title: Knowledge, attitudes, and practices among border crossers during temporary enforcement of a formal entry requirement for Mexican-style soft cheeses, 2009.
abstract: Mexican-style soft cheese known as queso fresco (QF), which is often unpasteurized, has been implicated in outbreaks of foodborne illness in the United States. The U.S. Food and Drug Administration (FDA) exercises discretion in enforcement of noncommercial importation of cheese. To test control measures aimed at decreasing unlawful QF importation, in 2009 the FDA temporarily enforced a requirement for formal commercial entry for all cheeses over 5 lb (2.3 kg) at the San Diego-Tijuana border. Enforcement was combined with educational outreach. Border crossers importing cheese and those not importing cheese were surveyed at the beginning and end of the temporary enforcement period. Data collected included participant demographic information, knowledge of QF-associated health risks, and attitudes and practices regarding QF consumption and importation. We surveyed 306 importers and 381 nonimporters. Compared with nonimporters, importers had a lower level of knowledge regarding QF-associated health risks (P < 0.0001). Border crossers carrying cheese were more likely to have less education, be U.S. or dual residents, consume QF more frequently, and cross the border less often. Importation and consumption of unpasteurized QF remained prevalent among border crossers during the temporary enforcement period, and the level of knowledge regarding QF-associated risks remained low among these crossers. More vigorous, sustained messaging targeted at high-risk groups is needed to change behaviors. Definition and consistent enforcement of limits will likely be needed to reduce QF importation and the risk of QF-associated diseases along the U.S.-Mexico border; however, public health benefits will need to be balanced against the cost of enforcement.
authors.affiliation: Division of Global Migration and Quarantine, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA; Council of State and Territorial Epidemiologists, Atlanta, Georgia 30341, Mercer University School of Medicine, Macon, GA 31207, USA.
authors.forename: An V
authors.initials: AV
authors.lastname: Nguyen
authors.affiliation: Division of Global Migration and Quarantine, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. ncohen@cdc.gov.
authors.forename: Nicole J
authors.initials: NJ
authors.lastname: Cohen
authors.affiliation: Division of Global Migration and Quarantine, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
authors.forename: Hongjiang
authors.initials: H
authors.lastname: Gao
authors.affiliation: Division of Global Migration and Quarantine, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA; SRA International, Atlanta, Georgia 30329, Myanmar Research International, Yangon, Myanmar.
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Fishbein
authors.affiliation: Division of Global Migration and Quarantine, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia 30333, Strive Preparatory Schools, Denver, CO 80219, USA.
authors.forename: Jane
authors.initials: J
authors.lastname: Keir
authors.affiliation: Division of Global Migration and Quarantine, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
authors.forename: J Miguel
authors.initials: JM
authors.lastname: Ocana
authors.affiliation: San Diego County Office of Public Health Services, Health and Human Services Agency, San Diego, California 92101, USA.
authors.forename: Lori
authors.initials: L
authors.lastname: Senini
authors.affiliation: U.S. Food and Drug Administration, Alameda, California 94502, USA.
authors.forename: Aleta
authors.initials: A
authors.lastname: Flores
authors.affiliation: Division of Global Migration and Quarantine, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
authors.forename: Stephen H
authors.initials: SH
authors.lastname: Waterman
mesh_terms: D001290:Attitude; D002611:Cheese / Q000032:analysis* / Q000191:economics* / Q000382:microbiology; D005506:Food Contamination / Q000191:economics / Q000331:legislation & jurisprudence; D005513:Food Inspection / Q000331:legislation & jurisprudence; D005517:Foodborne Diseases / Q000517:prevention & control / Q000523:psychology*; D006801:Humans; D008800:Mexico; D015995:Prevalence; D014481:United States; D014486:United States Food and Drug Administration