the United States, was the beginning of the spread of Chinese food in the country. The 1st Chinese restaurant was opened in San Francisco in 1849, and it served Cantonese cuisine. However, other regional Chinese cuisines, such as Hunan, subsequently began to be featured in U.S. restaurants (Lu and Fine 1995). By 1851, around 25000 Chinese had arrived in California, because the discovery of gold in the Sacramento Valley had encouraged migration from south China to this country (Roberts 2002). However, Chinese food was still perceived as new and was sometimes refused (Lloyd 1876). As more and more Chinese immigrated to this region, more could find employment and opened restaurants, and by 1960, there were over 6000 Chinese restaurants in the United States, with 600 in New York City and San Francisco alone (Kung 1962). In 1972, tea, dim sum, and noodle dishes were widely served, and restaurant décor featured comfortable oriental motifs (Roberts 2002). In 1883, Disturnell's “Strangers’ Guide to San Francisco and Vicinity” recommended some Chinese restaurants in Chinatown and around San Francisco to tourists as serving safe food (Disturnell 1983).
The beginning of Japanese cuisine in the United States also started with Japanese immigration. Japanese traditional dishes, such as chicken teriyaki, mame, and sushi were eaten among the Japanese immigrants, and Japanese farmers imported Napa cabbage and radishes from Japan (Gabaccia 1998). Few Japanese restaurants were established in the United States until well after World War II, and throughout the 1930s, only simple menus, including sukiyaki, teriyaki, and tempura dishes, were offered. In 1957, sushi bars began to appear, and in the 1970s, the number of sushi and sashimi restaurants grew rapidly (Mariani 1991). Only a few Japanese restaurants in bigger cities of California and Hawaii attracted Americans in 1970. However, it did not become one of the mainstream ethnic foods until the popularity of sushi, particularly the California roll, came about (Life in the USA 2011). In the early 1980s, entrepreneurial chefs contributed to the popularization of sushi in Los Angeles, and Japanese foods became much more popular in the United States (Japanese Food in America 2011). Figure 1 displays the history of various ethnic foods in the world.
Consumer Attitudes toward Ethnic Cuisines
It is obvious that consumer attitudes toward or perceptions of ethnic foods have become more positive when we consider the popularity of ethnic foods and the presence of ethnic restaurants in the United States. Previous studies have established some influencing factors on the increase of ethnic foods, such as extrinsic factors (growing international trade, globalization, migration, and tourism), psychological factors (the desire for healthier diets, flavorful taste, and adventure), and sociocultural factors related to changes in lifestyle and values (Verbeke and Viaene 2000; Miles and Frewer 2001; Saba 2001; Verbeke and López 2005). Some ethnic foods are perceived as healthy because they include low-calorie items (low in fats, and oils) and plenty of vegetables (Block and others 2004). As consumers have become more interested in “healthy eating,” more restaurants have begun using “healthy food” strategies in their menus. Nowadays, restaurants often present Asian foods as “healthy” menu items. A common example is fast food chain restaurants’ use of Asian menu items, such as McDonald's Asian salad which offers the nutritional information of the item. It seems that ethnic restaurant consumers perceive some ethnic foods as healthy, and this positive perception of ethnic foods may be regarded as one of the influencing factors on consumers’ intentions to visit ethnic restaurants. Mintel's (2012) recent report found that consumers are attracted to ethnic foods by word-of-mouth from friends and relatives (more than 50%), media exposure, such as seeing the foods in a store or restaurant (around 24%), and, beginning in 2009, the Internet exposure.
Researchers have recognized the importance of ethnic restaurants in the food industry due to an increase in ethnic cuisine consumption. Today, American consumers are more familiar with ethnic foods, and their attitudes toward ethnic cuisines have much changed (Natl. Restaurant Assn. 2000). Consumers prefer to have an excellent overall dining experience rather than simply experiencing good taste or affordable prices (Liu and Jang 2009). Researchers have identified how consumers think about ethnic cuisines and how to please ethnic restaurant consumers. First, the image of Chinese cuisine to consumers is rich and diverse compared to other cuisines because of China's huge terrain and cultural diversity (Halvorsen 1999). Additionally, other images attributed to Chinese cuisine include: “The choice of ingredients is very liberal and extensive,” “The taste is diverse and abundant,” and “diluted starch, spice and seasoning, and oil are used” (Barer-Stein 1999; Gu and others 2006; Ha 2006).
Previous studies have examined the important factors at Chinese restaurants that satisfied consumers. Qu (1997) determined that the factors influencing the choice of customers in Indiana to dine at Chinese restaurants include: “food and environment,” “service and courtesy,” “price and value,” and “location, advertising, and promotion.” Liu and Jang (2009) found that food quality (especially taste) and service quality (especially service reliability) are important attributes for consumer satisfaction in Chinese restaurants, along with dining atmosphere, food authenticity, and fair price. Maa and others (2011) stated several factors that can affect consumer satisfaction: “employee services and atmosphere” (including employee friendliness, proper level of service, and atmosphere); “food quality and dining environment” (including good food quality, consistent food quality, and reasonable price); and “physical attribute” (including good location, convenient parking, and convenient operation hours).
Compared to Chinese restaurants, there is a dearth of studies focused on Italian and Japanese cuisines related to consumer behavior. The image of Italian cuisine is of “simplicity” or “rusticity,” “fresh ingredients,” “good portions,” “good value for the money,” and of its “authenticity,” namely, “a growing appreciation among consumers for authentic foodstuff over Americanized substitutes” (Girardelli 2004). In the study of Camillo and others (2010), taste, simplicity, and the variety of Italian regional cuisines were factors found to influence the success of Italian cuisine in the United States. Girardelli (2004) identified some myths about Italian food in the United States, such as “romance,” “family,” and “slow-paced lifestyle,” and argued that these myths have some positive aspects. Huliyeti and others (2008) found that younger generations in the United States prefer Italian style and tastes. The common American image of Japanese cuisine is that seasoning is used lightly, the natural flavor of the ingredients is emphasized, and a traditional menu composition is common (Barer-Stein 1999; Gu and others 2006; Ha 2006).
American images of Mexican restaurants include “concrete floors,” “low prices,” and “casual cantina atmospheres” (Goldman 1993). In the 1990s, there was a trend toward casual family atmosphere and moderate price, which resulted in the boom of Mexican restaurant popularity (Goldman 1993). Munoz and Wood (2009) conducted a study about the atmosphere of Mexican restaurants to examine the impact of atmosphere on consumer perceptions. Their findings suggest that consumer perceptions of the degree of authenticity at Mexican restaurants vary depending upon geographic locations. For example, there are differences in consumer perceptions between people in the southwest and the northeast toward the level of authenticity of Mexican restaurants (Munoz and Wood 2009).
To sum up, previous studies demonstrated that consumer attitudes toward ethnic cuisine are positive due to specific ethnic food images, such as “healthy,” “low-calorie,” “plenty of vegetables,” “fresh ingredients,” “authentic,” and “rich and diverse.” Like other mainstream restaurants, attributes such as price, employee services, food quality, location, and parking convenience, similarly influence consumer perceptions toward ethnic restaurants. An especially critical attribute of an ethnic restaurant's attractiveness and popularity is its “authentic” environment.
Spices in Ethnic Cuisines
Various kinds of spices and herbs used in ethnic cuisines (Table 1) contribute to their distinctive flavors and tastes. Popular spices used in Mexican cuisines are cilantro, oregano, thyme, parsley, mint, marjoram, cumin, and chili powder (Jeanroy 2012). In detail, herbs used in Mexican foods are: acuyo or tlanepa, amaranth, anise, annatto, avocado leaf, balm-gentle, banana leaf, bay leaf, bean flower, chamomile, chaya, chepiche, chepil or chipil, chia, cilantro, cuajes, cumin, flor de cimal, halachas, hierbasanta, Indian paintbrush, lemon grass, lemon verbena, lenguitas, marjoram, Mexican safflower, oregano, pápalo, pepicha, peppermint, purslane, quintoniles, sesame, spearmint, sweet basil, Tilia, vervain, watercress, and wormseed. Spices used in Chinese cuisines are star anise, fennel seed, clove, cinnamon, 5-spice powder, ginger, peppercorns, bird's eye chili, kaffir lime leaf, yellow ginger, and lemongrass (Chinese traditional food.com 2012). Spices used in Italian cuisines are basil, bay leaves, black pepper, borage, chilies, chives, coriander, fennel, fennel seeds, garlic, ginger, juniper, marjoram, myrtle, nutmeg, oregano, parsley, rosemary, saffron, sage, thyme, and vanilla (Yahoo 2012). Japanese cuisine uses a range of spices and herbs, including ginger, hashouga, karashi, myouga, sansho pepper, shichimi pepper, shiso, shouga, wasabi, and yuzu (The Matsuri Restaurant 2012; The Japanese Kitchen 2012). Herbs that are valued as a garnish are dropwort: boufu and mitsuba; Japanese basil: akajiso, hojiso, and ohba/aojiso; and water pepper: benidate and tade (The Matsuri Restaurant 2012).
Table 1. Various types of spices and their descriptions (cited from Wikipedia)
Name of spices
Refers to perilla.
Commonly known as the Prince-of-Wales feather.
Belongs to the family Apiaceae, is sweet and aromatic, and has a similar flavor with fennel and tarragon.
Derived from the achiote tree seeds, and widely used for food coloring in many cheeses, cheese products, dairy products, and nondairy products because of its yellow to orange color.
Known as Ocimumbasilicum and is a member of family Lamiaceae (mints). Sweet basil and bush basil are commonly used as aromatic herbs. Especially in Italy, sweet basil is widely used in salads, soups, and pizzas.
Fresh or dried bay leaves are used in cooking as a flavoring for casseroles, soups, stews, praises, and sometimes roasts.
Known as starflower. Borage is used as vegetables in Germany, in the Spanish regions, and in the Greek island. It is used as filling for pasta ravioli and pansoti widely in Italian Liguria.
The aromatic dried flower buds of a tree which is a member of family Myrtaceae. They are used in meat and curries to add flavor, and also used in sweet dishes.
Belongs to the family Apiaceae. The leaves are known as coriander leaves, fresh coriander, Chinese parsley, or cilantro. The leaves have a citrus flavor. The fresh leaves are used in dishes from various countries. The dry fruits of this plant are known as coriander or coriandi seeds. Dried coriander fruits have a lemony citrus flavor when crushed because of the terpenes linalool and pinene. Coriander seeds can be roasted or heated on a dry pan. It can be eaten as a snack, used as a spice in curries, used for pickling vegetables, or used for making sausages in Germany and South Africa.
A mixture of 5 spices, including bajiao (star anise), cloves, cinnamon, huajiao (Sichuan pepper), and ground fennel seeds. It is used as a spice of chicken, duck, pork, and seafood dishes.
Is widely pickled in vinegar to make benishogarandgari in Japan. Beni-shouga is red color thin strips of ginger. Gari is thinly sliced young ginger after it has been marinated in a sugar and vinegar solution, and has a sweet flavor. Beni-shouga and gari are served with many Japanese dishes.
The root of Glycyrrhizaglabra. It is used for medicinal uses. In China, it is used for making flavor broths.
Has sweet pine and citrus flavors. The leaves are used as green or dry condition because of it aroma.
Belongs in the mint family, and comprises of 2 kinds, red (or purple) leaves and green leaves. In Japan, a whole leaf of green shiso is used as the ingredient of wasabi. Typically, chopped fresh green leaves are used for cold dishes, such as cold noodles or cold tofu. Red leaves are used for making pickled plum or eggplant.
A large number of studies have shown that many spices have antimicrobial properties. The antimicrobial effects of basil and thyme and their major constituents, thymol, p-cymene, estragole, linalool, and carvacrol on the growth of Shigella were demonstrated in a study by Bagamboula and others (2003). The antimicrobial effects of essential oils from herbs and spices on many pathogens, such as Salmonella Typhimurium, Escherichia coli O157:H7, Listeria monocytogenes, Bacillus cereus, and Staphylococcus aureus, have been demonstrated in a study by Tajkarimi and others (2010) among several others. In addition, the suppressed growth of bacteria such as E. coli, Pseudomonas fluorescens, and Lactobacillus plantarum in solutions of extracts from cinnamon and rosemary has been reported by Kong and others (2007). The inhibitory effect of spices and herbs on the growth of microbes is closely related to microbial food quality and safety. The study findings mentioned above imply that ethnic cuisines containing a variety of spices may be inhibitory to certain foodborne pathogens and have a longer shelf-life or longer storage period than foods that lack spices.
The Occurrence of Foodborne Pathogens and Associated Disease Outbreaks Linked to Ethnic Cuisine around the World
Foodborne illness outbreaks associated with various ethnic cuisines have been reported around the world and in the United States. In China, the presence of L. monocytogenes in various food products was identified in a study by Yan and others (2010). L. monocytogenes, at the rate of 4.13%, was detected from a total of 2177 food samples collected in 9 cities of northern China from 2005 to 2007. The pathogen was found in frozen food made of wheat or rice products (10.32%), raw meat products (6.28%), cooked meat (1.17%), seafood (0.98%), and nonfermented bean products (0.62%). Foodborne illness outbreaks associated with botulism occurred in China's Hebei Province from August to September, 2007. An immediate investigation followed and microbiological testing showed that all affected patients had eaten sausage contaminated with Clostridium botulinum toxin type A which, when stored at room temperature, is capable of spore germination and toxin production (Zhang and others 2010). As raw and partially cooked oysters became popular in China, 31.1% of 5770 foodborne outbreaks associated with Vibrio parahaemolyticus occurred in China between 1991 and 2001 (Liu and others 2004). In addition, Chen and others (2010) investigated the occurrence of foodborne pathogens in oysters in food markets of southern China from 2007 to 2008. The findings showed that Vibrio vulnificus and V. parahaemolyticus could be detected in 67 (54.9%) and 109 (89.3%), with a Most Probably Number (MPN) value of greater than or equal to 3 from the 122 oyster samples analyzed, respectively. Fu and others (1999) examined 3746 samples of 7 types of foods in 12 Chinese provinces for L. monocytogenes. Their findings showed the presence of L. monocytogenes in cold drinks (1.39%), raw meat (1.53%), sterilized milk products (0.52%), cooked meat products (0.47%), raw milk (0.72%), and aquatic products (0.19%). Wang and others (2007) reviewed 2447 papers from published journals in order to determine the occurrence of foodborne illness outbreaks in China. Their findings reported that 1082 bacterial foodborne disease cases occurred between 1994 and 2005. The most frequent foodborne disease is caused by V. parahaemolyticus, followed by Salmonella and C. botulinum. V. parahaemolyticus caused the highest percentage of outbreaks in the coastal provinces, while Salmonella caused the highest percentage of outbreak in inland provinces.
The report “Outbreak of Salmonella Braenderup infection originating in boxed lunches in Japan in 2008” identified 176 foodborne illness cases associated with Salmonella enterica serotype Braenderup infection (Mizoguchi and others 2011). The findings showed that 3 food items, including tamagotoji (soft egg with mixed vegetables and meat), pork cooked in soy sauce, and vinegared foods, were significantly associated with a higher risk of illness. The main food vehicle of the outbreaks was unpasteurized liquid eggs contaminated with S. Braenderup. This species was isolated from 5 out of 9 sampled cases and 6 food handlers.
Sushi and sashimi are often associated with parasites. The epidemiology of fish zoonoses is associated with sushi and sashimi because of inappropriate treatment of fish products during hunting and frozen storage (Öktener and others 2010). Sumner and Ross (2002) developed a scale to assess seafood risk assessment. According to this risk assessment of sea food hazard/product combinations, there is some risk of finding parasites in Austrian sushi/sashimi (Sumner and Ross 2002). The results showed that low levels of Pseudomonas spp., Staphylococcus spp., Enterobacteriaceae members, E. coli, and Bacillus cereus were detected, and it was recommended that hygiene be improved at restaurants.
In the United Kingdom, Salmonella Enteritidis (SE) phage type 34a infection occurred among people who had eaten food from a Chinese restaurant in 2002 (Linnane and others 2002). The Outbreak Control Team found that eggs used for egg-fried rice left at room temperature were the vehicle for the outbreak. In Korea, a microbial assessment of fried-rice dishes at Chinese restaurants was performed, and the prevalence of B. cereus detected in cooked rice at the consumption point was 37.5%.
As demonstrated by the aforementioned studies above, various microbial pathogens are involved in foodborne illness outbreaks associated with ethnic cuisines throughout the world. As with any food that is served to consumers, proper preparation, cooking, and storage are critical to prevent foodborne outbreaks in the food industry, both mainstream and ethnic. A trial to identify the issues and challenges that ethnic foods faced was done by a report entitled “A food inspector's guide to ethnic foods in Michigan” (Po 2007). This report suggests several recommendations to prevent foodborne illness outbreaks associated with ethnic cuisine. Understanding the culture, including language, religion, body language, tone of voice, or values regarding time helps when communicating with foreign food handlers, as does getting more knowledge about food culture, including geographic or economic factors, and letting food handlers become familiar with ethnic foods. Moreover, appropriate cooking and storage procedures are most important. Risk factors and regulatory concern for specific ethnic cuisines were identified by this report. The recommended cooking and storage procedures for specific ethnic cuisines are listed in Table 2.
Table 2. Safe handling instructions for ethnic cuisines (Po 2007)
Risk factors and regulatory concern for ethnic cuisines
Improper cooking temperatures:
◼ Taking rice directly from the refrigerator to the steam table.
◼ Reheating temperature of 165 °F (74 °C).
Improper holding temperature:
◼ Leaving rice at room temperature is a violation of the Food Code.
◼ Must be held at 135 °F (57 °C).
◼ Rice should be dried in order to prevent the growth and possible toxin formation of B. cereus and cooled and stored in an air-tight container and refrigerated.
Improper cooking temperatures:
◼ Vegetables must be heated to 130 °F (54 °C), and meat should heat to 145 °F (63 °C).
◼ Reheating temperature is 165 °F (74 °C).
Improper holding temperature:
◼ Egg rolls must be held at 135 °F (57°C) or above.
◼ Egg rolls must be cooled down from 130 °F (54 °C) to 70 °F (21 °C) within 2 h, and from 70 °F (21 °C) to 41 °F (5 °C) within 4 h.
Burritos & tacos
Improper cooking temperatures:
◼ Meat must be grilled; beef to 145 °F (63 °C), and chicken 165 °F (74 °C).
Improper holding temperature:
◼ Meat must be held continuously at 135 °F (57 °C) or above.
◼ Held from 130 °F (54 °C) to 70 °F (21 °C) within 2 h, from 70 °F (21 °C) to 41 within 4 h.
◼ Wash vegetables well.
◼ Use clean chopping board.
◼ Wash raw vegetables and fruits properly.
Storage temperature not adequate:
◼ Proper refrigeration is required because of fresh raw ingredients.
Not enough acidity:
◼ Fresh salsa has a shorter shelf life.
Undercooking/improper hot holding temperature:
◼ Topping meat should be properly cooking.
◼ Avoid cheeses or fresh vegetables held at temperature of 41 °F (5 °C).
Sushi & sashimi
Improper holding temperatures:
◼ Raw seafood must be frozen and maintained below 41 °F (5 °C).
pH above 4.2:
◼ Sushi rice including vinegar should have pH 4.2 or less
Poor personal hygiene:
◼ No bare hand contact is allowed during preparation or service.
Source of vegetables:
◼ Use uncontaminated raw vegetables.
Improper holding temperature:
◼ Filing and sauce should be refrigerated before baking.
◼ Wash avocadoes and tomatoes well.
◼ Use clean cutting board.
Storage temperature not adequate:
◼ Processed guacamole should be kept refrigerated after unsealing.
Foodborne Illness Outbreaks Associated with Ethnic Cuisines in the United States
As ethnic cuisines have increased in popularity, more foodborne illness outbreaks associated with them have occurred in the United States. Approximately 48 million cases of overall foodborne illness outbreaks are reported annually, and the major source of such outbreaks is restaurants, at a 66% occurrence rate (Jones and others 2004; Kufel and others 2011; Scallan and others 2011). The case of ethnic cuisines seems similar. Foodborne illness outbreaks associated with Mexican cuisine showed that fresh vegetables or eggs were identified as the main causes. Red salsa, especially, which is a common side item in Mexican foods and offered with chips, was related to 70 foodborne outbreaks (2280 illness cases) from 1990 to 2006, and among these outbreaks 70% occurred in restaurants (Franco and Simonne 2009). The ingredients of red salsa are fresh tomatoes, onions, chili peppers, cilantro, and seasonings. Previous studies have pointed out the vegetables in Mexican foods as food vehicles of foodborne illness outbreaks. For example, in the report analyzing the foodborne illness outbreak data from the Centers for Disease Control and Prevention's Foodborne Disease Outbreak Surveillance System (FDOSS) from 1973 to 2008, salsa and guacamole were pointed out as vehicles (Kendall and others 2013). Kendall and others (2013) found 136 outbreaks associated with salsa or guacamole and insisted that improper storage increases the risk of foodborne illness outbreaks. Canvin and others (2004) reported outbreaks of hepatitis A associated with green onions from Mexico. Fresh tomatoes linked to a Salmonella outbreak were mentioned in the study of Beuchat and Mann (2008) and Cummings and others (2001) and fresh cilantro linked to a Salmonella outbreak has been reported in the study of Campbell and others (2001). In May 1996, the outbreak of SE in Waycross, Georgia, was reported by the Georgia Div. of Public Health. A deep-fried Mexican dish (chile relleno), sold in the restaurant, was significantly related to SE infection (4 of 21 cases compared with 0 of 26 controls, odds ratio undefined, 95% CI > 1.46, P = 0.034) (McNeil and others 1999). In 2003, a large foodborne outbreak occurred among patrons of a single restaurant in Pennsylvania, whereby 3 died, and at least 124 were hospitalized among an identified 601 patients. The hepatitis A virus, which originated from mild salsa containing green onions grown in Mexico, was the causative agent, and the green onions had been contaminated before arrival at the restaurant (Wheeler and others 2005). Franco and Simonne (2009) specified that foodborne illness outbreaks from 1990 to 2006 were associated with Mexican cuisines, based on the CDC report “Mexican food safety trends.” Mexican foods were associated with 560 foodborne illness outbreaks out of a total of 15997 reports, and these outbreaks occurred in 43 states. The percentage of outbreaks associated with Mexican foods has somewhat increased from 2.6% in 1990 to 2.8% in 2006. Forty-seven percent of outbreaks associated with Mexican foods began in restaurants. The causes of 215 outbreaks out of 560 outbreaks in Mexican foods were identified. Among the known causative agents, Salmonella caused 34%, Clostridium caused 23%, Shigella caused 6%, Staphylococcus caused 5%, pathogenic E. coli caused 5%, and others (L. monocytogenes, E. coli O157:H7, and norovirus) caused 5% of the outbreaks. The most frequent Mexican food vehicles associated with foodborne illness outbreaks from 1990 to 2006 were tacos (18%), chili (9%), salsa (9%), refried beans (8%), burritos (7%), and guacamole (4%). Because of the inherent use of fresh vegetables in Mexican cuisine and the fact that many cases of foodborne illness outbreaks associated with Mexican foods are due to contaminated fresh vegetable ingredients, it could be implied that extra preventative care need to be taken by restaurant operators serving Mexican food in order to avoid the occurrence of foodborne illnesses from contaminated fresh vegetables.
In the case of Japanese cuisine, sushi, a sticky vinegar rice that is shaped into bite-sized pieces and topped with raw or cooked fish (salmon, snapper, tuna, mackerel, and yellowtail) or formed into a roll with fish, egg, or vegetables and wrapped in seaweed; or sashimi, delicately sliced raw fish (salmon, cooked shrimp, tuna, mackerel, fatty tuna, yellowtail, and octopus) which is served with only a dipping sauce (Po 2007), have been suspected of causing foodborne illness outbreaks. Unless fish intended for raw consumption is stored at less than –35 °C for 15 h or at below –20 °C for 7 d (which is recommended by the U.S. Food and Drug Administration), the product can be expected to carry much higher risks of zoonotic parasites (Nawa and others 2005). According to Diplock (2003), previous studies focused on the fish rather than the rice as the source of illness. However, rice prepared in advanced has a high-risk potential for causing foodborne illness outbreaks (Sutherl and others 1996; Nichols and others 1999). In 2001, prepared rice stored at room temperature at a Japanese restaurant was observed by a public health inspector, who mandated that the rice be discarded (Diplock 2003). Foodborne illness outbreaks that led to diarrhea occurred among sushi restaurant patrons in Nevada in August and November 2004. In this Nevada outbreak, enterotoxigenic E. coli was found in stool samples from 6 of 7 ill patrons and 2 of 27 employees of sushi restaurants. The presence of the bacterium was determined to be the cause because of poor food-handling and bad hygiene practices (Jain and others 2008).
Regarding sushi outbreaks, one concern is the growth of B. cereus when the rice is stored in the danger zone (4.4 to 60 °C) (Diplock 2003), and another is the transfer of pathogenic bacteria, such as Salmonella, Vibrio, Listeria, and E. coli, to fish, which then may result in contamination of sushi (Atanassova and others 2008). Adams and others (1990) examined the microbiological quality of salmon-sushi and rice from 14 restaurants in Seattle, Washington. A 1 in 13 chance of anisakid larvae was found from salmon slices, and rice from 3 restaurants was positive for S. aureus and B. cereus (Adams and others 1990). Microbial assessments of 50 restaurants in Seattle in 1994 were conducted from 32 samples of salmon, tuna, mackerel, and rockfish sushi during 19 mo. The results showed that 10% of salmon sushi pieces were infected with a maximum of 3 nematodes per piece. About 5% of mackerel sushi pieces were infected with nematodes. All nematodes were 3rd-stage juveniles of the genus Anisakis and were dead. Clearly, the aforementioned reports indicate that the use of raw fish, pre-prepared rice, and poor hygienic practices are areas that need to be properly controlled to prevent foodborne disease outbreaks from Japanese cuisines.
The incidence of foodborne illness associated with ethnic foods from 1990 to 2000 based on the CDC data was determined and reported by Simonne and others (2004). Ethnic foods resulted in 3% of the total number of outbreaks in 1990, and this percentage increased to 7% in 2000. The most frequent outbreaks were associated with Mexican, Italian, and Asian foods, and among these categories, Mexican food resulted in the highest number of outbreaks. The major causative microorganisms for outbreaks in Mexican foods were Salmonella (47%), Clostridium (26%), Shigella (10%), and S. aureus (5%). The major causative microorganisms for outbreaks in Italian foods were Salmonella (58%), S. aureus (12%), Clostridium (10%), and Norwalk virus or norovirus (10%). The major causative microorganisms for outbreaks in Asian foods were Bacillus spp. (50%), Salmonella (31%), and S. aureus (14%). Compared to Asian and Italian foods, more harmful causative microorganisms, such as E. coli O157:H7 or C. botulinum, were found in Mexican food. In descending order, Florida (n = 136), California (n = 74), New York (n = 42), Maryland (n = 40), and Michigan (n = 37) were the states most frequently associated with ethnic food outbreaks, and restaurants were the places where the highest numbers of outbreaks originated from.
In order to determine the most recent safety trends of ethnic foods at restaurants, this current study examined foodborne illness outbreaks associated with ethnic foods at restaurants from 2001 to 2009 based on a CDC (2011) database. This database categorized the types of restaurants into 3 types, including restaurants of other or unknown type, restaurants for sit-down dining, and restaurants for fast food (drive-up service or pay-at-counter). As Figure 2 shows, the majority of incidents occurred in restaurants of other or unknown type. This could be because fast food restaurants have established systemized cook procedures.
It is not easy to rank the severity of outbreaks for each cuisine because the severity of outbreaks and illness is related to mortality and hospitalization rates, the profile of the causative microorganisms, and health status of the host. However, the breakdown of cases per outbreak does provide clues for each group (Figure 3). For most years, Mexican foods showed the highest number of outbreaks as compared to Chinese, Italian, and Japanese foods, while the lowest number of outbreaks related to all 4 ethnic food groups occurred in 2004 and 2009 (Figure 3).
As Figure 4 shows, taking into consideration confirmed etiologies at restaurants, 2727 cases of outbreaks associated with Mexican foods occurred in restaurants between 2001 and 2009. The majority of the species of microbial causes were S. enterica (n = 1486), followed by norovirus (n = 694), Clostridium perfringens (n = 151), Campylobacter jejuni (n = 121), B. cereus (n = 111), shiga toxin-producing E. coli (n = 92), Shigella sonnei (n = 23), S. aureus (n = 21), and other bacteria (n = 16).
The total number of outbreaks associated with Chinese foods occurring in restaurants was 113 between 2001 and 2009 (confirmed etiology). B. cereus made up the majority of bacterial causes with 52 cases (Figure 5). The next highest cause was norovirus with 36 cases, followed by E. coli and others with 5 cases. C. jejuni, S. aureus, other campylobacters, and other bacteria comprised 4% each.
Between 2001 and 2009, 336 cases of foodborne illness outbreaks associated with Italian foods occurred in restaurants (confirmed etiology). As Figure 6 shows, norovirus (n = 259) ranked 1st of the causative agents, followed by S. aureus (n = 40), B. cereus (n = 17), various chemicals (n = 7), C. perfringens (n = 6), S. enterica (n = 5), and other bacteria (n = 2).
The total number of cases in outbreaks associated with Japanese foods occurring in restaurants was 298 between 2001 and 2009 (confirmed etiology). As Figure 7 shows, the majority of causes were S. enterica (n = 211), norovirus (n = 72), other bacteria (n = 5), Campylobacter (n = 4), S. aureus (n = 2), B. cereus (n = 2), and scombroid toxin (n = 2), in descending order.
In sum, the foodborne illness outbreak trends, based on CDC data analysis from 2001 to 2009 of the current study, showed that Mexican foods resulted in the highest number of outbreaks as compared to Chinese, Italian, and Japanese foods. This is consistent with the CDC data from 1990 to 2000 (Simonne and others 2004). S. enterica ranked 1st of the causative agents of outbreaks in Mexican and Italian foods, B. cereus ranked 1st of the causative agents of outbreaks in Chinese foods, and norovirus ranked 1st of the causative agents of outbreaks in Japanese foods.
In our recently completed study (Lee 2012), an evaluation of microorganisms was determined in 4 different types of local ethnic restaurant food samples (Mexican, Italian, Chinese, and Japanese) procured from Columbia, Missouri. The results from a total of 24 food samples showed that less than 1 log CFU/g Bacillus was found in all tested food samples, while coliforms, E. coli, S. aureus, and Salmonella were not detected in any of the samples. Total aerobic counts of Mexican food samples averaged 4.73 ± 0.34 log CFU/g, that for Italian averaged 1.40 ± 1.15 log CFU/g, and those for Chinese and Japanese food samples, respectively, averaged 0.55 ± 0.95 log CFU/g and 4.70 ± 0.88 log CFU/g. Mexican and Japanese food samples showed the highest number, and Chinese samples showed the lowest number of aerobic counts. The assessments of the 4 types of ethnic restaurant food samples in Lee's report showed that the highest aerobic counts in food samples were in Mexican samples, and these results were consistent with the CDC (2011) data analysis provided above. Lee (2012) pointed out that regardless of the type of ethnic cuisines, those containing cooked ingredients have fewer microbial quality and safety issues than those containing raw ingredients, such as raw tomato, onion, and cilantro in Mexican food, and raw fish in Japanese food.
Foodborne disease is regarded as an important public health issue in the United States, and ethnic restaurants are some of the major places from where foodborne outbreaks originate (Mead and others 1999; Olsen and others 2000; Hedberg and others 2006). Furthermore, ethnic foods contain unfamiliar ingredients, flavors, and features, and this unfamiliarity with ethnic cuisines is often accompanied by uncertainty and risk.
Risk perception of ethnic cuisine is an important issue because of the potential negative influence it has on consumers’ visits to ethnic cuisine restaurants. There are 2 dimensions of risk perception: 1) the probability of a particular event occurring during a period of time (such as how often foodborne illness outbreaks occur); and 2) the seriousness or scale of outbreak consequences (how serious the foodborne illnesses are) (Breakwell 2007). Risk perception was defined by Yeung and Morris (2006) as “the uncertainty that consumers face when they cannot foresee the consequences of their purchase decisions” or “the individual judgment of the likelihood that a consequent loss could occur and the seriousness of its likely consequences.”
Risk perception consists of 5 types: functional risk, physical risk, financial risk, psychological risk, and time risk. Functional risk refers to the risk that the product will not perform as expected, physical risk refers to the risk to self and others that the product may pose, financial risk refers to the risk that the product will not be worth its cost, psychological risk refers to the risk that a poor product choice will bruise a consumer's ego, and time risk refers to the risk that the time spent in product search may be wasted if the product does not perform as expected (Schiffman and Kanuk 2007; Goyal 2008).
Perception of risk involves financial loss, time loss, and physical loss, thus it influences the willingness to purchase (Roehl and Fesenmaier 1992; Mitchell 1998; Mitra and others 1999). Ample studies have shown a negative relationship between risk perception and subsequent purchase behavior in the consumer marketing context (Bauer 1967; Cunningham 1967; Roselius 1971; Mitchell and Boustani 1992). Specifically, Park and others (2005) found negative impacts of online shoppers’ perceived risk of inaccurate website product presentation on Internet shopping purchase intentions. Yeung and Morris (2001a) supported the negative impact of risk perception on the attitudes and behavior of consumers with respect to the purchase of chicken products, and Roselius (1971) supported the strong link between risk perception and the purchase of products. Kim and others (2005) found that perceived risk was negatively correlated with consumers’ online airline ticket purchase intentions, and perceived risk significantly affected consumers’ willingness to purchase online airline tickets.
The negative influence of risk perception on consumer behavior has been supported in food-related research. Yeung and Morris (2001b) observed that bacterial outbreaks, bovine spongiform encephalopathy, and alleged risks associated with genetically modified organisms found in foods negatively affect consumers’ confidence in the “healthiness” of food products. From this perspective, it is probable that risk perception affects consumer intentions to visit ethnic restaurants. Our recent completed study (Lee 2012) supported the negative influence of consumers’ risk perception toward Chinese cuisines on consumer intentions to visit ethnic cuisine restaurants. Specifically, this study identified the impact of protection motivation on risk perceptions. People evaluate specific foods when they perceive a health threat and adjust their behavior to the threat. This psychological mechanism process is called protection motivation (Rogers 1975). Our study (Lee 2012) showed that the evaluations of threats, including the perceived seriousness of foodborne illnesses and the perceived probability of foodborne illness outbreaks do influence consumer risk perception of ethnic cuisines. In other words, people who perceive foodborne illness as being serious have a higher risk perception, and those who perceive foodborne illness as something that occurs often also show a high-risk perception of ethnic cuisines.
Food Safety in the Restaurant Industry
Despite over 150 y of advances in food microbiological processes and the latest in molecular biology techniques, increased reports of foodborne diseases indicate that food safety is still not assured (Griffith 2000; Redmond and Griffith 2003). Griffith (2006) pointed out various reasons for this, such as “changing patterns of food consumption, a change in cooking/shopping practices to weekly or monthly shopping rather than daily, greater times of eating out, changes in farming practices, evolution of existing and new food pathogens, and a lengthened gap between production and consumption.” It is interesting that more ethnic cuisines also contribute to an increase in foodborne illness outbreaks. The FDA Retail Food Steering Committee recommends that regulatory agencies focus their efforts on reducing the occurrence of the factors most commonly identified by the CDC as being associated with foodborne illness outbreaks, including food from unsafe sources, inadequate cooking, improper holding temperatures, contaminated equipment, and poor personal hygiene (Mauer and others 2006). The FDA established a goal of reducing the percentage of “out-of-compliance” risk factors by 25% by 2010 in institutional food service, restaurants, and retail food establishments (FDA Natl. Retail Food Team 2004; Mauer and others 2006; Fraser and Alani 2009). Although food safety/sanitation is important in the food industry, not many studies compared ethnic foods and restaurants to nonethnic foods and restaurants. Moreover, few studies examined the role of safety and sanitation issues of ethnic foods and restaurants in consumer behaviors. Satow and others (2009) examined sanitation levels of a sample of 290 restaurants in San Francisco and found that Italian and Japanese restaurants scored high in sanitation performance, whereas Chinese and Mexican restaurants scored low.
Some studies have indicated that, in the United States, eating in restaurants involves a high risk of foodborne disease transmission (Hedberg and others 2006). Ethnic restaurants have a higher probability of causing foodborne illness outbreaks because they typically use unfamiliar ethnic ingredients, their employees may lack ethnic food knowledge, and their employees may be divided by ethnic cultural issues (such as communication difficulties) (Simonne and others 2004).
HACCP Program in the Hospitality Business
HACCP is a system developed to prevent foodborne illness by monitoring and controlling food processing procedures (Sun and Ockerman 2005). In 1999, HACCP was proposed as an innovative approach to improve food safety in restaurants (Allwood and others 1999). HACCP has 7 principles (Boehnke and Graham 2000): “Analyze hazards, identify critical control points, establish preventive measures with critical limits for each control point, establish procedures to monitor the critical control points, establish corrective actions to be taken when monitoring shows that a critical limit has not been met, establish procedures to verify that the system is working properly, and establish effective record-keeping to document the HACCP.” In a HACCP system, identification of PHF is important. According to the FDA Food Code, PHF are foods that can support the growth and toxin production by pathogenic microbes. The specific water activity and pH associated with PHF is 0.85 and 4.6 or above, respectively (FDA 2013b). A properly implemented HACCP system is designed to prevent the risk of foodborne illnesses associated with PHF. There are differences between an inspection and a HACCP audit. Typically, the major goal of an inspection is to answer the question “Is it clean?” (Boehnke and Graham 2000). Inspections are focused on the cleanliness of the environment in which the food is handled and on the temperature of foods. On the other hand, the HACCP audit process is focused on making sure that the operator examines and records the entire process, including purchases, arrival, storage, handling, preparation, service and packing, and shipping. Overall, the audit puts more emphasis on specific potential danger points (Boehnke and Graham 2000).
HACCP implementation is less common in small food facilities with less than 50 staff members than in larger food facilities (Panisello and others 1999). In their university restaurant study, Soriano and others (2002) also noted that the HACCP system is often not correctly implemented in small working spaces and with low numbers of employees. Adoption of HACCP in small companies is not easy because it requires significant mindset changes, expertise, time, and money (Taylor 2001). Taylor (2001) suggests that there are 4 problems with implementing HACCP in small food facilities:
Because small food facility operators often think they already provide safe enough food, it is difficult to change their beliefs and motivate them to adopt HACCP.
Implementation of HACCP requires information, food safety knowledge, skills, and hygiene training. Unfortunately, small food facilities are limited when it comes to those resources. According to Holt (personal communication, October 1999), employees’ levels of experience and technical qualifications affect the successful implementation of HACCP. A lack of food safety skills and knowledge is problematic in small food facility operations because their employees typically participate in incomprehensive short courses.
The training department in large companies can afford to provide comprehensive HACCP training, whereas small companies often cannot.
The requirement for documentation for HACCP is cumbersome.
If the above difficulties can be conquered, there are several benefits to small food facilities for implementing HACCP. Taylor (2001) listed several, based on previous studies. First, when it works well, implementation of HACCP can provide the operator with confidence. Second, HACCP is more effectively done in a small food operation and can result in reduced costs. Third, adoption of HACCP can be a legal defense when an outbreak of foodborne disease happens, since HACCP is the most effective management tool to secure safe food. Fourth, the success of implementing HACCP helps organizations to easily adapt to new circumstances because they have already developed new skills and knowledge in the workplace.
In a restaurant study about HACCP program implementation in Iowa and Kansas, employee knowledge and time, and also manager knowledge, were found to be the 3 top obstacles to implementing HACCP programs (Roberts and others 2005). Food facility operators implement a HACCP program with reasons for self-improvement and legal compliance (Mortimore 2001). Previous studies of HACCP in foodservice areas highlight the positive impact of HACCP systems in various places, from universities to the airline industry (Kang 2000; Soriano and others 2002; Sun and Ockerman 2005). Kang (2000) showed in detail that the implementation of HACCP improved food safety in in-flight foods. Soriano and others (2002) examined a university restaurant before and after implementation of a HACCP system and found improvement in microbiological quality and food safety. Lack of education and proper training on HACCP can negatively affect attitudes toward food safety (Toh and Birchenough 2000), thus, regular and frequent HACCP practices are needed to produce safer food (Baker 2002). Training at restaurants is very closely related to HACCP practices because regular and appropriate training results in higher levels of food safety and leads to better HACCP practices. Most ethnic food restaurants are small food facilities, so they should consider the burdens of HACCP as listed above. However, since ethnic food restaurants may have more food safety concerns regarding foodborne illness outbreaks, the implementation of HACCP is more vital and seems to be an important factor in ensuring safe ethnic foods.
Food Safety Training
Food safety training is an effective way to prevent foodborne illness outbreaks in ethnic restaurants. The positive impact of training in the food service business is supported by previous studies. Using research conducted from 1998 to 2000, researchers found that untrained staff was cited 100 times as contributing to food poisoning outbreaks (Worsfold and Griffith 2003). Howes and others (1996) noted that 97% of foodborne illness in food service establishments was due to inadequately trained staff. In the study by Worsfold and Griffith (2003) of a food catering service, evaluations of caterers’ hygiene issues, perceptions of risk toward food safety, and attitudes toward perceptions of HACCP were compared before, during, and after training. The results of Worsfold's study show improvement in awareness and knowledge of HAACP after training. Martinez-Tome and others (2000) collected samples from 4 school kitchen salads before and after the staff had received training about food handlers’ hygiene practices. The comparison showed that the number of bacteria in the food sample decreased after training (Martinez-Tome and others 2000). This result supports the importance of food safety education and training.
The effect of food safety training as a method to reduce foodborne illness is obvious; however, food safety training that acknowledges different cultures and learning styles is lacking even though the percentage of foreign workers in ethnic restaurants is relatively high compared to nonethnic restaurants. Po (2007) pointed out that ethnic restaurant food handlers’ limited ability to speak in English and different cultural factors may result in miscommunication with food inspectors. Understanding the different cultural factors of foreign food handlers, such as body language, values regarding time, and food culture, is very important to prevent foodborne illness outbreaks. Po and others (2011) pointed out that appropriate translation and culturally appropriate or sensitive approaches to food safety is required for effective food safety education training for ethnic food handlers. Cho and others (2012) argued that Latino(a) restaurant employees tend to follow more appropriate food safety practices when food safety training focuses on benefits of their restaurants because the culture of Mexico and other Latin American countries is based on collectivism, so Latino(a) workers are more interested in group, family, or extended relationships than individual ones. Thus, food safety training for ethnic restaurant handlers can be effective in preventing foodborne illness if cultural components are reflected and taken into consideration.
Restaurant Inspection Scores
In order to prevent foodborne disease, restaurant inspections are conducted by local, county, or state Health Dept. personnel, and scores can be accessed by the public through the Internet or local news media (Jones and others 2004). Restaurant inspections are usually done twice a year in the United States (Allwood and others 1999). There are different types of inspection systems existing in the United States. The restaurant inspection system varies depending on the state or locality. In Los Angeles county, a restaurant hygiene grade card system is utilized. The grading system was introduced in 1998, and letter grades, based on numeric inspection scores (90 to 100 = A, 80 to 89 = B, 70 to 79 = C) are utilized by the Health Dept. These grades must be posted within 5 feet of a restaurant's point of entry (Fielding and others 2001; Simon and others 2005). In Tennessee, inspection evaluation is based on 44 items that yield a possible total score of 100. Out of 44 items, 13 are critical, measuring violations “which are more likely to contribute to food contamination, illness, or environmental degradation, represent substantial public health hazards, and are most closely associated with potential foodborne disease transmission” (U.S. Dept. of Health and Human Services 2001; Jones and others 2004). The Natl. Restaurant Assn., one of the most reputable associations representing the United States restaurant industry, agreed to make inspection reports public documents. However, they complained that poor-quality notes have caused them to question the inspectors’ abilities as professionals or food specialists (Boehnke and Graham 2000).
The positive effect of restaurant inspection on maintaining restaurant food safety and predicting foodborne outbreaks has been studied (Irwin and others 1989; Buchholz and others 2002). Allwood and others (1999) pointed out that researchers question the importance of restaurant health inspections as a food safety strategy. In order to determine whether restaurant inspections generate major benefits or not, Allwood and others (1999) also examined whether a positive relationship between the sanitary rating of a restaurant and the frequency of a restaurant inspection exists. Their findings confirmed that restaurant health inspections play an important role in maintaining restaurant food safety (Allwood and others 1999).
The effect of the inspection score on decreasing foodborne diseases was determined by Simon and others (2005). Comparing Los Angeles county to the rest of California between 1993 and 2000, Simon and others (2005) examined the number of foodborne disease hospitalizations caused by infectious agents (Salmonella, Campylobacter, E. coli, and other bacteria), and the overall number of foodborne disease hospitalizations each year. Their findings showed a significant reduction of foodborne disease hospitalization in Los Angeles County compared to the rest of California after the introduction of the grade card system in Los Angeles County (posting the inspection score at the restaurant's entrance).
The literature overwhelmingly agree that food facility inspection programs provide a strong incentive for facilities to instill good sanitary and hygienic practices among their employees, which, in turn, may contribute to reducing the risks of foodborne illness outbreaks associated with the specific restaurants (Irwin and others 1989; Buchholz and others 1999). Jin and Leslie (2003) found that restaurant hygiene grade cards (displaying food safety inspection grade cards in restaurant windows) contribute to increased consumer sensitivity to restaurant food safety, and that encourages operators to improve their hygiene. Use of such Los Angeles grade cards led to a 20% reduction in foodborne illness hospitalization. Therefore, the inspection scores of ethnic food restaurants can accurately represent the degree of food safety at ethnic food restaurants. Good inspection scores are regarded as outcomes following clean and hygienic restaurant practices.
Food safety in independent ethnic restaurants must be improved when we consider the low inspection scores of these restaurants and the foodborne illness outbreaks associated with ethnic foods (Kwon and others 2010). These authors compared the food code violations between nonethnic restaurants and ethnic restaurants in Kansas. They found that ethnic restaurants showed significantly higher numbers of violations. The greatest number of food code violations was “potentially hazardous foods must be maintained at appropriate temperature of 5 °C or less” (39.2%), “equipment and utensils must be clean to sight and touch” (28.8%), “employees wash hands at appropriate times” (22.6%), “food should be clearly marked to indicate the date food should be consumed by, sold, or discarded” (18.8%), and “person in charge is able to demonstrate knowledge of foodborne disease prevention and application of HACCP” (17.6%). Choi and others (2011) also argued that customized training for Asian restaurants is required based on the results of a review of 326 restaurant inspection reports of 156 independent Asian restaurants in Kansas which showed numerous critical Food Code violations.
U.S. Regulation of Imported Foods
The safety of imported foods is associated with the safety of ethnic foods because many of the ingredients used in ethnic foods are imported from various countries. Imported foods comprise around 15% of U.S. food consumption (Neily 2012). According to the CDC, 39 foodborne outbreaks resulted in 2348 illnesses between 2005 and 2010. These outbreaks were all associated with imported food. On January 4, 2011, President Obama signed the Food Safety and Modernization Act (FSMA) ensuring not only the safety of the U.S. food supply, but also the safety of imported foods by strengthening the food safety system. The FSMA gives FDA the authority to ensure that imported foods should match the standards required for domestic foods. The implements which met the standards are “Importer accountability,” “Third party certification,” “Certification for high risk foods,” “Voluntary qualified importer program,” and “Authority to deny entry.” In detail, importer accountability gives foreign suppliers the responsibility for maintaining adequate preventive controls to ensure food safety; 3rd-party certification requires the FSMA to establish a program which can certify that foreign suppliers comply with U.S. food safety standards through credible 3rd parties; certification for high-risk foods gives the FDA a right to check and request a reliable 3rd-party certification of high-risk imported foods; the voluntary qualified importer program requires the FDA to establish a voluntary program for importers so importers participating in the program are eligible for the prompt food safety tests and entry; and authority to deny entry gives the FDA a right to refuse entry of food from foreign facilities when the county in which the facility is located denies access to the FDA (FDA 2013a). Even though the U.S. FDA makes an effort to ensure imported food safety through regulations, it is questionable how the consumer perceives imported food safety. The information concerning imported foods is provided to consumers from the country of origin. According to the Country of Origin Labeling (COOL) law, which became effective through the USDA in 2009, all imported foods must indicate from which countries they originated (Hostetler 2008). Consumer behavior researchers agreed that a large percentage of consumer evaluations of foreign products depends upon the dimensions of a country's image, such as level of economic development (Juric and Worsely 1998). Consumers show a tendency to perceive industrial products from developed country more positively than imported products from an undeveloped country (Schooler 1971; Gaedeke 1973; Wang and Lamb 1983). Possibly, food safety perceptions of imported foods are related to country of origin regardless of the actual food safety issue. This current study proposes that detailed information concerning imported food safety is helpful to consumers. Numerous consumer behavioral studies support the positive effects of product information on consumer's willingness to pay, intention to purchase (Devine and Marion 1979), and favorable attitudes (Kozup and other 2003). When considering the role of information in consumer behavior, providing more detailed information about imported foods might be an effective way to gain the trust of consumers.
Even though the best-known ethnic foods in the United States—Mexican, Italian, Chinese, and Japanese—are regarded as mainstream foods, in-depth literature reviews of ethnic cuisines are scant. The history of ethnic cuisines begins with ethnic population immigration into the country in the 18th century, and now the ethnic food market is expected to increase to $3.9 billion by 2016. Food safety professionals have observed that the number of foodborne illness outbreaks associated with ethnic cuisines has increased as sales of ethnic cuisines have risen. The statistical analyses of this current review showed that between 2001 and 2009, 2727 cases of outbreaks associated with Salmonella, norovirus, C. perfringens, C. jejuni, B. cereus, and E. coli were associated with Mexican restaurants; 113 cases of outbreaks due to B. cereus, norovirus, C. jejuni, S. aureus, and Campylobacter were associated with Chinese restaurants; 336 cases of outbreaks linked to norovirus, S. aureus, B. cereus, C. perfringens, and S. enterica were associated with Italian restaurants; and 298 cases of outbreaks due to S. enterica, norovirus, B. cereus, Campylobacter, and S. aureus were associated with Japanese restaurants.
This review identified the main causes of foodborne illness outbreaks linked to ethnic cuisines. In the case of Mexican foods, fresh vegetables were the main cause, and in the case of Japanese foods, raw fish was the main cause. Lee's (2012) study also argued that fresh ingredients, not cooked ingredients, among ethnic foods contribute to foodborne illness outbreaks rather than particular types of ethnic foods. Po (2007) pointed out that the main reason ethnic foods are associated with foodborne illness outbreaks is that food handlers are not familiar with the ingredients of ethnic foods. Food safety issues are critical because they are directly related to human health, and also increase consumers’ risk perceptions toward ethnic cuisine which, in turn, can result in a decrease in ethnic foods sales.
More foodborne outbreaks are expected as consumption of ethnic cuisines increases. However, they may vary depending on food safety efforts by the restaurant industry and regulatory agencies. The current study provides some suggestions to ensure ethnic food safety by reviewing factors from previous studies that can prevent foodborne illness outbreaks. First, HACCP system implementation can ensure food safety at both small and large ethnic cuisine restaurants. HACCP program implementation can have positive effects on the prevention of foodborne illness outbreaks by monitoring and controlling food processing procedures. However, HACCP program implementation at small ethnic cuisine restaurants is limited compared to large food facilities, because it requires food safety information, and food safety knowledge and skills. Second, effective training can ensure food safety at ethnic cuisine restaurants. This review shows the positive impact of food safety training on the prevention of foodborne illness outbreaks. It is essential to keep in mind, however, that food safety training at ethnic restaurants requires special attention to ethnic food handlers’ unique cultural factors. Third, a restaurant inspection system can help to ensure food safety. This review shows that ethnic cuisine restaurant operations reported more food code violations compared to nonethnic cuisine restaurants. Restaurant inspection evaluation is disclosed to consumers, and is directly related to restaurant sales. As a result, restaurant operators scheduled for regular inspections make a conscientious effort to maintain good hygiene. Additionally, this review proposes that providing information about imported food safety could be an effective way to reduce risk perception toward ethnic food products.
Even though more foodborne disease outbreaks have been expected as consumption of ethnic cuisines increases, there is a lack of research centered on ethnic foods. This review focuses on only the most popular ethnic foods. As consumption of ethnic cuisine is expected to increase overall, more diverse ethnic cuisines will exhibit unique food safety issues. Therefore, future research is needed to provide a more comprehensive understanding of various types of ethnic foods.
The authors sincerely thank Dr. Lillian Po for her invaluable input and suggestions during the course of this work.