THE CONSUMER AND THE STREET FOOD IN SALVADOR-BA: HABITS, KNOWLEDGE AND RISK PERCEPTION CARDOSO, R.C.V.

*; SANTANA, G. R.**, GUIMARES, T.F.D.**

*Teacher at the School of Nutrition Federal University of Bahia (UFBA), Bahia, Brazil ** Scientific initiation students/ School of Nutrition - Federal University of Bahia R. Arajo Pinho, 32, Canela, Salvador, Bahia, Brazil, CEP: 40.110-150 E-mail: ryzia@ufba.br

Abstract The street food trade stands out as an emerging informal market, mainly in developing countries, being part of the social and cultural urban context. Given the historical practice of the street food trade in Salvador (Bahia, Brazil) and the paucity of publications on this subject, this study was aimed at characterizing the street food consumers in Salvador, their eating habits, hygiene knowledge and health risk perception. A cross-sectional study was carried out by means of semi-structured forms with 1,004 consumers at the Historical Center Health District. Consumers were mainly young adults, female (57.3%), with secondary educational level (54.2%) and low income (54.7%). Thirty-seven percent of them were shown to use street food at least once a day, which characterizes a food habit, and the most consumed products were salted homemade snacks (40.5%) and sandwiches (32.5%), replacing short meals or lunch. Nevertheless, 71.4% reported not relying on the quality of these products and 92.3% informed that the street food could be contaminated. The most common criteria for purchasing those products included the hygiene of the selling place (64.8%) and the sellers hygiene (42.5%), mainly based on visual aspects. The occurrence of food transmitted diseases associated with street food was reported by 28.5% of the subjects, with hot-dogs (50.1%), salted snacks (39%) and acaraje (38.8%) being mentioned as higher risk products. Among the consumers, 68.8% declared to be exclusively responsible for their own health while eating street food, thus overlooking the sellers and the states responsibility. The results point to the need for intervention programs for street food consumers, aiming to protect the populations health. Key-words: street food, consumer, food safety

1. Introduction The industrial, commercial and urban development in the last decades have favored the work informal market proliferation in the developing countries, as a consequence of the social and economic inequality. In this scenario, the street food trade stands out as an emerging and nonstructered informal market, inserting a big portion of the population (LATHAM, 1997; FAO 1989). The street food is known as the food and beverage sold in thoroughfares, ready to immediate or later consumption, and that dont require other preparation phases, including fruits (WHO,1996). In Brazil, reflecting this reality, the street food market have been expending itself, specially in the cities where the higher unemployment rates prevails, just as in Salvador BA, representing an economic alternative to work and to attend the basic necessities of a significant portion of the population. Internationally, the business volume of this nonofficial industry exceeds millions of dollars, being, beyond doubt, the most lucrative activity between the ones that require a low initial investment (FAO, 1989). At the same time, it represents a positive contribution to improve the quality of life for millions of people. In Calcutta, India, a profit of US$ 100 million dollars per year is estimated for 130.000 street food sellers. In Latin America and in Caribbean, some studies evaluated that the mensal sell rate per seller would be around US$ 150 and US$500 dollars (FAO, 1997). Besides the economic contributions, the street foods contribute to the nutritional and energetic basic needs of the population, especially of the urban population with low income (DRAPER, 2004). Investigations carried out in India, Indonesia, Nigeria and Peru showed that it has become evident that the traditional food sold in thoroughfares constitutes an important source of various nutrients (FAO, 1989). Despite this fact, just a few publications emphasize the nutritional value of the street food, which can represent, in different countries, 50% to 80% of the diary nutrient consume (LATHAM, 1997). In France, the recognition of the contribution of the street food to nourishment is marked by the development of studies that aim the fortification of these products with micronutrients to reduce the nutritional deficiencies (DARMON et al., 2003).

On the other hand, it has been given grate attention from the authorities and international organizations to the food market in thoroughfares. They focus there efforts in the analysis of the economic, social and sanitary impacts of this activity (GERMANO et al., 2000). In what concerns to the sanitary aspects, the food is vulnerable to contaminations and become susceptible to nutritional, sensorial and microbiologic alterations in the absence of a rigid quality control system during the preparation, store and sale of the products (GES, 1999). The food can be infected not only with pathogenic microorganisms, such as virus, bacteria and parasites that cause diseases, but also with food additives, toxins, pesticides residues used in the production and preservation, besides the heavy metals, such as lead (LATHAM, 1997). This primary load of contaminants can be reduced and, usually, can be exterminated when the food is submitted to adequate hygienicsanitary and quality controls. What, most of the time, doesnt occur with the food commercialized on the streets. Studies carried out in different countries, focused in microbiologic analysis of the food sold in the streets, evidenced the occurrence of high levels of contamination and a lot of the food analyzed were pointed as the cause of a food poisoning outbreak (ARAMBULO III et al., 1995; SIMOPULOS & BHAT, 2000). According to a study realized in Salvador-BA, 23 samples of typical preparations and their complements were considered inappropriate to consumption. Between the food investigated, 39,1% of acarajs; 95,6% of vataps; 82,6% of salads and 100% of dry shrimps presented contamination above the standard for: thermotolerant coliforms, Bacillus cereus, Staphylococcus aureus, Salmonella spp e clostridium sulfite reducer (LEITE et al., 1998). Considering the historical tradition of the street food in Salvador-BA and its large utilization by the population, this study aimed to characterize the street food consumers of this city, in relation to theirs consume habits, hygiene knowledge and health risk perception. In this context, stands out that, because of the informality of the activity, not much is studied and published about this subject, becoming relevant a detailed investigation, under the perspective of food and nutritional security, in a way that makes possible delimit the profile and behavior of these consumers.

2. Materials and Methods A cross-sectional, descriptive and exploratory study was realized in the Historical Center Health District, in Salvador-BA, with 1004 street food consumers, approached from an itinerant and systematic sampling, in the various sell points situated in the referred location. The sample size was based in a previous study (CARDOSO et al., 2005; CARDOSO et al., 2006), conducted with street food sellers, that involved 450 participants; from this value and paying attention to the fact that the number of consumers is always larger then the number of sellers, the consumers sample should, on the minimum, double the number of the sellers. The data collection was made trough semi-structured forms, previously tested. The working up of the forms were based in the literature content and in the city consumers report, trough the researchers field experiences. The approach of the consumers was made by trained interviewers, who explain the research goals; requested consent and previously presented the street food concept, as establish by the World Health Organization (WHO,1996). In the form, the questions were organized in four categories: consumers profile; consumption habits characteristics; opinion questions and hygiene knowledge and health risk perception characteristics. The form pattern adopted requires basic knowledge about food hygiene and health and, because of it, in this sample, consumers younger then 18 years were not considered. The data were collected between the months of March, 2004 and March, 2005. For the statistical analysis, the program SPSS version 11.0 was used. There were proceeded descriptive analysis, association testes and logistic regression analysis. In the descriptive analysis, all the variables of the data base were used. For the constant variants, the distribution standards were evaluated trough central tendency and dispersion measures. Aiming to identify the consumption and the health risk perception predictive factors, bivariate and multivariate analysis were realized with all the variables of interest (educational level, age, sex, income, etc). In this stage, the variables statistical importance was determined based in the confidence level of 0,5.

3. Results and Discussion The results are distributed in blocks, respecting the form structure, but in a distinct order, aiming a better description of the information.

3.1. Participants identification The Table 1 exhibits the participants socio-demographic characteristics

TABLE 1 Street food consumers socio-demographic characteristics at the Historical Center Health District, Salvador-BA.

Characteristics Age (years) Mean (amplitude) Mode 32 (18-83) 18

Sex (%) Masculine/Feminine Educational level (%) Illiterate Elementary school Middle school Secondary school Income (%) < 1 MW* 1 3 MW 3 5 MW 4,6 50,1 25,7 1,2 35,5 54,2 9,2 42,7/ 57,3

> 5 MW DIDNT REPORT *MW: Minimum Wage

18,5 1,2

The sample embraced mainly young adults in the reproductive age (the mean age is 32 and 18 is the mode). With regard to sex, women were predominant (57,3%), differing of previous studies conducted by RIET et al. (2001), in witch most of the consumers were from the masculine sex. The predominance of women may reflect their insertion in the formal job market, because, in a certain way, families of low income overprotect the girls and women, what make possible for them to have a better qualification; while the men in these families are more inserted in the informal market because of their low qualification and the urgent necessity to grant the domestic sustenance (PEDRO, 2003). The prevalent educational level were middle school (54,2%), followed by elementary school (35,5%), what indicates a positive association between a higher consumption of street food and a lower formal educational level; witch was statistically confirmed (p<0,05). In parallel, family incomes lower then three minimum wages were more observed (54,7%), followed by the 3 and 5 categories (25,7%) and by more then 5 wages (18,5%), what indicates not only a higher consumption by people with lower incomes, but also the use of this kind of food by people with higher acquisitive power. These data agree with reports presented by RIET et al. (2001), in Nairobi, but also revealed the street food as a food alternative to the urban societies, independently of the acquisitive power, becoming part of the food culture. According to written reports from the Food and Agriculture Organization FAO (2001), in the last two decades, the street food consumption have been spread, establishing a food habit for the big urban centers metropolitan populations, in different countries in the world. The consumers reported to live mostly in the capital (90,5%) and a representative portion stayed 10 to 12 hours out of their homes, indicating the contribution of the street food to the ingestion of these people. Its also important

that, between the interviewees, the salaried workers were predominant (63,3%), from the formal economic sector (41,8%) and informal (21,5%), having also an expressive number of unemployed (14,0%) and students (13,5%).

3.2 Consumption habits For 50,4% of the participants, the street food consumption started during adolescence, while for 32,6% this consumption occurred during the childhood, what demonstrate the consumption of this kind of food as a habit, culturally perpetuated in the family environment. This evidence was once again confirmed when its verified the frequency of the street food consumption, illustrated in the Figure 1. Three observations could be made: there was a significant relationship between the income lower then three minimum wages and the higher consumption frequency (p<0,05) and men eat more street foods (OR: 1854; confidence interval: 1,329-2,586; p<0,00), such as people older then 30 years (OR: 2,232; confidence interval: 1,590-3,133; p<0,00).

FIGURE 1 Street food consumption frequency, according to the participants.

The first observation is according to the results reported by RIET et al. (2001) and by SIMOPOULOS & BHAT (2000), for Nairobi and the Latin American cities, respectively, which confirms the expressive street food consumption by populations

with low income, because of its cost and, consequently, easier access. According to SIMOPOULOS & BHAT (2000), in Latin America the street food represents an important role in the poor families diet, contributing with even 35% of their diary food ingestion; in Haiti, school age children get even 25% of their diary energetic support from this kind of food. In relation to the bigger proportion of street food consumption by man, once the historical and social context determine that women have more experience with food and its preparation process, it is probable that they become more demanding than man, and, because of it, consume these products less frequently. Between the reasons for consumption, hunger was pointed by 47,2% of the interviewees as the major motive, followed, in a smaller proportion, by the practicality (24,3%) and by the flavor/pleasure (21,8%). It was verified that 78,8% consumed the street food where they bought it, revealing that the immediate satisfaction of the basic physiologic need, quickly and pleasurably, its a preponderant factor for the street food consumption. According to a research realized by LUCCA (2000), in Sao Paulo-SP, with a group of 134 street food consumers, the price, the quickness and the flavor were the major motives for consumption. Similar results were observed in a study conducted by RIET et al. (2001), in Nairobi districts, Africa, in which it was identified that the time saved, the low price and the flavor were determinants to the street food consumption, evidencing decisive aspects to the acquisition of this kind of food. Although the present study didnt have as object the nutritional contribution of the street food, evaluating the consumers habits we noticed that most of them (95,1%) replaced at least one diary meal by street food, specially short meals (42,7%) and lunch (29%), which can represent a contribution of, at least, 25% of the diary nutritional support. Between the food reported as the most consumed stand out the salted snacks (40,5%), sandwiches (32,5%), juices (30,6%), hot-dogs (28,8%), acaraj (26,4%) and fruits (7,27%). Paying attention to this support, studies suggesting the fortification of the food commercialized in thoroughfares are being published, because this procedure is a effective way to strive against one of the biggest heath problems in developing

countries: the nutritional privation. According to DRAPER (1996), the street foods constitute an extraordinary opportunity to distribute micronutrients trough the destitute population, especially in urban groups.

3.3 Hygiene knowledge and health risk perception Evaluating the risk perception associated to the street food consumption, the consumers were questioned if all the people could use this kind of food. According to the results, 72,5% of the interviewees presented restrictions, considering that not everyone could consume street foods. This limitation, however, didnt referred only to the risk of food-transmitted diseases (FTD); 75% showed special concern with people who have health problems and non-transmitted chronic diseases, including hypertensive, diabetics and dyslipidemics; for 16,4% the restriction was indicated to children, elders and pregnant women, once they constitute the more vulnerable groups; for 2,5%, these products arent adequate for people in diet programs. With regard to the consumer reliability in the quality of the street foods, the results are summarized in the Figure 2. We could note that an expressive portion of the consumers (62%) didnt rely in this kind of food; and just a few of them (10%) reported relying on street foods. Reinforcing this data, 92,3% of the interviewees believed that the street food could be infected. Between the terms used to describe the kind of infection 44% referred filthiness, 26,4% pollution and bacteria, 25,1% flies, 15,5% germs, 10,3% car smoke, 6,2% parasites and 5,7% fungus.

FIGURE 2 Distribution of the participants according to the question: Do you rely on the street food quality?

For 64,4% of the consumers, the major information source about food infection is the television, what confirms the potential and importance of this information vehicle. Schools were indicated just by 26,1%, what signalizes negatively theirs educational role in what refers to the basic sanitary education, helping people to have access to safe products. Additionally, papers were referred by 14,8%, magazines by 9,4% and radio by 7,3%, reinforcing the role of the communication vehicles. With regard to the hands hygiene, 77,4% of the interviewed people recognized that their own hands could infect the food, specially if theyre dirty, according to 60% of the reports. In this context, despite the relativity between the conceptions of dirty and clean (TELES, 2003), this recognition is a relevant fact, once the hands are considered one of the major vehicles of pathogenic microorganisms dissemination. In the Figure 3, the criterions adopted by the consumers to purchase the street foods are presented, sticking out the aspects related to the selling place cleanness (64,8%) and the sellers hygiene (42,5%). There was also observed that the number of criterions pointed by women was significantly higher (p=0,014) then mens.

FIGURE 3 Criterions adopted by the consumers to purchase street foods.

In a research realized by FERNANDEZ et al. (1997), in Havana, Cuba, with 2000 street food consumers, 64% reported to select their acquisition by observing the food quality and the aspect of the seller. These characteristics, which are similar to the criterions adopted by the street food consumers in Salvador, indicate that, in general, the consumers are paying more attention to the visual aspects, ignoring other quality and innocuity determinant criterions, such as the raw material precedence, the store, the thermal control and the handler health. When questioned about the term fecal coliforms, 51,7% said that have already listened about it, however, 46,3% havent have notion of the precedence of these microorganisms. On the other hand, contesting the previous data, a significant portion of the participants (67,6%) reported that have already received orientation about food hygiene and 67,2% pointed that even food with good aspect and flavor could propagate diseases. By this description, consider that the participants educational and informational levels could influence their lack of knowledge about food hygiene is possible, and its also possible to consider that it can raise the risks related not only to the consume, but also to the production of street foods, once the consumers dont demand their rights from sellers and authorities.

The foods pointed by the participants as the more risky ones included: hot-dog (50,1%), salted snacks (39,3%), acaraje (38,8%), sandwiches (17,6%), juices (6,8%) and fruits (5,7%). In this context, its important to stick out that the meat based food, such as hot-dogs, some salted snacks and sandwiches, cited by the consumers, are considered of high health risk, because they are more susceptible to infections and deterioration during the production process, resulting in a bigger contaminant load in the final product (ARAMBULO III et al., 1995). When questioned about the possibility of FTDs associated to the street foods, 28,5% of the participants answered positively; 14,2% reported toxinfections and 13,7% just reported suggestive symptoms. In parallel, it was verified that 34,5% of the interviewees related street food consumption to gastrointestinal diseases of their relatives. Considering the consolidation and the growth of the street food segment, international assistance organizations have been alerting, specially the developing countries, about the risks and the high number of food toxinfections outbreaks associated to street food consumption. In this scenery, considering the ample and stable position that the street food market have been ranking in the social and economic context, and its nutritional contribution, specially for the more vulnerable groups, in other words, the low income population, the FAO recommends, since the XXI Regional Conference (FAO,1989), the enforcement of the quality control of this kind of food, once the exclusion of this market could generate higher levels of food insecurity between the poor people and also higher unemployment rates. By this way, because of the great consumption of these foods in the country, its inconceivable the Brazilian government entities being negligent with this market control and regulation, letting that unnecessary outbreaks and deaths keep occurring in the urban areas of the big cities (SANTA,2005).

3.4. Opinions 43,6% of the consumers evaluated the street food market as positive, because it attends people needs. Besides that, 16,9% pointed out other favourable aspect: the job creation. On the other hand, 30,1% of the consumers signalized the necessity of more inspection and better quality of the products; while 9,4% presented different opinions that were not categorized.

According to part of the interviewees (24,4%), the inspection responsibility is of the city hall, not making references to any sector of this administration; for 23,7% the responsibility if of the Sanitary Vigilance service, while 21,9% mentioned Public Health and 12,9% the government. By these results, its evident the consumers majority perception about the competence of the public sector; however, considering the low number of citations of the Sanitary Vigilance and the actuation areas of this service, also reaching the regulation of the street food market, its notable the consumers lack of elucidation about the essential role of this service in the health protection actions. Once the street food signifies for many individuals the more accessible food alternative out of their homes, despite the health risks, the participants were questioned how they felt consuming these products; the results are presented in Figure 4.

FIGURE 4 Feelings expressed by the participants related to the street food consumption.

By the answers, we could clearly notice the insecurity, represented by the fear or even the auto-recrimination, although a considerable portion of the interviewees affirmed to feel well, essentially in virtue of the possibility to appease ones hunger. The analysis of the answers, combined to the results about the reliability of the consumers on the street food quality, revealed a significant association (p<0,05) between relying in the street food quality and feeling well; and between dont relying and feel the fear.

In parallel, 68,8% of the consumers assumed to be exclusively responsible for their health when while consuming street foods, while 13,3% answered that consumers and sellers are responsible and just 10,4% attributed the responsibility to the sellers. These results, too restrictive in the consumer direction, at the same time that denote lack of knowledge about the principles standardized by the Consumer Defense Code, omit the state responsibility in the health promotion and protection. In this perspective, the FAO/OMS Codex Alimentarius commission, responsible for establish the food innocuity standards all around the world, are producing documents that guide the realization of campaigns to inform the street food consumers about their rights to demand a better quality of the food sold by street vendors (FAO, 2001). The majority of the interviewees, 90,9%, affirmed that the street food quality needs to improve, being the most indicated aspect illustrated in Figure 5.

FIGURE 5 Aspects considered by the consumers to improve the street food quality.

As noted, the points related to the hygiene, especially the sellers and the selling place hygiene, point out between the aspects reported by the consumers, also including the supervision as a fundamental street food sell control point. In this context, its possible to note an articulation between the suggestions presented and the choice criterions indicated by the consumers, confirming a partial comprehension of the conditions necessary to the offer of secure products.

4. Conclusions According to the results obtained, its evident that the street food use is a undeniable fact between the participants, configuring a habit integrated to the sociocultural context of Salvador City, replacing especially the short meals and the lunch, with a preferential acquisition of salted homemade snacks and sandwiches. As factors associated to the higher consumption there were verified: low income individuals, masculine sex and people older then 30 years. But, the majority of the consumers signalized restrictions to the street food consumption, especially to people who have non-transmitted chronic diseases. A high percentage informed that dont rely on the quality of this kind of food and almost everyone considered that the street foods could be infected, inclusive by their own hands. The information source most indicated to inform about food infection was the television, the schools being in a secondary position. The more observed criterions for the acquisition of street foods were related to the selling place cleanness and the sellers hygiene, what comprehend a limited visual evaluation, disregarding other facts involved in the determination of the products innocuity. In parallel, women were more exigent and presented more selection criterions. Although an expressive part reported that received orientation about food hygiene, almost half of them reported not to know the term fecal coliforms. The occurrence of FTDs associated to street foods was related by almost a third part of the participants and the more associated products included: hot-dog, salted snacks, acaraj and sandwiches. A big percentage of the interviewees reported to be exclusively responsible for their health when consuming street foods, not considering the sellers and state responsibilities; paradoxaly, it was noted a perception that the street food standardization its up to the public sector, not being pointed out the strategic role of the Sanitary Vigilance. It was identified that a insecurity feeling predominates between the participants, although a considerable portion of them reported to feel well by consuming street foods. More than half of the consumers saw the street food market segment as positive because of the offer of foods and because of the job creation.

The necessity of improvement in the street food market segment was pointed by almost all the consumers, being the indicated items a reflex of the capacity of comprehension of these individuals in what refers to the different aspects involved in the food insecurity. The informations founded in this research come to add a, until now, little known perspective, in what refers to the street food consumers, considering the importance of the role that these individuals have in the informal food market expansion. This way, considering that the street food provides the food needs of an expressive parcel of the population, as a habit, occupying each day more space in the urban life, and that the results evidence the limited knowledge of the participants about the hygiene criterions and associated risks of these foods, as well as the occurrences of diseases, it is signalized the necessity of intervention strategies, aiming the public health protection.

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