INTRODUCTION
PROBLEM STATEMENTS
The Agricultural Revolution significantly increased food production and improved laborers' health, contributing to human capital development Ensuring food safety is crucial, as disruptions can negatively impact sustainable development and national security in developing countries Recent outbreaks of food-related diseases have shifted global focus from merely increasing food quantity to ensuring food safety, highlighting its importance for public health and economic stability.
The widespread use of pesticides, chemical fertilizers, and feedstuffs enhances agricultural productivity, but their overuse and misuse compromise food quality Additionally, preservation, processing methods, and the misuse of food additives can further reduce food safety According to WHO (2015), bacteria, viruses, parasites, chemicals, and toxins are the primary causes of foodborne diseases Vulnerable populations such as children, pregnant women, and the elderly are most at risk of foodborne illnesses.
Due to the development of transportation and international trade, food safety issue is not only the problem of any countries but also a global problem For examples:
Chinese milk scandal, New Zealand material milk crisis caused an enormous loss for the manufacturer and impinge on other countries as well as consumer’s health
1 World Health Organization (WHO) and Food and Agriculture Organization (FAO) defined:
“Food safety is the assurance that food will not cause harm to the consumer when it is prepared and eaten according to its intended use” (WHO and FAO, 2009, p 6).
Figure 1.1: The number of food-borne cases annually (WHO, 2015)
Foodborne diseases (FBD) occur worldwide, with developing regions like Southeast Asia and Africa experiencing the majority of cases Despite limited food sources and weaker food safety controls, African countries report fewer foodborne illness cases than Southeast Asia, possibly due to the region's diverse high-nutrition foods and tropical climate, which create ideal conditions for bacteria and other pathogens to impact human health In contrast, developed areas such as Europe and America report the lowest numbers of foodborne cases, highlighting regional differences in food safety and environmental factors.
WHO (2015) estimated that every year food-borne disease cause almost 10% global populations to fall ill and responsible for 420,000 deaths (one third are children)
Among all FBD, diarrheal diseases are the most common illnesses resulting from
Africa unsafe food, accounted for half of global burden of FBD and made 550 million people falling ill (including 220 million children), cause 230,000 deaths (96,000 children’s)
Figure 1.2: The number of death caused by FBD annually (WHO, 2015)
The number of deaths caused by foodborne diseases (FBD) mirrors the trend observed in foodborne illness cases, with Southeast Asia and Africa experiencing the highest mortality rates, while Europe and America report the lowest The African region has fewer FBD-related deaths compared to Southeast Asia, potentially due to greater international medical support in Africa Additionally, differences in the physical resilience of local populations between these regions may also contribute to the variations in mortality figures.
The FBD caused the burden about 33 million DALYs 2 Diarrheal diseases agents were the largest contributors, accounted for 18 million DALYs, 54% of total All three
Disability-adjusted life years (DALYs) are a comprehensive measure of global health, combining years of life lost due to premature death (YLL) and years lived with disability (YLD) This metric effectively quantifies the burden of disease by capturing both mortality and morbidity, making it a vital tool for health impact assessments and policy planning By understanding DALYs, health professionals and policymakers can identify priorities, allocate resources efficiently, and evaluate interventions' effectiveness in reducing overall health gaps.
Africa figures 1.1, 1.2, 1.3 both indicated that South East Asian and African region’s food safety issue is severe and these areas suffered an enormous burden from FBD
Despite fewer death cases in Africa compared to Asia, the burden of foodborne diseases (FBD) in Africa is nearly twice as high as in Southeast Asia and significantly exceeds other regions In contrast, Europe, the Western Pacific, and the Americas have a combined FBD burden comparable to Southeast Asia, but only half of Africa's These disparities highlight the effectiveness of healthcare infrastructure and food safety policies across regions and their critical impact on population health outcomes.
FBD (WHO, 2015) highlights the varying degrees of severity in the burden of disease, emphasizing that time is the main metric for measuring death and disability One DALY (Disability-Adjusted Life Year) represents the loss of one year of healthy life, providing a comprehensive measure of disease burden This approach allows for standardized comparisons across different health conditions, underscoring the importance of targeting interventions to reduce the overall impact on individuals' quality of life.
Vietnam is classified within the WHO Western Pacific region, which overall faces a mid-level global burden of food-borne illnesses This regional trend is reflected in Vietnam's data, indicating similar challenges The Western Pacific includes diverse countries, from highly developed nations like Australia, Japan, and South Korea to developing countries such as Cambodia, the Philippines, and Vietnam, leading to significant disparities in food safety contributions Detailed information about Vietnam's specific situation is provided in Chapter 4.
Developed countries also face significant challenges related to food-borne illnesses, despite the economic and healthcare advantages According to the CDC, the USA experienced 864 foodborne disease outbreaks in 2014, resulting in 13,246 illnesses, 712 hospitalizations, and 21 deaths, along with 21 food recalls The majority of food poisoning cases occurred in restaurants (65%), followed by private homes (12%), highlighting common sources of contamination Bacteria were identified as the leading cause of foodborne illnesses, responsible for 22% of cases, including both confirmed and suspected infections These statistics demonstrate that even nations with robust healthcare systems and strict food safety policies must continuously combat food-borne diseases.
CDC also predicted that food safety issue would continue emerge in the future due to:
- Changes in our food production and supply, including more imported foods
- Changes in the environment leading to food contamination
- Better detection of multistate outbreaks
- New and emerging bacteria, toxins, and antibiotic resistance
- Changes in consumer preferences and habits
- Changes in the tests that diagnose foodborne illness.
Despite the surge in immigration, increased international trade, and the challenges of globalization, food-borne diseases remain a neglected issue that transcends national borders As a pressing global health concern, food safety requires coordinated efforts and heightened awareness worldwide Addressing food-borne illnesses is essential for protecting public health in our increasingly interconnected world.
RESEARCH OBJECTIVES AND RESEARCH QUESTIONS
Vietnam's diverse food markets offer convenience for households, leading most Vietnamese families to cook and eat at home at least once a day Family food preparation habits are deeply rooted in traditional and agricultural culture, passing down knowledge of food processing and preservation through generations These cultural influences significantly shape cooking behaviors, which in turn impact the risk of food poisoning among residents Additionally, socio-economic status, individual characteristics, and living conditions also play crucial roles in influencing food safety practices within Vietnamese households.
Research studies in Thua Thien Hue Province (Duong, 2013) and Ho Chi Minh City (Nguyen, 2010) highlight a significant correlation between individuals' knowledge, attitude, and food safety practices in settings such as food factories, restaurants, and households According to the "10 Golden Principles in Food Processing" (MOH, 2005), essential food safety behaviors encompass proper hygiene, safe food handling, regular equipment cleaning, and adherence to health standards to prevent contamination and ensure food safety.
- Clean, tidy kitchen and the cooker surface
- Using waste basket with cover
- Use clean water to handle food
- Separate well-done food and raw food in processing and preserving
- Use clean tool to prepare and divide food
- Not use forbidden food additives or out of date food
- Washing hand before cooking and after toileting
- Not smoke, spit out or nail polished while cooking
These fundamental principles have been widely applied in numerous studies in Vietnam and serve as the basis for this thesis However, many of these prior researches primarily focus on the medical perspective, often overlooking the influence of socio-economic factors and individual characteristics Consequently, the impact of these variables on food safety behaviors has not been explicitly evaluated, highlighting the need for a more comprehensive analysis that considers these important determinants.
The research findings highlight the current state of food safety issues within the community but lack comprehensive analysis of multiple contributing factors to determine their specific impact Additionally, the study participants did not take part in the annual survey, which limits the understanding of long-term trends As a result, the influence of government policies and activities on food safety remains unaddressed in the current research.
This study aims to identify and assess the key factors influencing food safety behavior, including socio-economic status, knowledge about food safety, personal perceptions, and information sources Understanding these factors enables the government to develop targeted strategies to modify behaviors, reduce risky practices, and minimize the risk of foodborne diseases among the population By addressing individual causes, policymakers can effectively prevent foodborne illnesses and decrease their public health burden.
To analyze food safety behavior and health outcomes of household primary cook
- To determine the relationship between knowledge, perception of consumer and their food safety practice at household kitchen
- To evaluate the impact of individual food safety practice to their food-borne disease probability
(1) Do food safety knowledge and perception have impact on individual food safety practice?
(2) How food safety practice affect to individual food-borne poisoning risk?
SCOPE OF RESEARCH
This study analyzed survey data on individual food poisoning, focusing on household knowledge, attitudes, and practices in Ho Chi Minh City in 2013 The survey was conducted across all 24 districts of Ho Chi Minh City from March to April 2013, with primary household cooks serving as respondents Local medical staff collected the data, ensuring accurate and reliable information on food safety behaviors and awareness among residents.
Although this survey on the same theme is conducted annually, the types of participants vary each year, including householders in 2010 and 2013, and restaurant workers in 2012, 2014, 2015, and 2016 Additionally, the specific respondents within each participant category differ from year to year, with the latest household data available in 2013 As a result, the data is not consistent across years, preventing the construction of panel data for longitudinal analysis. -Simplify your survey analysis and overcome panel data gaps with Wren AI's smart GenBI platform—see how [Learn more](https://pollinations.ai/redirect/397623)
This research focuses on analyzing community behavior and acute food poisoning incidents in Ho Chi Minh City from March to April 2013 to assess the influence of various factors The study employs descriptive statistics alongside advanced econometric methods such as factor analysis, multivariate probit models, and propensity score matching to provide comprehensive insights into the determinants of food poisoning outbreaks and community responses.
THESIS STRUCTURE
Due to the available of the data, thesis is composed as the structure below:
This chapter introduces the research problem by highlighting the global burden of foodborne diseases (FBD), emphasizing their significant impact on public health worldwide It discusses the benefits of studying FBD, including improved prevention strategies and healthcare outcomes The scope of the research focuses on understanding the factors contributing to foodborne illnesses and developing effective control measures Additionally, the chapter provides an overview of FBD's prevalence and economic implications, setting the stage for the thesis's objectives—aimed at enhancing food safety protocols and reducing FBD incidence globally.
Chapter 2: Literature Review provides an essential overview of the key concepts and definitions related to the study It examines previous research on the various factors and models frequently used in this field, establishing a solid foundation for the analytic framework This chapter highlights how these models inform the methodology, enabling a comprehensive analysis of the effects of each component within the framework.
Chapter 3: Research Methodology outlines the framework and econometric tools used in the study, providing a clear structure for the analysis It details the data sources and collection methods to ensure transparency and reliability Additionally, this chapter describes the variables involved in the research, facilitating a comprehensive understanding of the methodological approach.
Chapter 4: Research Results presents a comprehensive analysis of the collected data, highlighting key findings and comparing them with existing studies to contextualize the results This chapter also includes descriptive statistics of the variables, offering clear insights into their distributions and relationships The results provide valuable evidence to support the research hypotheses and contribute to the overall understanding of the topic.
- Chapter 5: Conclusion and policy implications This chapter concludes the research finding, provides implication, further suggestion as well as the research limitations
LITERATURE REVIEW
FOOD SAFETY AND FOOD-BORNE DISEASES
Food-borne diseases (FBD) are conditions primarily transmitted through contaminated food, caused by enteric pathogens, parasites, chemical contaminants, and biotoxins (WHO, 2007) There are two main methods for estimating the burden of FBD: the etiologic agent approach, which starts with identifying exposure levels and assessing how much is food-borne, and the syndromic approach, which begins with disease outcomes like gastroenteritis and attributes a portion to food-borne sources A thorough assessment of FBD burden combines both approaches to provide a comprehensive understanding.
In 2015, WHO estimated approximately 600 million cases of foodborne illnesses and 420,000 deaths worldwide, with 40% of the disease burden affecting children under five years old (WHO, 2015) However, the data used in this study was collected via participant interviews through questionnaires, without laboratory testing of food samples Consequently, the diagnosis of foodborne disease relied on respondents’ self-assessment combined with medical staff evaluations based on individual symptom descriptions.
Food safety is defined as ensuring that food does not cause harm to human health or life, covering the entire process from growing and harvesting to preserving and processing, not just preparation and consumption (Vietnam Ministry of Health, 2010) Although this definition is less specific than that of WHO, its comprehensive scope makes it suitable for addressing food safety concerns in Vietnam Due to its broad coverage and widespread recognition among the Vietnamese population, this definition was adopted as the fundamental concept of food safety in this thesis.
THE HEALTH BELIEF MODEL
The Health Belief Model (HBM) originated from psychological theories of individual decision-making under uncertainty, where behaviors are predicted based on the evaluation of the “value – expectancy” of potential outcomes (Maiman and Becker, 1974) When adapted to healthcare, the model assumes that individuals critically assess the benefits of illness prevention and health improvement, believing that specific actions can prevent disease and enhance their well-being These health-related expectations are influenced by personal evaluations of susceptibility to illness, perceived severity of potential diseases, and the likelihood of getting sick based on their behavior According to Glanz et al (2008), the main components of the HBM include perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, and self-efficacy.
Table 2.1: The concepts of Health Belief Model
Perceived susceptibility Belief about the chances of experiencing a risk or getting a condition or disease
Define population(s) at risk, risk levels
Personalize risk based on a person’s characteristics or behavior
Make perceived susceptibility more consistent with individual’s actual risk
Perceived severity Belief about how serious a condition and its sequelae are
Specify consequences of risks and conditions
Perceived benefits Belief in efficacy of the advised action to reduce risk or seriousness of impact
Define action to take: how, where, when; clarify the positive effects to be expected
Perceived barriers Belief about the tangible and psychological costs of the advised action
Identify and reduce perceived barriers through reassurance, correction of misinformation, incentives, assistance
Cues to action Strategies to activate
Provide how-to information, promote awareness, use appropriate reminder systems
Self-efficacy Confidence in one’s ability to take action
Provide training and guidance in performing recommended action
The various components combine with individual characteristics to form three main groups of factors: modifying factors, individual beliefs, and actions These groups interact and influence one another, shaping overall behavior and outcomes The relationships, components, and impact of each group are illustrated in the accompanying figure, providing a clear overview of how these elements work together to drive specific results.
Figure 2.1: Health Belief Model Components and Linkages (Glanz et al, 2008)
Numerous studies have utilized the Health Belief Model (HBM) to analyze food safety behaviors among diverse groups, including restaurant workers (Cho et al., 2010), primary food preparers in families with young children (Lum, 2013; Meysenburg et al., 2013), and older adults (Hanson and Benedict, 2002) These studies demonstrate that HBM components interact and influence individual behaviors, with food safety knowledge having a particularly strong impact on perceptions of food safety.
EMPIRICAL REVIEWS ON DRIVERS OF FOOD SAFETY PRACTICES
Participants with college or higher degrees demonstrated significantly better food safety knowledge and practices compared to those with lower education levels (Meysenburg et al., 2013) Utilizing the Health Belief Model combined with a mixed-method approach, the researchers analyzed a sample of 72 individuals through script interviews and group discussions, providing comprehensive insights into food safety behaviors.
Modifying factors Individual Beliefs Action
Age Gender Ethnicity Personality Socioeconomics Knowledge
Perceived susceptibility to and severity of disease
According to Unusan (2005), higher education levels positively influence confidence in food safety practices, with more educated groups exhibiting fewer risk behaviors The study also determined that socio-economic status does not significantly correlate with individual food safety practices Unusan collected data from Turkish households and analyzed the findings using MANOVA techniques, highlighting the importance of education over socio-economic factors in promoting safe food handling behaviors.
Research by Unusan highlights that gender and education level significantly influence food safety knowledge, with women and highly educated individuals tending to have better understanding due to their roles as primary food preparers and increased attention to information Studies by Byrd-Bredbenner et al (2007) and Mullan et al (2014) support these findings, emphasizing that age also impacts food safety knowledge, as older individuals generally score higher Additionally, women are generally more responsible for food safety matters than men, as evidenced by Jevsnik et al (2006), with ANOVA analysis confirming these gender differences.
Research by Langiano et al (2012) found that married participants demonstrated healthier and more precise food behaviors compared to singles Additionally, larger family sizes were associated with more accurate food preparation practices by the primary cook, indicating the influence of family dynamics on nutrition habits.
Food preparers primarily acquire their food processing knowledge from family members and relatives, highlighting the significant role of family in shaping food safety practices (Meysenburg et al., 2013) Research also emphasizes that family acts as a key resource for food safety information, which influences individual food handling behaviors and safety awareness (Kwon et al., 2008).
Kwon (2006) examined participants of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) through a questionnaire assessing their food knowledge and behaviors The study utilized ANOVA analysis to determine the relationship between food knowledge and practices, finding that respondents with excellent food knowledge exhibited more precise and healthier food behaviors.
(T H Vo et al, 2015) These authors group investigated in the canteens’ and restaurant’s workers by using logistic regression model to get this finding
Research by Cho et al (2010) indicates that food safety knowledge does not significantly influence food handling practices among participants, based on their study of restaurant workers using multiple regression and maximum likelihood estimation Similarly, Roberts et al (2008) found that training and education in food safety result in only limited changes in workers’ behaviors, supporting the idea that knowledge alone has minimal impact on behavior modification in food safety practices.
High self-efficacy is associated with confidence in preventing health threats, including foodborne diseases, when individuals have control over food handling (Meysenburg et al., 2013) However, this confidence tends to decrease when others prepare the food Additionally, experiencing a foodborne illness or causing one within the family due to improper food handling can diminish an individual's confidence in their food preparation skills.
Many studies have shown mixed results on food safety perception and behavior
Research by Nesbitt et al (2013) reveals that many consumers believe food contamination primarily occurs before food reaches their kitchen, and most who experienced foodborne illness attributed it to food prepared outside the home In contrast, Unusan’s (2007) study shows that consumers often do not recognize food poisoning or foodborne diseases as serious health problems, instead considering them normal issues This misperception results in consumers being less likely to adopt proper food safety practices or pay attention to food safety concerns.
Jevsnik et al (2006) discovered that household cooks prefer farm-produced food over industrial products, believing that food from farmers is safer However, consumers generally do not see themselves responsible for food safety, instead attributing this responsibility to food handlers such as farmers, food factories, retailers, catering services, and the government Additionally, the study revealed that individuals under 30 tend to overestimate their food safety handling skills, despite evidence (Byrd-Bredbenner et al., 2007) indicating their actual abilities may be lacking.
Research by T H Vo et al (2015) highlights a significant correlation between food safety knowledge and individual attitudes toward food safety issues, though the link between attitude and actual food practices was found to be insignificant Similarly, Cho et al (2010) demonstrated that consumers with comprehensive food safety knowledge are more likely to accurately perceive the severity and risk of food poisoning Additionally, consumers with precise food safety knowledge tend to face fewer challenges and barriers when handling food safely, reinforcing the importance of education in promoting safe food practices.
This study found that while there was no direct link between knowledge and perception of foodborne disease (FBD) prevention or safe food practices, perceived benefits significantly influence individual food safety behaviors Respondents who understood the advantages of avoiding food poisoning were more likely to adopt and regularly practice safer food handling behaviors, highlighting the importance of benefit perception in promoting food safety.
Hanson and Benedict (2002) found that awareness of Food-Borne Disease (FBD) severity can enhance individual food safety behaviors However, their study indicated that the correlation between perception of FBD hazards and actual food safety practices was relatively weak These findings were determined using nonparametric statistics, specifically Spearman rank correlation coefficients, highlighting the complex relationship between awareness and behavior in food safety management.
Research by Cho et al (2010) highlights a strong correlation between cues and individual food safety practices, emphasizing that those who have previously suffered from foodborne diseases (FBD) are more likely to adopt safe food handling behaviors (Lum, 2010) However, Lum also notes that experiencing symptoms of illness does not necessarily guarantee improved or consistent safe food handling practices.
A similar result from Hanson and Benedict (2002) showed that the cue, content of communication, education material had impact to safety food practice of responders
This study reveals that males are less influenced by education compared to females, while the impact of education increases with age Additionally, the effect of education on food handling practices varies depending on an individual's frequency of food handling, highlighting the importance of targeted educational strategies for different demographic groups.
RESEARCH METHODOLOGY
ANALYTIC FRAMEWORK
Consulting from other relating research, thesis implemented the HBM framework with the components evaluated through specific variables for food safety behaviors
Modifying factors such as participants' individual and demographic characteristics, along with family background, influence food safety behaviors Knowledge primarily pertains to awareness of food safety issues, while individual beliefs are reflected in attitudes and the respondents' understanding of food safety concerns Actions are assessed through various food safety practices, with information sources serving as cues that trigger these behaviors.
Due to the limitation of the secondary data, the components from HBM measured in several variables:
- Modifying factors: age, gender, residential location, occupation, education level, number of family’s member and the knowledge about food safety issue
- Individual belief: the awareness about the food safety problem, risky group and reason of food poisoning; attitude about food selection and processing; food source chosen
- Individual behavior: hygiene, process, preserve practice
- Cues to action: the food safety information source The relatives and interactions of those components illustrated in the figure below:
ECONOMETRIC MODELS
This study employs a multivariate probit model (MVP) to analyze the impact of independent variables on different food safety behavior groups The dataset encompasses three key aspects of food safety practices: hygiene kitchen practices, food processing and preservation practices, and personal hygiene practices By utilizing the MVP with three equations, the research provides comprehensive insights into how various factors influence each specific behavior category, supporting targeted interventions to improve food safety standards.
- Food expenditure, Number of family’s member
+ TV, newspaper + Local food safety communicator
Perceived susceptibility to and severity of disease
- Attention about food safety problem
Individual beliefs significantly influence dependent variables, with the trivariate probit model effectively capturing these relationships (Cappellari & Jenkins, 2003) This model is expressed as y*ₙm = βₘ Xₙₘ + ϵₙₘ, where yₙm = 1 if y*ₙm > 0 and 0 otherwise, for m = 1, 2, 3 The error terms ϵₙₘ are assumed to follow a multivariate normal distribution with a mean of zero and a variance-covariance matrix V, which has ones on the diagonal and symmetric correlation coefficients (ρ_jk) off-diagonal, capturing dependencies among the three equations.
The log-likelihood function for the sample of N independent observation is given by:
Where ωi is an optional weight for observation i=1,…, N, and ϕ3 is the trivariate standard normal distribution with arguments ài and Ω, where
𝜇 𝑖 = (𝐾 𝑖1 𝛽 1 ′ 𝑋 𝑖1 , 𝐾 𝑖2 𝛽 2 ′ 𝑋 𝑖2 , 𝐾 𝑖3 𝛽 3 ′ 𝑋 𝑖3 ) With Kik=2yik – 1, for each I, k = 1,…,3 Matrix Ω has constituent elements Ωjk, where: Ωij = 2 for j =1,…,3 Ω21 = Ω12 = Ki1Ki2ρ21 Ω31 = Ω13 = Ki3Ki1ρ31 Ω32 = Ω23 = Ki3Ki2ρ32
The probability of every outcome is given by:
This study assesses nine food safety practices, categorized into three behavior groups: hygiene kitchen practices ("kprac"), process and preserve practices ("pprac"), and individual hygiene practices ("iprac") Each practice is scored as 1 for correct implementation or 0 for incorrect, with the overall group considered correct only if all behaviors within it are correctly performed The behaviors are based on the "10 golden principles in food processing," including key actions like maintaining a clean, tidy kitchen and cooker surface, and properly separating cooked and raw foods during processing and preserving For ease of evaluation, some behaviors, such as maintaining a clean kitchen and separating cooked from raw foods, are divided into multiple specific tasks This comprehensive approach ensures accurate assessment of food safety practices aligned with best food processing standards.
- “sex” is the dummy variable indicate the sexuality of participant, 0 for male and
1 for female The expected regression coefficient of this variable is predicted insignificant, due to the fact that most of the responders were females;
The variable "loc" functions as a dummy indicator of the responder's location, where 0 denotes suburban participants, encompassing districts such as Binh Tan, Binh Chanh, Thu Duc, Go Vap, Districts 9, 12, 6, 8, Nha Be, Can Gio, Cu Chi, and Hoc Mon Conversely, a value of 1 signifies urban participants, including 12 specified districts within the city.
Urban participants from districts such as 1, 2, 3, 4, 5, 7, 10, 11, Phu Nhuan, Tan Binh, Tan Phu, and Binh Thanh are more likely to exhibit precise behavior, as indicated by the predicted positive regression coefficient This suggests that residents in urban areas tend to perform better in the evaluated activity compared to their suburban counterparts.
In the study, the variables "age," "exp," and "f_member" represent the individual's age in years, the family’s food expenditure in hundred thousand VND, and the number of family members, respectively The expected regression coefficients for these variables are anticipated to be positive To improve the statistical analysis, the thesis employs the natural logarithm transformations—specifically, ln(age) and ln(exp)—to normalize these variables, ensuring more reliable and accurate coefficient estimates.
In our study, the variables “job” and “edu” serve as key categories representing respondents' professional background and education level "Job" includes categories such as office clerk, retirement, household lady, physical labor, and farmer, while "edu" captures education levels ranging from primary, junior high, high school, college or university, to below primary To simplify analysis and enhance interpretability, we transformed these categorical variables into numerical formats: “edu” was represented by years of schooling, and “job” was condensed into broader categories such as householder (hholder), common labor (com_labor), and others This approach reduces the number of dummy variables and facilitates clearer insights into the relationship between education, occupation, and other variables in the study.
The variable "know" assesses participants' food safety knowledge based on a questionnaire aligned with WHO standards, dividing into two categories: food safety selection and food processing and preservation Participants' scores, derived from their survey responses, reflect their level of knowledge and are calculated using the difficulty index method (Collen, 2006, pp 98-100), providing a comprehensive measure of food safety awareness.
𝑁 , where: ρ: difficulty index nc: the number of right answer
N: the total number of responders
The term "per" indicates participants' perceptions related to food safety issues, assessed through a questionnaire focusing on four key areas: susceptibility to and severity of foodborne diseases (FBD), perceived benefits of food safety measures, perceived barriers, and self-efficacy Despite limited data, the study employed Factor Analysis to identify underlying perception factors from three of these four groups, excluding the perception of benefits This approach provided valuable insights into consumer attitudes toward food safety, emphasizing the importance of understanding these perceptions for effective food safety interventions.
The “cue” variable represents the information source respondents rely on for food safety, categorized as TV, radio, newspaper, local medical staff, or food documentary For analytical purposes, these cues are encoded as dummy variables—TV, radio, news, local_staff, and food_doc—allowing for precise assessment of their influence All variables incorporated in the model are detailed in the accompanying table, facilitating a comprehensive understanding of the factors affecting perceptions of food safety.
Sex Gender of participant 0 for male, 1 for female
Location Residential place 0 for suburb, 1 for urban
Age The age of participant Years old
Expenditure Amount of money for food consumption Hundred thousand VND Family member Number of family member Person
Education Education level The number of schooling years
Job Occupation of participant Category variable: common labor, householder, other
Understanding food safety knowledge is essential for promoting safe food handling practices Perception plays a crucial role, as awareness about food safety issues can be effectively measured using a 3-point Likert scale Additionally, cues to action, such as reliable food safety information sources—including TV, radio, newspapers, local medical staff, and food documentaries—serve as important category variables that influence public awareness and behavior towards food safety.
Multicollinearity occurs when explanatory variables in a regression model are linearly related, affecting the stability and interpretability of the model There are two types: perfect multicollinearity, where regression coefficients become indeterminate and standard errors tend to infinity, and imperfect multicollinearity, where coefficients remain determinate but have large standard errors, reducing the precision and accuracy of estimates (Gujarati, 2004) Addressing multicollinearity is essential for reliable regression analysis and accurate variable interpretation.
Studies by Cho et al (2010) and T H Vo et al (2015) examined the relationship between knowledge and perception of food safety, with perception measured using a Likert scale to indicate trends rather than the magnitude of impact Due to the large sample size of over 1,000 observations, the influence of multicollinearity in the regression model was minimized Additionally, the thesis employed both the reduced and original forms of the Moral Valence Perception (MVP) to estimate regression coefficients, ensuring comprehensive analysis of the factors influencing food safety behaviors.
3.2.3 Propensity Score Matching (PSM) Method
Chow and Mullan (2009) emphasize that past behavior is a strong predictor of future food safety practices, suggesting that providing cues can help establish food safety behaviors as habitual routines However, many consumers are often unaware of their crucial role in the food safety chain (Jevsnik et al., 2007), highlighting the need for increased awareness and education to prevent foodborne diseases effectively (Byrd-Bredbenner et al.) Implementing strategies that reinforce positive habits and highlight consumers' responsibilities can significantly reduce the risk of foodborne illnesses.
2007) Due to these reason, the consumers could hardly change their behavior in a short time period after suffering food poisoning
Individuals utilize rationality when they understand the cause-effect relationship between proper behaviors and health benefits (Mari et al., 2008) However, household cooks may find it challenging to identify incorrect practices that lead to foodborne disease (FBD) Additionally, since the food poisoning data only covers a two-week period, this study assumes that food poisoning incidents did not influence individual behaviors Consequently, the research estimates the probability of food poisoning using the Propensity Score Matching (PSM) method based on observed behaviors.
DATA
This study utilizes data from a 2013 investigation into individual food poisoning incidents in Ho Chi Minh City, alongside the 2013 Household Survey on Knowledge, Attitude, and Practice (KAP) related to food safety The research aims to analyze the causes and prevalence of food poisoning cases within the city and assess residents' awareness and behaviors concerning food safety practices By integrating these data sources, the study provides comprehensive insights into the factors contributing to food safety risks and highlights areas for targeted public health interventions in Ho Chi Minh City.
- Data source: Safety Hygiene Food Branch of Ho Chi Minh city
- Data description: the data had two parts:
+ Part 1 is the investigation in individual food poisoning and the relevant symptoms, included: individual characteristic, demographic information, food poisoning statement and clinical symptoms
+ Part 2 is the KAP survey of primary cook of household, included: individual characteristic, food safety knowledge, food safety attitude and examining the food safety practicing of primary cook
- Size of samples: 1,174 households and 4,593 individual participate in the survey The households were chosen by Probability Proportional to Size sampling technique (PPS):
Researchers selected 30 randomly chosen wards out of 319 in Ho Chi Minh City for their study In each ward, surveyors randomly selected the first household for investigation and then interviewed the next 39 households on the right side, using four questionnaires: acute food poisoning investigation, food knowledge assessment, attitude survey, and food practice evaluation The food practice checklist was completed by the surveyor, while respondents answered the other questionnaires Local medical staff responsible for food safety at each ward conducted the surveys, ensuring accurate and relevant data collection.
Participants in the survey were required to live at the same address for at least six months prior to the investigation, ensuring their eligibility Household members needed to consent to participate and share common living arrangements, including sharing meals and household responsibilities Households that were unreachable after three contact attempts were replaced to maintain the survey's accuracy and representativeness.
Participants in the survey must be free from mental illness, deafness, or speech impairments Children involved in the study should be at least 6 months old, as infant nutrition primarily involves lac feminnum at this stage For children under 10, their responses were verified by their mothers or primary guardians to ensure accuracy and reliability.
Food poisoning is typically diagnosed based on symptoms such as stomach-intestine issues—including colic, vomiting, and diarrhea—and nerve-related symptoms like tongue stiffening, hallucinations, decreased vision, delirium, or convulsions, which vary depending on the causative pathogen Importantly, a food poisoning case is confirmed only if the affected individual consumed a meal at home prior to the onset of symptoms A household is considered to have experienced food poisoning if the primary cook or any family member develops symptoms following a home-cooked meal.
This study combines data on knowledge, perceptions of food safety, and individual behaviors to assess their relevance and impact It aims to evaluate how personal understanding and attitudes influence food safety practices Additionally, the research estimates the effect of these food safety behaviors on the likelihood of food poisoning, highlighting the importance of proper practices in reducing health risks.
RESEARCH RESULTS
FOOD SAFETY PROBLEMS IN VIETNAM
According to WHO (2016), food-borne diseases in Vietnam impose an economic burden of approximately 1 billion USD annually, accounting for about 2% of the country's GDP This figure includes costs related to lost work time, decreased productivity due to illness, and associated market losses Additionally, data from the Vietnam Food Administration (VFA) between 2007 and 2015 indicate that there have been between 150 to [additional data needed to complete this point], highlighting ongoing concerns regarding food safety and public health in Vietnam.
Vietnam experiences approximately 250 mass food poisoning outbreaks annually, affecting over 5,000 people each year Despite the implementation of the National Strategy on Food Safety since 2006 and the validation of the strategy for 2011–2020, the number of food poisoning cases remains consistently around 5,000 annually.
Figure 4.1: The number of food poisoning cases in Vietnam (MOH, 2016)
The stagnation in food safety progress can be attributed to the weaknesses of legacy institutions Although the Food Safety Law was enacted in 2011, related regulatory documents remain insufficient to meet current needs, leaving the Food Safety Department without a strong institutional framework for effective administration Additionally, manufacturers and consumers lack adequate information and guidance on proper food safety practices The complex Food Safety Administration network, involving multiple ministries and departments, further hampers effective implementation Furthermore, Vietnam's tropical climate and climate change increase the risk of food poisoning outbreaks, while the diverse cuisine combined with limited consumer knowledge heightens the likelihood of foodborne diseases Despite stable food poisoning cases, the death rate has decreased slowly, with about half of these fatalities caused by natural toxins (Nguyen, 2016).
Figure 4.2: The number of food poisoning outbreaks and death in Vietnam
In Ho Chi Minh City, food poisoning incidents have shown a decreasing trend annually, with a total of only 20 cases reported between 2012 and 2016 and no recorded deaths The majority of these cases, 19 out of 20, were caused by bacteria, while the remaining incident had an unidentified cause, highlighting ongoing improvements in food safety and public health efforts in the region.
Figure 4.3: The number of food poisoning cases in HCM city (FSBDH, 2016)
Food poisoning cases in Vietnam and Ho Chi Minh City are underreported, partly due to limited government oversight and research attention on this critical public health issue Consequently, there are few effective programs focused on educating households about safe food preparation and cooking practices The government's resources are primarily allocated to regulating manufacturers and managing merchandise, leaving a gap in community-level food safety initiatives Strengthening public awareness and implementing targeted food safety education are essential to reduce food poisoning incidents in the region.
However, the finding from the survey in 2013 show that the individual food poisoning ratio is 2.18% That figure implies the high possibility of population with food-borne diseases
4.1.2 Problems with household’s cooking behavior
The Vietnamese government's insufficient attention to household food safety has led to poor cooking practices among primary cooks A 2010 investigation by the Safety Hygiene Food Branch of Ho Chi Minh City revealed widespread issues, highlighting the need for enhanced awareness and improved food safety measures at the household level.
54.3% of consumers in Ho Chi Minh city behave accurately in cooking The figures for Lao Cai province and Dong Thap Province are 67.7% and 76%, respectively (Nguyen,
Research indicates the need for targeted education programs to improve household cooking behaviors; however, most communication strategies focus primarily on food producers and workers Household food poisoning risks are often perceived as less severe compared to incidents in schools and factories, leading to underestimated importance Additionally, urban consumers frequently dine outside their homes due to busy work schedules and convenience, which diminishes the focus on household cooking practices Consequently, there is minimal government effort to address and improve household food safety behaviors, despite their significant role in public health.
DESCRIPTIVE STATISTICS
The data includes 1,174 households primary cooks with the characteristics listed in Table 4.1 and Table 4.2
Table 4.1: Demographic characteristics of participants (category variables) Demographic characteristics Number of participants (n) %
According to the data, females constitute the majority of primary household cooks, accounting for 93.02% Additionally, householders make up 69.78% of respondents, indicating their dominant role in household management Apart from common labor and householders, other occupational categories are negligible, leading to the regression analysis where these occupations are grouped into three categories: householder, common labor, and others.
The majority of respondents have completed junior and high school education, despite variations across different education levels The sampling method resulted in nearly equal urban and suburban participants, with 53.53% from urban areas and 46.47% from suburbs Television is the primary information source for households, used by 87.31%, followed by newspapers as the second most popular source In contrast, only 24.19% of respondents obtain food safety information from local medical staff, indicating a limited role of healthcare providers in this area The food poisoning incidence among households is 5.11%, while individual cases account for 2.18%, with the difference arising because some households experience multiple food poisoning incidents.
In contrast, the descriptive statistic of continuous variables is show on the table below:
Table 4.2: Demographic characteristics of participants (continuous variables)
Variables Mean SD Min Max
The average age of the primary cook is 47 years old, reflecting the traditional role of middle-aged women as household food preparers in Vietnam The typical household in Ho Chi Minh City comprises just over four members, aligning with government population policies promoting family size On average, households spend nearly 100,000 VND daily on food, indicating household food expenditure levels The primary cook’s average food safety knowledge score is 9.46 out of 14.04, suggesting a basic understanding of food safety principles However, due to the survey’s focus on the percentage of correct answers in 2010, it is not possible to compare knowledge levels across different periods.
Based on the Health Belief Model, perceived susceptibility, perceived severity, perceived benefits, perceived barriers, and perceived self-efficacy are key latent variables; however, due to data limitations, only four components—perceived susceptibility, perceived benefits, perceived barriers, and perceived self-efficacy—were evaluated The correlation coefficients among these items ranged from -0.0004 to 0.8587, indicating meaningful relationships, supported by a high KMO value of 0.947 that signifies strong inter-item correlations Additionally, the correlation matrix's determinant was non-zero (p < 0.01), and Bartlett’s test confirmed the data's suitability for factor analysis (p < 0.01), ensuring the validity of applying this method to the dataset.
The Cronbach alpha’s value of all components and the factor analysis result (after rotation) were showed in the table below
- Attention about food safety problem
- Hygiene in food processing Separate cooking tool
Hygiene hand before touching food Hygiene hand after touching food Use clean water
- Hygiene in food preserving Wash ingredient
Eating food right after processing Heating food after 2 hours
Among 18 factors (Appendix 2), there are three factors which Eigen value were more than one, accounted for a cumulative 66% of variance Therefore, the thesis showed all 3 factors and using only factor 1 (accounted for 50% of variance) as the indicator of perception value for the multivariate regression In summarize, the perception value varied from -3.01 to 2.36 with the average at 1 This figure implied the majority of participant perceived the threat of food safety issue
A recent survey revealed that individual hygiene practices were the most accurately performed behavior among the three groups, accounting for 81.48% Hand washing was identified as the specific behavior with the highest compliance, with 97.77% of participants practicing it correctly In contrast, only 78.34% of participants correctly followed processing and preserving behaviors, the lowest adherence rate observed Additionally, behaviors such as not smoking, spitting, or applying nail polish while cooking showed a high compliance rate of 81.68%, highlighting overall good hygiene practices among respondents.
In general, a large proportion of responders practiced precisely in food safety practice, but the rate of people with 100% of right behavior is significant lower than each group
This figure is a bit higher than the result of the 2010 survey (61.87% versus 54.3%)
Although the 2010 survey did not involve medical staff in practice evaluation, the observed improvements in individual food safety practices remain significant The specific results, detailed in the table below, demonstrate notable progress in maintaining food safety standards despite the lack of professional oversight These findings highlight the importance of individual commitment to food safety, underscoring ongoing efforts to enhance practices within the community.
Behavior (n68) Responder with right behavior
- Separate cooking tool for cooked and uncooked material
- Separate in preserving with enough facilities
- Use clean tool to prepare, divide food
- Not use forbidden food additives or out of date food
- Wash hand before cooking or after toileting
- Not smoke, spit out, nail polished while cooking
Figure 4.4: The nonparametric relationship between food safety practice and knowledge, perception
Foo d s af et y K no w dle dg e v alu e
Foo d s af et y K no w dle dg e v alu e
Foo d s af et y K no w dle dg e v alu e
Figure 4.4 illustrates the correlations between participants' practice evaluations, their perception values, and knowledge scores The data shows that responders exhibiting correct behaviors in each practice group tend to have higher perception values and food safety knowledge levels Although the explanatory variables vary within a similar range, their relationships suggest that improved practice behaviors are associated with increased perception and knowledge Subsequent regression analysis will further clarify these relationships.
RESULTS FROM MULTIVARIATE PROBIT MODELS
Based on the Health Belief Model, behaviors are directly influenced by individuals' perception of risk and cues to action, while modifying factors such as demographic characteristics and food safety knowledge indirectly impact these behaviors To analyze these relationships, the study employs both a reduced multivariate probit model, focusing on perception value and cues to action as key predictors, and the original multivariate probit model that includes all relevant independent variables This approach ensures a comprehensive understanding of the factors shaping food safety behaviors under the framework of the Health Belief Model.
Table 4.5: MVP regression reduced form Variable Coefficient p-value Coefficient p-value Coefficient p-value
The table presents the coefficients, standard errors, and p-values of the reduced form of the multivariate probit model, indicating significant positive relationships among the variables Specifically, the point estimate of 0.57 suggests a strong positive association between Hygiene kitchen practice and Process/preserve practice Additionally, Hygiene individual practice is positively correlated with Hygiene kitchen practice, with an estimate of 0.46 Furthermore, Hygiene kitchen practice shows a significant positive correlation with Process/preserve practice, with a coefficient of 0.48 These results highlight the interconnected nature of hygiene behaviors in different practices.
Positive correlation coefficients indicate that a primary food preparer is more likely to consistently engage in related behaviors across different groups Specifically, excelling in at least one behavioral group significantly increases the likelihood of performing well in other groups This suggests that strong performance in one area may be associated with proficient practices in other food preparation behaviors, highlighting interconnected skills among primary food preparers.
The correlation coefficients of perception value are positive and highly significant for all three behaviors (hygiene kitchen practice: 0.191, process/preserve practice:
0.561, hygiene individual practice: 0.316) This result implies that the perception cause positive effect on food practice behavior
Radio news are the most influential factors among the five cues, significantly impacting hygiene practices and food preservation, with coefficients of 0.367 and 0.511 respectively Listening to radio news is positively associated with better kitchen hygiene and food preservation habits Conversely, exposure to food documentaries and advice from local medical staff negatively affect food preparers' practices; reading food documentaries correlates with poorer kitchen hygiene, while advice from local medical staff is linked to worse food preservation and individual hygiene The other factors show no significant impact on participants' food safety practices.
Table 4.6: MVP regression original form
Variable Coefficient p-value Coefficient p-value Coefficient p-value
Hygiene individual practice Food safety knowledge
- Local staff (*) -0.160 0.194 -0.611 0.000 -0.378 0.002 ρkp ρik ρip
The regression analysis revealed consistent variable coefficients in the reduced model, with only knowledge about food safety consistently influencing participants' behaviors across all three groups Living in an urban area significantly impacts food processing and preservation practices (p-value < 0.005), indicating that urban residents tend to process and preserve food less meticulously than those in suburban areas Additionally, the number of family members affects kitchen hygiene practices, suggesting that larger households tend to maintain cleaner kitchens Other variables showed no statistically significant effects The table below presents the marginal effects derived from the multivariate probit regression analysis.
Table 4.7: Marginal effect after MVP regression
Variable ME p-value ME p-value ME p-value
Hygiene individual practice Food safety knowledge
- Common labor (*) 0.017 0.722 0.015 0.722 0.016 0.722 Logarithm of Age 0.038 0.400 0.035 0.400 0.035 0.400 Logarithm of Food expenditure
Notes: (*) dummy variables, ME: marginal effect
The marginal effect of each variable reveals the specific impact of various factors on food safety behaviors For example, a one-point increase in participants' knowledge score raises the likelihood of practicing food safety correctly by 1.9% in hygiene kitchen practices, 1.7% in process and preservation practices, and in individual food safety behaviors Additionally, having more family members significantly boosts adherence to proper food safety practices across all three categories Improved perceptions about food safety are also associated with increased correct practices among all groups Moreover, individuals who listen to the radio for food safety information are approximately 10% more likely to demonstrate better hygiene kitchen practices compared to those who do not seek such information.
(process/preserve practice and individual practice)
Local medical staff advice can decrease the likelihood of individuals engaging in proper health practices by 37.8% Additionally, negative effects are observed when food safety information is derived from documentaries, with a 9.9% reduction in hygiene kitchen practices and an 8.9% decline in food processing and preservation behaviors These findings highlight the potential impact of certain informational sources on personal health and food safety practices.
To ensure the robustness of the regression results, the study employed a Poisson model to accurately predict the number of behaviors practiced by participants, assuming each behavior equally impacts food poisoning risk The model used the same independent variables as the multivariate probit model, with the dependent variable being the total number of correct behaviors performed (up to 12) The regression results, summarized in the table below, confirm the consistency of the findings across different analytical approaches.
Variable Coefficient p-value ME p-value
Poisson regression analysis reveals a significant relationship between food safety knowledge, perception value, location, and cues to action such as radio, food documents, and local medical staff, aligning with MVP regression results in both direction and significance However, unlike MVP regression, Poisson regression indicates that the number of family members does not influence the number of precise food safety behaviors exhibited by the primary cook in the household.
RESULTS FROM PROPENSITY SCORE MATCHING MODEL
A survey of 4,593 respondents identified 98 suspected food poisoning cases across 79 households Among these, only 60 cases reported symptom onset following the consumption of home-prepared meals, highlighting potential food safety concerns associated with domestic food handling.
The MVP model's explanatory variables are included in the estimated probit regression to identify the causes of FBD symptoms To enhance interpretation, the thesis introduces the variable food_place, which indicates where food was purchased: coded as “0” for markets or supermarkets with governance boards, and “1” for spontaneous markets without governance This variable is expected to negatively influence the likelihood of food poisoning Additionally, the expenditure variable was removed to maintain the balancing property The dependent variable is whether a household experienced food poisoning, coded as “1” for households that suffered and “0” for those that did not.
The coefficients in the regression result are not implied the same meaning as other regression above due to the huge different in the two values of the dependant variable
(60 versus 1115) The table below shows the result of the probit model:
However, after estimating the propensity score and choosing the control group by radius matching (caliper is 0.0001), there are only 33 observations in treated group and
In the control group, there were 96 other participants Although the expenditure variable caused instability in the probit regression model, its impact was thoroughly evaluated through additional testing to ensure robustness This assessment confirmed that the expenditure variable did not influence the results of the Propensity Score Matching (PSM) method The mean differences in continuous variables between individuals who experienced Foodborne Disease (FBD) and those who did not were analyzed using t-tests, with the results indicating significant differences that support the study’s findings.
Table 4.10: Differences of continuous variables
(Not suffered FBD – Suffered FBD) p-value
At the 5% significance level, the only notable differences between individuals who experienced poisoning and those who did not relate to the amount of money spent on food and years of schooling Specifically, those who suffered poisoning tend to spend approximately 21,000 VND more on food and have longer schooling durations than those who did not experience poisoning Additionally, there is a significant distinction in the accuracy of specific behaviors between the two groups, with non-poisoned individuals demonstrating more precise practices; however, this difference is only statistically significant at the 10% level.
On the other hand, the correlations between the binary variables and the FBD variable tested by the Pearson’s Chi square test:
Table 4.11: Correlations between binary variables and FBD
Variable Pearson’s Chi square value p-value
The analysis revealed that only the place of residence significantly influences the likelihood of experiencing foodborne diseases (FBD), with a p-value less than 0.05 Other factors examined did not show a meaningful relationship with FBD occurrence This suggests that there are minimal differences between individuals affected by FBD and those who are not, apart from their living location.
DISCUSSION AND IMPLIED POLICY
DISCUSSIONS AND CONCLUSIONS
This study highlights the significant impact of participants' knowledge and perceptions on their food safety practices Both factors demonstrate a strong correlation with safe food handling behaviors, as confirmed by multivariate probit and Poisson model analyses These findings support previous research by T H., emphasizing the importance of awareness and perceptions in promoting food safety Enhancing knowledge and positive perceptions can effectively improve food safety practices among individuals.
Vo et al (2015), Hanson and Benedict (2002) although it is opposed to Roberts et al
(2008) and Cho et al (2010) The controversial conclusion of those researchers may because of the difference in the questionnaire of the knowledge and perception value
Thesis and T H Vo et al (2015) used the survey based on WHO and the regulatory of Vietnam Ministry of Health while others used the questionnaire FightBAC!™ (U.S
Radio shows significantly influence both the type and frequency of correct behaviors, serving as an effective cue to action Conversely, local medical staff have a negative impact on the number of accurate practices, likely due to their limited quantity and lack of expertise in food safety Many staff members are not adequately trained in food safety protocols and are often burdened with additional responsibilities, which further diminishes their effectiveness in promoting proper practices.
Demographic characteristics like occupation and gender do not significantly influence individual behavior, possibly because most survey participants are female householders An increase in family members can put pressure on the primary cook, but it also provides more support from other members This dynamic enhances the cook's hygiene skills, leading to cleaner kitchens.
Based on the PSM results, key differences between FBD-affected and unaffected responders include food expenditure and years of schooling These differences may stem from the fact that household heads represent the largest participant group and traditionally have lower levels of formal education Additionally, food knowledge is primarily acquired within the family environment, so individuals spending more time at home tend to gain more culinary knowledge.
High-priced foods do not necessarily ensure consumer safety The PSM results suggest that individuals who do not suffer from foodborne diseases (FBD) often invest effort in selecting or self-sourcing their food, such as growing vegetables or obtaining food from relatives This approach allows them to access lower-cost, safer food options while decreasing their risk of foodborne illnesses.
The living environment of respondents plays a significant role in the risk of foodborne disease (FBD), highlighting the impact of where individuals reside on food safety outcomes While healthy individuals tend to practice better food safety measures compared to those who have experienced poisoning, individual behaviors alone do not show a clear link to reducing FBD risk The Propensity Score Matching (PSM) analysis suggests that external factors, such as environment, may not have a definitive influence, though conclusive evidence remains limited Additionally, the study found no significant differences in food safety practices or purchase locations between the two groups, although slight variations in specific behaviors were observed at a low significance level.
Therefore, we need more evidence to get any conclusion.
POLICY IMPLICATION
To ensure effective food safety management, the government must enhance the skills of medical staff and develop institutions to assign local personnel solely responsible for food safety Improving communication channels by increasing both the quantity and quality of food safety information—particularly guidance on proper food processing—is essential, moving beyond just warnings broadcasted on national TV Radio emerges as a highly effective platform for disseminating food safety information, especially in mountainous and remote regions where radio signals are more accessible than television The observed improvement in food safety knowledge between 2010 and 2013 indicates growing public awareness and concern about food safety issues The government can leverage this trend to further promote food safety education and actively involve the community, such as engaging freelancers and local communicators, to strengthen administrative efforts and heighten public participation.
The study suggests that behaviors and food purchase locations are not directly linked to the risk of foodborne diseases (FBD); therefore, controlling food resources and restaurant quality is essential to prevent hazards Additionally, school education programs should incorporate practical life skills alongside food safety awareness, focusing communication efforts more on the public than on manufacturers or restaurant workers The quality of food from supermarkets or organized markets may not necessarily surpass that of spontaneous markets, despite higher costs; thus, governments should establish specific standards and develop quality inspection institutions for these vendors Finally, environmental factors, especially water sources, require regular inspection and improvement, as the lack of access to clean water in Ho Chi Minh poses health risks and warrants urgent attention.
LIMITATION AND IMPLICATIONS FOR FURTHER RESEARCH
The FBD survey relies on participants' self-reports rather than medical doctors' assessments, which may lead to imprecise results Additionally, the data primarily reflects medical perspectives and lacks sufficient information and variables related to economic factors, particularly perceptions Further research is necessary to identify the key factors influencing FBD probability and to understand the roles of living environment and food resources.
Furthermore, the FBD expose not only with food poisoning but also with chronic diseases such as cancer though it is complicated to impute the pathogen to food
Therefore, more researches need to implement to this field to find more evidences
The thesis highlights that the living environment significantly influences foodborne disease (FBD) prevalence, emphasizing the need for more concrete evidence to support this connection In particular, water quality used for edible purposes plays a crucial role, as urban and suburban areas have different water sources, which can impact food safety Understanding these environmental factors is essential for developing targeted strategies to reduce FBD risks across diverse living environments.
The measurement method for variables in this research has notable drawbacks, as many variables were assessed differently compared to similar studies, potentially limiting the comparability of results Additionally, the perception data was gathered through a questionnaire with an insufficient number of questions and an inadequate method to encourage respondents to reveal their true perceptions These limitations may affect the accuracy and reliability of the findings, emphasizing the need for standardized measurement approaches in comparable research.