0920-0879 Unpasteurized Milk Outbreak Prevention Survy

Attachment B – Unpasteurized Milk Outbreaks Survey (Word)

Form Approved

OMB No. 0920-0879

Expiration Date 01/31/2021

Unpasteurized Milk Outbreaks: An Assessment of the Legal Landscape, Outbreak Investigations, and Prevention at the State Level

Introduction

The Centers for Disease Control and Prevention (CDC) is conducting a survey of state health and agriculture officials across the United States. The goal of this survey is to better understand how state officials prevent raw milk outbreaks and barriers to prevention, through exploring the legal landscape, outbreak investigations, and other outbreak prevention work. Information gathered will assist in identifying how CDC can better support state raw milk outbreak prevention work. The data will be aggregated and, to further protect the anonymity of survey respondents, no data will be reported at the state level. Results will be published to aid in further dissemination of these findings.

Your participation in this survey is strictly voluntary; you can decide to stop at any time. All information collected will remain secure; we will not collect any personally identifiable information, such as your name or contact information. There are no negative consequences to you should you decline to participate or not complete the survey in its entirety.

If you think someone else within your state health or agriculture agencies may have expertise in this area to share, please forward this email to that individual. NOTE: Only individuals who work for the state government should be extended the invitation to participate in this assessment.

Thank you for all your hard work and collaboration in this important project!

This survey should take you approximately 20 minutes to complete.

If you have any questions or concerns about completing this survey, please contact Misha Robyn at 404-718-5508 or [email protected].

Thank you for taking the time out of your busy schedule to complete this survey.

CDC estimates the average public reporting burden for this collection of information as 20 minutes per response, including the time for reviewing instructions, searching existing data/information sources, gathering and maintaining the data/information needed, and completing and reviewing the collection of information.  An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing burden to CDC/ATSDR Information Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-0879)

Demographics

1. In what state do you work? (Drop-down answer choices)

2. What agency do you work for?

   1. State health department

   2. State agriculture department

   3. Other state agency, please describe.

   4. Non-state governmental organization (If this is selected, skip to end.)

3. What is your position within your agency? Select all that apply.

   1. Epidemiologist

   2. Public Information Officer/Public Affairs Specialist

   3. Public Health Analyst

   4. Veterinarian

   5. Inspector

   6. Other, please describe

   7. Prefer not to answer

4. How long have you been in your current position?

   1. Less than 1 year

   2. 1-5 years

   3. 6-10 years

   4. More than 10 years

Legal Context- The following section will ask questions about the legal landscape surrounding raw milk sales and distribution in your state.

5. Within your state, the legal status of the sale or distribution of raw milk is: (Select all that apply)

   1. Sale is legal in retail stores

   2. Sale is legal in restaurants

   3. Sale is legal on farm where produced

   4. Sale is legal at farmers’ markets

   5. Sale is legal when sold as pet food

   6. Distribution is legal via cow or herd shares

   7. Sale is illegal

   8. Don’t know

   9. Other, please describe

6. In your state, cow or herd shares are _____________.

   1. Expressly allowed by state statutes or regulations

   2. Expressly prohibited by state statutes or regulations

   3. There are no state statutes or regulations referencing cow or herd shares

   4. Don’t know

   5. Other, please describe

7. Within your state, which government entity or entities have the authority to enforce statutes and regulations around raw milk sale and distribution? Mark all that apply.

   1. State health department

   2. State agriculture department

   3. Local health departments

   4. Local agriculture departments

   5. Don’t know

   6. Other, please describe.

The following three questions will ask you how much you agree with the written statement.

8. Laws within the state are effective in preventing illnesses associated with raw milk consumption.

1. Strongly disagree

2. Disagree

3. Neutral

4. Agree

5. Strongly agree

6. Uncertain

7. N/A

Please explain:

9. Despite current state laws restricting raw milk sales, raw milk consumers continue to find ways to get raw milk.

a) Strongly disagree

b) Disagree

c) Neutral

d) Agree

e) Strongly agree

f) Uncertain

g) N/A

Please explain:

10. Laws surrounding raw milk sales and distribution are strictly enforced.

a) Strongly disagree

b) Disagree

c) Neutral

d) Agree

e) Strongly agree

f) Uncertain

g) N/A

Please explain:

11. Inspections are conducted on a routine basis to verify compliance with regulations surrounding raw milk sales and distribution (Such as verifying labeling requirements for raw milk products, if applicable).

a) Yes

b) No

c) Don’t know

d) N/A

Please explain:

12. Are there local ordinances (i.e., county, city) that make state laws around raw milk difficult to enforce?

a) Yes

b) No

c) Don’t know

If yes please describe the ordinance(s):

13. Are there state laws around raw milk that contradict one another making them difficult to enforce (For example, state law prohibits sale of raw milk but expressly allows sales at farmers markets)?

a) Yes

b) No

c) Don’t know

if yes, please describe the laws:

14. Are there local ordinances (i.e., county, city) that are more restrictive for consumer access to raw milk compared to state laws?

a) Yes

b) No

c) Don’t know

Please explain:

15. Are you aware of plans for future legislative or regulatory efforts surrounding raw milk in your state?

    1. Yes

    2. No

    3. I don’t know

If you are not aware of future legislative changes, please SKIP to the next page. (question 19 in web survey)

16. Please describe the future legislative or regulatory efforts. (Open response)

17. What is your agency’s role in this effort? (Open response), Don’t Know, N/A

18. These future legislative or regulatory efforts would impact consumer access to raw milk in the state by:

    1. Making consumer access to raw milk easier

    2. Making consumer access to raw milk more difficult

    3. Not change difficulty for consumer access to raw milk

    4. Other, please describe.

Raw Milk Outbreak Investigations

The following questions will ask about raw milk outbreak investigations. Please answer these questions from your own perspectives and experiences.

19. How would you say consumers acquire raw milk in your state? (Select all that apply)

    1. Through cow or herd shares

    2. Purchase as pet food

    3. By driving to neighboring states

    4. Through illegal sales inside the state

    5. Through mail delivery orders

    6. Purchase at farmers markets

    7. Purchase at retail stores

    8. Purchase at restaurants

    9. Purchase on farms of production

    10. Friends and/or neighbors

    11. Own personal cow(s)

    12. Don’t know

    13. Other, please describe

20. Would you say that raw milk outbreak investigations have a higher, lower, or the same level of urgency as other food related outbreaks in your state?

    1. Higher level of urgency

    2. Same level of urgency

    3. Lower level of urgency

    4. Don’t know

21. Does state government have the authority to stop facility operations when a facility is implicated in an outbreak linked to raw milk?

    1. Yes

    2. No

    3. Don’t know

    4. Other, please explain

The following six questions will ask you how much you agree with the written statement.

22. When a facility is implicated in an outbreak linked to raw milk, state or local government authority is used to cease operations.

a) Strongly disagree

b) Disagree

c) Neutral

d) Agree

e) Strongly agree

f) Uncertain

g) N/A

Please explain:

23. After a facility is implicated in an outbreak linked to raw milk, it is easy for them to continue to sell raw milk.

a) Strongly disagree

b) Disagree

c) Neutral

d) Agree

e) Strongly agree

f) Uncertain

g) N/A

Please explain:

24. Producers/Farmers are usually cooperative during a raw milk outbreak investigation.

a) Strongly disagree

b) Disagree

c) Neutral

d) Agree

e) Strongly agree

f) Uncertain

g) N/A

Please explain:

25. Retailers are usually cooperative during a raw milk outbreak investigation.

a) Strongly disagree

b) Disagree

c) Neutral

d) Agree

e) Strongly agree

f) Uncertain

g) N/A

Please explain:

26. Consumers are usually cooperative during a raw milk outbreak investigation.

a) Strongly disagree

b) Disagree

c) Neutral

d) Agree

e) Strongly agree

f) Uncertain

g) N/A

Please explain:

27. In general, consumers who become a part of a raw milk outbreak were aware of the risks of raw milk consumption prior to getting sick.

a) Strongly disagree

b) Disagree

c) Neutral

d) Agree

e) Strongly agree

f) Uncertain

g) N/A

Please explain:

28. My agency notifies the public about raw milk-associated outbreaks in my state.

a) Never

b) Seldom

c) Sometimes

d) Often

e) Almost always

f) Don’t know

g) N/A

Please explain:

Outbreak Prevention

29. What is your perception of the consumption of raw milk in your state?

    1. Increasing

    2. Decreasing

    3. I have not noticed a difference

    4. Don’t know

30. What is your perception of most consumer behavior after they discover they became sick from raw milk? (Select all that apply)

    1. They stop consuming raw milk

    2. They continue to consume raw milk

    3. Don’t know

    4. Other, please describe

31. Communicating to the public about raw milk outbreaks is an effective tool for outbreak prevention.

a) Strongly disagree

b) Disagree

c) Neutral

d) Agree

e) Strongly agree

f) Uncertain

g) N/A

Please explain:

32. In general, people in raw milk outbreaks typically consume raw milk___.

    1. Weekly

    2. A few times a year

    3. Once a year

    4. Are trying raw milk for the first time

    5. Don’t Know

33. My agency uses the following prevention strategies to reduce illnesses associated with raw milk consumption: (Select all that apply)

1. Communication to consumers

   1. Maintains a portion of our website with current raw milk prevention information (i.e. risks of consumption, outbreaks, legal status for consumption)

   2. Works with consumer groups who are trying to educate the public on risks associated with raw milk consumption

   3. Targets consumers with educational materials describing the risks associated with raw milk consumption

   4. Communicates to the public about outbreaks linked to raw milk

2. Communication with raw milk producers

   1. Promotes best practices for raw milk production

   2. Targets producers with education materials describing the risks associated with raw milk consumption

3. Inform legislative efforts

   1. Provides information to inform legislative efforts aimed to change laws associated with raw milk sales and distribution in the state

4. Work with other agencies and states

   1. Shares experiences with other states or agencies around raw milk outbreaks and prevention opportunities and challenges

5. Other, please describe.

6. None

34. What resources do you use in the prevention efforts you selected above (from Q33)?

    1. Previous outbreak data and press/media releases

    2. In-house infographics, webinars, and other communication materials

    3. Infographics, webinars, and other communication materials from other organizations

    4. Presentations at in-person conferences and meetings

    5. N/A

    6. Other, please describe

35. Which organizations do you get infographics, webinars, and other communication materials from that you use in your prevention efforts?

    1. CDC

    2. FDA

    3. USDA

    4. N/A

    5. Other, if other, please describe

36. When it comes to preventing raw milk-associated outbreaks, my agency… (Select all that apply)

    1. Responds to foodborne outbreaks, including raw milk

    2. Communicates about risks of raw milk consumption

    3. Has a sufficient amount of personnel to do prevention work outside of an outbreak response setting

    4. Collects and analyzes data to better understand why raw milk outbreaks occur

    5. Don’t Know

    6. Other, please describe.

37. My agency is interested in pursuing more prevention work surrounding raw milk consumption in my state.

    1. Yes

    2. No

    3. Don’t know

38. What does your agency need to pursue more prevention work surrounding raw milk consumption? (open response)

39. Is there anything else that you would like to share? (Open response)