Food Service Personnel Research Articles

Making Partnerships Happen: 5 a Day and Team Nutrition

In 1997, a Memo of Understanding was signed between the National Cancer Institute and the Food and Consumer Service of the USDA to encourage state Team Nutrition and 5 A Day contacts to partner and jointly promote their programs. Monetary resources became available through a mini-grant process in 1998 for local health departments to partner with the county Team Nutrition schools, school food service and county cooperative extension service to increase nutrition education interventions in school sites during the 1998-1999 school year. Nineteen local health departments partnered to create programs to compliment existing 5 A Day nutrition activities. Nutrition interventions were tailored to specific school and community needs. Messages were promoted to school food service personnel, administrators, teachers, students and parents with community outreach. Activities included student - developed school announcements, classroom and cafeteria learning stations, theatrical productions, nutrition fairs, vegetable gardens, and fruit and vegetable tasting and challenges. Local media coverage of events and promotions increased community awareness. Regional workshops were held in the spring to provide a forum for county participants to showcase and share their mini-grant activities. Pre-tests by teachers, students and school food service personnel indicated strong interest in planned activities. Post testing continues to be performed and monitored. An additional result of partnering is the development of new county nutrition coalitions in a majority (13) of the communities. In counties where coalitions already existed, membership and development were strengthened by partnership activities. Current plans indicate continued 5 A Day and Team Nutrition joint school-based interventions.

Anaphylaxis in Schools and Other Child Care Settings

AAAAI Board of DirectorsJ Allergy Clin Immunol.1021998173176This physician's statement is published to better identify the problem of anaphylaxis in schools and other child care settings with an emphasis on avoidance, treatment strategies, and making available emergency health care plans.Do not apply to this review.This critically important statement is an excellent guide for primary care providers to deal with anaphylaxis. The diagnosis of allergy with a risk of anaphylaxis is made based on the patient's history and confirmed with skin or blood tests performed by appropriately trained allergy specialists. It also identifies the fact that school personnel should develop a system of identifying children with life-threatening allergies to prevent anaphylactic reactions, and school personnel should be prepared to deal with these reactions. When prescribed, every student should also have an epinephrine auto injector device clearly labeled with his or her name and classroom number. School personnel should be instructed about the location of the medication and expiration dates should be checked carefully. This physician's statement makes comments about the avoidance of foods, especially dealing with the student who is going to eat from the cafeteria menu. The child's parents should inform the cafeteria staff in writing about foods to be avoided and suggest safe substitutions. All food service personnel should be instructed of the student's allergies. The physician's statement also deals with treatment strategies. Treatment protocols need to be prescribed by a physician. School staff should have written instructions. Epinephrine should be the first drug that should be used in the emergency management. All individuals receiving emergency epinephrine should be immediately transported to a hospital even if symptoms appear to have resolved. Additional epinephrine should be available during transport if necessary. All individuals entrusted with the care of children need to have familiarity with basic first aid and resuscitative techniques. The physician's statement also nicely defines the common symptoms and signs of an allergic reaction, and has an excellent emergency health care plan sample which includes a form that could be readily used by schools and other facilities taking care of children who may have the potential for anaphylaxis.Although not a research paper, this article was included because of its great relevance to pediatricians.

Time and Temperature Analysis Of a School Lunch Meal Prepared In a Commissary With Conventional Versus Cook-Chill Systems

The purposes of this study were to compare time and temperature histories of a selected menu item prepared in two different production systems and to ascertain important operational practices affecting food quality and safety. The study was conducted at three elementary schools in a Midwestern school district, which was converting its food production system from a centralized conventional to a centralized cook-chill system. Time and temperature histories of a selected menu item prepared by two different food production systems were monitored throughout food product flow for three days prior to and after changing the system. No consistent reheating method for chilled products was observed among schools in the cook-chill system. Hot holding time of chilled products was extended because of time and equipment constraints. Wide variations in time and temperature histories during hot holding and reheating processes were found among schools in both systems. Results may have been influenced by variability observed in temperatures of hot holding carts and steam tables among the schools. Inconsistency in food quality and potential food safety problems associated with time and temperature abuse was observed more frequently in the cook-chill system than the conventional system. The results indicate that stringent operating procedures for holding and reheating foods should be developed for both systems to assist school foodservice personnel in maintaining quality and safety of the products. Continuous in-service training and supervision are very important for foodservice personnel in a cook-chill system. Availability of equipment, labor, and time at a unit kitchen should be considered when menus are planned to eliminate an extended hot holding time. Both management and foodservice personnel are responsible for maintaining high quality of foods by the implementation of controls throughout the system.

Improving Storage and Serving Temperatures of Milk In Schools

The storage and serving temperatures of milk in schools was studied through the implementation of a nutrition education project. An educational poster was developed that reminded food service personnel of the proper storage and serving temperatures of milk. All schools were sent the poster with an invitation to enroll in the milk temperature study, Cold Milk In School is Cool. A total of 862 schools, 30% of the eligible buildings, participated in the study. Project packets sent to enrolled schools included a Taylor thermometer, data recording sheets, and a demographic survey. A total of 553 schools, or 64% of enrolled buildings, completed the study and returned data. Mean temperature data was analyzed to identify schools with storage and serving temperatures within the optimum range of 32-40 degrees Fahrenheit. A total of 336 buildings (60.7%) reported average temperatures within the optimum range. It was noted that 74% of schools reported no problem with warm milk in the demographic survey. Letters were sent to school food service directors with results for participating buildings. A retest form and suggestions for improving milk storage and serving temperatures was sent to buildings who reported mean temperatures outside of the optimum range. Forms were received from 25% of retest buildings.

“Getting a Jumpstart On HACCP” - A Program To Introduce Foodservice Operators To The Hazard Analysis Critical Control Point (HACCP) System

“Getting a Jumpstart on HACCP” was developed to introduce foodservice operators to HACCP fundamentals and to assist personnel in implementing a basic HACCP system within their operations. The workshop materials were produced using information obtained from the Educational Foundation of the National Restaurant Association and the Food and Drug Administration's 1995 and 1997 Food Code. Content of the program incorporated an introduction to HACCP, food safety hazards including microorganisms, an in-depth review of the seven principles of HACCP, and active learning activities. These exercises included analysis of menus for hazards, identification of critical control points in recipes, and development of flow charts for recipes and/or groups of foods. Participants were recruited from the Kansas School Foodservice Association, Kansas Restaurant and Hospitality Association, Kansas Area on Aging, Kansas Dietetic Association, and Kansas Association of Sanitarians. Workshops were scheduled in five locations throughout the state of Kansas for the six-hour workshop. More than 300 persons including Registered Dietitians, school foodservice personnel, state sanitarians, Family and Consumer Science Agents, Dietary Managers, restaurant operators, and Area Agency on Aging personnel attended the workshops. A significant (p=<.001) increase in participants’ knowledge of HACCP concepts was found between pre and post evaluations. Participants stated that the workshop was effective in introducing basic HACCP principles and that the active learning exercises increased their ability to apply basic HACCP concepts. Materials developed for this program can be used by other states when presenting HACCP workshops. The increased emphasis by regulatory agencies on application of HACCP could provide those dietetic professionals knowledgeable of HACCP additional employment opportunities.

Body elimination attitude and occupation.

16 food service personnel and 20 bank employees scored significantly higher (indicating greater disgust) on the Templer, King, Brooner, and Corgiat 1984 Body Elimination Attitude Scale than 46 nursing personnel and 15 sewage workers.

Dietetics and Foodservice Personnel are Ready for Team Problem Solving

Objective To determine the readiness of dietetics and foodservice personnel for contributing to team problem solving. Design A descriptive, correlation study in which a five-part questionnaire was designed to collect data. Subjects Dietetics and foodservice personnel (n=632) in eight hospital settings; 321 subjects (51%) volunteered to participate. S tatistical analyses performed Statistical data to summarize demographic information and two-way analysis of variance with a Scheffe post hoc analysis was used to investigate differences between dietetics and foodservice personnel on each of the subscales. Results In general, all respondents were somewhat oriented toward group problem solving and were confident in their problem-solving skills. Problem-solving expertise within the organization decreased for the respondents as the problem moved from their direct work areas to the organization level. Dietitians displayed higher self-efficacy in contributing to problem-solving teams than did foodservice personnel, indicating a 75% chance that they would contribute whereas all other respondents indicated a 50% chance of contributing. Applications The results of this study generate optimism for involving all dietetics and foodservice personnel in team problem solving. However, training activities are needed for both foodservice personnel and dietetics professionals.

Assessment of Program Practices in Missouri Child Care Centers Participating in The Federal Child and Adult Care Food Program

LEARNING OUTCOME: To identify four groups whose input into menu plans should be considered in enhancing the child nutrition programs in day care centers. Nutritionists in the state's Child and Adult Care Food Program (CACFP) have identified and ranked recurrent problems where participating child care centers-are failing to meet required program guidelines. The purpose of this study was to determine the child care centers’ demographics, training and resource needs; differences in program practices compared to requirements; services used and perceived helpfulness of reference materials (unseen in the literature); and influence of the directors’ education level on CACFP practices. A 28-item questionnaire was distributed to 334 non-residential day care centers with a total of 218 completed surveys being returned for 65.3% response rate. The centers’ reported compliance to properly completed program documents was high, where five dimensions measured 67% or greater, when compared to requirements. Areas of training desired by centers consisted of training related to the basics of child nutrition, child growth and development, and the capacity to properly and safely plan, provide, and account for nutritious meals. The majority of written CACFP materials were reported as being either “very helpful” or “somewhat helpful”, and written CACFP materials were reported being used by child care centers more often than other services available from the state CACFP. Center directors and food service personnel were cited most often as being the planner of menus and for having the most input into the menu planning process. Teachers and dietitians/nutritionists were each reported less than 17% of the time as being a menu planner but had higher rates for having input into the menu plans at 60% and 23%, respectively. Chi-square analysis revealed no significant differences between directors with and without college degrees in meeting reported CACFP requirements. Significant differences were seen in centers whose directors had college degrees and whose menu plans considered input from food service personnel, teachers, children, and parents. Menu planners should strive to include input from these key participants and when possible, to participate in nutrition education opportunities provided by state and local agencies in order to optimize and improve child nutrition programs.

Effect of Added Citric Acid and Acetic Acid on the Growth of Staphylococcus and Listeria in a Mayonnaise-based Salad

LEARNING OUTCOME: To determine the effect of 2 concentrations of citric acid and acetic acid on the growth of Staphylococcus aureus and Listeria monocytogenes in a mayonnaise-based salad. The microbial safety of mayonnaise-based deli salads is a concern due to extensive handling during preparation by foodservice personnel and potential abusive temperatures during storage. The pH of a mayonnaise-based surimi salad (control - pH 5.45) was adjusted to approximately 5.0 and 4.6 with 5% and 10% citric acid or acetic acid. Duplicate samples of each salad were inoculated with 10 8CFU/g S.aureus (FRI 100 SEA) or 10 7CFU/g L. monocytogenes (ATCC 49594). The Listeria inoculated samples were held at 4°C (refrigeration) for 28 days and 10°C (temperature abuse) for 8 days. Samples inoculated with Staphylococcus were held for 8 days at 10°C. Samples were analyzed for microbial growth at predetermined intervals. Three replications of the experiment were conducted. A 2 log reduction of Listeria was obtained for the control salad and the 5% citric acid added salad held at 4°C. An additional 1 log reduction was obtained for salads with 5% or 10% acetic acid or 10% citric acid added. At 10°C, a 1 log reduction of Listeria resulted in the control salad, and the salads with 5% or 10% citric acid or 5% acetic acid added. The salad with 10% acetic acid resulted in another 1 log reduction of Listeria when salads were held at the abusive temperature. For salads inoculated with S.aureus and held at 10°C, no reduction was found for the control and the 5% citric acid added samples. A 1 log reduction of S.aureus occurred for salads with 5% acetic or 10% citric acid added. A 2 log reduction of S.aureus obtained for the salad with 10% acetic acid added. Results of this study indicate that the effectiveness of acids added to a mayonnaise-based salad were: 10% acetic acid >5%acetic acid >10% citric acid > 5%citric acid. However, the addition of acid is not a replacement for proper temperature control

The Army Dietitian's Role in Humanitarian Assistance

LEARNING OUTCOME: Describe the roles the Army dietitian can provide in support of military medical nation assistance programs. Regional crises and conflicts present the predominant threat to US national security for the future. Peacetime engagement, as a guiding foreign policy is a coordinated effort of political, economic, and military assistance promoting stability throughout the world. Nation assistance, conducted by the US, provides one conduit to foster stability, deter conflict and protect national interests. As other nations pursue their national objectives, the US can actively engage them by utilizing military assistance. Military medical efforts can be a cost effective strategy to achieve peacetime engagement through nation assistance. Army dietitian's have been involved in humanitarian aid and nation assistance activities since 1959 when a dietitian deployed to Peru to instruct and supervise the training of Peruvian food service personnel in a newly constructed hospital. More recent examples, include the assessment of nutritional operations in hospitals and coordination of food donations in Haiti, nutritional assessment and feeding of Chinese refugees in Kwajalein and disaster relief feeding in Saint Thomas after Hurricane Marilyn. A historical review examines the professional capabilities and unique contributions made by this allied health specialty. Trained in the areas of food service management and sanitation as well as clinical nutrition, the Army dietitian is a versatile resource in assessing the nutritional status of local populations, implementing food service relief efforts, and teaching proper food safety and sanitation to the local populace. The Army dietitian can positively influence the development of the host nation's medical infrastructure through nutritional support, general preventive medicine, and medical education and training. The most cost effective nation assistance activities in the future will require further refinement of operational concepts, innovative policies and proactive programs promoting an expanded role for Army dietitians.

Hazard Analysis Critical Control Point (HZCCP) Practices and Food Safety Education of Food Safety Education of Foodservice Personnel at Long-Term Facilities

LEARNING OUTCOME: To identify the level of food safety education and use of Hazard Analysis Critical Control Point (HACCP) practices of foodservice directors and employees at long-term care facilities. The Food and Drug Administration (FDA) estimates that between 6.5 to 33 million people in the U.S. become ill each year as a result of foodborne illness and that 9,000 die. The elderly in long-term care facilities are considered at high risk for foodborne disease. HACCP has been advocated as a system designed to reduce risk of outbreaks of foodborne illness. Purpose of the study was to determine level of food safety education and knowledge and application of HACCP among nursing home foodservice employees and directors. A mail survey was conducted using a random sample of 50 licensed nursing home facilities from a 19 county region of north Texas. Completed forms were received from 152 employees and 17 directors from 17 facilities. Results showed that the majority of the directors and supervisors had completed a 16-hour certificaiton course on food safety. However, the majority of foodservice employees were required to have only a food handler's card requiring 1-2 hours of training. Twelve of the directors indicated knowledge of HACCP, but only nine used any of the HACCP steps at their facility. The most often used HACCP step was to identify critical control points in food production and service. Results indicate that there is a need for increased education of foodservice employees and application of HACCP principles at long-term care facilities.

Meeting the U.S. Dietary Guidelines in School Meals: Current Practices, Perceived Barriers, and Future Training Needs

A sample of 628 school food service personnel was surveyed to determine what changes had been instituted in school food service programs to ensure compliance with the U.S. Dietary Guidelines, perceived barriers that prevented making such changes, self-perceived training needs, and type and amount of nutrition education being provided. The majority of school food service staff reported having made changes to school meals to ensure compliance with the Dietary Guidelines. Perceived barriers included lack of training and time for modified meal preparation, poor student acceptance of modified meals, and higher costs of modified meals. Perceived training needs included training on developing standardized menus, computer diet analysis training, information on using commodity foods in modified menus, methods for implementing the U.S. Dietary Guidelines in school meals, and methods for increasing student acceptance of meals. The majority of respondents felt that nutrition education was an important part of their job, but less than half of the respondents reported providing it. Lack of time, training and education materials, inadequate staff cooperation, not being required to teach nutrition, and not being comfortable when teaching nutrition were cited as barriers to providing nutrition education.

Status of Nutrition Education in Ohio Elementary Schools

Many foods and nutrition programs have been developed for elementary schools but have had minimal impact on children's eating behaviors. We assessed the status of nutrition education in Ohio elementary schools during the 1992–93 school year to identify intervention targets and potentially effective strategies for increasing the effectiveness of school-based foods and nutrition programs. A questionnaire was developed and mailed to a 1.6% sample of Ohio elementary school teachers, and a 53% response rate was obtained. Most respondents believed that elementary schools should provide children with foods and nutrition instruction but two-thirds taught this subject during only one-quarter of the school year, providing a total of up to 15 hours of classroom instruction. Previous teaching in nutrition emerged as an important factor in the decision to teach foods and nutrition. Although they are willing to collaborate with school foodservice personnel, teachers have no clear conviction regarding the responsibility of a specific group of people for providing leadership in this field. If school–based foods and nutrition programs are to be strengthened, the activities of teachers and school foodservice personnel will need to be coordinated.

Obstacles to Nutrition Labeling in Restaurants

Objective This study determined the major obstacles that foodservices face regarding nutrition labeling. Design Survey questionnaire was conducted in May 1994. In addition to demographic questions, the directors were asked questions addressing willingness, current practices, and perceived obstacles related to nutrition labeling. Subjects/setting Sixty-eight research and development directors of the largest foodservice corporations as shown in Restaurants &. Institutions magazine's list of the top 400 largest foodservices (July 1993). Statistical analyses performed P tests were used to determine significance within a group for the number of foodservices that were currently using nutrition labeling, perceived impact of nutrition labeling on sales, and perceived responsibility to add nutrition labels. Regression analysis was used to determine the importance of factors on willingness to label. Results Response rate was 45.3%. Most companies were neutral about their willingness to use nutrition labeling. Two thirds of the respondents were not currently using nutrition labels. Only one third thought that it was the foodservice's responsibility to provide such information. Several companies perceived that nutrition labeling would have a potentially negative effect on annual sales volume. Major obstacles were identified as menu or personnel related, rather than cost related. Menu-related obstacles included too many menu variations, limited space on the menu for labeling, and loss of flexibility in changing the menu. Personnel-related obstacles included difficulty in training employees to implement nutrition labeling, and not enough time for foodservice personnel to implement nutrition labeling. Applications Numerous opportunities will be created for dietetics professionals in helping foodservices overcome these menu- or personnel-related obstacles. J Am Diet Assoc. 1997; 97:157–161.

Nutrition Knowledge, Attitudes, and Behavior of Individuals Responsible for Foodservice in Texas Daycare Facilities

LEARNING OUTCOME: To assess nutrition knowledge, attitudes, and food behaviors of food service personnel in daycare facilities.Preschool years are important in a child's physical and emotional development and are a primary period for development of eating habits. The purpose of the present study was the assessment of nutrition knowledge, attitudes, and practices of day care center food service personnel and day home providers in Texas. Approximately 100 day care facilities from the 11 Public Health Regions of Texas agreed to participate in the study. Facilities were also participants in the Child and Adult Care Food Program (CACFP). The sample included 55 food service personnel from day care centers and 160 day home providers. Scores on nutrition knowledge assessment of these two groups were 82% and 77% respectively. Knowledge score for food management principles was 68% for food service personnel. Nutrition attitudes were very positive with a mean/standard deviation of 4.43/0.30 for food service personnel and 4.39/0.34 for day home providers on a 5.0 point scale. The ability of these respondents to translate knowledge into practice was determined by nutrient evaluation of written menus; compliance of observed meals with CACFP requirements, and; compliance with basic principles of food safety and sanitation. A distinct difference existed between written menus and actual meals served. Written menus exceeded 67% of Recommended Dietary Allowances for age. Actual foods prepared, served, and portions provided were less than the minimum standards required by CACFP. Problems in food sanitation were identified. Refrigerator temperatures were higher than 0°F in 51 % of the facilities. Routine handwashing procedures were omitted by 58% of foodservice workers and 43% of children. Recommendations include educational opportunities for day care food service personnel regarding; menu planning; making appropriate menu substitutions, and; principles of food safety. (Research funded by the Texas Nutrition Education and Training Program)

Incentives Perceived by Management Dietitians Which Minimized Absenteeism of Foodservice Personnel

LEARNING OUTCOME: To investigate incentives which minimized absenteeism of foodservice.Questionnaires were sent to 987 randomly selected dietitians in the practice group: Management in Health Care Systems of the American Dietetic Association (ADA), and the response rate was 32% (N=317). Frequencies, percentages, and Chi-square were used in data analysis. Management dietitians were mostly female. 41 to 60 years of age, with BS or MS degrees in foods/ nutrition or dietetics; and completed a dietetic internship. They had 16 to 25 years experience in the dietetic profession, and 1 to 10 years as directors of a unit. Most of the respondents worked in small urban facilities, supervising 30 or less, ethnically diverse, married, female employees, 41 to 60 years of age, with no dependents at home. Major reasons for absence were health-related and rarely job-related. Absenteeism which was below 5% in 1/3 of the facilities was significantly associated (p⩽0.05) with gender and ethnic background, while turnover which was 1 to 10% in 1994 was significantly associated (p⩽0.05) with age, marital status, young children at home and miles traveled to work. Incentives perceived by management dietitians which effectively minimized absenteeism were fairness, training and education with tuition break, health promotions, flextime, job content improvement, and team building. Availability of transportation and health promotions were significantly associated (p⩽0.05) with most of the demographic and institutional variables. Further studies need to explore job-related causes of absence, and verify if incentives such child/elderly care services, monetary/non-monetary compensation, job sharing and employment of an ombudsman would significantly minimize absenteeism among foodservice personnel.

Evaluation of Keep Food Safe Food-Handler Training of School Food Service Personnel

LEARNING OUTCOME: To describe the impact of safe food handling instruction on attitudes and knowledge of school food service personnelA questionnaire was used to determine the impact of safe food handling instruction on attitudes and knowledge of school food service participants attending 5 Delaware Cooperative Extension Keep Food Safe Workshops during 1993-94. Before and after instruction (video, discussion, hands-on activities), 111 school food service personnel completed a questionnaire. Learner objectives and questionnaire evaluating attitudes and knowledge covered the most frequently contributing factors to outbreaks of foodborne illness: cross contamination, cooling/reheating, personal hygiene, temperature control and general food safety knowledge. Demographic and pre/post questionnaire data were analyzed using descriptive statistics, paired t-tests, and multiple linear regression. Demographics of participants were: 96% female; mean age 43 years; 27% completed high school or some college; experience included an average of 7 years at their current facility; 9 years at other facilities - most frequently commercial restaurants (37%) and churches (23%). On the job training by supervisors (60%), coworkers (59%) and classes (36%) were most frequenty identified as the kinds of safe food handling training they had received. On the job classes predicted a significantly higher pre-questionnaire score in cross-contamination while college course was significant for temperature control; experience in commercial restaurants was significant for cooling/reheating. Paired t-tests of pre/post-questionnaires revealed significant differences for 43% of the attitude questions (P< 0.01, < 0.001) and 60% of the knowledge questions (P< 0.05, < 0.01, < 0.001). 80% listed at least one specific food handling practice they would change as a result of the training. Of these changes, 25% related to personal hygiene and 11% involved temperature control. Results demonstrate learning gains for school food service personnel at these workshops.

Comparing Computer and Traditional Hazard Analysis Critical Control Point System Training Methods

LEARNING OUTCOME: To examine the effectiveness of two versions-paper versus computer-of a Hazard Analysis Critical Control Point training plan developed for instructing experienced food service personnel.An independent study training plan on the Hazard Analysis Critical Control Point (HACCP) system was developed and evaluated. It was intended for training enlisted military personnel having approximately seven or more years of work experience in Air Force medical food service facilities. Both a paper-version and a computer-version were developed, and their effectiveness was determined using a pre-test, independent training, and post-test format. Computer-attitude was also determined using a modification to another researcher's questionnaire.A pilot test was first conducted on 29 college students. The training plans were then revised based on observation and feedback. The actual research study was then conducted on 69 experienced hospital food service personnel. Participants were randomly assigned to take either the paper- or computer-version of the training.Both versions of the research study revealed significant increases from pre- to post-test scores (i.e., overall average score for the pre-test was 48.0%, while it was 72.4% for the post-test), with no significant difference between the overall effectiveness of the two versions. However, there were different degrees of pre- to post-test score improvement seen for each test question, indicating the need for further validation of the tests’ reliability, or possible changes required in the training plans. All post-test subjects correctly answered that there are seven steps to HACCP, but pre- versus post-test responses were actually better on two questions regarding the acronym HACCP and critical control points. The overall attitude toward computers was 3.72 on a scale of 1 to 5, indicating a generally positive attitude among participants. This training plan, with minor modifications, will be a valuable educational tool that can be used in commercial as well as military food service facilities.

Sexual harassment in the hospital industry: an empirical inquiry.

A 1994 survey of hospital HRMs has revealed that charges of sexual harassment within the health care industry are increasing at an alarming rate. Most charges are filed by women who claim they were victims of "hostile environments." Nurses levy the largest number of complaints, followed by clerical/secretarial personnel, technicians, custodial workers, food service personnel, and therapists. Most charges are filed against coworkers. Approximately 10 percent of all charges of sexual harassment in hospitals are brought against physicians.

Commentary on school meals from school food service personnel and researchers

Commentary on school meals from school food service personnel and researchers