Award Date

December 2016

Degree Type


Degree Name

Master of Public Health (MPH)


Environmental and Occupational Health

First Committee Member

Brian Labus

Second Committee Member

Patricia Cruz

Third Committee Member

Guogen Shan

Fourth Committee Member

Clark Kincaid

Number of Pages



In the United States, someone becomes infected with a foodborne illness every 2 seconds, is hospitalized by a foodborne illness every 4 minutes and dies due to a foodborne illness every 3 hours. Foodborne illness is preventable, yet each year, 1 in 6 Americans is affected by it from contaminated foods or beverages. There are over 250 different foodborne diseases, and in 2015, there were 73 confirmed cases of Salmonella infection in Southern Nevada alone. Since the emergence of public health, food establishment inspections have been an important part of the regulation of food safety. Risk-based inspections were developed by the U.S. Department of Agriculture (USDA) Food Safety and Inspection Service with the intention of focusing resources on the establishments that posed a greater risk to public health. The Southern Nevada Health District (SNHD) is the governmental agency in Clark County, NV, that is responsible for safeguarding over 2 million residents and over 42 million annual visitors, making it one of the largest health departments in the United States. In 2013, the Southern Nevada Health District developed and implemented the Think Risk Initiative, which is based on the USDA’s risk-based inspections. The purpose of this initiative was to encourage food operators and food inspectors to consider the risk associated with each violation when working with food. SNHD modified the inspection report form to place greater emphasis on the violations that are associated with the highest risk of foodborne illness. The purpose of this study was to evaluate the effects of the Think Risk Initiative on the overall scores of the food establishments. The categories evaluated were the change in letter grades earned on routine inspections, the change in total demerits earned and the change in adjusted demerits. Data were collected from SNHD for all food establishments from 2011-2015. Data from 2011-2012 were compared to data from 2014-2015 for all food establishments that were operational for all 5 years. Facilities grades were a mean of 2.83 ± 0.38 pre-initiative and remained at 2.83 ± 0.36 post-initiative. The mean change of 0.00 (95% CI, -0.01 to 0.01) is not statistically significant (p=0.946). Facilities scores pre-initiative were 6.90 ± 5.65 and were reduced to 5.84 ± 5.57 post-initiative. The mean change of 1.06 (95% CI, 0.95 to 1.18) is statistically significant (p<0.001), t(10,334) = 18.51. Facilities adjusted demerits pre-initiative were 6.66 ± 7.36 and were reduced to 6.29 ± 6.94 post-initiative. The mean change of 0.37 (95% CI, 0.21 to 0.53) is statistically significant (p<0.001), t(9,811) = 4.49. No change in the letter grades was observed from the Think Risk Initiative and the total demerits decreased on average by only 1. When the demerits were rescored to be equal pre- and post- initiative, this was reduced to only an average of 0.37 demerit decrease, which would result in no change of score or grade. This suggests that the reduction in total demerits is due to rescoring the inspection forms and not due to any facility improvement. The guidelines recommended by the Food and Drug Administration (FDA), as implemented by the SNHD through the Think Risk Initiative, did not encourage the facilities to improve compliance with the regulations. The Think Risk Initiative did offer some benefits to the industry and community. It appears to have shifted the focus of inspections and inspection scores to violations that directly correspond to risk for foodborne illness. It also prevents facilities from receiving downgrades and closures caused by violations that are not directly related to foodborne illness.


Food Safety; Health Department; Inspection; Risk-based; Scores; Think Risk Initiative


Environmental Health | Environmental Health and Protection | Epidemiology | Public Health

File Format


Degree Grantor

University of Nevada, Las Vegas




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