Popular Ethnic Foods in the United States: A Historical and Safety Perspective

Popular Ethnic Foods in the United States:A Historical and Safety PerspectiveJee Hye Lee, Johye Hwang, and Azlin Mustapha

Abstract: In recent years, a dramatic increase in the demand for ethnic foods in the United States has been observed.Interestingly, with their rise in popularity, more foodborne illness outbreaks associated with ethnic foods have also beenreported. Despite a more than 200-y history of ethnic foods in the United States, there is a paucity of information aboutthem. Furthermore, there is also a lack of research on food safety issues involving ethnic foods. Therefore, this paperprovides a comprehensive overview of ethnic foods, including the history, types, popularity, characteristics, ingredients,and consumer attitudes toward them. Importantly, this review provides an analysis of the statistics of foodborne illnessoutbreaks associated with ethnic foods based on data from the Centers for Disease Control and Prevention (CDC). Thebreakdown of etiology of ethnic foods identified the number of total outbreaks, the causative microorganisms, the foodvectors, and the locations where foodborne disease outbreaks have occurred. Also covered is a review of the HazardAnalysis Critical Control Point (HACCP) system implementation, food safety training, and inspection score systemsrelated to ethnic foods and how these can serve as effective tools for the prevention of foodborne illness outbreaks. Thisstudy contributes to the body of food safety literature by providing helpful information about ethnic foods in the UnitedStates.

IntroductionAs immigration, tourism, and international trade have increased

worldwide, the role of ethnicity has become more important notonly in business and consumer behavior (Rossiter and Chan 2004),but also in food culture and the food industry. Consumers whoenjoy ethnic foods have increased in number and ethnic restaurantshave become mainstream in the United States (Po 2007). In 2011,the ethnic food market continued to grow with $3 billion in salesand 5% to 6% annual growth and it is expected that sales willreach $3.9 billion in 2016 (Mintel 2012). U.S. Census Bureauprojections (2010) showed that the U.S. population has becomemore diverse, and the number of Asian and Hispanic citizenshave grown, with the Asian population currently at 4.6% and theHispanic population at 16.0%. Meanwhile, other ethnic groupsare reported as follows: Caucasian at 64.7% and African Americanat 12.9%. “Ethnic Restaurants 2012,” a report published by theresearch company Mintel showed that the diverse U.S. populationstrongly encouraged the growth of the ethnic restaurant industryin this country. In addition to diversity in the U.S. population,international travel may also be a cause for increased ethnic food

MS 20130631 Submitted 5/11/2013, Accepted 8/19/2013. Author Lee is withFood and Nutrition, Univ. of Ulsan, San 29 Mugeo 2-dong, Nam-gu, Ulsan 680-749, Republic of Korea. Author Hwang is with College of Hotel and Tourism Man-agement, Kyung Hee Univ., 26 Kyungheedaero, Dongdaemun-gu, Seoul 130-701,Republic of Korea. Author Mustapha is with Food Science Program, 256 WilliamStringer Wing, Eckles Hall, Univ. of Missouri, Columbia, MO 65211, U.S.A.Direct inquiries to author Mustapha (E-mail: [email protected]).

sales. International travel increased 3% in 2011 (Mintel 2012) andthe experience of international travel often brings greater interestin ethnic cuisines, which may have added to the current increasein ethnic food sales.

Interestingly, as ethnic restaurants become more accessible, agreater number of foodborne illness outbreaks have been linkedto ethnic foods. A 7% increase in foodborne disease outbreaksrelated to ethnic foods was reported from 1990 to 2000, and135 outbreaks with 2593 cases of illness were linked to contam-inated multi-ingredient ethnic foods, including Italian, Mexican,and Chinese foods between 1990 and 2003 (Simonne and oth-ers 2004; Fraser and Alani 2009). As the number and variety ofethnic foods increase in food facilities in the United States, foodsafety issues related to ethnic foods have become more realizedand understood (Simonne and others 2004). Food handlers areoften not familiar with ethnic foods and ethnic food ingredients,therefore a science-based approach including inspection, training,introduction to the potentially hazardous foods (PHF) criteria, andimplementation of a Hazard Analysis and Critical Control Point(HACCP) program may be a way to address food safety issuesrelated to these foods.

Despite the importance and popularity of ethnic restaurantsin the foodservice industry, few researchers have discussed eth-nic cuisines in depth (Qu 1997; George 2001; Ebster and Guist2004; Josiam and Monteiro 2004; Sukalakamala and Boyce 2007).Furthermore, relatively little research has been carried out on ex-ploring how ethnic food safety issues can be tackled. This presentreview provides a comprehensive summary on ethnic cuisines,with particular focus on ethnic food safety issues.

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doi: 10.1111/1541-4337.12044

Ethnic foods in the United States . . .

Types, Popularity, and Characteristics of Major EthnicCuisines in the United States

Various types of ethnic foods, including Mexican, Italian, Chi-nese, Japanese, Korean, Vietnamese, Thai, Greek, Indian, French,have been introduced in the United States. The ethnic foods mar-ket is still growing amid an economic recession. Among Asiancuisines, specifically, this study focuses on 2, based on their highpopularity: Chinese and Japanese. The following section describessome details of Mexican, Italian, Chinese, and Japanese cuisineand points out the characteristics of each.

MexicanThe largest segment of the ethnic foods market in the United

States appears to be Mexican, comprising 62% of the FDMx (food,drug, mass index), excluding Wal-Mart sales. However, growth ofthe Mexican food market slowed down in 2009–2010 (Mintel2010). Mexican foods can be categorized by the regional areafrom which they originate: 1) Northern cuisine includes itemsfrom north Mexico that use beef, cheese, and wheat (populardishes are machaca, arrachera, and cabrito); 2) Oaxaca cuisine aredishes from the city of Oaxaca emphasizing staples such as corn,beans, and chili peppers (popular dishes are triques, chapulines, and 7moles); 3) Yucatan cuisine are specialties from the Yucatan penin-sula that are based on Mayan food (the cuisine is often reddishin color, and a popular dish is cochinita pibil); 4) Mexican citycuisine (popular dishes are barbacoa, birria, cabrito, carnitas, andvarious moles); 5) Western Mexican cuisine (items from west ofMexico City that incorporates a great deal of fish); and 6) Ve-racruz cuisines (preparations from the Gulf of Mexico that usevarious tropical fruits) (Perez 2009; Kenyon and Alpers 2010; Tor-navuelta 2010; Mexconnect 2013). Ground beef tacos, enchiladas,burritos, and tostadas, as well as beans are popular Mexican foodsamong non-Hispanic Americans in the United States. Mexicanfood is perceived as having a great value for the price, good forcarry-out, hot and spicy, and also good for children to eat (Natl.Restaurant Assn. 2000).

ItalianItalian restaurants are also popular in the United States, and re-

gardless of age, gender, income, education level, or geographic lo-cation, consumers are known to enjoy Italian foods (Natl. Restau-rant Assn. 2000). Local cuisines vary by region, such as Lombardycuisine (polenta, pizzoccheri, risotto, ossobuco, cotoletta, and cassoelua),Emilia-Romagna cuisine (parmigiano reggiano and tortellini), Tus-cany cuisine (steak alla fiorentina and ribollita with panzanella), Laziocuisine (spaghetti alla carbonara and artichokes alla Romana), Cam-pania cuisine (pizza, water buffalo mozzarella, calzone, casatiello, andtortano), and Sicily cuisine (caponata and veal Marsala) (AcademiaBarilla 2013). According to CNBC, the pizza industry earns $32billion and comprises 8% of the restaurant operation market (PMQ2008). The number of Italian restaurants in the 10 most popularU.S. cities was around 16783 operations. This number is higherthan Mexican (7102) and Chinese (8493) restaurants. Consumers’image of Italian food is indulgence, good for celebrations, amplein portions, full of variety, and irresistible in dessert selection (Natl.Restaurant Assn. 2000).

ChineseThere are 43139 Chinese restaurants in the United States, which

is more than any other domestic fast food restaurants, such asMcDonalds, Wendy’s, and Burger King (Liu and Jang 2009). Chinahas a large terrain and is composed of various races, so Chinese

cuisine is one of the richest and boasts the most diverse culinarytradition in the world (Halvorsen 1999). Chinese foods can becategorized by the regional area from which they originate, inparticular Canton, Shanghai, Beijing, and Hunan/Szechuan.

Canton cuisine is cuisine from the southern area that empha-sizes frying, roasting, steaming, and poaching. Traditional dishesare Cantonese chow mein, sweet and sour chicken, roast duck,dumplings and egg rolls, also stewed fried pork, Chinese steamedeggs, congee with lean pork and century eggs, stewed beef brisket,steamed frog legs on lotus leaves, blanched vegetables with oystersauce, and stir-fried hairy gourd with dried shrimp and cellophanenoodles. Shanghai cuisine is from the eastern part of China. It isdelicate, sweet in flavor, and not oily or greasy. Traditional dishesare Yang Chow fried rice, Shanghai noodles, spare ribs with sweetand sour sauce, fish ball soup, shrimp in egg whites, hairy crabs,light broth, paper-wrapped foods, and shredded pears with crystalfruit. Beijing cuisine is from the northern part of China featur-ing elegant dishes that are strong, spicy, and generous in the useof garlic. Traditional dishes are Peking duck, hot and sour soup,beggar’s chicken, cold pig’s ear in sauce, fish cooked with 5-spicepowder, Peking wonton, sea cucumber with quail eggs, abalonewith peas and fish paste, soft-fried tenderloin, meatball soup, friedsesame egg cake, lard with flour wrapping glazed in honey, stewedpig’s organs, goat’s or sheep’s intestine filled with blood, Pekingribs, sauteed clams, orange beef, lamb in tea sauce, shaomai, andsweet and sour recipes. Hunan/Szechuan cuisine is cuisine fromthe western part of China that uses hot, strong and spicy flavors in-volving chili, peppers, spices, and herbs. The traditional dishes arehot and sour soup, Szechuan chicken, twice-cooked pork, KungPao chicken, stewed sharks’ fin, spiced beef, tea-smoked duck,Mapo tofu, Sichuan hotpot, Fuqifeipian, spicy deep-fried chicken,water-cooked dishes, dandan noodles, and bon-bon chicken (Po2007).

The characteristics of traditional Chinese food culture are lib-eral and extensive in the choice of ingredients, with diverse andabundant flavors, common use of oil in the cooking process, richappearance, and plentiful use of spices and seasonings. However,Chinese cuisine in the United States differs from the original be-cause “Americanized” Chinese food is usually less pungent thanthe authentic recipes, with higher levels of monosodium gluta-mate (MSG) to enhance the flavor, and involving more deep fry-ing (Mosby 2009). Some characteristics of Chinese cuisine whichconsumers like include being handy for carry-out, good for veg-etarians, and characterized by highly varied flavors (Natl. Restau-rant Assn. 2000). However, some American consumers suffer from“Chinese Restaurant Syndrome,” which is manifested in symp-toms ranging from mild headaches to depression caused by the useof high levels of MSG, characteristics of “Americanized” Chinesefood (Mosby 2009).

JapaneseThere are approximately 9000 Japanese restaurants operating in

the United States, and Japanese food, both ready-made and cook-ing ingredients, are available at conventional grocery stores, in-cluding Wal-Mart (Japan External Trade Organization 2011). Theincrease in food imports from Japan to the United States reflectsthe popularity of Japanese foods. An article from Japan’s ExternalTrade Organization (2011) pointed out that the key factor for thesuccess of Japanese foods is that they contain less sugar, less fat, andfewer calories. Japanese foods use various crops, fish, and marineingredients, due to the fact that Japan is an island country (Ashke-nazi and Jacob 2003). Using fresh fish, such as sashimi and sushi,

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is a unique characteristic of Japanese cuisine. Traditional Japanesedishes are tempura, sushi, sashimi, sukiyaki, kaisekiryori, yakitori,tonkatsu, shabu-shabu, soba, and udon. Local cuisines vary de-pending on the regional area, including Hokkaido cuisine (withspecialties such as ishikari-nabe and genghis khan), Tohoku cuisine(sasakamaboko, wanko-soba, and kiritanpo), Kanto cuisine (namerou,monja-yaki, and fukagawa-meshi), Hokuriku cuisine (hotaruikaand jibu-ni), Kansai cuisine (funazushi, yudofu, koyadofu, and takoy-aki), Chugoku cuisine (okonomiyaki, fugu, and izumo soba), Shikokucuisine (bonito, tai, and sanuki-udon), and Kyushu cuisine (mizutaki,shochu, sara-udon, and hiyajiru) (Japan Natl. Tourism Organization2013).

The Japanese regard food preparation as a type of art (Barer-Stein1999) in that an artistic sense and beauty of the display, the properarrangement of food, and the choice of receptacles are important(Ha 2006). Characteristics of Japanese food culture are rice asa dietary staple in a traditional menu composition (1 soup and 3dishes), light seasoning, and an emphasis on the natural flavor of theingredients (Barer-Stein 1999; Gu and others 2006). According toa survey by the Natl. Restaurant Assn. (2000), consumers likeJapanese food because the food is “beautifully presented,” “goodfor a formal or special occasion,” “difficult to prepare at home,”has “mild, pleasant flavors,” and the “decor and atmosphere areimportant.” Japanese foods are especially loved by consumers withhigher incomes and people who live in the Western United Statesor in large metropolitan areas.

The History of Ethnic Cuisines in the United StatesThe history of the introduction of ethnic cuisine varies by types

and is closely tied to the history of immigration. U.S. immigrationgoes back to the 18th century. Five million immigrants from Eng-land, Ireland, Germany, and Scandinavia entered the country from1815 to 1860. Ten million immigrants arrived from northwest-ern Europe from 1865 to 1890, and 15 million immigrants fromcentral, eastern, and southern Europe came to the United Statesfrom 1890 to 1914. During the 19th century, Chinese, Japanese,Italians, and Mexicans affected American’s eating patterns and al-ready in the 1920s and 1930s popular ethnic foods were chowmein, spaghetti, pastrami, and tamales (Gabaccia 1998). The de-velopments of these 4 ethnic cuisines are described in detail below.

MexicanIn the 1930s, Mexican immigrants were a small minority and

Mexican cuisine was a minority’s food. In 1943 in San Antonio,Texas, chili powder was imported from Mexico (Gabaccia 1998).Mexican food was mainstream among the lower classes, but laterbecame universalized as working-class dishes around 1980. In theyear 1879, wine (4 million gallons), sparkling wine (140000 cases),brandy (500000 gallons), and olive oil (300000 gallons) were im-ported from Mexico into California (Hittell 1982).

ItalianIn 1987, Italian cuisine expanded based on the strong network

between Italian immigrants and other communities (Camillo andothers 2010). Ettore Boiardi produced a large quantity of cannedItalian food (spaghetti in tomato sauce) targeting the children ofthe baby boom generation and their suburban mothers, and cre-ated various types of products through the Chef Boyardee FoodProducts Co. (DiStasi 1989). However, in the 1920s, the Amer-ican middle class was not familiar with the Italian food culture(Janni and McLean 2002). By the 1930s, Italian restaurant ownerspromoted Italian dining as an “experience,” not just food, and

modified their foods to suit the American palate (Gabaccia 1998).Around 10000 Italian restaurants were established in New YorkCity by the 1930s, and most of these restaurants were simple andundecorated (Federal Writers’ Project 1983). It was only after the1970s that Italian dishes became quite popular in the United States(Cinotto 2011).

ChineseChinese migration, starting in 1848 to the United States, was

the beginning of the spread of Chinese food in the country. The1st Chinese restaurant was opened in San Francisco in 1849, andit served Cantonese cuisine. However, other regional Chinesecuisines, such as Hunan, subsequently began to be featured inU.S. restaurants (Lu and Fine 1995). By 1851, around 25000 Chi-nese had arrived in California, because the discovery of gold in theSacramento Valley had encouraged migration from south Chinato this country (Roberts 2002). However, Chinese food was stillperceived as new and was sometimes refused (Lloyd 1876). Asmore and more Chinese immigrated to this region, more couldfind employment and opened restaurants, and by 1960, there wereover 6000 Chinese restaurants in the United States, with 600 inNew York City and San Francisco alone (Kung 1962). In 1972,tea, dim sum, and noodle dishes were widely served, and restau-rant decor featured comfortable oriental motifs (Roberts 2002). In1883, Disturnell’s “Strangers’ Guide to San Francisco and Vicin-ity” recommended some Chinese restaurants in Chinatown andaround San Francisco to tourists as serving safe food (Disturnell1983).

JapaneseThe beginning of Japanese cuisine in the United States also

started with Japanese immigration. Japanese traditional dishes,such as chicken teriyaki, mame, and sushi were eaten amongthe Japanese immigrants, and Japanese farmers imported Napacabbage and radishes from Japan (Gabaccia 1998). Few Japaneserestaurants were established in the United States until well afterWorld War II, and throughout the 1930s, only simple menus, in-cluding sukiyaki, teriyaki, and tempura dishes, were offered. In1957, sushi bars began to appear, and in the 1970s, the number ofsushi and sashimi restaurants grew rapidly (Mariani 1991). Only afew Japanese restaurants in bigger cities of California and Hawaiiattracted Americans in 1970. However, it did not become one ofthe mainstream ethnic foods until the popularity of sushi, partic-ularly the California roll, came about (Life in the USA 2011). Inthe early 1980s, entrepreneurial chefs contributed to the popular-ization of sushi in Los Angeles, and Japanese foods became muchmore popular in the United States (Japanese Food in America2011). Figure 1 displays the history of various ethnic foods in theworld.

Consumer Attitudes toward Ethnic CuisinesIt is obvious that consumer attitudes toward or perceptions of

ethnic foods have become more positive when we consider thepopularity of ethnic foods and the presence of ethnic restaurantsin the United States. Previous studies have established some in-fluencing factors on the increase of ethnic foods, such as extrinsicfactors (growing international trade, globalization, migration, andtourism), psychological factors (the desire for healthier diets, fla-vorful taste, and adventure), and sociocultural factors related tochanges in lifestyle and values (Verbeke and Viaene 2000; Milesand Frewer 2001; Saba 2001; Verbeke and Lopez 2005). Some eth-nic foods are perceived as healthy because they include low-calorie

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Pasta & noodles ---2000BC------10th century---Peking duck

Sushi & sashimi---15th century---Tempura---16th century--- ---16th century---Teriyaki chicken

Rice in South Carolina---1690---Tofu in America---1769---

---1790---Pasta & tomato sauceChinese food in America---1847---

Pizza---1889------1914--- Fettuccine Alfredo

Tacos in LA ---1931---American Tex-Mex---1950s--

Frozen pizza---1950------1957---Italian-American Spaghetti Carbonara

Brown rice in USA---1960s------1968---Taco salad---1970's---California rolls---1971---Fajitas

Figure 1–History of various ethnic foods in the world (Olver 2012).

items (low in fats, and oils) and plenty of vegetables (Block and oth-ers 2004). As consumers have become more interested in “healthyeating,” more restaurants have begun using “healthy food” strate-gies in their menus. Nowadays, restaurants often present Asianfoods as “healthy” menu items. A common example is fast foodchain restaurants’ use of Asian menu items, such as McDonald’sAsian salad which offers the nutritional information of the item. Itseems that ethnic restaurant consumers perceive some ethnic foodsas healthy, and this positive perception of ethnic foods may be re-garded as one of the influencing factors on consumers’ intentionsto visit ethnic restaurants. Mintel’s (2012) recent report found thatconsumers are attracted to ethnic foods by word-of-mouth fromfriends and relatives (more than 50%), media exposure, such as see-ing the foods in a store or restaurant (around 24%), and, beginningin 2009, the Internet exposure.

Researchers have recognized the importance of ethnic restau-rants in the food industry due to an increase in ethnic cuisineconsumption. Today, American consumers are more familiar withethnic foods, and their attitudes toward ethnic cuisines have muchchanged (Natl. Restaurant Assn. 2000). Consumers prefer to havean excellent overall dining experience rather than simply expe-riencing good taste or affordable prices (Liu and Jang 2009).Researchers have identified how consumers think about ethniccuisines and how to please ethnic restaurant consumers. First, theimage of Chinese cuisine to consumers is rich and diverse com-pared to other cuisines because of China’s huge terrain and culturaldiversity (Halvorsen 1999). Additionally, other images attributedto Chinese cuisine include: “The choice of ingredients is veryliberal and extensive,” “The taste is diverse and abundant,” and“diluted starch, spice and seasoning, and oil are used” (Barer-Stein1999; Gu and others 2006; Ha 2006).

Previous studies have examined the important factors at Chi-nese restaurants that satisfied consumers. Qu (1997) determinedthat the factors influencing the choice of customers in Indiana todine at Chinese restaurants include: “food and environment,” “ser-vice and courtesy,” “price and value,” and “location, advertising,and promotion.” Liu and Jang (2009) found that food quality (es-pecially taste) and service quality (especially service reliability) areimportant attributes for consumer satisfaction in Chinese restau-rants, along with dining atmosphere, food authenticity, and fairprice. Maa and others (2011) stated several factors that can affectconsumer satisfaction: “employee services and atmosphere” (in-

cluding employee friendliness, proper level of service, and atmo-sphere); “food quality and dining environment” (including goodfood quality, consistent food quality, and reasonable price); and“physical attribute” (including good location, convenient park-ing, and convenient operation hours).

Compared to Chinese restaurants, there is a dearth of stud-ies focused on Italian and Japanese cuisines related to consumerbehavior. The image of Italian cuisine is of “simplicity” or “rus-ticity,” “fresh ingredients,” “good portions,” “good value for themoney,” and of its “authenticity,” namely, “a growing apprecia-tion among consumers for authentic foodstuff over Americanizedsubstitutes” (Girardelli 2004). In the study of Camillo and others(2010), taste, simplicity, and the variety of Italian regional cuisineswere factors found to influence the success of Italian cuisine inthe United States. Girardelli (2004) identified some myths aboutItalian food in the United States, such as “romance,” “family,”and “slow-paced lifestyle,” and argued that these myths have somepositive aspects. Huliyeti and others (2008) found that youngergenerations in the United States prefer Italian style and tastes. Thecommon American image of Japanese cuisine is that seasoning isused lightly, the natural flavor of the ingredients is emphasized, anda traditional menu composition is common (Barer-Stein 1999; Guand others 2006; Ha 2006).

American images of Mexican restaurants include “concretefloors,” “low prices,” and “casual cantina atmospheres” (Gold-man 1993). In the 1990s, there was a trend toward casual fam-ily atmosphere and moderate price, which resulted in the boomof Mexican restaurant popularity (Goldman 1993). Munoz andWood (2009) conducted a study about the atmosphere of Mexi-can restaurants to examine the impact of atmosphere on consumerperceptions. Their findings suggest that consumer perceptions ofthe degree of authenticity at Mexican restaurants vary dependingupon geographic locations. For example, there are differences inconsumer perceptions between people in the southwest and thenortheast toward the level of authenticity of Mexican restaurants(Munoz and Wood 2009).

To sum up, previous studies demonstrated that consumer atti-tudes toward ethnic cuisine are positive due to specific ethnic foodimages, such as “healthy,” “low-calorie,” “plenty of vegetables,”“fresh ingredients,” “authentic,” and “rich and diverse.” Likeother mainstream restaurants, attributes such as price, employeeservices, food quality, location, and parking convenience, similarlyinfluence consumer perceptions toward ethnic restaurants. An es-pecially critical attribute of an ethnic restaurant’s attractiveness andpopularity is its “authentic” environment.

Spices in Ethnic CuisinesVarious kinds of spices and herbs used in ethnic cuisines

(Table 1) contribute to their distinctive flavors and tastes. Pop-ular spices used in Mexican cuisines are cilantro, oregano, thyme,parsley, mint, marjoram, cumin, and chili powder (Jeanroy 2012).In detail, herbs used in Mexican foods are: acuyo or tlanepa, ama-ranth, anise, annatto, avocado leaf, balm-gentle, banana leaf, bayleaf, bean flower, chamomile, chaya, chepiche, chepil or chipil,chia, cilantro, cuajes, cumin, flor de cimal, halachas, hierbasanta,Indian paintbrush, lemon grass, lemon verbena, lenguitas, mar-joram, Mexican safflower, oregano, papalo, pepicha, peppermint,purslane, quintoniles, sesame, spearmint, sweet basil, Tilia, ver-vain, watercress, and wormseed. Spices used in Chinese cuisinesare star anise, fennel seed, clove, cinnamon, 5-spice powder, gin-ger, peppercorns, bird’s eye chili, kaffir lime leaf, yellow ginger,and lemongrass (Chinese traditional food.com 2012). Spices used



Table 1–Various types of spices and their descriptions (cited from Wikipedia).

Name of spices Description

Akajiso Refers to perilla.Amaranth Commonly known as the Prince-of-Wales feather.Anise Belongs to the family Apiaceae, is sweet and aromatic, and has a similar flavor with fennel and tarragon.Annatto Derived from the achiote tree seeds, and widely used for food coloring in many cheeses, cheese products, dairy products, and

nondairy products because of its yellow to orange color.Basil Known as Ocimumbasilicum and is a member of family Lamiaceae (mints). Sweet basil and bush basil are commonly used as

aromatic herbs. Especially in Italy, sweet basil is widely used in salads, soups, and pizzas.Bay leaves Fresh or dried bay leaves are used in cooking as a flavoring for casseroles, soups, stews, praises, and sometimes roasts.Borage Known as starflower. Borage is used as vegetables in Germany, in the Spanish regions, and in the Greek island. It is used as filling

for pasta ravioli and pansoti widely in Italian Liguria.Clove The aromatic dried flower buds of a tree which is a member of family Myrtaceae. They are used in meat and curries to add flavor,

and also used in sweet dishes.Coriander Belongs to the family Apiaceae. The leaves are known as coriander leaves, fresh coriander, Chinese parsley, or cilantro. The

leaves have a citrus flavor. The fresh leaves are used in dishes from various countries. The dry fruits of this plant are known ascoriander or coriandi seeds. Dried coriander fruits have a lemony citrus flavor when crushed because of the terpenes linalooland pinene. Coriander seeds can be roasted or heated on a dry pan. It can be eaten as a snack, used as a spice in curries, usedfor pickling vegetables, or used for making sausages in Germany and South Africa.

Five-spice powder A mixture of 5 spices, including bajiao (star anise), cloves, cinnamon, huajiao (Sichuan pepper), and ground fennel seeds. It isused as a spice of chicken, duck, pork, and seafood dishes.

Ginger Is widely pickled in vinegar to make benishogarandgari in Japan. Beni-shouga is red color thin strips of ginger. Gari is thinly slicedyoung ginger after it has been marinated in a sugar and vinegar solution, and has a sweet flavor. Beni-shouga and gari areserved with many Japanese dishes.

Licorice/licuorice The root of Glycyrrhizaglabra. It is used for medicinal uses. In China, it is used for making flavor broths.Marjoram Has sweet pine and citrus flavors. The leaves are used as green or dry condition because of it aroma.Shiso Belongs in the mint family, and comprises of 2 kinds, red (or purple) leaves and green leaves. In Japan, a whole leaf of green shiso

is used as the ingredient of wasabi. Typically, chopped fresh green leaves are used for cold dishes, such as cold noodles or coldtofu. Red leaves are used for making pickled plum or eggplant.

in Italian cuisines are basil, bay leaves, black pepper, borage, chilies,chives, coriander, fennel, fennel seeds, garlic, ginger, juniper, mar-joram, myrtle, nutmeg, oregano, parsley, rosemary, saffron, sage,thyme, and vanilla (Yahoo 2012). Japanese cuisine uses a range ofspices and herbs, including ginger, hashouga, karashi, myouga, san-sho pepper, shichimi pepper, shiso, shouga, wasabi, and yuzu (TheMatsuri Restaurant 2012; The Japanese Kitchen 2012). Herbs thatare valued as a garnish are dropwort: boufu and mitsuba; Japanesebasil: akajiso, hojiso, and ohba/aojiso; and water pepper: benidateand tade (The Matsuri Restaurant 2012).

A large number of studies have shown that many spices haveantimicrobial properties. The antimicrobial effects of basil andthyme and their major constituents, thymol, p-cymene, estragole,linalool, and carvacrol on the growth of Shigella were demonstratedin a study by Bagamboula and others (2003). The antimicrobialeffects of essential oils from herbs and spices on many pathogens,such as Salmonella Typhimurium, Escherichia coli O157:H7, Listeriamonocytogenes, Bacillus cereus, and Staphylococcus aureus, have beendemonstrated in a study by Tajkarimi and others (2010) amongseveral others. In addition, the suppressed growth of bacteria suchas E. coli, Pseudomonas fluorescens, and Lactobacillus plantarum in solu-tions of extracts from cinnamon and rosemary has been reported byKong and others (2007). The inhibitory effect of spices and herbson the growth of microbes is closely related to microbial foodquality and safety. The study findings mentioned above imply thatethnic cuisines containing a variety of spices may be inhibitory tocertain foodborne pathogens and have a longer shelf-life or longerstorage period than foods that lack spices.

The Occurrence of Foodborne Pathogens and Asso-ciated Disease Outbreaks Linked to Ethnic Cuisinearound the World

Foodborne illness outbreaks associated with various ethniccuisines have been reported around the world and in the UnitedStates. In China, the presence of L. monocytogenes in various foodproducts was identified in a study by Yan and others (2010). L.monocytogenes, at the rate of 4.13%, was detected from a total of

2177 food samples collected in 9 cities of northern China from2005 to 2007. The pathogen was found in frozen food madeof wheat or rice products (10.32%), raw meat products (6.28%),cooked meat (1.17%), seafood (0.98%), and nonfermented beanproducts (0.62%). Foodborne illness outbreaks associated withbotulism occurred in China’s Hebei Province from August toSeptember, 2007. An immediate investigation followed and mi-crobiological testing showed that all affected patients had eatensausage contaminated with Clostridium botulinum toxin type Awhich, when stored at room temperature, is capable of spore ger-mination and toxin production (Zhang and others 2010). As rawand partially cooked oysters became popular in China, 31.1% of5770 foodborne outbreaks associated with Vibrio parahaemolyticusoccurred in China between 1991 and 2001 (Liu and others 2004).In addition, Chen and others (2010) investigated the occurrenceof foodborne pathogens in oysters in food markets of southernChina from 2007 to 2008. The findings showed that Vibrio vulnifi-cus and V. parahaemolyticus could be detected in 67 (54.9%) and 109(89.3%), with a Most Probably Number (MPN) value of greaterthan or equal to 3 from the 122 oyster samples analyzed, respec-tively. Fu and others (1999) examined 3746 samples of 7 types offoods in 12 Chinese provinces for L. monocytogenes. Their findingsshowed the presence of L. monocytogenes in cold drinks (1.39%),raw meat (1.53%), sterilized milk products (0.52%), cooked meatproducts (0.47%), raw milk (0.72%), and aquatic products (0.19%).Wang and others (2007) reviewed 2447 papers from publishedjournals in order to determine the occurrence of foodborne ill-ness outbreaks in China. Their findings reported that 1082 bacte-rial foodborne disease cases occurred between 1994 and 2005. Themost frequent foodborne disease is caused by V. parahaemolyticus,followed by Salmonella and C. botulinum. V. parahaemolyticus causedthe highest percentage of outbreaks in the coastal provinces, whileSalmonella caused the highest percentage of outbreak in inlandprovinces.

The report “Outbreak of Salmonella Braenderup infection orig-inating in boxed lunches in Japan in 2008” identified 176 food-borne illness cases associated with Salmonella enterica serotype



Braenderup infection (Mizoguchi and others 2011). The find-ings showed that 3 food items, including tamagotoji (soft egg withmixed vegetables and meat), pork cooked in soy sauce, and vine-gared foods, were significantly associated with a higher risk ofillness. The main food vehicle of the outbreaks was unpasteurizedliquid eggs contaminated with S. Braenderup. This species wasisolated from 5 out of 9 sampled cases and 6 food handlers.

Sushi and sashimi are often associated with parasites. The epi-demiology of fish zoonoses is associated with sushi and sashimibecause of inappropriate treatment of fish products during hunt-ing and frozen storage (Oktener and others 2010). Sumner andRoss (2002) developed a scale to assess seafood risk assessment.According to this risk assessment of sea food hazard/productcombinations, there is some risk of finding parasites in Austriansushi/sashimi (Sumner and Ross 2002). The results showed thatlow levels of Pseudomonas spp., Staphylococcus spp., Enterobacteri-aceae members, E. coli, and Bacillus cereus were detected, and it wasrecommended that hygiene be improved at restaurants.

In the United Kingdom, Salmonella Enteritidis (SE) phage type34a infection occurred among people who had eaten food froma Chinese restaurant in 2002 (Linnane and others 2002). TheOutbreak Control Team found that eggs used for egg-fried rice leftat room temperature were the vehicle for the outbreak. In Korea,a microbial assessment of fried-rice dishes at Chinese restaurantswas performed, and the prevalence of B. cereus detected in cookedrice at the consumption point was 37.5%.

As demonstrated by the aforementioned studies above, variousmicrobial pathogens are involved in foodborne illness outbreaksassociated with ethnic cuisines throughout the world. As withany food that is served to consumers, proper preparation, cook-ing, and storage are critical to prevent foodborne outbreaks inthe food industry, both mainstream and ethnic. A trial to iden-tify the issues and challenges that ethnic foods faced was doneby a report entitled “A food inspector’s guide to ethnic foods inMichigan” (Po 2007). This report suggests several recommenda-tions to prevent foodborne illness outbreaks associated with ethniccuisine. Understanding the culture, including language, religion,body language, tone of voice, or values regarding time helps whencommunicating with foreign food handlers, as does getting moreknowledge about food culture, including geographic or economicfactors, and letting food handlers become familiar with ethnicfoods. Moreover, appropriate cooking and storage procedures aremost important. Risk factors and regulatory concern for specificethnic cuisines were identified by this report. The recommendedcooking and storage procedures for specific ethnic cuisines arelisted in Table 2.

Foodborne Illness Outbreaks Associated with EthnicCuisines in the United States

As ethnic cuisines have increased in popularity, more food-borne illness outbreaks associated with them have occurred inthe United States. Approximately 48 million cases of over-all foodborne illness outbreaks are reported annually, andthe major source of such outbreaks is restaurants, at a 66%occurrence rate (Jones and others 2004; Kufel and others2011; Scallan and others 2011). The case of ethnic cuisinesseems similar. Foodborne illness outbreaks associated withMexican cuisine showed that fresh vegetables or eggs were identi-fied as the main causes. Red salsa, especially, which is a commonside item in Mexican foods and offered with chips, was related to70 foodborne outbreaks (2280 illness cases) from 1990 to 2006, andamong these outbreaks 70% occurred in restaurants (Franco and

Table 2–Safe handling instructions for ethnic cuisines (Po 2007).

Food Risk factors and regulatory concern for ethniccuisines

Fried rice Improper cooking temperatures:� Taking rice directly from the refrigerator to the

steam table.� Reheating temperature of 165 ◦F (74 ◦C).Improper holding temperature:� Leaving rice at room temperature is a violation of

the Food Code.� Must be held at 135 ◦F (57 ◦C).Cross contamination:� Rice should be dried in order to prevent the

growth and possible toxin formation of B. cereusand cooled and stored in an air-tight containerand refrigerated.

Egg rolls Improper cooking temperatures:� Vegetables must be heated to 130 ◦F (54 ◦C), and

meat should heat to 145 ◦F (63 ◦C).� Reheating temperature is 165 ◦F (74 ◦C).Improper holding temperature:� Egg rolls must be held at 135 ◦F (57◦C) or above.� Egg rolls must be cooled down from 130 ◦F

(54 ◦C) to 70 ◦F (21 ◦C) within 2 h, and from 70 ◦F(21 ◦C) to 41 ◦F (5 ◦C) within 4 h.

Burritos & tacos Improper cooking temperatures:� Meat must be grilled; beef to 145 ◦F (63 ◦C), and

chicken 165 ◦F (74 ◦C).Improper holding temperature:� Meat must be held continuously at 135 ◦F (57 ◦C)

or above.� Held from 130 ◦F (54 ◦C) to 70 ◦F (21 ◦C) within

2 h, from 70 ◦F (21 ◦C) to 41 within 4 h.Cross contamination:� Wash vegetables well.� Use clean chopping board.

Salsa Contamination:� Wash raw vegetables and fruits properly.Storage temperature not adequate:� Proper refrigeration is required because of fresh

raw ingredients.Not enough acidity:� Fresh salsa has a shorter shelf life.

Nachos Undercooking/improper hot holding temperature:� Topping meat should be properly cooking.Cold holding:� Avoid cheeses or fresh vegetables held at

temperature of 41 ◦F (5 ◦C).Sushi & sashimi Improper holding temperatures:

� Raw seafood must be frozen and maintainedbelow 41 ◦F (5 ◦C).

pH above 4.2:� Sushi rice including vinegar should have pH 4.2 or

lessPoor personal hygiene:� No bare hand contact is allowed during

preparation or service.Enchilada Source of vegetables:

� Use uncontaminated raw vegetables.Improper holding temperature:� Filing and sauce should be refrigerated before

baking.Guacamole Contamination:

� Wash avocadoes and tomatoes well.� Use clean cutting board.Storage temperature not adequate:� Processed guacamole should be kept refrigerated

after unsealing.

Simonne 2009). The ingredients of red salsa are fresh tomatoes,onions, chili peppers, cilantro, and seasonings. Previous studieshave pointed out the vegetables in Mexican foods as food vehi-cles of foodborne illness outbreaks. For example, in the reportanalyzing the foodborne illness outbreak data from the Centersfor Disease Control and Prevention’s Foodborne Disease Out-break Surveillance System (FDOSS) from 1973 to 2008, salsa and



guacamole were pointed out as vehicles (Kendall and others 2013).Kendall and others (2013) found 136 outbreaks associated withsalsa or guacamole and insisted that improper storage increases therisk of foodborne illness outbreaks. Canvin and others (2004) re-ported outbreaks of hepatitis A associated with green onions fromMexico. Fresh tomatoes linked to a Salmonella outbreak were men-tioned in the study of Beuchat and Mann (2008) and Cummingsand others (2001) and fresh cilantro linked to a Salmonella outbreakhas been reported in the study of Campbell and others (2001). InMay 1996, the outbreak of SE in Waycross, Georgia, was reportedby the Georgia Div. of Public Health. A deep-fried Mexican dish(chile relleno), sold in the restaurant, was significantly related to SEinfection (4 of 21 cases compared with 0 of 26 controls, odds ratioundefined, 95% CI > 1.46, P = 0.034) (McNeil and others 1999).In 2003, a large foodborne outbreak occurred among patrons of asingle restaurant in Pennsylvania, whereby 3 died, and at least 124were hospitalized among an identified 601 patients. The hepatitisA virus, which originated from mild salsa containing green onionsgrown in Mexico, was the causative agent, and the green onionshad been contaminated before arrival at the restaurant (Wheelerand others 2005). Franco and Simonne (2009) specified that food-borne illness outbreaks from 1990 to 2006 were associated withMexican cuisines, based on the CDC report “Mexican food safetytrends.” Mexican foods were associated with 560 foodborne ill-ness outbreaks out of a total of 15997 reports, and these outbreaksoccurred in 43 states. The percentage of outbreaks associated withMexican foods has somewhat increased from 2.6% in 1990 to 2.8%in 2006. Forty-seven percent of outbreaks associated with Mex-ican foods began in restaurants. The causes of 215 outbreaks outof 560 outbreaks in Mexican foods were identified. Among theknown causative agents, Salmonella caused 34%, Clostridium caused23%, Shigella caused 6%, Staphylococcus caused 5%, pathogenic E.coli caused 5%, and others (L. monocytogenes, E. coli O157:H7, andnorovirus) caused 5% of the outbreaks. The most frequent Mexi-can food vehicles associated with foodborne illness outbreaks from1990 to 2006 were tacos (18%), chili (9%), salsa (9%), refried beans(8%), burritos (7%), and guacamole (4%). Because of the inherentuse of fresh vegetables in Mexican cuisine and the fact that manycases of foodborne illness outbreaks associated with Mexican foodsare due to contaminated fresh vegetable ingredients, it could beimplied that extra preventative care need to be taken by restaurantoperators serving Mexican food in order to avoid the occurrenceof foodborne illnesses from contaminated fresh vegetables.

In the case of Japanese cuisine, sushi, a sticky vinegar rice that isshaped into bite-sized pieces and topped with raw or cooked fish(salmon, snapper, tuna, mackerel, and yellowtail) or formed intoa roll with fish, egg, or vegetables and wrapped in seaweed; orsashimi, delicately sliced raw fish (salmon, cooked shrimp, tuna,mackerel, fatty tuna, yellowtail, and octopus) which is served withonly a dipping sauce (Po 2007), have been suspected of causingfoodborne illness outbreaks. Unless fish intended for raw con-sumption is stored at less than –35 ◦C for 15 h or at below –20 ◦Cfor 7 d (which is recommended by the U.S. Food and Drug Ad-ministration), the product can be expected to carry much higherrisks of zoonotic parasites (Nawa and others 2005). Accordingto Diplock (2003), previous studies focused on the fish ratherthan the rice as the source of illness. However, rice prepared inadvanced has a high-risk potential for causing foodborne illnessoutbreaks (Sutherl and others 1996; Nichols and others 1999).In 2001, prepared rice stored at room temperature at a Japaneserestaurant was observed by a public health inspector, who man-dated that the rice be discarded (Diplock 2003). Foodborne illness

outbreaks that led to diarrhea occurred among sushi restaurantpatrons in Nevada in August and November 2004. In this Nevadaoutbreak, enterotoxigenic E. coli was found in stool samples from6 of 7 ill patrons and 2 of 27 employees of sushi restaurants. Thepresence of the bacterium was determined to be the cause becauseof poor food-handling and bad hygiene practices (Jain and others2008).

Regarding sushi outbreaks, one concern is the growth of B.cereus when the rice is stored in the danger zone (4.4 to 60 ◦C)(Diplock 2003), and another is the transfer of pathogenic bacteria,such as Salmonella, Vibrio, Listeria, and E. coli, to fish, which thenmay result in contamination of sushi (Atanassova and others 2008).Adams and others (1990) examined the microbiological quality ofsalmon-sushi and rice from 14 restaurants in Seattle, Washington.A 1 in 13 chance of anisakid larvae was found from salmon slices,and rice from 3 restaurants was positive for S. aureus and B. cereus(Adams and others 1990). Microbial assessments of 50 restaurantsin Seattle in 1994 were conducted from 32 samples of salmon, tuna,mackerel, and rockfish sushi during 19 mo. The results showed that10% of salmon sushi pieces were infected with a maximum of 3nematodes per piece. About 5% of mackerel sushi pieces wereinfected with nematodes. All nematodes were 3rd-stage juvenilesof the genus Anisakis and were dead. Clearly, the aforementionedreports indicate that the use of raw fish, pre-prepared rice, and poorhygienic practices are areas that need to be properly controlled toprevent foodborne disease outbreaks from Japanese cuisines.

The incidence of foodborne illness associated with ethnic foodsfrom 1990 to 2000 based on the CDC data was determined andreported by Simonne and others (2004). Ethnic foods resulted in3% of the total number of outbreaks in 1990, and this percent-age increased to 7% in 2000. The most frequent outbreaks wereassociated with Mexican, Italian, and Asian foods, and amongthese categories, Mexican food resulted in the highest number ofoutbreaks. The major causative microorganisms for outbreaks inMexican foods were Salmonella (47%), Clostridium (26%), Shigella(10%), and S. aureus (5%). The major causative microorganismsfor outbreaks in Italian foods were Salmonella (58%), S. aureus(12%), Clostridium (10%), and Norwalk virus or norovirus (10%).The major causative microorganisms for outbreaks in Asian foodswere Bacillus spp. (50%), Salmonella (31%), and S. aureus (14%).Compared to Asian and Italian foods, more harmful causative mi-croorganisms, such as E. coli O157:H7 or C. botulinum, were foundin Mexican food. In descending order, Florida (n = 136), Cal-ifornia (n = 74), New York (n = 42), Maryland (n = 40), andMichigan (n = 37) were the states most frequently associated withethnic food outbreaks, and restaurants were the places where thehighest numbers of outbreaks originated from.

In order to determine the most recent safety trends of ethnicfoods at restaurants, this current study examined foodborne illnessoutbreaks associated with ethnic foods at restaurants from 2001 to2009 based on a CDC (2011) database. This database categorizedthe types of restaurants into 3 types, including restaurants of otheror unknown type, restaurants for sit-down dining, and restaurantsfor fast food (drive-up service or pay-at-counter). As Figure 2shows, the majority of incidents occurred in restaurants of otheror unknown type. This could be because fast food restaurants haveestablished systemized cook procedures.

It is not easy to rank the severity of outbreaks for each cuisinebecause the severity of outbreaks and illness is related to mortalityand hospitalization rates, the profile of the causative microorgan-isms, and health status of the host. However, the breakdown ofcases per outbreak does provide clues for each group (Figure 3).



Figure 2–Breakdown of outbreaks of ethnic foods by restaurant types with confirmed and suspicious etiology from 2001 to 2009 (data from CDC2011).

Figure 3–Breakdown of outbreaks by types of food from 2001 to 2009 (data from CDC 2011).

For most years, Mexican foods showed the highest number of out-breaks as compared to Chinese, Italian, and Japanese foods, whilethe lowest number of outbreaks related to all 4 ethnic food groupsoccurred in 2004 and 2009 (Figure 3).

As Figure 4 shows, taking into consideration confirmed etiolo-gies at restaurants, 2727 cases of outbreaks associated with Mex-ican foods occurred in restaurants between 2001 and 2009. Themajority of the species of microbial causes were S. enterica (n =1486), followed by norovirus (n = 694), Clostridium perfringens(n = 151), Campylobacter jejuni (n = 121), B. cereus (n = 111),shiga toxin-producing E. coli (n = 92), Shigella sonnei (n = 23),S. aureus (n = 21), and other bacteria (n = 16).

The total number of outbreaks associated with Chinese foodsoccurring in restaurants was 113 between 2001 and 2009 (con-firmed etiology). B. cereus made up the majority of bacterial causeswith 52 cases (Figure 5). The next highest cause was noroviruswith 36 cases, followed by E. coli and others with 5 cases. C. jejuni,S. aureus, other campylobacters, and other bacteria comprised 4%each.

Between 2001 and 2009, 336 cases of foodborne illness out-breaks associated with Italian foods occurred in restaurants (con-firmed etiology). As Figure 6 shows, norovirus (n = 259) ranked1st of the causative agents, followed by S. aureus (n = 40), B. cereus(n = 17), various chemicals (n = 7), C. perfringens (n = 6), S.enterica (n = 5), and other bacteria (n = 2).

The total number of cases in outbreaks associated with Japanesefoods occurring in restaurants was 298 between 2001 and 2009

(confirmed etiology). As Figure 7 shows, the majority of causeswere S. enterica (n = 211), norovirus (n = 72), other bacteria (n =5), Campylobacter (n = 4), S. aureus (n = 2), B. cereus (n = 2), andscombroid toxin (n = 2), in descending order.

In sum, the foodborne illness outbreak trends, based on CDCdata analysis from 2001 to 2009 of the current study, showedthat Mexican foods resulted in the highest number of outbreaks ascompared to Chinese, Italian, and Japanese foods. This is consistentwith the CDC data from 1990 to 2000 (Simonne and others2004). S. enterica ranked 1st of the causative agents of outbreaksin Mexican and Italian foods, B. cereus ranked 1st of the causativeagents of outbreaks in Chinese foods, and norovirus ranked 1st ofthe causative agents of outbreaks in Japanese foods.

In our recently completed study (Lee 2012), an evaluation ofmicroorganisms was determined in 4 different types of local ethnicrestaurant food samples (Mexican, Italian, Chinese, and Japanese)procured from Columbia, Missouri. The results from a total of24 food samples showed that less than 1 log CFU/g Bacillus wasfound in all tested food samples, while coliforms, E. coli, S. aureus,and Salmonella were not detected in any of the samples. Totalaerobic counts of Mexican food samples averaged 4.73 ± 0.34log CFU/g, that for Italian averaged 1.40 ± 1.15 log CFU/g,and those for Chinese and Japanese food samples, respectively,averaged 0.55 ± 0.95 log CFU/g and 4.70 ± 0.88 log CFU/g.Mexican and Japanese food samples showed the highest number,and Chinese samples showed the lowest number of aerobic counts.The assessments of the 4 types of ethnic restaurant food samples in



Figure 4–Etiology of foodborne illness outbreaks associated with Mexican foods from 2001 to 2009 (data from CDC 2011).

Figure 5–Etiology of foodborne illness outbreaks associated with Chinese foods from 2001 to 2009 (data from CDC 2011).

Figure 6–Etiology of foodborne illness outbreaks associated with Italian foods from 2001 to 2009 (data from CDC 2011).

Lee’s report showed that the highest aerobic counts in food sampleswere in Mexican samples, and these results were consistent withthe CDC (2011) data analysis provided above. Lee (2012) pointedout that regardless of the type of ethnic cuisines, those containingcooked ingredients have fewer microbial quality and safety issuesthan those containing raw ingredients, such as raw tomato, onion,and cilantro in Mexican food, and raw fish in Japanese food.

Risk PerceptionsFoodborne disease is regarded as an important public health

issue in the United States, and ethnic restaurants are someof the major places from where foodborne outbreaks origi-nate (Mead and others 1999; Olsen and others 2000; Hed-berg and others 2006). Furthermore, ethnic foods contain un-familiar ingredients, flavors, and features, and this unfamiliarity



Figure 7–Etiology of foodborne illness outbreaks associated with Japanese foods from 2001 to 2009 (data from CDC 2011).

with ethnic cuisines is often accompanied by uncertainty andrisk.

Risk perception of ethnic cuisine is an important issue becauseof the potential negative influence it has on consumers’ visits toethnic cuisine restaurants. There are 2 dimensions of risk percep-tion: 1) the probability of a particular event occurring during aperiod of time (such as how often foodborne illness outbreaks oc-cur); and 2) the seriousness or scale of outbreak consequences (howserious the foodborne illnesses are) (Breakwell 2007). Risk percep-tion was defined by Yeung and Morris (2006) as “the uncertaintythat consumers face when they cannot foresee the consequencesof their purchase decisions” or “the individual judgment of thelikelihood that a consequent loss could occur and the seriousnessof its likely consequences.”

Risk perception consists of 5 types: functional risk, physicalrisk, financial risk, psychological risk, and time risk. Functionalrisk refers to the risk that the product will not perform as expected,physical risk refers to the risk to self and others that the productmay pose, financial risk refers to the risk that the product will notbe worth its cost, psychological risk refers to the risk that a poorproduct choice will bruise a consumer’s ego, and time risk refersto the risk that the time spent in product search may be wasted ifthe product does not perform as expected (Schiffman and Kanuk2007; Goyal 2008).

Perception of risk involves financial loss, time loss, and physi-cal loss, thus it influences the willingness to purchase (Roehl andFesenmaier 1992; Mitchell 1998; Mitra and others 1999). Amplestudies have shown a negative relationship between risk percep-tion and subsequent purchase behavior in the consumer mar-keting context (Bauer 1967; Cunningham 1967; Roselius 1971;Mitchell and Boustani 1992). Specifically, Park and others (2005)found negative impacts of online shoppers’ perceived risk of in-accurate website product presentation on Internet shopping pur-chase intentions. Yeung and Morris (2001a) supported the neg-ative impact of risk perception on the attitudes and behavior ofconsumers with respect to the purchase of chicken products, andRoselius (1971) supported the strong link between risk percep-tion and the purchase of products. Kim and others (2005) foundthat perceived risk was negatively correlated with consumers’ on-line airline ticket purchase intentions, and perceived risk signifi-cantly affected consumers’ willingness to purchase online airlinetickets.

The negative influence of risk perception on consumer be-havior has been supported in food-related research. Yeung andMorris (2001b) observed that bacterial outbreaks, bovine spongi-form encephalopathy, and alleged risks associated with geneticallymodified organisms found in foods negatively affect consumers’confidence in the “healthiness” of food products. From this per-spective, it is probable that risk perception affects consumer inten-tions to visit ethnic restaurants. Our recent completed study (Lee2012) supported the negative influence of consumers’ risk per-ception toward Chinese cuisines on consumer intentions to visitethnic cuisine restaurants. Specifically, this study identified the im-pact of protection motivation on risk perceptions. People evaluatespecific foods when they perceive a health threat and adjust theirbehavior to the threat. This psychological mechanism process iscalled protection motivation (Rogers 1975). Our study (Lee 2012)showed that the evaluations of threats, including the perceived se-riousness of foodborne illnesses and the perceived probability offoodborne illness outbreaks do influence consumer risk perceptionof ethnic cuisines. In other words, people who perceive foodborneillness as being serious have a higher risk perception, and thosewho perceive foodborne illness as something that occurs often alsoshow a high-risk perception of ethnic cuisines.

Food Safety in the Restaurant IndustryDespite over 150 y of advances in food microbiological pro-

cesses and the latest in molecular biology techniques, increasedreports of foodborne diseases indicate that food safety is still not as-sured (Griffith 2000; Redmond and Griffith 2003). Griffith (2006)pointed out various reasons for this, such as “changing patternsof food consumption, a change in cooking/shopping practicesto weekly or monthly shopping rather than daily, greater timesof eating out, changes in farming practices, evolution of exist-ing and new food pathogens, and a lengthened gap betweenproduction and consumption.” It is interesting that more eth-nic cuisines also contribute to an increase in foodborne illnessoutbreaks. The FDA Retail Food Steering Committee recom-mends that regulatory agencies focus their efforts on reducingthe occurrence of the factors most commonly identified by theCDC as being associated with foodborne illness outbreaks, in-cluding food from unsafe sources, inadequate cooking, improperholding temperatures, contaminated equipment, and poor per-sonal hygiene (Mauer and others 2006). The FDA established a



goal of reducing the percentage of “out-of-compliance” risk fac-tors by 25% by 2010 in institutional food service, restaurants, andretail food establishments (FDA Natl. Retail Food Team 2004;Mauer and others 2006; Fraser and Alani 2009). Although foodsafety/sanitation is important in the food industry, not many stud-ies compared ethnic foods and restaurants to nonethnic foods andrestaurants. Moreover, few studies examined the role of safetyand sanitation issues of ethnic foods and restaurants in con-sumer behaviors. Satow and others (2009) examined sanitationlevels of a sample of 290 restaurants in San Francisco and foundthat Italian and Japanese restaurants scored high in sanitationperformance, whereas Chinese and Mexican restaurants scoredlow.

Some studies have indicated that, in the United States, eat-ing in restaurants involves a high risk of foodborne disease trans-mission (Hedberg and others 2006). Ethnic restaurants have ahigher probability of causing foodborne illness outbreaks becausethey typically use unfamiliar ethnic ingredients, their employeesmay lack ethnic food knowledge, and their employees may be di-vided by ethnic cultural issues (such as communication difficulties)(Simonne and others 2004).

HACCP Program in the Hospitality BusinessHACCP is a system developed to prevent foodborne illness by

monitoring and controlling food processing procedures (Sun andOckerman 2005). In 1999, HACCP was proposed as an innova-tive approach to improve food safety in restaurants (Allwood andothers 1999). HACCP has 7 principles (Boehnke and Graham2000): “Analyze hazards, identify critical control points, establishpreventive measures with critical limits for each control point, es-tablish procedures to monitor the critical control points, establishcorrective actions to be taken when monitoring shows that a crit-ical limit has not been met, establish procedures to verify that thesystem is working properly, and establish effective record-keepingto document the HACCP.” In a HACCP system, identificationof PHF is important. According to the FDA Food Code, PHFare foods that can support the growth and toxin production bypathogenic microbes. The specific water activity and pH associ-ated with PHF is 0.85 and 4.6 or above, respectively (FDA 2013b).A properly implemented HACCP system is designed to preventthe risk of foodborne illnesses associated with PHF. There are dif-ferences between an inspection and a HACCP audit. Typically,the major goal of an inspection is to answer the question “Is itclean?” (Boehnke and Graham 2000). Inspections are focused onthe cleanliness of the environment in which the food is handledand on the temperature of foods. On the other hand, the HACCPaudit process is focused on making sure that the operator exam-ines and records the entire process, including purchases, arrival,storage, handling, preparation, service and packing, and shipping.Overall, the audit puts more emphasis on specific potential dangerpoints (Boehnke and Graham 2000).

HACCP implementation is less common in small food facili-ties with less than 50 staff members than in larger food facilities(Panisello and others 1999). In their university restaurant study,Soriano and others (2002) also noted that the HACCP system isoften not correctly implemented in small working spaces and withlow numbers of employees. Adoption of HACCP in small com-panies is not easy because it requires significant mindset changes,expertise, time, and money (Taylor 2001). Taylor (2001) suggeststhat there are 4 problems with implementing HACCP in smallfood facilities:

(1) Because small food facility operators often think they al-ready provide safe enough food, it is difficult to changetheir beliefs and motivate them to adopt HACCP.

(2) Implementation of HACCP requires information, foodsafety knowledge, skills, and hygiene training. Unfortu-nately, small food facilities are limited when it comes tothose resources. According to Holt (personal communica-tion, October 1999), employees’ levels of experience andtechnical qualifications affect the successful implementationof HACCP. A lack of food safety skills and knowledge isproblematic in small food facility operations because theiremployees typically participate in incomprehensive shortcourses.

(3) The training department in large companies can afford toprovide comprehensive HACCP training, whereas smallcompanies often cannot.

(4) The requirement for documentation for HACCP iscumbersome.

If the above difficulties can be conquered, there are severalbenefits to small food facilities for implementing HACCP. Taylor(2001) listed several, based on previous studies. First, when it workswell, implementation of HACCP can provide the operator withconfidence. Second, HACCP is more effectively done in a smallfood operation and can result in reduced costs. Third, adoption ofHACCP can be a legal defense when an outbreak of foodbornedisease happens, since HACCP is the most effective managementtool to secure safe food. Fourth, the success of implementingHACCP helps organizations to easily adapt to new circumstancesbecause they have already developed new skills and knowledge inthe workplace.

In a restaurant study about HACCP program implementation inIowa and Kansas, employee knowledge and time, and also managerknowledge, were found to be the 3 top obstacles to implement-ing HACCP programs (Roberts and others 2005). Food facilityoperators implement a HACCP program with reasons for self-improvement and legal compliance (Mortimore 2001). Previousstudies of HACCP in foodservice areas highlight the positive im-pact of HACCP systems in various places, from universities tothe airline industry (Kang 2000; Soriano and others 2002; Sunand Ockerman 2005). Kang (2000) showed in detail that the im-plementation of HACCP improved food safety in in-flight foods.Soriano and others (2002) examined a university restaurant be-fore and after implementation of a HACCP system and foundimprovement in microbiological quality and food safety. Lack ofeducation and proper training on HACCP can negatively affectattitudes toward food safety (Toh and Birchenough 2000), thus,regular and frequent HACCP practices are needed to produce saferfood (Baker 2002). Training at restaurants is very closely relatedto HACCP practices because regular and appropriate training re-sults in higher levels of food safety and leads to better HACCPpractices. Most ethnic food restaurants are small food facilities,so they should consider the burdens of HACCP as listed above.However, since ethnic food restaurants may have more food safetyconcerns regarding foodborne illness outbreaks, the implementa-tion of HACCP is more vital and seems to be an important factorin ensuring safe ethnic foods.

Food Safety TrainingFood safety training is an effective way to prevent foodborne

illness outbreaks in ethnic restaurants. The positive impact of train-ing in the food service business is supported by previous studies.Using research conducted from 1998 to 2000, researchers found



that untrained staff was cited 100 times as contributing to foodpoisoning outbreaks (Worsfold and Griffith 2003). Howes andothers (1996) noted that 97% of foodborne illness in food ser-vice establishments was due to inadequately trained staff. In thestudy by Worsfold and Griffith (2003) of a food catering ser-vice, evaluations of caterers’ hygiene issues, perceptions of risktoward food safety, and attitudes toward perceptions of HACCPwere compared before, during, and after training. The results ofWorsfold’s study show improvement in awareness and knowledgeof HAACP after training. Martinez-Tome and others (2000) col-lected samples from 4 school kitchen salads before and after thestaff had received training about food handlers’ hygiene practices.The comparison showed that the number of bacteria in the foodsample decreased after training (Martinez-Tome and others 2000).This result supports the importance of food safety education andtraining.

The effect of food safety training as a method to reduce food-borne illness is obvious; however, food safety training that ac-knowledges different cultures and learning styles is lacking eventhough the percentage of foreign workers in ethnic restaurantsis relatively high compared to nonethnic restaurants. Po (2007)pointed out that ethnic restaurant food handlers’ limited abil-ity to speak in English and different cultural factors may resultin miscommunication with food inspectors. Understanding thedifferent cultural factors of foreign food handlers, such as bodylanguage, values regarding time, and food culture, is very impor-tant to prevent foodborne illness outbreaks. Po and others (2011)pointed out that appropriate translation and culturally appropri-ate or sensitive approaches to food safety is required for effectivefood safety education training for ethnic food handlers. Cho andothers (2012) argued that Latino(a) restaurant employees tend tofollow more appropriate food safety practices when food safetytraining focuses on benefits of their restaurants because the cul-ture of Mexico and other Latin American countries is based oncollectivism, so Latino(a) workers are more interested in group,family, or extended relationships than individual ones. Thus, foodsafety training for ethnic restaurant handlers can be effective inpreventing foodborne illness if cultural components are reflectedand taken into consideration.

Restaurant Inspection ScoresIn order to prevent foodborne disease, restaurant inspections

are conducted by local, county, or state Health Dept. personnel,and scores can be accessed by the public through the Internetor local news media (Jones and others 2004). Restaurant inspec-tions are usually done twice a year in the United States (Allwoodand others 1999). There are different types of inspection systemsexisting in the United States. The restaurant inspection systemvaries depending on the state or locality. In Los Angeles county, arestaurant hygiene grade card system is utilized. The grading sys-tem was introduced in 1998, and letter grades, based on numericinspection scores (90 to 100 = A, 80 to 89 = B, 70 to 79 =C) are utilized by the Health Dept. These grades must be postedwithin 5 feet of a restaurant’s point of entry (Fielding and others2001; Simon and others 2005). In Tennessee, inspection evalua-tion is based on 44 items that yield a possible total score of 100.Out of 44 items, 13 are critical, measuring violations “which aremore likely to contribute to food contamination, illness, or envi-ronmental degradation, represent substantial public health hazards,and are most closely associated with potential foodborne diseasetransmission” (U.S. Dept. of Health and Human Services 2001;Jones and others 2004). The Natl. Restaurant Assn., one of the

most reputable associations representing the United States restau-rant industry, agreed to make inspection reports public documents.However, they complained that poor-quality notes have causedthem to question the inspectors’ abilities as professionals or foodspecialists (Boehnke and Graham 2000).

The positive effect of restaurant inspection on maintainingrestaurant food safety and predicting foodborne outbreaks has beenstudied (Irwin and others 1989; Buchholz and others 2002). All-wood and others (1999) pointed out that researchers question theimportance of restaurant health inspections as a food safety strat-egy. In order to determine whether restaurant inspections generatemajor benefits or not, Allwood and others (1999) also examinedwhether a positive relationship between the sanitary rating of arestaurant and the frequency of a restaurant inspection exists. Theirfindings confirmed that restaurant health inspections play an im-portant role in maintaining restaurant food safety (Allwood andothers 1999).

The effect of the inspection score on decreasing foodborne dis-eases was determined by Simon and others (2005). Comparing LosAngeles county to the rest of California between 1993 and 2000,Simon and others (2005) examined the number of foodbornedisease hospitalizations caused by infectious agents (Salmonella,Campylobacter, E. coli, and other bacteria), and the overall num-ber of foodborne disease hospitalizations each year. Their findingsshowed a significant reduction of foodborne disease hospitalizationin Los Angeles County compared to the rest of California afterthe introduction of the grade card system in Los Angeles County(posting the inspection score at the restaurant’s entrance).

The literature overwhelmingly agree that food facility inspec-tion programs provide a strong incentive for facilities to instill goodsanitary and hygienic practices among their employees, which, inturn, may contribute to reducing the risks of foodborne illnessoutbreaks associated with the specific restaurants (Irwin and oth-ers 1989; Buchholz and others 1999). Jin and Leslie (2003) foundthat restaurant hygiene grade cards (displaying food safety inspec-tion grade cards in restaurant windows) contribute to increasedconsumer sensitivity to restaurant food safety, and that encour-ages operators to improve their hygiene. Use of such Los Angelesgrade cards led to a 20% reduction in foodborne illness hospital-ization. Therefore, the inspection scores of ethnic food restaurantscan accurately represent the degree of food safety at ethnic foodrestaurants. Good inspection scores are regarded as outcomes fol-lowing clean and hygienic restaurant practices.

Food safety in independent ethnic restaurants must be improvedwhen we consider the low inspection scores of these restaurantsand the foodborne illness outbreaks associated with ethnic foods(Kwon and others 2010). These authors compared the food codeviolations between nonethnic restaurants and ethnic restaurants inKansas. They found that ethnic restaurants showed significantlyhigher numbers of violations. The greatest number of food codeviolations was “potentially hazardous foods must be maintained atappropriate temperature of 5 ◦C or less” (39.2%), “equipment andutensils must be clean to sight and touch” (28.8%), “employeeswash hands at appropriate times” (22.6%), “food should be clearlymarked to indicate the date food should be consumed by, sold,or discarded” (18.8%), and “person in charge is able to demon-strate knowledge of foodborne disease prevention and applicationof HACCP” (17.6%). Choi and others (2011) also argued thatcustomized training for Asian restaurants is required based on theresults of a review of 326 restaurant inspection reports of 156 in-dependent Asian restaurants in Kansas which showed numerouscritical Food Code violations.



U.S. Regulation of Imported FoodsThe safety of imported foods is associated with the safety of

ethnic foods because many of the ingredients used in ethnic foodsare imported from various countries. Imported foods comprisearound 15% of U.S. food consumption (Neily 2012). Accordingto the CDC, 39 foodborne outbreaks resulted in 2348 illnessesbetween 2005 and 2010. These outbreaks were all associated withimported food. On January 4, 2011, President Obama signed theFood Safety and Modernization Act (FSMA) ensuring not only thesafety of the U.S. food supply, but also the safety of imported foodsby strengthening the food safety system. The FSMA gives FDA theauthority to ensure that imported foods should match the standardsrequired for domestic foods. The implements which met the stan-dards are “Importer accountability,” “Third party certification,”“Certification for high risk foods,” “Voluntary qualified importerprogram,” and “Authority to deny entry.” In detail, importer ac-countability gives foreign suppliers the responsibility for maintain-ing adequate preventive controls to ensure food safety; 3rd-partycertification requires the FSMA to establish a program which cancertify that foreign suppliers comply with U.S. food safety standardsthrough credible 3rd parties; certification for high-risk foods givesthe FDA a right to check and request a reliable 3rd-party certifica-tion of high-risk imported foods; the voluntary qualified importerprogram requires the FDA to establish a voluntary program for im-porters so importers participating in the program are eligible forthe prompt food safety tests and entry; and authority to deny entrygives the FDA a right to refuse entry of food from foreign facilitieswhen the county in which the facility is located denies access to theFDA (FDA 2013a). Even though the U.S. FDA makes an effort toensure imported food safety through regulations, it is questionablehow the consumer perceives imported food safety. The informa-tion concerning imported foods is provided to consumers fromthe country of origin. According to the Country of Origin La-beling (COOL) law, which became effective through the USDAin 2009, all imported foods must indicate from which countriesthey originated (Hostetler 2008). Consumer behavior researchersagreed that a large percentage of consumer evaluations of for-eign products depends upon the dimensions of a country’s image,such as level of economic development (Juric and Worsely 1998).Consumers show a tendency to perceive industrial products fromdeveloped country more positively than imported products froman undeveloped country (Schooler 1971; Gaedeke 1973; Wangand Lamb 1983). Possibly, food safety perceptions of importedfoods are related to country of origin regardless of the actual foodsafety issue. This current study proposes that detailed informationconcerning imported food safety is helpful to consumers. Nu-merous consumer behavioral studies support the positive effects ofproduct information on consumer’s willingness to pay, intentionto purchase (Devine and Marion 1979), and favorable attitudes(Kozup and other 2003). When considering the role of informa-tion in consumer behavior, providing more detailed informationabout imported foods might be an effective way to gain the trust ofconsumers.

ConclusionsEven though the best-known ethnic foods in the United

States—Mexican, Italian, Chinese, and Japanese—are regarded asmainstream foods, in-depth literature reviews of ethnic cuisinesare scant. The history of ethnic cuisines begins with ethnic pop-ulation immigration into the country in the 18th century, andnow the ethnic food market is expected to increase to $3.9 billionby 2016. Food safety professionals have observed that the number

of foodborne illness outbreaks associated with ethnic cuisines hasincreased as sales of ethnic cuisines have risen. The statistical anal-yses of this current review showed that between 2001 and 2009,2727 cases of outbreaks associated with Salmonella, norovirus, C.perfringens, C. jejuni, B. cereus, and E. coli were associated with Mex-ican restaurants; 113 cases of outbreaks due to B. cereus, norovirus,C. jejuni, S. aureus, and Campylobacter were associated with Chi-nese restaurants; 336 cases of outbreaks linked to norovirus, S.aureus, B. cereus, C. perfringens, and S. enterica were associated withItalian restaurants; and 298 cases of outbreaks due to S. enterica,norovirus, B. cereus, Campylobacter, and S. aureus were associatedwith Japanese restaurants.

This review identified the main causes of foodborne illnessoutbreaks linked to ethnic cuisines. In the case of Mexican foods,fresh vegetables were the main cause, and in the case of Japanesefoods, raw fish was the main cause. Lee’s (2012) study also arguedthat fresh ingredients, not cooked ingredients, among ethnic foodscontribute to foodborne illness outbreaks rather than particulartypes of ethnic foods. Po (2007) pointed out that the main reasonethnic foods are associated with foodborne illness outbreaks is thatfood handlers are not familiar with the ingredients of ethnic foods.Food safety issues are critical because they are directly relatedto human health, and also increase consumers’ risk perceptionstoward ethnic cuisine which, in turn, can result in a decrease inethnic foods sales.

More foodborne outbreaks are expected as consumption ofethnic cuisines increases. However, they may vary dependingon food safety efforts by the restaurant industry and regulatoryagencies. The current study provides some suggestions to ensureethnic food safety by reviewing factors from previous studies thatcan prevent foodborne illness outbreaks. First, HACCP systemimplementation can ensure food safety at both small and largeethnic cuisine restaurants. HACCP program implementation canhave positive effects on the prevention of foodborne illness out-breaks by monitoring and controlling food processing procedures.However, HACCP program implementation at small ethniccuisine restaurants is limited compared to large food facilities,because it requires food safety information, and food safetyknowledge and skills. Second, effective training can ensure foodsafety at ethnic cuisine restaurants. This review shows the positiveimpact of food safety training on the prevention of foodborneillness outbreaks. It is essential to keep in mind, however, that foodsafety training at ethnic restaurants requires special attention toethnic food handlers’ unique cultural factors. Third, a restaurantinspection system can help to ensure food safety. This reviewshows that ethnic cuisine restaurant operations reported morefood code violations compared to nonethnic cuisine restaurants.Restaurant inspection evaluation is disclosed to consumers, and isdirectly related to restaurant sales. As a result, restaurant operatorsscheduled for regular inspections make a conscientious effortto maintain good hygiene. Additionally, this review proposesthat providing information about imported food safety could bean effective way to reduce risk perception toward ethnic foodproducts.

Even though more foodborne disease outbreaks have been ex-pected as consumption of ethnic cuisines increases, there is a lackof research centered on ethnic foods. This review focuses on onlythe most popular ethnic foods. As consumption of ethnic cui-sine is expected to increase overall, more diverse ethnic cuisineswill exhibit unique food safety issues. Therefore, future research isneeded to provide a more comprehensive understanding of varioustypes of ethnic foods.



AcknowledgmentsThe authors sincerely thank Dr. Lillian Po for her invaluable

input and suggestions during the course of this work.

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Popular Ethnic Foods in the United States: A Historical and Safety Perspective

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