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标题：Impact of a Letter-Grade Program on Restaurant Sanitary Conditions and Diner Behavior in New York City
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作者：Melissa R. Wong ; Wendy McKelvey ; Kazuhiko Ito 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2015
卷号：105
期号：3
页码：e81-e87
DOI：10.2105/AJPH.2014.302404
语种：English
出版社：American Public Health Association
摘要：Objectives. We evaluated the impact of the New York City restaurant letter-grading program on restaurant hygiene, food safety practices, and public awareness. Methods. We analyzed data from 43 448 restaurants inspected between 2007 and 2013 to measure changes in inspection score and violation citations since program launch in July 2010. We used binomial regression to assess probability of scoring 0 to 13 points (A-range score). Two population-based random-digit-dial telephone surveys assessed public perceptions of the program. Results. After we controlled for repeated restaurant observations, season of inspection, and chain restaurant status, the probability of scoring 0 to 13 points on an unannounced inspection increased 35% (95% confidence interval [CI] = 31%, 40%) 3 years after compared with 3 years before grading. There were notable improvements in compliance with some specific requirements, including having a certified kitchen manager on site and being pest-free. More than 91% (95% CI = 88%, 94%) of New Yorkers approved of the program and 88% (95% CI = 85%, 92%) considered grades in dining decisions in 2012. Conclusions. Restaurant letter grading in New York City has resulted in improved sanitary conditions on unannounced inspection, suggesting that the program is an effective regulatory tool. Restaurant food safety is increasingly important, with almost half of the US food dollar spent on restaurant food 1 and about one third of caloric intake from foods prepared outside the home. 2 In New York City (NYC), residents eat out nearly 1 billion times each year. 3 Although most diners do not get sick, foodborne pathogens cause millions of preventable illnesses in the United States annually. 4 The exact proportion of restaurant-attributable foodborne illness is unknown, but national surveillance in the United States found that two thirds of reported foodborne outbreaks from 1998 through 2008 occurred in the restaurant or deli setting, 5 and consumption of food prepared outside the home has been linked to an increased risk of sporadic foodborne diseases. 6 Regular inspection of restaurants for food safety is a core function of local health authorities, guided by the US Food and Drug Administration (FDA) Food Code. 7 Although all states have sanitation codes modeled after the FDA Food Code, 8 implementation methods vary by jurisdiction. The NYC Department of Health and Mental Hygiene (hereafter, Health Department) is charged with inspecting restaurants, coffee shops, bars, nightclubs, employee or university cafeterias, bakeries, and fixed-site food stands (hereafter, restaurants). Its inspection program uses a scoring system to measure compliance with the NYC Health Code, which is updated regularly to maintain consistency with the FDA Food Code and the New York State Sanitary Code. Restaurants are entitled to an impartial review of inspection results by an administrative tribunal, which can improve an assigned score and reduce associated monetary fines. Before letter grading, the Health Department aimed to inspect restaurants at least once per year and imposed monetary fines for violations cited at inspections. Inspection results were available on the Health Department Web site. However, financial disincentives and the Web site posting were insufficient to drive improvements across the industry, with most restaurants cited for multiple public health hazards. Mean inspection scores and restaurant sanitary conditions were stagnant (D. Kass, email communication, February 2009). In an effort to improve restaurant food safety and increase transparency of inspection information, the Health Department launched its letter-grade program on July 27, 2010. The program uses public disclosure of inspection scores in the form of letter grades at point of decision-making; a more finely tuned, risk-based inspection schedule; and financial incentives to encourage high food-safety standards. It began after an 18-month planning process that included a public announcement of the intent to begin letter grading; meetings with restaurant industry representatives, food safety experts, and regulators from a jurisdiction with a restaurant sanitary grade program; promulgation of 2 regulations subject to notice and comment; and training and education for restaurateurs. The process was covered by the media, and by July 2010, restaurateurs were aware of the program and anticipating the launch. 9,10 We evaluated the impact of the restaurant letter-grade program by assessing (1) hygiene and food-safety practices as characterized by inspection outcomes before and after program implementation and (2) public response to the program measured by 2 population-based telephone surveys.