Nosestretcher alert: Food trucks are safer than restaurants; show me the real data

I love food carts, and usually try to pick up some local specialities at some when traveling. With complex foods (other than the standard just reheating cooked meats) comes complicated preparation and handling steps. Multiple raw ingredients need to be kept at the right temperature; operators have to avoid cross-contamination; clean and sanitize their equipment; and, keep bacteria and viruses off of their hands. All within the confines of a cart or trailer. It can be yummy, but making the meals safely is a tricky activity.Screen-Shot-2014-02-16-at-2.19.42-PM-222x300

The Institute for Justice, a libertarian group based in Arlington VA has released an analysis of food truck inspection reports in some major U.S. cities. In the report, author Angela Erickson suggests that mobile food vendors have close to the same inspection scores as restaurants:

Street food, long a part of American life, has boomed in popularity in recent years. Yet an idea persists that food from trucks and sidewalk carts is unclean and unsafe. This report tests that com- mon, but unsubstantiated claim by reviewing more than 260,000 food-safety inspection reports from seven large American cities. In each of those cities, mobile vendors are covered by the same health codes and inspection regimes as restaurants and other brick-and-mortar businesses, allowing an apples-to-apples comparison. The report finds:

• In every city examined—Boston, Las Vegas, Los Angeles, Louisville, Miami, Seattle and Washington, D.C.—food trucks and carts did as well as or better than restaurants (on total violations -ben).

• In six out of seven cities—Boston, Las Vegas, Los Angeles, Louisville, Miami and Washington, D.C.—food trucks and carts averaged fewer sanitation violations than restaurants, and the differences were statistically significant.

• In Seattle, mobile vendors also averaged fewer violations, but the difference was not statistically significant, meaning mobile vendors and restaurants performed about the same (not about the same, but statistically the same -ben).

It shouldn’t be surprising that food trucks and carts are just as clean and sanitary as restaurants. Both business models rely on repeat customers, and few people are going to eat twice at a place that made them ill. With the rise of social media like Yelp, word of mouth about a business—whether good or bad—spreads further and more quickly than ever before. And one advantage of food trucks and carts is that it is easier to watch as your food is being prepared—something you simply cannot do at most restaurants.

Not forefront in their report is that critical foodborne violations are hard to get at (and weren’t distilled consistiently out of each jurisdiction’s inspection report).  In Boston, food trucks had less overall violations but about the same critical foodborne infractions. The same info wasn’t presented for other cities.

The risk factor-based violations mean so much more to public health than the walls, floors, ceilings.

There are some other limitations including when the inspections they compared took place (was it at an annual licensing visit or did an EHO actually see the operation in action?) – and one that I’ve written about before: An inspection grade/overall result doesn’t related directly to likelihood of an illness – which is really the central issue.

Slate covered the inspection thing a couple of weeks ago:

According to North Carolina State University assistant professor and food safety expert Ben Chapman, there is “little correlation” between inspection scores and food poisoning outbreaks. Restaurant inspections vary from state to state, but a 2004 Emerging Infectious Diseases study found that restaurants with verified food poisoning outbreaks didn’t have lower inspection scores than those without, and a 2001 American Journal of Public Health study revealed that inspection scores didn’t help predict future outbreaks. This may be because there are all kinds of inspection violations that have nothing to do with the improper storage or handling of food: A “B” restaurant might be visibly grungier than an “A” (or at least less aligned with health inspectors’ rigid standards), but it’s not necessarily more likely to cause illness.

What’s missing here is some good stuff that friend of barfblog Ruth Petran published in 2012 which shows that for certain pathogens there was little correlation between some  inspection factors related to sanitation and outbreaks. But there are some violation categories that are important.

Ruth and her colleagues show that bare hand contact violation is twice as likely to occur at a norovirus outbreak-linked restaurants than what the authors call a nonoutbreak restaurant. Other food handler factors that seem to matter for norovirus outbreaks: single use and single service articles (relative risk of 8.82 when comparing outbreak to nonoutbreak restaurants) proper eating/tobacco use by staff (of 5.88) and cross-contamination (2.21). Sanitation of facilities and non-food contact surfaces only came up in noro outbreaks with a relative risk of less than the lack of single use/service articles and weirdly proper cooling and date marking. Dirty facilities, as defined by traditional inspections, weren’t seen as a risk factor popping up in Salmonella or C. perfringens outbreaks at all.

Making Erickson’s concluding comments of, “consumers can rest assured that food trucks and carts are as clean as restaurants, and in fact are often more so,” a bit hollow.

I don’t really care if food trucks are clean, inspectionally-speaking; I care whether they are implementing risky practices – specifically whether the factors Petran and colleagues described as important are popping up. The Institute for Justice report is a nice thing for businesses to show city councilors. It’s not a convincing document that shows food trucks are less likely to make me ill.