Perceptions and Practices Related to

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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
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.
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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)

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Hispanic-Latinos Reproductive Health

• HL fastest growing U.S. minority group
• 14.2 of U.S. population
• 47 immigrants
• Pregnancy outcome rates, 19982002
• 93.30/yr Live births
• 100.30/yr Fetal loss
• 10.05/yr PTD
• 5.61/yr LBW
• Limited research on HLs health behaviors
• Listeriosis and pregnancy complications

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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 45C
• Incidence higher in HL
• Infants
• Women of childbearing age

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Listeriosis Rate by Ethnicity FoodNet
Sites,19962003
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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

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Listeriosis and Pregnancy

• Transmission
• Ingestion of contaminated food
• Transplacental
• Clinical features
• 26 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

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Futura Mamá
Qualitative and Quantitative Study on Health
Behaviors

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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

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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 countys HL population
• Catholic Church in Gainesville, GA.
• Membership of 16,000 HL
• Participants enrolled by age group and gender
• 7 Womens groups (1825, 2632, 3340, gt41 years)
• 1 Mens group (gt18 years)

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Focus Group Participants

• 76 participants (616 participants per group)
• 70 born in Mexico
• 53 women childbearing age
• (range 1840 years)
• 5 pregnant women

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Perceptions of Focus Groups Participants (N76)

• 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

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Focus Group Findings

• Compared to older women, women aged lt32 (n35)
  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

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Quantitative StudyCommunity Survey, Hall County,
GA19.6 HL
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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

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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

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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

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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

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Health Communication Channels
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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

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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

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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

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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

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Acknowledgments

• Office of Minority and Womens Health, NCID, CDC
• Marian McDonald, PhD
• Georgia State DOH
• Susan Lance-Parker,D.V.M., PhD
• Melissa DAngelo
• 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.