Food safety labelling of chicken to prevent campylobacteriosis: consumer expectations and current practices

Campylobacter is a leading cause of human enteric infection, and its rising incidence in many parts of the world poses a significant public health concern [1]. It is the most common bacterial cause of diarrhoeal disease worldwide and the most common foodborne pathogen in many high income countries [2, 3]. In addition to gastroenteritis, potential sequelae of Campylobacter infection include hepatitis, pancreatitis, and Guillain-Barré syndrome [3]. In New Zealand, the burden of Campylobacter is significant, with 162 cases per 100,000 population in 2016 [4]. At least half of campylobacteriosis cases in New Zealand are attributable to contaminated chicken [5], and increasing levels of antimicrobial resistance in Campylobacter derived from chicken [6] raises concerns for future treatment of infection in humans.

Campylobacteriosis is at least partially preventable through improvements in consumer preparation of chicken products [7‐9]. For example, Cogan et al. found that using hot water and detergent to clean hands and utensils after chicken preparation achieved a 50% reduction in Campylobacter contamination [9]. More broadly, greater awareness of food safety through the media has been shown to correlate with improvements in home food handling practices [10]. Therefore, ensuring consumers know correct techniques for safe chicken preparation is an important strategy in addressing high rates of campylobacteriosis.

Mandatory food safety labelling is a potential strategy to inform consumers of safe chicken preparation techniques. Labels have excellent consumer reach [11], unlike television, radio or internet advertisements which require device access, and are not widely used by some socio-demographic groups [12]. Labelling can be a cost-effective intervention [13, 14], as the cost can be borne by the producer provided they have a sufficiently long compliance period [15]. Moreover, government-mandated label content encourages food producer accountability [16] and is likely to be trusted by consumers [17], unlike food safety information from friends, relatives [12], retailers brochures or advertisements [17]. Providing information on contamination levels of retail chicken has been used in the United Kingdom as a strategy to increase accountability by chicken producers and retailers [18]. However, it is unknown whether current chicken labels meet the food safety needs and expectations of consumers. This is important because the attention given by consumers towards different forms of food safety information on labels (for example traceability barcodes versus certified quality marks) vary, and are not always predictable [19].

The aims of this study were to: 1) assess consumer knowledge of safe chicken preparation, 2) assess consumer expectations for food safety content on chicken labelling, and 3) investigate if these expectations are being met by current chicken labelling in New Zealand.

We found that, while food safety knowledge was generally good, many consumers have important gaps in their knowledge of chicken product safety. Only 55% of respondents were aware that rinsing fresh raw chicken under the tap does not reduce the likelihood of illness, and only 15% knew that 60–90% [27] of retail chicken meat in New Zealand is contaminated with Campylobacter. Previous studies have also identified areas for improvement of consumers’ knowledge of food safety. A recent literature review of food safety knowledge and behaviour of Canadian consumers reported good knowledge about safe meat preparation, but also identified specific opportunities to improve handling practices, for example the use of a thermometer to check internal meat temperature [28].

Our findings demonstrate that current supermarket and butchery chicken labels have poor safety information content. Consumers expressed a desire for specific food safety information such as the level of Campylobacter contamination on chicken. Consumers also want this information displayed effectively, and identified a mock-up label with prominently displayed safety information as the most effective at conveying food safety advice, in comparison to current labels. In our label analysis, we found that this information was entirely absent on products from some retailers, or if present was often difficult to read. Similar variability in label content and display quality has been identified previously. An analysis of food labelling in Canada reported that improving the consistency of food label safety information display, such as typography and location on the packaging, would improve consumer access to this information [25]. The study also recommended stricter regulations regarding legibility [25].

Our results demonstrate that consumer demand for safety information on chicken products is not being met by current chicken labelling. This deficiency in safety information may relate to the fact that New Zealand and Australian labelling standards do not mandate provision of preparation or storage information on chicken products, instead advocating “promotion of food safety” to prevent illness from Campylobacter [29]. Similar regulatory gaps exist in the United Kingdom and Canada where chicken handling information is also not mandated on labels [30, 31]. This deficiency suggests that market self-regulation of labelling is insufficient to meet consumer needs and expectations. Consequently, policy changes appear necessary, including mandatory disclosure of Campylobacter risk, to ensure industry accountability for chicken quality and to meet consumer demand for safety information.

The effect of brightly-coloured, informative warning labels on chicken products is likely to be two-fold. As well as informing consumers of Campylobacter risk and prevention measures, labelling of chicken products, particularly if mandatory, is likely to incentivise industry measures to reduce Campylobacter levels. In the United Kingdom, Public Health England identified the lack of pressure on the chicken industry as a barrier to Campylobacter reduction and consequently recommended mandating disclosure of Campylobacter levels to consumers [18]. Introduction of this strategy saw an overall decline in the amount of chicken contaminated with the highest levels of Campylobacter from 20% in 2014 to 7% in 2017, resulting in an estimated 100,000 fewer campylobacteriosis cases per year [32]. Implementation of a mandatory labelling scheme should be supported by other initiatives such as education campaigns. The impact and value of these interventions should be evaluated with qualitative and quantitative research to assess whether consumers understand what they are reading on labels, whether it changes their behaviour, and whether it impacts disease rates. An economic evaluation of the labelling change along with other interventions would also be useful to better understand the benefits of these approaches, which can be very large compared with their costs [33]. Ultimately it may be more effective to directly regulate and enforce production standards to lower contamination levels in fresh chicken. Such interventions have been shown to be highly effective (halving the rate of campylobacteriosis in New Zealand during 2007 within months of being implemented) [5] and almost certainly have the greatest potential to reduce disease burden if fully implemented.

The results of this study should be interpreted in the context of some methodological considerations. First, we cannot exclude the possibility that social desirability bias may have influenced participants to identify an aspect of chicken label information as ‘essential’, believing that this would be viewed favourably by the surveyor. However, given the topic of the survey was non-personal, the impact of social desirability bias is likely to be minimal. Second, providing information regarding the extent of Campylobacter contamination of chicken may have influenced participants to express a desire for more informative and eye-catching labels. However, in designing this study it was hypothesised that many respondents would be unaware of Campylobacter levels and would require this information to respond to the survey. Third, we asked consumers which mock up label was ‘most effective’ for them personally. It is unclear if consumers interpreted this to mean their preferred label or the more ‘attention grabbing’ display, which was evidently label C (see Additional file 1). Nonetheless, attracting consumer attention is essential for delivering warning messages, and bright colours are known to be effective at achieving this purpose [34].

Campylobacteriosis from contaminated chicken meat is one of the most important food safety problems in western countries, and dissemination of antibiotic resistant organisms is a growing concern. It is also a preventable disease. Food labels are a universally accessible means of conveying safe chicken preparation information to consumers. Our research identified demand for comprehensive safe chicken preparation and handling information on labels and demonstrated several gaps in consumer knowledge. Consumers currently underestimate the level of Campylobacter contamination on fresh raw chicken, and have stated a desire to have such information presented on labels to inform their purchasing decisions. Furthermore, our chicken label analysis demonstrated a lack of consistent safety messages in an easily-useable format, highlighting a key deficiency to be addressed. We recommend mandatory introduction of comprehensive, high-quality, chicken safety labelling, along with evaluation to establish whether this intervention leads to changes in consumer behaviour and reductions in the incidence of Campylobacter infection.