"As a result, the main public health goal of the recall was met," said William Hallman, director of Rutgers University's Food Policy Institute. "However, fewer Americans were aware of important details related to the recall. Many were confused about the types of spinach affected, where it was grown, the organism that caused the contamination, the symptoms of the resulting illness, and perhaps most significantly, whether or not the recall had ended." The Rutgers researchers interviewed a nationally representative sample of 1,200 Americans by telephone from November 8 to 29, 2006. The results of the nationwide telephone survey describe the level of consumer awareness and knowledge of the recall and foodborne illness, they say. The results also provide insight into consumer behaviour during the recall and likely future behaviour in response to the recall, Hallman said. "Our survey not only provides data to improve communications about future food recalls, but also enables us to explore how our systems might work in the case of intentional food contamination," Hallman said. The results of the Rutgers survey show that the FDA's main message to consumers warning that bagged fresh spinach had been contaminated and should not be eaten was heard by 87 per cent of Americans. About 84 per cent of those who had heard about the recall said that they had also talked about it with others. In addition, the data clearly indicate that the majority of consumers stopped eating spinach because of the recall. While nearly 95 per cent of those who had heard about the recall knew that bagged fresh spinach had been recalled, only about two-thirds, or 68 per cent, knew that loose fresh spinach was also part of the recall. However, they were confused about the safety of frozen and canned spinach during the recall. Only 57 per cent knew that frozen spinach was not affected by the recall, while 71 per cent knew that the canned variety was not. About 52 per cent knew that the contaminated spinach had been grown in California. Only 52 per cent could identify E. coli as the contaminant that made people ill. In addition, while 87 per cent correctly recognized that abdominal cramps are a common symptom of E. coli infection, only about two-thirds correctly recognized the key symptom, bloody diarrhea. Instead, Americans are more likely to incorrectly associate the symptoms of nausea and vomiting with an E. coli infection. Moreover, about three-quarters incorrectly identified fever as a symptom, and 22 per cent reported that rashes were a symptom despite the fact that they are not commonly associated with any foodborne illness. "Most Americans know little about the symptoms of foodborne illnesses," said Hallman. "E. coli infections are no exception." Not everyone followed the FDA's advice. About 13 per cent of those who ate spinach before the recall reported that they ate fresh spinach during the recall, and 74 per cent of them knew about the recall at the time. The study found that some Americans went to the other extreme, generalizing the warnings about spinach to other similar foods. Nearly one-fifth of those aware of the recall said they stopped buying other bagged produce. In addition, nearly half reported that the spinach recall caused them to wash their food more thoroughly. "Clearly, the recall had a bigger effect on the public than just throwing away a few bags of spinach," Hallman concluded. "Consumers confidence in the safety of other produce seems to have been affected." While almost all of those surveyed got the initial message that they should not eat fresh spinach, less of them got the message that it is safe to eat it again. As of November 2006, 13 per cent believed that it was still in effect, and 18 per cent said they did not know if it was still ongoing. About 44 per cent of spinach-eaters who knew about the recall said that they were already eating spinach again and 47 per cent said they may go back to eating spinach, many within the next several months. About 5 per cent of spinach-eaters who were aware of the recall said that they will never go back to eating the green again. The Food Policy Institute is a research unit of Rutgers, in New Jersey. Every year, the Food and Drug Administration issues dozens of food-related recalls, withdrawals and advisories, but few received the attention that the one regarding E.coli-contaminated spinach received in September 2006, the Rutgers researchers said. With the broad scale of the resulting recall and related media attention, the researchers decided to use the event as a means of studying the system.