<?xml version="1.0" encoding="UTF-8"?>
<!DOCTYPE article PUBLIC "-//NLM//DTD Journal Publishing DTD v2.0 20040830//EN" "http://dtd.nlm.nih.gov/publishing/2.0/journalpublishing.dtd">
<article xmlns:xlink="http://www.w3.org/1999/xlink" article-type="research-article" dtd-version="2.0">
  <front>
    <journal-meta>
      <journal-id journal-id-type="publisher-id">IJMR</journal-id>
      <journal-id journal-id-type="nlm-ta">Interact J Med Res</journal-id>
      <journal-title>Interactive Journal of Medical Research</journal-title>
      <issn pub-type="epub">1929-073X</issn>
      <publisher>
        <publisher-name>JMIR Publications</publisher-name>
        <publisher-loc>Toronto, Canada</publisher-loc>
      </publisher>
    </journal-meta>
    <article-meta>
      <article-id pub-id-type="publisher-id">v12i1e43936</article-id>
      <article-id pub-id-type="pmid">37870896</article-id>
      <article-id pub-id-type="doi">10.2196/43936</article-id>
      <article-categories>
        <subj-group subj-group-type="heading">
          <subject>Original Paper</subject>
        </subj-group>
        <subj-group subj-group-type="article-type">
          <subject>Original Paper</subject>
        </subj-group>
      </article-categories>
      <title-group>
        <article-title>Consumer Willingness to Pay for Food Defense and Food Hygiene in Japan: Cross-Sectional Study</article-title>
      </title-group>
      <contrib-group>
        <contrib contrib-type="editor">
          <name>
            <surname>Eysenbach</surname>
            <given-names>Gunther</given-names>
          </name>
        </contrib>
        <contrib contrib-type="editor">
          <name>
            <surname>de Azevedo Cardoso</surname>
            <given-names>Taiane</given-names>
          </name>
        </contrib>
      </contrib-group>
      <contrib-group>
        <contrib contrib-type="reviewer">
          <name>
            <surname>Nielsen</surname>
            <given-names>Jesper</given-names>
          </name>
        </contrib>
      </contrib-group>
      <contrib-group>
        <contrib id="contrib1" contrib-type="author" corresp="yes">
          <name name-style="western">
            <surname>Matsumoto</surname>
            <given-names>Shinya</given-names>
          </name>
          <degrees>PhD</degrees>
          <xref rid="aff1" ref-type="aff">1</xref>
          <address>
            <institution>Department of Environmental Medicine and Public Health</institution>
            <institution>Faculty of Medicine</institution>
            <institution>Shimane University</institution>
            <addr-line>Enya-cho 89-1</addr-line>
            <addr-line>Izumo, 693-8501</addr-line>
            <country>Japan</country>
            <fax>81 853 20 2160</fax>
            <phone>81 853 20 2162</phone>
            <email>smatsumo@med.shimane-u.ac.jp</email>
          </address>
          <ext-link ext-link-type="orcid">https://orcid.org/0000-0001-5719-9709</ext-link>
        </contrib>
        <contrib id="contrib2" contrib-type="author">
          <name name-style="western">
            <surname>Kanagawa</surname>
            <given-names>Yoshiyuki</given-names>
          </name>
          <degrees>MD, PhD</degrees>
          <xref rid="aff2" ref-type="aff">2</xref>
          <ext-link ext-link-type="orcid">https://orcid.org/0000-0001-7729-9037</ext-link>
        </contrib>
        <contrib id="contrib3" contrib-type="author">
          <name name-style="western">
            <surname>Nagoshi</surname>
            <given-names>Kiwamu</given-names>
          </name>
          <degrees>MD, PhD</degrees>
          <xref rid="aff1" ref-type="aff">1</xref>
          <ext-link ext-link-type="orcid">https://orcid.org/0000-0002-2767-8482</ext-link>
        </contrib>
        <contrib id="contrib4" contrib-type="author">
          <name name-style="western">
            <surname>Akahane</surname>
            <given-names>Takemi</given-names>
          </name>
          <degrees>MD, PhD</degrees>
          <xref rid="aff3" ref-type="aff">3</xref>
          <ext-link ext-link-type="orcid">https://orcid.org/0000-0002-6675-0475</ext-link>
        </contrib>
        <contrib id="contrib5" contrib-type="author">
          <name name-style="western">
            <surname>Imamura</surname>
            <given-names>Tomoaki</given-names>
          </name>
          <degrees>MD, PhD</degrees>
          <xref rid="aff2" ref-type="aff">2</xref>
          <ext-link ext-link-type="orcid">https://orcid.org/0000-0003-1981-9959</ext-link>
        </contrib>
        <contrib id="contrib6" contrib-type="author">
          <name name-style="western">
            <surname>Akahane</surname>
            <given-names>Manabu</given-names>
          </name>
          <degrees>MD, PhD</degrees>
          <xref rid="aff4" ref-type="aff">4</xref>
          <ext-link ext-link-type="orcid">https://orcid.org/0000-0003-4184-2151</ext-link>
        </contrib>
      </contrib-group>
      <aff id="aff1">
        <label>1</label>
        <institution>Department of Environmental Medicine and Public Health</institution>
        <institution>Faculty of Medicine</institution>
        <institution>Shimane University</institution>
        <addr-line>Izumo</addr-line>
        <country>Japan</country>
      </aff>
      <aff id="aff2">
        <label>2</label>
        <institution>Department of Public Health, Health Management and Policy</institution>
        <institution>Nara Medical University</institution>
        <addr-line>Kashihara</addr-line>
        <country>Japan</country>
      </aff>
      <aff id="aff3">
        <label>3</label>
        <institution>Department of Gastroenterology</institution>
        <institution>Nara Medical University</institution>
        <addr-line>Kashihara</addr-line>
        <country>Japan</country>
      </aff>
      <aff id="aff4">
        <label>4</label>
        <institution>Department of Health and Welfare Services</institution>
        <institution>National Institute of Public Health</institution>
        <addr-line>Wako</addr-line>
        <country>Japan</country>
      </aff>
      <author-notes>
        <corresp>Corresponding Author: Shinya Matsumoto <email>smatsumo@med.shimane-u.ac.jp</email></corresp>
      </author-notes>
      <pub-date pub-type="collection">
        <year>2023</year>
      </pub-date>
      <pub-date pub-type="epub">
        <day>23</day>
        <month>10</month>
        <year>2023</year>
      </pub-date>
      <volume>12</volume>
      <elocation-id>e43936</elocation-id>
      <history>
        <date date-type="received">
          <day>7</day>
          <month>11</month>
          <year>2022</year>
        </date>
        <date date-type="rev-request">
          <day>31</day>
          <month>12</month>
          <year>2022</year>
        </date>
        <date date-type="rev-recd">
          <day>21</day>
          <month>2</month>
          <year>2023</year>
        </date>
        <date date-type="accepted">
          <day>29</day>
          <month>9</month>
          <year>2023</year>
        </date>
      </history>
      <copyright-statement>©Shinya Matsumoto, Yoshiyuki Kanagawa, Kiwamu Nagoshi, Takemi Akahane, Tomoaki Imamura, Manabu Akahane. Originally published in the Interactive Journal of Medical Research (https://www.i-jmr.org/), 23.10.2023.</copyright-statement>
      <copyright-year>2023</copyright-year>
      <license license-type="open-access" xlink:href="https://creativecommons.org/licenses/by/4.0/">
        <p>This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Interactive Journal of Medical Research, is properly cited. The complete bibliographic information, a link to the original publication on https://www.i-jmr.org/, as well as this copyright and license information must be included.</p>
      </license>
      <self-uri xlink:href="https://www.i-jmr.org/2023/1/e43936" xlink:type="simple"/>
      <abstract>
        <sec sec-type="background">
          <title>Background</title>
          <p>In Japan, incidents of falsified expiration dates on popular cookie brands and health hazards associated with frozen Chinese dumplings have raised food safety awareness. To prevent the intentional contamination of food by foreign substances, large food manufacturing companies have adopted the concept of food defense.</p>
        </sec>
        <sec sec-type="objective">
          <title>Objective</title>
          <p>The aim of this study was to assess people’s willingness to pay for food protection measures. In addition, the impact of participants’ personalities and considerations regarding their purchase choices on how much they were willing to pay when shopping for food and other products were measured.</p>
        </sec>
        <sec sec-type="methods">
          <title>Methods</title>
          <p>A questionnaire on willingness to pay for food hygiene and food defense was administered via a web survey and 1414 responses were included in the analysis. Univariate logistic regression analyses were performed with individuals willing and unwilling to pay additional costs as the objective variable and other questionnaire items as explanatory variables. A principal component analysis was performed on 12 questions regarding how much additional money people were willing to pay, and the principal component scores and other questions were examined for implications and other information.</p>
        </sec>
        <sec sec-type="results">
          <title>Results</title>
          <p>Approximately one-third of the respondents stated that they were unwilling to pay additional costs and reported a willingness to consume delivery food even if it contained items that were not part of the original order. The first principal component reflected the extent to which people were willing to pay additional money, and if so, how much. This tendency existed even if the individual foods and amounts varied. The third principal component reflected the amount of extra money that people were willing to pay, which was determined by the amount people had to pay toward food safety measures. Those who answered “zero” were more likely to believe that consumers should not have to pay to ensure food safety. The second principal component reflected an axis separating food defense and food hygiene. Some items not directly related to food were correlated with this axis.</p>
        </sec>
        <sec sec-type="conclusions">
          <title>Conclusions</title>
          <p>In Japan, the concept of food hygiene is well-established and is generally taken for granted. In contrast, the concept of food defense is relatively new and has not yet fully penetrated the Japanese market. Our research shows that people who think that clothing brands provided added value to clothing products may have similar feelings about food defense. In addition, food hygiene efforts to prevent outbreaks of food poisoning are common in Japan and have been established as the basis of food safety. While food defense efforts are spreading, mainly in companies, it is presumed that they are valuable for the general public as supplementary measures to routine (or basic) food hygiene.</p>
        </sec>
      </abstract>
      <kwd-group>
        <kwd>food defense</kwd>
        <kwd>food hygiene</kwd>
        <kwd>contingent valuation method</kwd>
        <kwd>willingness</kwd>
        <kwd>food</kwd>
        <kwd>cost</kwd>
        <kwd>awareness</kwd>
        <kwd>food safety</kwd>
        <kwd>questionnaire</kwd>
        <kwd>Japan</kwd>
        <kwd>prevention</kwd>
        <kwd>food poisoning</kwd>
        <kwd>safety</kwd>
      </kwd-group>
    </article-meta>
  </front>
  <body>
    <sec sec-type="introduction">
      <title>Introduction</title>
      <p>Terrorism can be carried out using various means, including food terrorism. Food terrorism is the act of intentionally contaminating food using poisonous substances to achieve political goals, causing harm to people and stirring up social unrest. Food defense represents an effort to prevent the intentional contamination of food [<xref ref-type="bibr" rid="ref1">1</xref>-<xref ref-type="bibr" rid="ref6">6</xref>]. Since the attacks of September 11, 2001, widespread attention has been directed to the danger of so-called food terrorism worldwide and building food defense [<xref ref-type="bibr" rid="ref7">7</xref>]. Fortunately, no large-scale terrorist attacks using food have been reported to date; however, other issues plague food safety, such as cases of food counterfeiting or the falsification of expiration dates and a food’s place of origin. These issues have been reported as threats to food safety and security in Japan and elsewhere [<xref ref-type="bibr" rid="ref8">8</xref>,<xref ref-type="bibr" rid="ref9">9</xref>].</p>
      <p>In addition to food hygiene measures, food defense measures are becoming more common to ensure food safety [<xref ref-type="bibr" rid="ref10">10</xref>-<xref ref-type="bibr" rid="ref13">13</xref>]. Food hygiene measures involve the monitoring of food and beverages to prevent foodborne health hazards. These measures include preventing spoilage by pathogenic microorganisms as well as contamination by harmful chemicals. To prevent spoilage and contamination, each stage of the food supply chain, such as production, transportation, packaging, preparation, and the sale of food and beverages, is undertaken with utmost care. In other words, the prevention of food poisoning enables maintaining a safe food supply chain while avoiding food poisoning. By contrast, food defense is a means to prevent health hazards caused by the intentional contamination of food and beverages with foreign substances [<xref ref-type="bibr" rid="ref10">10</xref>,<xref ref-type="bibr" rid="ref12">12</xref>,<xref ref-type="bibr" rid="ref13">13</xref>]. Contamination in the food defense context is not accidental, such as that caused by human error, but rather involves incidents in which food or beverages are intentionally contaminated by foreign substances with malicious intent. Food defense measures are required to ensure food safety in all food aspects, both at the manufacturing level and at the retail and consumer levels.</p>
      <p>Although not directly considered an act of food terrorism, intentional contamination or adulteration of food products with foreign substances has been reported in Japan and elsewhere [<xref ref-type="bibr" rid="ref9">9</xref>]. In Japan, the health hazards caused by Chinese-made frozen dumplings in 2008 and the pesticide contamination of frozen foods manufactured in Japan in 2013 raised awareness for ensuring food safety during the food manufacturing process [<xref ref-type="bibr" rid="ref10">10</xref>]. It has been approximately 10 years since efforts to prevent the intentional contamination of food were widely recognized as a food defense measure, especially by major food manufacturing companies in Japan [<xref ref-type="bibr" rid="ref1">1</xref>].</p>
      <p>To prevent health hazards caused by the intentional contamination of food, measures must be taken throughout the food supply chain. In other words, in addition to food defense measures adopted by food companies in food manufacturing and distribution and by retail stores and restaurants, citizens, as consumers, should also be aware of food safety. Therefore, in this study, a questionnaire survey was conducted to determine if and to what degree people are willing to pay for food safety and to identify the characteristics of people who perceive the risk of incidents that will threaten food in the future. In addition, the degree of willingness to pay to ensure food safety was surveyed. This study is the first to clarify whether and how much consumers are willing to pay for food safety.</p>
    </sec>
    <sec sec-type="methods">
      <title>Methods</title>
      <sec>
        <title>Data Acquisition</title>
        <p>This study was conducted as a cross-sectional survey using an internet panel survey company (Macromill Inc) and all participants were registered with the company. First, to recruit study participants, the survey company randomly sampled a list of registered participants between the ages of 15 and 79 years. Second, an email was sent to everyone on the list to inquire whether they were interested in participating in this study. Enrollment closed when the number of participants in each group by gender and age in 10-year increments reached the target sample size (103 people per group). Participants completed the survey via a web survey screen and received a small monetary reward upon survey completion. There were 1442 participants in the study; after data cleaning, 1414 participants were included in the analysis with 706 men and 708 women.</p>
        <p>Although the Japanese population has a higher number of people in their 70s than in their 20s, all age/sex groups had an equal number of respondents in this study owing to the method used to enroll participants. We did not employ data augmentation methods because we used traditional statistical methods for the analysis. Regarding regions, there was a slightly higher number of respondents in the city prefectures of Kanto and Kansai than in other areas. The respondents’ incomes were categorized in ranges: the median household income of the respondents was 6-8 million yen (100 yen=US $0.9596), which is higher than the national median household income of 4.4 million yen.</p>
      </sec>
      <sec>
        <title>Questionnaire Items</title>
        <p>Age, gender, weight, height, and region of residence were recorded when the participants first registered with the panel survey company.</p>
        <p>In addition to items related to food safety, food hygiene, and food defense, the survey included questions about the participants’ personalities (self-evaluation) and lifestyles (what they considered important when purchasing electrical appliances and clothes).</p>
        <p>The value of food hygiene and food defense was evaluated using the contingent valuation method (CVM). There were six questions each pertaining to the specific additional costs to be paid for food hygiene measures (Q27) and for food defense measures (Q28) for a total of 12 questions. The unit prices of several food products were provided as examples, and the respondents were asked how much extra they would be willing to pay for food hygiene or food defense measures to be incorporated. The relevant questions are presented in <xref ref-type="boxed-text" rid="box1">Textbox 1</xref>. The unit price is expressed in Japanese yen, and the exchange rate at the time of the survey, January 2021, was 100 yen=US $0.9596.</p>
        <boxed-text id="box1" position="float">
          <title>Survey questions about additional costs (100 yen=US $0.9596).</title>
          <p>Q27. Food manufacturing companies in Japan have implemented food hygiene measures (ie, measures to prevent food poisoning), but these incur additional costs. How much extra would you be willing to pay for each of the following items owing to these measures?</p>
          <p>(Please write “0” if you would not pay anything extra)</p>
          <list list-type="bullet">
            <list-item>
              <p>1000-yen lunch box</p>
            </list-item>
            <list-item>
              <p>1000-yen juice</p>
            </list-item>
            <list-item>
              <p>500-yen frozen food</p>
            </list-item>
            <list-item>
              <p>500-yen side dish</p>
            </list-item>
            <list-item>
              <p>500-yen snack</p>
            </list-item>
            <list-item>
              <p>200-yen soft drink</p>
            </list-item>
          </list>
          <p>Q28. Not all food manufacturing companies in Japan have implemented food defense measures (measures to prevent intentional contamination of food with foreign substances/drugs). Nevertheless, as these require additional expenditure, how much extra would you be willing to pay for each of the following items due to the measures?</p>
          <p>(Please write “0” if you would not pay anything extra)</p>
          <list list-type="bullet">
            <list-item>
              <p>1000-yen lunch box</p>
            </list-item>
            <list-item>
              <p>1000-yen juice</p>
            </list-item>
            <list-item>
              <p>500-yen frozen food</p>
            </list-item>
            <list-item>
              <p>500-yen side dish</p>
            </list-item>
            <list-item>
              <p>500-yen snack</p>
            </list-item>
            <list-item>
              <p>200-yen soft drink</p>
            </list-item>
          </list>
        </boxed-text>
      </sec>
      <sec>
        <title>Data Analysis</title>
        <p>We performed a distribution check on the payment amount for additional costs for food defense. As many people answered “0 yen” (not willing to pay), we performed comprehensive univariate logistic regression analyses for all combinations of the 12 objective variables and other questionnaire items as explanatory variables to analyze the characteristics of this subgroup. The univariate logistic regression analysis variable was evaluated using z-scores. By averaging the z-scores for the 12 questions (<xref ref-type="boxed-text" rid="box1">Textbox 1</xref>), we considered the strength of the relationship between the other questions and willingness to pay. The z-scores of the 12 logistic regression analyses, which changed the objective variable, were averaged and arranged in order of absolute values of the average of z-scores. The z-score is a statistic affected by sampling and therefore has small variation owing to sampling, whereas large fluctuations are unlikely. In this study, the responses to the 12 similar questions were converted to binary values and logistic regression was performed with the converted values as the objective variables. Given the slight variation in z-scores among the 12 logistic regression analyses, evaluating the 12 z-scores individually was not required and comparisons were made using mean values.</p>
        <p>Since our questions concerned amounts of money, the data distribution was often skewed to the right (positive skewness). In the case of such a distribution, a transformation is often implemented to ensure that the distribution is closer to a normal distribution. As the Box-Cox transformation cannot be defined for 0, we added 1 to the transformation so that the distribution shape would follow a normal distribution. Since λ was estimated to be approximately 0 for each variable, we set λ=0 for all 12 variables. In other words, a logarithmic transformation was performed. Next, principal component analysis was performed on the 12 variables after the Box-Cox transformation and a principal component score was calculated for each respondent.</p>
        <p>Univariate linear regression analyses were performed for all combinations with the top three principal component scores as the objective variables and all questionnaire items not used in the principal component analysis as the explanatory variables. Consequently, items that had strong relationships were identified. The relationships between each principal component score and the questionnaire items were examined.</p>
      </sec>
      <sec>
        <title>Ethical Considerations</title>
        <p>This study was conducted with approval of the Ethics Committee of the National Institute of Public Health, Japan (approval number NIPH-IBRA#12302). All participants provided informed consent online for data collection and storage. Informed consent for participation in the study was obtained at the time of registration. In cases where participants were under the age of 18 years, a consent screen was displayed to obtain permission from their parents or guardians. The web-based questionnaire survey was conducted by an authorized research company compliant with personal information protection and we obtained anonymized data from the company.</p>
      </sec>
    </sec>
    <sec sec-type="results">
      <title>Results</title>
      <p>The survey included questions regarding how much additional cost participants would pay for certain products. However, several respondents indicated they would pay many times more than the original unit price (double or more). The respondents who answered that they would pay more than 1.5 times the product’s unit price were considered outliers and excluded from the analysis. Therefore, responses for 1414 participants were included in the final analysis.</p>
      <p><xref rid="figure1" ref-type="fig">Figure 1</xref> shows how much more money a respondent was willing to pay for each product according to the product type and unit price. Approximately 30% of respondents answered that they were not willing to pay any additional amount (0 yen) for each product. The most frequent value range, excluding 0 yen, was the same for food defense (Q28) and food hygiene (Q27): 51-100 yen for a 1000-yen lunch; 21-50 yen for a 1000-yen fruit juice drink, 500-yen frozen food, or 500-yen side dish; and 6-10 yen for a 200-yen snack and 200-yen soft drink.</p>
      <fig id="figure1" position="float">
        <label>Figure 1</label>
        <caption>
          <p>Distribution of the amount of additional costs (100 yen=US $0.9596). JPY: Japanese yen.</p>
        </caption>
        <graphic xlink:href="ijmr_v12i1e43936_fig1.png" alt-version="no" mimetype="image" position="float" xlink:type="simple"/>
      </fig>
      <p><xref ref-type="table" rid="table1">Table 1</xref> shows the median and mean additional costs for all respondents and for the respondents after data cleaning. Focusing on the average value after data cleaning, which is often used for CVM, the values were approximately 7% to 10% of the unit price. Comparing the same products, the amount of additional cost for food hygiene (Q27) was slightly higher than that for food defense (Q28).</p>
      <table-wrap position="float" id="table1">
        <label>Table 1</label>
        <caption>
          <p>Summary of additional costs for the contingent valuation analysis (100 yen=US $0.9596).</p>
        </caption>
        <table width="1000" cellpadding="5" cellspacing="0" border="1" rules="groups" frame="hsides">
          <col width="30"/>
          <col width="260"/>
          <col width="180"/>
          <col width="180"/>
          <col width="0"/>
          <col width="180"/>
          <col width="170"/>
          <thead>
            <tr valign="top">
              <td colspan="2">Question</td>
              <td colspan="3">All responses</td>
              <td colspan="2">After data cleaning</td>
            </tr>
            <tr valign="top">
              <td colspan="2">
                <break/>
              </td>
              <td>Median additional cost (yen)</td>
              <td>Mean additional cost (yen)</td>
              <td colspan="2">Median additional cost (yen)</td>
              <td>Mean additional cost (yen)</td>
            </tr>
          </thead>
          <tbody>
            <tr valign="top">
              <td colspan="7">
                <bold>Q27: food hygiene</bold>
              </td>
            </tr>
            <tr valign="top">
              <td>
                <break/>
              </td>
              <td>1000-yen lunch box</td>
              <td>50</td>
              <td>121.80</td>
              <td colspan="2">50</td>
              <td>101.60</td>
            </tr>
            <tr valign="top">
              <td>
                <break/>
              </td>
              <td>1000-yen juice</td>
              <td>30</td>
              <td>94.77</td>
              <td colspan="2">27.5</td>
              <td>79.38</td>
            </tr>
            <tr valign="top">
              <td>
                <break/>
              </td>
              <td>500-yen frozen food</td>
              <td>20</td>
              <td>98.18</td>
              <td colspan="2">20</td>
              <td>48.10</td>
            </tr>
            <tr valign="top">
              <td>
                <break/>
              </td>
              <td>500-yen side dish　</td>
              <td>20</td>
              <td>64.58</td>
              <td colspan="2">20</td>
              <td>49.28</td>
            </tr>
            <tr valign="top">
              <td>
                <break/>
              </td>
              <td>200-yen snack</td>
              <td>10</td>
              <td>24.47</td>
              <td colspan="2">10</td>
              <td>20.71</td>
            </tr>
            <tr valign="top">
              <td>
                <break/>
              </td>
              <td>200-yen soft drink</td>
              <td>10</td>
              <td>24.12</td>
              <td colspan="2">10</td>
              <td>20.21</td>
            </tr>
            <tr valign="top">
              <td colspan="7">
                <bold>Q28: food defense</bold>
              </td>
            </tr>
            <tr valign="top">
              <td>
                <break/>
              </td>
              <td>1000-yen lunch box</td>
              <td>50</td>
              <td>103.8</td>
              <td colspan="2">50</td>
              <td>87.85</td>
            </tr>
            <tr valign="top">
              <td>
                <break/>
              </td>
              <td>1000-yen juice</td>
              <td>20</td>
              <td>7715</td>
              <td colspan="2">20</td>
              <td>69.91</td>
            </tr>
            <tr valign="top">
              <td>
                <break/>
              </td>
              <td>500-yen frozen food</td>
              <td>10</td>
              <td>108.6</td>
              <td colspan="2">10</td>
              <td>41.57</td>
            </tr>
            <tr valign="top">
              <td>
                <break/>
              </td>
              <td>500-yen side dish　</td>
              <td>15</td>
              <td>47.59</td>
              <td colspan="2">10</td>
              <td>41.33</td>
            </tr>
            <tr valign="top">
              <td>
                <break/>
              </td>
              <td>200-yen snack</td>
              <td>10</td>
              <td>22.62</td>
              <td colspan="2">10</td>
              <td>18.92</td>
            </tr>
            <tr valign="top">
              <td>
                <break/>
              </td>
              <td>200-yen soft drink</td>
              <td>10</td>
              <td>20.34</td>
              <td colspan="2">8</td>
              <td>18.13</td>
            </tr>
          </tbody>
        </table>
      </table-wrap>
      <p><xref ref-type="table" rid="table2">Table 2</xref> shows the top 30 items in the analysis results. The first item was a direct question regarding paying additional costs; however, many questionnaire items that showed positive attitudes toward food defense and food hygiene were also present. Although they were not included in the top 30 items, people who were indifferent to food safety, such as those who would eat frozen food even if it had a strange smell, were also associated with paying 0 yen.</p>
      <p>A principal component analysis was conducted on the 12 variables related to additional cost in the two major questions Q27 and Q28. The SD of the first principal component was greater than 5 and that of the second and third principal components exceeded 1.2 and were considered to be valid. <xref ref-type="table" rid="table3">Table 3</xref> lists the factor loadings up to the third component. All the signs were the same for the first component. For the second component, Q27 and Q28 had differing positive and negative signs, respectively. In the third component, the loadings of the questions for expensive products were positive and those for cheap food products were negative.</p>
      <table-wrap position="float" id="table2">
        <label>Table 2</label>
        <caption>
          <p>Top 30 items correlated with “0 yen” responses (unwilling to pay additional cost).</p>
        </caption>
        <table width="1000" cellpadding="5" cellspacing="0" border="1" rules="groups" frame="hsides">
          <col width="830"/>
          <col width="170"/>
          <thead>
            <tr valign="top">
              <td>Question/statement</td>
              <td>Average z-score</td>
            </tr>
          </thead>
          <tbody>
            <tr valign="top">
              <td>Please tell us about your thoughts on safety: I will pay additional fees to ensure safety</td>
              <td>–7.423</td>
            </tr>
            <tr valign="top">
              <td>When making a purchase, you take into consideration product labels (marks, etc) indicating that the product has been manufactured in a factory that adopts the following measures: food hygiene measures</td>
              <td>–5.818</td>
            </tr>
            <tr valign="top">
              <td>The following are important for you when buying food (here, the rating would indicate the degree of importance): safety</td>
              <td>–5.373</td>
            </tr>
            <tr valign="top">
              <td>Please tell us about yourself: I am cooperative</td>
              <td>–5.202</td>
            </tr>
            <tr valign="top">
              <td>You consider the following when purchasing food (here, the rating would indicate the degree of consideration given): expiry date/best-before date</td>
              <td>–5.053</td>
            </tr>
            <tr valign="top">
              <td>The following are important to prevent food poisoning when eating at home: cleanliness of the place where you are cooking</td>
              <td>–5.023</td>
            </tr>
            <tr valign="top">
              <td>The following are important for you when buying food (here, the rating would indicate the degree of importance): manufactured domestically</td>
              <td>–4.841</td>
            </tr>
            <tr valign="top">
              <td>When making a purchase, you take into consideration product labels (marks, etc) indicating that the product has been manufactured in a factory that adopts the following measures: food defense measures</td>
              <td>–4.731</td>
            </tr>
            <tr valign="top">
              <td>The following are important to prevent food poisoning when eating at home: expiry date</td>
              <td>–4.622</td>
            </tr>
            <tr valign="top">
              <td>Please tell us about yourself: I have a strong sense of morality</td>
              <td>–4.561</td>
            </tr>
            <tr valign="top">
              <td>The following are important to prevent food poisoning when eating at home: heat cooking</td>
              <td>–4.505</td>
            </tr>
            <tr valign="top">
              <td>You are worried the following will increase the risk of infection when eating at a restaurant amid the COVID-19 pandemic: condiments put on the table (containers with a lid)</td>
              <td>–4.414</td>
            </tr>
            <tr valign="top">
              <td>You practice the following often to maintain hygiene and cleanliness: wearing a mask</td>
              <td>–4.400</td>
            </tr>
            <tr valign="top">
              <td>The following are important for you when buying electrical appliances (here, the rating would indicate the degree of importance): safety</td>
              <td>–4.384</td>
            </tr>
            <tr valign="top">
              <td>You try to obtain new information on the following topics: domestic situation</td>
              <td>–4.375</td>
            </tr>
            <tr valign="top">
              <td>You are worried the following will increase the risk of infection when eating at a restaurant amid the COVID-19 pandemic: buffet-style layout</td>
              <td>–4.326</td>
            </tr>
            <tr valign="top">
              <td>When making a purchase, you take into consideration product labels (marks, etc) indicating that the product has been manufactured in a factory that adopts the following measures: allergen labeling</td>
              <td>–4.274</td>
            </tr>
            <tr valign="top">
              <td>You are worried the following will increase the risk of infection when eating at a restaurant amid the COVID-19 pandemic: drinks put on the table (pitchers with a lid)</td>
              <td>–4.160</td>
            </tr>
            <tr valign="top">
              <td>You try to obtain new information on the following topics: international situation</td>
              <td>–4.150</td>
            </tr>
            <tr valign="top">
              <td>When making a purchase, you take into consideration product labels (marks, etc) indicating that the product has been manufactured in a factory that adopts the following measures: labeling of foods for specified health use (FOSHU)</td>
              <td>–4.145</td>
            </tr>
            <tr valign="top">
              <td>Have you heard of the following terms? (Yes/No): food security and safety</td>
              <td>4.107</td>
            </tr>
            <tr valign="top">
              <td>You consider the following when purchasing food (here, the rating would indicate the degree of consideration given): ingredient labeling</td>
              <td>–4.085</td>
            </tr>
            <tr valign="top">
              <td>You practice the following often to maintain hygiene and cleanliness: hand washing</td>
              <td>–4.020</td>
            </tr>
            <tr valign="top">
              <td>Please tell us about yourself: I am diligent</td>
              <td>–3.966</td>
            </tr>
            <tr valign="top">
              <td>Considering that there have been several incidents of intentional contamination of food with foreign substances (pesticides, etc) in Japan, such incidents will recur in the future at the following places: food-related logistics facilities</td>
              <td>–3.819</td>
            </tr>
            <tr valign="top">
              <td>Please tell us about yourself: I have a strong sense of responsibility</td>
              <td>–3.756</td>
            </tr>
            <tr valign="top">
              <td>You are anxious about eating in the following style/places amid the COVID-19 pandemic (here, the rating would indicate the degree of anxiousness): buffet</td>
              <td>–3.743</td>
            </tr>
            <tr valign="top">
              <td>You worry about the following at international sports events held in the summer in Japan: heat stroke</td>
              <td>–3.722</td>
            </tr>
            <tr valign="top">
              <td>Personal income</td>
              <td>3.719</td>
            </tr>
            <tr valign="top">
              <td>You try to obtain new information on the following topics: environment</td>
              <td>–3.677</td>
            </tr>
          </tbody>
        </table>
      </table-wrap>
      <table-wrap position="float" id="table3">
        <label>Table 3</label>
        <caption>
          <p>Factor loadings from principal component analysis.</p>
        </caption>
        <table width="1000" cellpadding="5" cellspacing="0" border="1" rules="groups" frame="hsides">
          <col width="30"/>
          <col width="370"/>
          <col width="200"/>
          <col width="200"/>
          <col width="200"/>
          <thead>
            <tr valign="top">
              <td colspan="2">Question</td>
              <td>1st component</td>
              <td>2nd component</td>
              <td>3rd component</td>
            </tr>
          </thead>
          <tbody>
            <tr valign="top">
              <td colspan="5">
                <bold>Q27: food hygiene</bold>
              </td>
            </tr>
            <tr valign="top">
              <td>
                <break/>
              </td>
              <td>1000-yen<sup>a</sup> lunch box</td>
              <td>–0.33213</td>
              <td>0.40084</td>
              <td>0.29172</td>
            </tr>
            <tr valign="top">
              <td>
                <break/>
              </td>
              <td>1000-yen juice</td>
              <td>–0.32377</td>
              <td>0.41225</td>
              <td>0.15839</td>
            </tr>
            <tr valign="top">
              <td>
                <break/>
              </td>
              <td>500-yen frozen food</td>
              <td>–0.29709</td>
              <td>0.24143</td>
              <td>–0.18636</td>
            </tr>
            <tr valign="top">
              <td>
                <break/>
              </td>
              <td>500-yen side dish　</td>
              <td>–0.29346</td>
              <td>0.25852</td>
              <td>–0.12869</td>
            </tr>
            <tr valign="top">
              <td>
                <break/>
              </td>
              <td>200-yen snack</td>
              <td>–0.23692</td>
              <td>0.13195</td>
              <td>–0.42668</td>
            </tr>
            <tr valign="top">
              <td>
                <break/>
              </td>
              <td>200-yen soft drink</td>
              <td>–0.23624</td>
              <td>0.13591</td>
              <td>–0.41529</td>
            </tr>
            <tr valign="top">
              <td colspan="5">
                <bold>Q28: food defense</bold>
              </td>
            </tr>
            <tr valign="top">
              <td>
                <break/>
              </td>
              <td>1000-yen lunch box</td>
              <td>–0.33156</td>
              <td>–0.19234</td>
              <td>0.45951</td>
            </tr>
            <tr valign="top">
              <td>
                <break/>
              </td>
              <td>1000-yen juice</td>
              <td>–0.32478</td>
              <td>–0.20582</td>
              <td>0.35734</td>
            </tr>
            <tr valign="top">
              <td>
                <break/>
              </td>
              <td>500-yen frozen food</td>
              <td>–0.29400</td>
              <td>–0.33029</td>
              <td>–0.01778</td>
            </tr>
            <tr valign="top">
              <td>
                <break/>
              </td>
              <td>500-yen side dish　</td>
              <td>–0.28771</td>
              <td>–0.32699</td>
              <td>0.03124</td>
            </tr>
            <tr valign="top">
              <td>
                <break/>
              </td>
              <td>200-yen snack</td>
              <td>–0.24059</td>
              <td>–0.33121</td>
              <td>–0.27116</td>
            </tr>
            <tr valign="top">
              <td>
                <break/>
              </td>
              <td>200-yen soft drink</td>
              <td>–0.23670</td>
              <td>–0.32140</td>
              <td>–0.26522</td>
            </tr>
          </tbody>
        </table>
        <table-wrap-foot>
          <fn id="table3fn1">
            <p><sup>a</sup>100 yen=US $0.9596.</p>
          </fn>
        </table-wrap-foot>
      </table-wrap>
      <p>Univariate linear regressions were conducted with the first to third principal components as objective variables and the remaining questionnaire items as explanatory variables. For the first principal component, there were 78 significant items (<italic>P</italic>≤.05). The top 30 items are listed in <xref ref-type="table" rid="table4">Table 4</xref>. For the first principal component, the strongest questionnaire item was “Please tell us about your thoughts on safety: I will pay additional fees to ensure safety.” The second strongest questionnaire item was “Please tell us about yourself: I am cooperative.” Other items also indicated that people who were interested in food hygiene and food defense were willing to pay additional costs. The items strongly correlated with the first principal component were considered to indicate the difference in attitudes toward food safety.</p>
      <table-wrap position="float" id="table4">
        <label>Table 4</label>
        <caption>
          <p>Top 30 significant (<italic>P</italic>≤.05) questionnaire items in univariate linear regression for the first principal component.</p>
        </caption>
        <table width="1000" cellpadding="5" cellspacing="0" border="1" rules="groups" frame="hsides">
          <col width="830"/>
          <col width="170"/>
          <thead>
            <tr valign="top">
              <td>Question/statement</td>
              <td><italic>t</italic> value (<italic>df</italic>=1412)</td>
            </tr>
          </thead>
          <tbody>
            <tr valign="top">
              <td>Please tell us about your thoughts on safety: I will pay additional fees to ensure safety</td>
              <td>–7.4080</td>
            </tr>
            <tr valign="top">
              <td>Please tell us about yourself: I am cooperative</td>
              <td>–5.6810</td>
            </tr>
            <tr valign="top">
              <td>When making a purchase, you take into consideration product labels (marks, etc) indicating that the product has been manufactured in a factory that adopts the following measures: food hygiene measures</td>
              <td>–5.2480</td>
            </tr>
            <tr valign="top">
              <td>The following are important for you when buying food: manufactured domestically</td>
              <td>–5.0140</td>
            </tr>
            <tr valign="top">
              <td>You are worried the following will increase the risk of infection when eating at a restaurant amid the COVID-19 pandemic: buffet-style layout</td>
              <td>–4.9980</td>
            </tr>
            <tr valign="top">
              <td>The following are important for you when buying food: safety</td>
              <td>–4.9220</td>
            </tr>
            <tr valign="top">
              <td>You are worried the following will increase the risk of infection when eating at a restaurant amid the COVID-19 pandemic: drinks put on the table (pitchers with a lid)</td>
              <td>–4.8350</td>
            </tr>
            <tr valign="top">
              <td>The following are important to prevent food poisoning when eating at home: expiry date</td>
              <td>–4.8280</td>
            </tr>
            <tr valign="top">
              <td>You practice the following often to maintain hygiene and cleanliness: wearing a mask</td>
              <td>–4.7360</td>
            </tr>
            <tr valign="top">
              <td>You are worried the following will increase the risk of infection when eating at a restaurant amid the COVID-19 pandemic: condiments put on the table (containers with a lid)</td>
              <td>–4.7010</td>
            </tr>
            <tr valign="top">
              <td>The following are important to prevent food poisoning when eating at home: heat cooking</td>
              <td>–4.6800</td>
            </tr>
            <tr valign="top">
              <td>You consider the following when purchasing food: expiry date/best-before date</td>
              <td>–4.5550</td>
            </tr>
            <tr valign="top">
              <td>When making a purchase, you take into consideration product labels (marks, etc) indicating that the product has been manufactured in a factory that adopts the following measures: allergen labeling</td>
              <td>–4.4420</td>
            </tr>
            <tr valign="top">
              <td>When making a purchase, you take into consideration product labels (marks, etc) indicating that the product has been manufactured in a factory that adopts the following measures: food defense measures</td>
              <td>–4.3700</td>
            </tr>
            <tr valign="top">
              <td>When making a purchase, you take into consideration product labels (marks, etc) indicating that the product has been manufactured in a factory that adopts the following measures: labeling of foods for specified health use (FOSHU)</td>
              <td>–4.3230</td>
            </tr>
            <tr valign="top">
              <td>You are anxious about eating in the following style/places amid the COVID-19 pandemic: buffet</td>
              <td>–4.1600</td>
            </tr>
            <tr valign="top">
              <td>You are worried the following will increase the risk of infection when eating at a restaurant amid the COVID-19 pandemic: disposable chopsticks (kept in a chopstick stand without packaging)</td>
              <td>–4.1520</td>
            </tr>
            <tr valign="top">
              <td>Have you heard of the following terms? (Yes/No): food security and safety</td>
              <td>4.1430</td>
            </tr>
            <tr valign="top">
              <td>The following are important to prevent food poisoning when eating at home: cleanliness of the place where you are cooking</td>
              <td>–4.0640</td>
            </tr>
            <tr valign="top">
              <td>Please tell us about yourself: I have a strong sense of morality</td>
              <td>–3.9950</td>
            </tr>
            <tr valign="top">
              <td>Have you heard of the following terms? (Yes/No): food terrorism</td>
              <td>3.9630</td>
            </tr>
            <tr valign="top">
              <td>The following are important for you when buying electrical appliances: safety</td>
              <td>–3.8220</td>
            </tr>
            <tr valign="top">
              <td>The following are important to prevent food poisoning when eating at home: best-before date</td>
              <td>–3.7600</td>
            </tr>
            <tr valign="top">
              <td>Age group</td>
              <td>3.6820</td>
            </tr>
            <tr valign="top">
              <td>If the frozen food you purchased is contaminated with foreign substances (metal, hair, etc), you…: dispose of it</td>
              <td>–3.6720</td>
            </tr>
            <tr valign="top">
              <td>Please tell us about yourself: I am diligent</td>
              <td>–3.6160</td>
            </tr>
            <tr valign="top">
              <td>The following are important for you when buying food: reputation (word of mouth)</td>
              <td>–3.6090</td>
            </tr>
            <tr valign="top">
              <td>The following are important for you when buying electrical appliances: reputation (word of mouth)</td>
              <td>–3.5770</td>
            </tr>
            <tr valign="top">
              <td>Personal income</td>
              <td>3.5100</td>
            </tr>
            <tr valign="top">
              <td>Age</td>
              <td>3.4710</td>
            </tr>
          </tbody>
        </table>
      </table-wrap>
      <p>For the second principal component, there were 14 significant questionnaire items (<italic>P</italic>≤.05), which is considerably fewer than the number of significant items along the first principal component (<xref ref-type="table" rid="table5">Table 5</xref>). The strongest questionnaire item was “When you buy food, how important are the following: reputation (word of mouth),” followed by “When you buy clothes, how important are the following: price.” These are suggested to be related not only to food reputation but also to perspectives when purchasing items other than food.</p>
      <table-wrap position="float" id="table5">
        <label>Table 5</label>
        <caption>
          <p>Significant (<italic>P</italic>≤.05) questionnaire items in univariate linear regression for the second principal component.</p>
        </caption>
        <table width="1000" cellpadding="5" cellspacing="0" border="1" rules="groups" frame="hsides">
          <col width="830"/>
          <col width="170"/>
          <thead>
            <tr valign="top">
              <td>Question/statement</td>
              <td><italic>t</italic> value (<italic>df</italic>=1412)</td>
            </tr>
          </thead>
          <tbody>
            <tr valign="top">
              <td>The following are important for you when buying food: reputation (word of mouth)</td>
              <td>–3.2050</td>
            </tr>
            <tr valign="top">
              <td>The following are important for you when buying clothes: price</td>
              <td>–3.0380</td>
            </tr>
            <tr valign="top">
              <td>The following are important for you when buying food: price</td>
              <td>–2.9940</td>
            </tr>
            <tr valign="top">
              <td>Have you heard of the following terms? (Yes/No): food hygiene</td>
              <td>2.6100</td>
            </tr>
            <tr valign="top">
              <td>The following are important for you when buying food: brand</td>
              <td>–2.4850</td>
            </tr>
            <tr valign="top">
              <td>The frozen food you purchased has a bad (rotten, chemical, etc) smell. You…: dispose of it</td>
              <td>–2.4530</td>
            </tr>
            <tr valign="top">
              <td>You consider the following as “unhygienic” when eating at a restaurant: disposable chopsticks (kept in a chopstick stand without packaging)</td>
              <td>2.4110</td>
            </tr>
            <tr valign="top">
              <td>When making a purchase, you take into consideration product labels (marks, etc) indicating that the product has been manufactured in a factory that adopts the following measures: labeling of foods for specified health use (FOSHU)</td>
              <td>–2.3840</td>
            </tr>
            <tr valign="top">
              <td>When making a purchase, you take into consideration product labels (marks, etc) indicating that the product has been manufactured in a factory that adopts the following measures: food defense measures</td>
              <td>–2.3780</td>
            </tr>
            <tr valign="top">
              <td>The following are important for you when buying food: customer service/troubleshooting</td>
              <td>–2.3310</td>
            </tr>
            <tr valign="top">
              <td>The following are important for you when buying electrical appliances: brand</td>
              <td>–2.0830</td>
            </tr>
            <tr valign="top">
              <td>The following are important to prevent food poisoning when eating at home: order of cooking</td>
              <td>–2.0710</td>
            </tr>
            <tr valign="top">
              <td>When making a purchase, you take into consideration product labels (marks, etc) indicating that the product has been manufactured in a factory that adopts the following measures: food hygiene measures</td>
              <td>–1.9830</td>
            </tr>
            <tr valign="top">
              <td>The following are important to prevent food poisoning when eating at home: cold storage of ingredients</td>
              <td>–1.9650</td>
            </tr>
          </tbody>
        </table>
      </table-wrap>
      <p>For the third principal component, there were 100 significant (<italic>P</italic>≤.05) items in univariate regression; the top 30 items are listed in <xref ref-type="table" rid="table6">Table 6</xref>. The strongest item was “age.” This analysis indicated that the items constituting respondents’ basic information were more relevant than the questionnaire items regarding food safety.</p>
      <table-wrap position="float" id="table6">
        <label>Table 6</label>
        <caption>
          <p>Top 30 significant items (<italic>P</italic>≤.05) for the third principal component in univariate linear regression.</p>
        </caption>
        <table width="1000" cellpadding="5" cellspacing="0" border="1" rules="groups" frame="hsides">
          <col width="830"/>
          <col width="170"/>
          <thead>
            <tr valign="top">
              <td>Question statement</td>
              <td><italic>t</italic> value (<italic>df</italic>=1412)</td>
            </tr>
          </thead>
          <tbody>
            <tr valign="top">
              <td>Age</td>
              <td>6.2660</td>
            </tr>
            <tr valign="top">
              <td>Age group</td>
              <td>5.9030</td>
            </tr>
            <tr valign="top">
              <td>Have child (Yes/No)</td>
              <td>4.6800</td>
            </tr>
            <tr valign="top">
              <td>Marital status</td>
              <td>4.1900</td>
            </tr>
            <tr valign="top">
              <td>You find extra item(s), which you had not selected, in the food parcel delivered to you. You…: eat it without worrying</td>
              <td>–3.5670</td>
            </tr>
            <tr valign="top">
              <td>You consider the following when purchasing food: place (ie, country) of production</td>
              <td>3.4980</td>
            </tr>
            <tr valign="top">
              <td>Please tell us about yourself: I am diligent</td>
              <td>3.4700</td>
            </tr>
            <tr valign="top">
              <td>You find extra item(s), which you had not selected, in the food parcel delivered to you. You…: contact the shop from where you had ordered it</td>
              <td>3.4660</td>
            </tr>
            <tr valign="top">
              <td>You consider the following when purchasing food: expiry date/best-before date</td>
              <td>3.4190</td>
            </tr>
            <tr valign="top">
              <td>Please tell us about your thoughts on safety: terror acts do not occur in Japan</td>
              <td>3.3410</td>
            </tr>
            <tr valign="top">
              <td>Please tell us about yourself: I am honest</td>
              <td>3.1820</td>
            </tr>
            <tr valign="top">
              <td>The following are important for you when buying food: safety</td>
              <td>3.0710</td>
            </tr>
            <tr valign="top">
              <td>There have been several instances of intentional contamination of food with foreign substances/drugs in the past, and implementing measures to prevent this is called “food defense.” Considering this, such measures should be adopted for food manufactured/provided at the following places: international political event venues (summits, etc)</td>
              <td>3.0220</td>
            </tr>
            <tr valign="top">
              <td>You are anxious about eating in the following style/places amid the COVID-19 pandemic: bars</td>
              <td>2.9770</td>
            </tr>
            <tr valign="top">
              <td>There have been several instances of intentional contamination of food with foreign substances/drugs in the past, and implementing measures to prevent this is called “food defense.” Considering this, such measures should be adopted for food manufactured/provided at the following places: food service chain stores (restaurants, etc)</td>
              <td>2.9610</td>
            </tr>
            <tr valign="top">
              <td>The frozen food you purchased has a bad (rotten, chemical, etc) smell. You…: contact the manufacturer</td>
              <td>2.9070</td>
            </tr>
            <tr valign="top">
              <td>There have been several instances of intentional contamination of food with foreign substances/drugs in the past, and implementing measures to prevent this is called “food defense.” Considering this, such measures should be adopted for food manufactured/provided at the following places: international sports event venues (Olympics, etc)</td>
              <td>2.8990</td>
            </tr>
            <tr valign="top">
              <td>You worry about the following at international sport events held in the summer in Japan: terror attack(s)</td>
              <td>–2.8910</td>
            </tr>
            <tr valign="top">
              <td>There have been several instances of intentional contamination of food with foreign substances/drugs in the past, and implementing measures to prevent this is called “food defense.” Considering this, such measures should be adopted for food manufactured/provided at the following places: food factories</td>
              <td>2.7030</td>
            </tr>
            <tr valign="top">
              <td>You are anxious about eating in the following style/places amid the COVID-19 pandemic: event venues (stores)</td>
              <td>2.7010</td>
            </tr>
            <tr valign="top">
              <td>Please tell us about yourself: I have a strong sense of responsibility</td>
              <td>2.6900</td>
            </tr>
            <tr valign="top">
              <td>The frozen food you purchased has a bad (rotten, chemical, etc) smell. You…: eat it without worrying</td>
              <td>–2.5700</td>
            </tr>
            <tr valign="top">
              <td>The frozen food you purchased has a bad (rotten, chemical, etc) smell. You…: contact the shop where you purchased it</td>
              <td>2.5530</td>
            </tr>
            <tr valign="top">
              <td>Please tell us about yourself: I have a strong sense of morality</td>
              <td>2.4920</td>
            </tr>
            <tr valign="top">
              <td>The following are important for you when buying food: manufactured domestically</td>
              <td>2.4530</td>
            </tr>
            <tr valign="top">
              <td>You practice the following often to maintain hygiene and cleanliness: wearing a mask</td>
              <td>2.4410</td>
            </tr>
            <tr valign="top">
              <td>You are anxious about eating in the following style/places amid the COVID-19 pandemic: home</td>
              <td>–2.4120</td>
            </tr>
            <tr valign="top">
              <td>When making a purchase, you take into consideration product labels (marks, etc) indicating that the product has been manufactured in a factory that adopts the following measures: food defense measures</td>
              <td>2.3950</td>
            </tr>
            <tr valign="top">
              <td>You practice the following often to maintain hygiene and cleanliness: cleaning</td>
              <td>2.3640</td>
            </tr>
            <tr valign="top">
              <td>The following are important for you when buying food: customer service/troubleshooting</td>
              <td>2.1760</td>
            </tr>
          </tbody>
        </table>
      </table-wrap>
    </sec>
    <sec sec-type="discussion">
      <title>Discussion</title>
      <sec>
        <title>Principal Results</title>
        <p>In this study, a web-based survey was conducted in Japan to examine people’s willingness to pay for food safety and food defense. Approximately one-third of the respondents stated that they were unwilling to incur any additional costs. This subgroup also reported their willingness to consume food items included in their delivery even if those items were not part of their original order.</p>
        <p>To analyze the additional amount paid, principal component analyses were performed. The first principal component reflected whether one is willing to pay extra and if so, how much. This propensity was maintained even if individual foods and amounts of money differed and therefore does not need to be discussed further. However, the second principal component reflected an axis indicating a difference in the importance of food defense and food hygiene among respondents.</p>
      </sec>
      <sec>
        <title>Food Hygiene and Food Defense in Japan</title>
        <p>Individuals who expressed unwillingness to pay additional costs for food hygiene and food defense may perceive bearing the costs associated with ensuring food safety as the responsibility of businesses rather than that of consumers. The first principal component represented the amount paid, and many items strongly associated with this component were related to perceptions of safety. Some people may consider food safety as something that should be provided free of charge, whereas others are willing to pay for it.</p>
        <p>Respondents who were unwilling to pay for additional costs were often those who would consume food included in their delivery even if it posed a risk of intentional harm. Therefore, it can be concluded that this type of respondent is less concerned about food safety. The third principal component reflected the influence of the original price. Few people indicated that they would pay a fixed amount higher than 0 yen, regardless of the product’s price. Those who claimed that the price would not affect their decision may also be considered in the 0 yen category; in other words, they have no intention of spending additional money. Consequently, it can be inferred that Japanese food is perceived as safe and trustworthy [<xref ref-type="bibr" rid="ref2">2</xref>], and respondents with this perception do not intend to increase their expenditure.</p>
        <p>Some individuals in Japan believe that investing in safety is unnecessary. For example, Japan’s tap water is inexpensive and suitable for drinking, and it is considered a safe country overall [<xref ref-type="bibr" rid="ref14">14</xref>]. In 1970, Yamamoto (writing under the pseudonym Isaiah BenDasan) [<xref ref-type="bibr" rid="ref15">15</xref>] astutely pointed out that “Japanese people think water and safety are free.” Despite this perspective, citizens do pay for water and contribute through taxes for police services. Owing to the relatively low cost and its integration with other needs, there is a high possibility that some citizens are unaware of the necessity of investing in safety.</p>
        <p>In Japan, both food defense and food hygiene are crucial for ensuring safe and high-quality food. Food defense involves protecting food from intentional contamination, whereas food hygiene focuses on preventing unintentional contamination. Although government regulations strictly establish standards for food hygiene, guidelines for food defense are developed and published by a research team funded by the Ministry of Health, Labour, and Welfare’s scientific research grant [<xref ref-type="bibr" rid="ref1">1</xref>,<xref ref-type="bibr" rid="ref3">3</xref>]. In recent years, concerns have arisen regarding the intentional contamination of food products with foreign substances in Japan. Consequently, stronger food defense measures are required, and the industry is working toward addressing these issues and promoting greater transparency and traceability in the food supply chain.</p>
        <p>Thorough measures to improve food safety in the food supply chain have become imperative recently [<xref ref-type="bibr" rid="ref16">16</xref>,<xref ref-type="bibr" rid="ref17">17</xref>]. As all factors at each stage of the food chain, from primary production to consumers, can affect food safety, necessary actions must be taken [<xref ref-type="bibr" rid="ref18">18</xref>,<xref ref-type="bibr" rid="ref19">19</xref>]. To mitigate the risk of food-related health hazards, both businesses involved in the food supply chain as well as consumers must adopt appropriate measures.</p>
        <p>Overall, Japan has fostered a strong food safety culture and remains committed to ensuring citizen health and well-being through safe and nutritious food. However, the results of this survey indicate that some consumers may be unaware that maintaining Japan’s robust food safety culture, built over many years, may entail a financial burden.</p>
        <p>The second principal component revealed an axis that distinguishes between food hygiene and food defense. The most important factor indicating this distinction was “When buying food, the following are important to you: reputation (word of mouth).” The second most important factor was “When buying clothes, the following are important to you: price.” The fifth most important factor was “When buying food, the following are important to you: brand.” Based on these results, the second most important factor, “clothing,” is not directly related to food, whereas the fifth factor, “brand,” emphasizes the value of intangible qualities. The value of a brand has also been demonstrated by Aaker [<xref ref-type="bibr" rid="ref20">20</xref>] and Winters [<xref ref-type="bibr" rid="ref21">21</xref>].</p>
        <p>In the case of agricultural products, Koike et al [<xref ref-type="bibr" rid="ref22">22</xref>] conducted an internet survey and found that 64.5% of consumers preferred domestically produced agricultural products, 35.2% had no specific preference, and only 0.3% preferred foreign-produced products. This indicates the existence of the “domestic myth” (an emotional belief that domestic production is superior) or the perception that food produced in Japan is inherently safe, particularly regarding agricultural products. In our study’s questionnaire, most respondents stated that domestic production is important when purchasing food because “domestic products are trusted by many people.” Additionally, individuals who value brands in contexts other than food, such as clothing, also support food defense. We asked respondents whether they considered “manufactured domestically” to be important when buying food, with 1.3% responding “strongly disagree,” 2.9% responding “disagree,” 10.9% responding “somewhat disagree,” 33.5% responding “somewhat agree,” 31.2% responding “agree,” and 20.2% responding “strongly agree.” This indicates that the “domestic myth” of domestic production is prevalent in the food industry in Japan as 84.9% of respondents answered “somewhat agree” or higher. Our findings suggest that food hygiene is well-managed and recognized in Japan, while food defense is considered an added value, similar to brands.</p>
      </sec>
      <sec>
        <title>Future Work</title>
        <p>We intend to investigate causal relationships and other factors using analysis methods such as structural equation modeling to identify the type of consciousness the current result is based on.</p>
      </sec>
      <sec>
        <title>Limitations</title>
        <p>Several limitations to this study must be acknowledged. First, the data were collected only from respondents registered with an internet panel survey company, which may have biased the sample. Older people who use computers and the internet may be healthier and more active than those who do not. However, panel surveys are increasingly widely used in questionnaires [<xref ref-type="bibr" rid="ref5">5</xref>,<xref ref-type="bibr" rid="ref23">23</xref>-<xref ref-type="bibr" rid="ref26">26</xref>]. Second, respondents received a brief description of the survey via email and then chose whether to participate in the survey. Thus, there is a possibility of participant bias owing to their preferences. Third, we included an explanation of food defense in our survey because we thought that the concept of food defense was not well understood by the general public. In the future, we must clarify the difference between food defense and food hygiene and then ask the participants to respond. This may have affected some participants’ responses regarding food defense. Fourth, this was not a population-based study; therefore, the participants may not be representative of the general population in Japan. Fifth, participants received a small cash reward for their participation, which may have affected the randomness of the sample. However, the research firm minimized bias by using a large enrollment population to create the survey panel (the total number of people registered with the research firm was more than 1,300,000, accounting for approximately 1% of the Japanese population). Despite these limitations, internet questionnaires can be considered representative of the general public; therefore, we believe that the study results could represent the entire Japanese population to some extent.</p>
      </sec>
      <sec>
        <title>Conclusions</title>
        <p>Approximately one-third of respondents said they were unwilling to incur additional costs for ensuring food safety. This subgroup also described that they would eat foods included in their delivery that they had not ordered. We performed a principal component analysis on the amount of additional money that people were willing to pay for food defense and food hygiene measures, and found an axis that indicated the divergent importance of food defense and food hygiene for consumers.</p>
        <p>In Japan, food hygiene is taken for granted and food defense is considered of little significance by many people; it is only considered important by those who seek to gain peace of mind. Many companies are applying food defense efforts, but it is necessary to also educate consumers so that they understand the need for these measures.</p>
      </sec>
    </sec>
  </body>
  <back>
    <app-group/>
    <glossary>
      <title>Abbreviations</title>
      <def-list>
        <def-item>
          <term id="abb1">CVM</term>
          <def>
            <p>contingent valuation method</p>
          </def>
        </def-item>
      </def-list>
    </glossary>
    <ack>
      <p>This study was partially supported by a Grant-in-Aid for Scientific Research from the Ministry of Health, Labour and Welfare, Japan (21KA1009).</p>
    </ack>
    <notes>
      <sec>
        <title>Data Availability</title>
        <p>The data used in this study are available from the corresponding author upon reasonable request.</p>
      </sec>
    </notes>
    <fn-group>
      <fn fn-type="con">
        <p>SM designed the project, executed the analysis, and drafted the initial manuscript. YK, TI, TA, and MA developed the questionnaires. SM, KN, TI, and MA interpreted the results. MA directed and coordinated the project. All authors approved the final manuscript.</p>
      </fn>
      <fn fn-type="conflict">
        <p>None declared.</p>
      </fn>
    </fn-group>
    <ref-list>
      <ref id="ref1">
        <label>1</label>
        <nlm-citation citation-type="journal">
          <person-group person-group-type="author">
            <name name-style="western">
              <surname>Kanagawa</surname>
              <given-names>Y</given-names>
            </name>
            <name name-style="western">
              <surname>Akahane</surname>
              <given-names>M</given-names>
            </name>
            <name name-style="western">
              <surname>Hasegawa</surname>
              <given-names>A</given-names>
            </name>
            <name name-style="western">
              <surname>Yamaguchi</surname>
              <given-names>K</given-names>
            </name>
            <name name-style="western">
              <surname>Onitake</surname>
              <given-names>K</given-names>
            </name>
            <name name-style="western">
              <surname>Takaya</surname>
              <given-names>S</given-names>
            </name>
            <name name-style="western">
              <surname>Yamamoto</surname>
              <given-names>S</given-names>
            </name>
            <name name-style="western">
              <surname>Imamura</surname>
              <given-names>T</given-names>
            </name>
          </person-group>
          <article-title>Developing a national food defense guideline based on a vulnerability assessment of intentional food contamination in Japanese food factories using the CARVER+Shock vulnerability assessment tool</article-title>
          <source>Foodborne Pathog Dis</source>
          <year>2014</year>
          <month>12</month>
          <volume>11</volume>
          <issue>12</issue>
          <fpage>953</fpage>
          <lpage>959</lpage>
          <pub-id pub-id-type="doi">10.1089/fpd.2014.1767</pub-id>
          <pub-id pub-id-type="medline">25496071</pub-id>
        </nlm-citation>
      </ref>
      <ref id="ref2">
        <label>2</label>
        <nlm-citation citation-type="journal">
          <person-group person-group-type="author">
            <name name-style="western">
              <surname>Matsumoto</surname>
              <given-names>S</given-names>
            </name>
            <name name-style="western">
              <surname>Kanagawa</surname>
              <given-names>Y</given-names>
            </name>
            <name name-style="western">
              <surname>Nagoshi</surname>
              <given-names>K</given-names>
            </name>
            <name name-style="western">
              <surname>Imamura</surname>
              <given-names>T</given-names>
            </name>
            <name name-style="western">
              <surname>Akahane</surname>
              <given-names>M</given-names>
            </name>
          </person-group>
          <article-title>Characteristics of people in Japan based on their perceptions about food-related risks</article-title>
          <source>Shimane J Med</source>
          <year>2022</year>
          <volume>39</volume>
          <fpage>15</fpage>
          <lpage>25</lpage>
          <pub-id pub-id-type="doi">10.51010/sjms.39.1_15</pub-id>
        </nlm-citation>
      </ref>
      <ref id="ref3">
        <label>3</label>
        <nlm-citation citation-type="journal">
          <person-group person-group-type="author">
            <name name-style="western">
              <surname>Kanagawa</surname>
              <given-names>Y</given-names>
            </name>
            <name name-style="western">
              <surname>Akahane</surname>
              <given-names>M</given-names>
            </name>
            <name name-style="western">
              <surname>Imamura</surname>
              <given-names>T</given-names>
            </name>
            <name name-style="western">
              <surname>Hasegawa</surname>
              <given-names>A</given-names>
            </name>
            <name name-style="western">
              <surname>Yamaguchi</surname>
              <given-names>K</given-names>
            </name>
            <name name-style="western">
              <surname>Onitake</surname>
              <given-names>K</given-names>
            </name>
            <name name-style="western">
              <surname>Takaya</surname>
              <given-names>S</given-names>
            </name>
            <name name-style="western">
              <surname>Yamamoto</surname>
              <given-names>S</given-names>
            </name>
          </person-group>
          <article-title>Tentative food defense guidelines for food producers and processors in Japan</article-title>
          <source>Nihon Koshu Eisei Zasshi</source>
          <year>2014</year>
          <volume>61</volume>
          <issue>2</issue>
          <fpage>100</fpage>
          <lpage>9</lpage>
          <comment>
            <ext-link ext-link-type="uri" xlink:type="simple" xlink:href="http://japanlinkcenter.org/DN/JST.JSTAGE/jph/61.2_100?from=PubMed&#38;lang=en"/>
          </comment>
          <pub-id pub-id-type="doi">10.11236/jph.61.2_100</pub-id>
          <pub-id pub-id-type="medline">24739880</pub-id>
          <pub-id pub-id-type="pii">DN/JST.JSTAGE/jph/61.2_100</pub-id>
        </nlm-citation>
      </ref>
      <ref id="ref4">
        <label>4</label>
        <nlm-citation citation-type="journal">
          <person-group person-group-type="author">
            <name name-style="western">
              <surname>Sugiura</surname>
              <given-names>H</given-names>
            </name>
            <name name-style="western">
              <surname>Ohkusa</surname>
              <given-names>Y</given-names>
            </name>
            <name name-style="western">
              <surname>Akahane</surname>
              <given-names>M</given-names>
            </name>
            <name name-style="western">
              <surname>Sugahara</surname>
              <given-names>T</given-names>
            </name>
            <name name-style="western">
              <surname>Okabe</surname>
              <given-names>N</given-names>
            </name>
            <name name-style="western">
              <surname>Imamura</surname>
              <given-names>T</given-names>
            </name>
          </person-group>
          <article-title>Construction of syndromic surveillance using a web-based daily questionnaire for health and its application at the G8 Hokkaido Toyako Summit meeting</article-title>
          <source>Epidemiol Infect</source>
          <year>2010</year>
          <month>10</month>
          <volume>138</volume>
          <issue>10</issue>
          <fpage>1493</fpage>
          <lpage>1502</lpage>
          <pub-id pub-id-type="doi">10.1017/S095026880999149X</pub-id>
          <pub-id pub-id-type="medline">20067657</pub-id>
          <pub-id pub-id-type="pii">S095026880999149X</pub-id>
        </nlm-citation>
      </ref>
      <ref id="ref5">
        <label>5</label>
        <nlm-citation citation-type="journal">
          <person-group person-group-type="author">
            <name name-style="western">
              <surname>Sugiura</surname>
              <given-names>H</given-names>
            </name>
            <name name-style="western">
              <surname>Ohkusa</surname>
              <given-names>Y</given-names>
            </name>
            <name name-style="western">
              <surname>Akahane</surname>
              <given-names>M</given-names>
            </name>
            <name name-style="western">
              <surname>Sano</surname>
              <given-names>T</given-names>
            </name>
            <name name-style="western">
              <surname>Okabe</surname>
              <given-names>N</given-names>
            </name>
            <name name-style="western">
              <surname>Imamura</surname>
              <given-names>T</given-names>
            </name>
          </person-group>
          <article-title>Development of a web-based survey for monitoring daily health and its application in an epidemiological survey</article-title>
          <source>J Med Internet Res</source>
          <year>2011</year>
          <month>09</month>
          <day>23</day>
          <volume>13</volume>
          <issue>3</issue>
          <fpage>e66</fpage>
          <comment>
            <ext-link ext-link-type="uri" xlink:type="simple" xlink:href="https://www.jmir.org/2011/3/e66/"/>
          </comment>
          <pub-id pub-id-type="doi">10.2196/jmir.1872</pub-id>
          <pub-id pub-id-type="medline">21946004</pub-id>
          <pub-id pub-id-type="pii">v13i3e66</pub-id>
          <pub-id pub-id-type="pmcid">PMC3222160</pub-id>
        </nlm-citation>
      </ref>
      <ref id="ref6">
        <label>6</label>
        <nlm-citation citation-type="journal">
          <person-group person-group-type="author">
            <name name-style="western">
              <surname>Maeyashiki</surname>
              <given-names>A</given-names>
            </name>
            <name name-style="western">
              <surname>Akahane</surname>
              <given-names>M</given-names>
            </name>
            <name name-style="western">
              <surname>Sugiura</surname>
              <given-names>H</given-names>
            </name>
            <name name-style="western">
              <surname>Ohkusa</surname>
              <given-names>Y</given-names>
            </name>
            <name name-style="western">
              <surname>Okabe</surname>
              <given-names>N</given-names>
            </name>
            <name name-style="western">
              <surname>Imamura</surname>
              <given-names>T</given-names>
            </name>
          </person-group>
          <article-title>Development and application of an alert system to detect cases of food poisoning in Japan</article-title>
          <source>PLoS One</source>
          <year>2016</year>
          <volume>11</volume>
          <issue>5</issue>
          <fpage>e0156395</fpage>
          <comment>
            <ext-link ext-link-type="uri" xlink:type="simple" xlink:href="https://dx.plos.org/10.1371/journal.pone.0156395"/>
          </comment>
          <pub-id pub-id-type="doi">10.1371/journal.pone.0156395</pub-id>
          <pub-id pub-id-type="medline">27231884</pub-id>
          <pub-id pub-id-type="pii">PONE-D-15-49887</pub-id>
          <pub-id pub-id-type="pmcid">PMC4883778</pub-id>
        </nlm-citation>
      </ref>
      <ref id="ref7">
        <label>7</label>
        <nlm-citation citation-type="journal">
          <person-group person-group-type="author">
            <name name-style="western">
              <surname>Hennessey</surname>
              <given-names>M</given-names>
            </name>
            <name name-style="western">
              <surname>Kennedy</surname>
              <given-names>S</given-names>
            </name>
            <name name-style="western">
              <surname>Busta</surname>
              <given-names>F</given-names>
            </name>
          </person-group>
          <article-title>Demeter's Resilience: an International Food Defense exercise</article-title>
          <source>J Food Prot</source>
          <year>2010</year>
          <month>07</month>
          <volume>73</volume>
          <issue>7</issue>
          <fpage>1353</fpage>
          <lpage>1356</lpage>
          <comment>
            <ext-link ext-link-type="uri" xlink:type="simple" xlink:href="https://linkinghub.elsevier.com/retrieve/pii/S0362-028X(23)05984-7"/>
          </comment>
          <pub-id pub-id-type="doi">10.4315/0362-028x-73.7.1353</pub-id>
          <pub-id pub-id-type="medline">20615353</pub-id>
          <pub-id pub-id-type="pii">S0362-028X(23)05984-7</pub-id>
        </nlm-citation>
      </ref>
      <ref id="ref8">
        <label>8</label>
        <nlm-citation citation-type="journal">
          <person-group person-group-type="author">
            <name name-style="western">
              <surname>Everstine</surname>
              <given-names>K</given-names>
            </name>
            <name name-style="western">
              <surname>Spink</surname>
              <given-names>J</given-names>
            </name>
            <name name-style="western">
              <surname>Kennedy</surname>
              <given-names>S</given-names>
            </name>
          </person-group>
          <article-title>Economically motivated adulteration (EMA) of food: common characteristics of EMA incidents</article-title>
          <source>J Food Prot</source>
          <year>2013</year>
          <month>04</month>
          <volume>76</volume>
          <issue>4</issue>
          <fpage>723</fpage>
          <lpage>735</lpage>
          <comment>
            <ext-link ext-link-type="uri" xlink:type="simple" xlink:href="https://linkinghub.elsevier.com/retrieve/pii/S0362-028X(23)05509-6"/>
          </comment>
          <pub-id pub-id-type="doi">10.4315/0362-028X.JFP-12-399</pub-id>
          <pub-id pub-id-type="medline">23575142</pub-id>
          <pub-id pub-id-type="pii">S0362-028X(23)05509-6</pub-id>
        </nlm-citation>
      </ref>
      <ref id="ref9">
        <label>9</label>
        <nlm-citation citation-type="journal">
          <person-group person-group-type="author">
            <name name-style="western">
              <surname>Spink</surname>
              <given-names>J</given-names>
            </name>
            <name name-style="western">
              <surname>Moyer</surname>
              <given-names>DC</given-names>
            </name>
          </person-group>
          <article-title>Defining the public health threat of food fraud</article-title>
          <source>J Food Sci</source>
          <year>2011</year>
          <volume>76</volume>
          <issue>9</issue>
          <fpage>R157</fpage>
          <lpage>R163</lpage>
          <pub-id pub-id-type="doi">10.1111/j.1750-3841.2011.02417.x</pub-id>
          <pub-id pub-id-type="medline">22416717</pub-id>
        </nlm-citation>
      </ref>
      <ref id="ref10">
        <label>10</label>
        <nlm-citation citation-type="journal">
          <person-group person-group-type="author">
            <name name-style="western">
              <surname>Jurica</surname>
              <given-names>K</given-names>
            </name>
            <name name-style="western">
              <surname>Vrdoljak</surname>
              <given-names>J</given-names>
            </name>
            <name name-style="western">
              <surname>Karačonji</surname>
              <given-names>IB</given-names>
            </name>
          </person-group>
          <article-title>Food defence systems as an answer to food terrorism</article-title>
          <source>Arh Hig Rada Toksikol</source>
          <year>2019</year>
          <month>12</month>
          <day>01</day>
          <volume>70</volume>
          <issue>4</issue>
          <fpage>232</fpage>
          <lpage>255</lpage>
          <comment>
            <ext-link ext-link-type="uri" xlink:type="simple" xlink:href="https://sciendo.com/article/10.2478/aiht-2019-70-3357"/>
          </comment>
          <pub-id pub-id-type="doi">10.2478/aiht-2019-70-3357</pub-id>
          <pub-id pub-id-type="medline">32623862</pub-id>
          <pub-id pub-id-type="pii">aiht-2019-70-3357</pub-id>
        </nlm-citation>
      </ref>
      <ref id="ref11">
        <label>11</label>
        <nlm-citation citation-type="journal">
          <person-group person-group-type="author">
            <name name-style="western">
              <surname>Manning</surname>
              <given-names>L</given-names>
            </name>
            <name name-style="western">
              <surname>Soon</surname>
              <given-names>JM</given-names>
            </name>
          </person-group>
          <article-title>Food safety, food fraud, and food defense: a fast evolving literature</article-title>
          <source>J Food Sci</source>
          <year>2016</year>
          <month>04</month>
          <volume>81</volume>
          <issue>4</issue>
          <fpage>R823</fpage>
          <lpage>R834</lpage>
          <comment>
            <ext-link ext-link-type="uri" xlink:type="simple" xlink:href="https://core.ac.uk/reader/74238722?utm_source=linkout"/>
          </comment>
          <pub-id pub-id-type="doi">10.1111/1750-3841.13256</pub-id>
          <pub-id pub-id-type="medline">26934423</pub-id>
        </nlm-citation>
      </ref>
      <ref id="ref12">
        <label>12</label>
        <nlm-citation citation-type="journal">
          <person-group person-group-type="author">
            <name name-style="western">
              <surname>Xirasagar</surname>
              <given-names>S</given-names>
            </name>
            <name name-style="western">
              <surname>Kanwat</surname>
              <given-names>CP</given-names>
            </name>
            <name name-style="western">
              <surname>Qu</surname>
              <given-names>H</given-names>
            </name>
            <name name-style="western">
              <surname>Smith</surname>
              <given-names>LU</given-names>
            </name>
            <name name-style="western">
              <surname>Patterson</surname>
              <given-names>NJ</given-names>
            </name>
            <name name-style="western">
              <surname>Shewchuk</surname>
              <given-names>RM</given-names>
            </name>
          </person-group>
          <article-title>Preventing intentional food contamination: a survey to assess restaurant preparedness</article-title>
          <source>J Public Health Manag Pract</source>
          <year>2010</year>
          <volume>16</volume>
          <issue>4</issue>
          <fpage>E7</fpage>
          <lpage>E17</lpage>
          <pub-id pub-id-type="doi">10.1097/PHH.0b013e3181c4d950</pub-id>
          <pub-id pub-id-type="medline">20520363</pub-id>
          <pub-id pub-id-type="pii">00124784-201007000-00016</pub-id>
        </nlm-citation>
      </ref>
      <ref id="ref13">
        <label>13</label>
        <nlm-citation citation-type="journal">
          <person-group person-group-type="author">
            <name name-style="western">
              <surname>Xirasagar</surname>
              <given-names>S</given-names>
            </name>
            <name name-style="western">
              <surname>Kanwat</surname>
              <given-names>CP</given-names>
            </name>
            <name name-style="western">
              <surname>Smith</surname>
              <given-names>LU</given-names>
            </name>
            <name name-style="western">
              <surname>Li</surname>
              <given-names>Y</given-names>
            </name>
            <name name-style="western">
              <surname>Sros</surname>
              <given-names>L</given-names>
            </name>
            <name name-style="western">
              <surname>Shewchuk</surname>
              <given-names>RM</given-names>
            </name>
          </person-group>
          <article-title>Restaurant industry preparedness against intentional food contamination: results of a South Carolina survey</article-title>
          <source>J Public Health Manag Pract</source>
          <year>2010</year>
          <volume>16</volume>
          <issue>4</issue>
          <fpage>E18</fpage>
          <lpage>E30</lpage>
          <pub-id pub-id-type="doi">10.1097/PHH.0b013e3181c6b676</pub-id>
          <pub-id pub-id-type="medline">20520362</pub-id>
          <pub-id pub-id-type="pii">00124784-201007000-00017</pub-id>
        </nlm-citation>
      </ref>
      <ref id="ref14">
        <label>14</label>
        <nlm-citation citation-type="journal">
          <person-group person-group-type="author">
            <name name-style="western">
              <surname>Hino</surname>
              <given-names>K</given-names>
            </name>
            <name name-style="western">
              <surname>Schneider</surname>
              <given-names>RH</given-names>
            </name>
          </person-group>
          <article-title>Planning for crime prevention in Japan</article-title>
          <source>Built Eviron</source>
          <year>2013</year>
          <month>03</month>
          <day>01</day>
          <volume>39</volume>
          <issue>1</issue>
          <fpage>114</fpage>
          <lpage>139</lpage>
          <pub-id pub-id-type="doi">10.2148/benv.39.1.114</pub-id>
        </nlm-citation>
      </ref>
      <ref id="ref15">
        <label>15</label>
        <nlm-citation citation-type="book">
          <person-group person-group-type="author">
            <name name-style="western">
              <surname>Yamamoto</surname>
              <given-names>S</given-names>
            </name>
          </person-group>
          <source>The Japanese and the Jews</source>
          <year>1970</year>
          <publisher-loc>Tokyo</publisher-loc>
          <publisher-name>Yamamoto-Shoten</publisher-name>
        </nlm-citation>
      </ref>
      <ref id="ref16">
        <label>16</label>
        <nlm-citation citation-type="journal">
          <person-group person-group-type="author">
            <name name-style="western">
              <surname>Sarno</surname>
              <given-names>E</given-names>
            </name>
            <name name-style="western">
              <surname>Pezzutto</surname>
              <given-names>D</given-names>
            </name>
            <name name-style="western">
              <surname>Rossi</surname>
              <given-names>M</given-names>
            </name>
            <name name-style="western">
              <surname>Liebana</surname>
              <given-names>E</given-names>
            </name>
            <name name-style="western">
              <surname>Rizzi</surname>
              <given-names>V</given-names>
            </name>
          </person-group>
          <article-title>A review of significant European foodborne outbreaks in the last decade</article-title>
          <source>J Food Prot</source>
          <year>2021</year>
          <month>12</month>
          <day>01</day>
          <volume>84</volume>
          <issue>12</issue>
          <fpage>2059</fpage>
          <lpage>2070</lpage>
          <comment>
            <ext-link ext-link-type="uri" xlink:type="simple" xlink:href="https://linkinghub.elsevier.com/retrieve/pii/S0362-028X(22)05728-3"/>
          </comment>
          <pub-id pub-id-type="doi">10.4315/JFP-21-096</pub-id>
          <pub-id pub-id-type="medline">34197583</pub-id>
          <pub-id pub-id-type="pii">S0362-028X(22)05728-3</pub-id>
        </nlm-citation>
      </ref>
      <ref id="ref17">
        <label>17</label>
        <nlm-citation citation-type="journal">
          <person-group person-group-type="author">
            <name name-style="western">
              <surname>Cortés-Sánchez</surname>
              <given-names>ADJ</given-names>
            </name>
            <name name-style="western">
              <surname>Espinosa-Chaurand</surname>
              <given-names>LD</given-names>
            </name>
            <name name-style="western">
              <surname>Díaz-Ramirez</surname>
              <given-names>M</given-names>
            </name>
            <name name-style="western">
              <surname>Torres-Ochoa</surname>
              <given-names>E</given-names>
            </name>
          </person-group>
          <article-title>Plesiomonas: a review on food safety, fish-borne diseases, and tilapia</article-title>
          <source>ScientificWorldJournal</source>
          <year>2021</year>
          <volume>2021</volume>
          <fpage>3119958</fpage>
          <pub-id pub-id-type="doi">10.1155/2021/3119958</pub-id>
          <pub-id pub-id-type="medline">34594160</pub-id>
          <pub-id pub-id-type="pmcid">PMC8478591</pub-id>
        </nlm-citation>
      </ref>
      <ref id="ref18">
        <label>18</label>
        <nlm-citation citation-type="journal">
          <person-group person-group-type="author">
            <name name-style="western">
              <surname>Insfran-Rivarola</surname>
              <given-names>A</given-names>
            </name>
            <name name-style="western">
              <surname>Tlapa</surname>
              <given-names>D</given-names>
            </name>
            <name name-style="western">
              <surname>Limon-Romero</surname>
              <given-names>J</given-names>
            </name>
            <name name-style="western">
              <surname>Baez-Lopez</surname>
              <given-names>Y</given-names>
            </name>
            <name name-style="western">
              <surname>Miranda-Ackerman</surname>
              <given-names>M</given-names>
            </name>
            <name name-style="western">
              <surname>Arredondo-Soto</surname>
              <given-names>K</given-names>
            </name>
            <name name-style="western">
              <surname>Ontiveros</surname>
              <given-names>S</given-names>
            </name>
          </person-group>
          <article-title>A systematic review and meta-analysis of the effects of food safety and hygiene training on food handlers</article-title>
          <source>Foods</source>
          <year>2020</year>
          <month>08</month>
          <day>25</day>
          <volume>9</volume>
          <issue>9</issue>
          <fpage>1169</fpage>
          <comment>
            <ext-link ext-link-type="uri" xlink:type="simple" xlink:href="https://www.mdpi.com/resolver?pii=foods9091169"/>
          </comment>
          <pub-id pub-id-type="doi">10.3390/foods9091169</pub-id>
          <pub-id pub-id-type="medline">32854221</pub-id>
          <pub-id pub-id-type="pii">foods9091169</pub-id>
          <pub-id pub-id-type="pmcid">PMC7555000</pub-id>
        </nlm-citation>
      </ref>
      <ref id="ref19">
        <label>19</label>
        <nlm-citation citation-type="journal">
          <person-group person-group-type="author">
            <name name-style="western">
              <surname>Lee</surname>
              <given-names>JH</given-names>
            </name>
            <name name-style="western">
              <surname>Seo</surname>
              <given-names>KH</given-names>
            </name>
          </person-group>
          <article-title>An integrative review of hygiene practice studies in the food service sector</article-title>
          <source>J Food Prot</source>
          <year>2020</year>
          <month>12</month>
          <day>01</day>
          <volume>83</volume>
          <issue>12</issue>
          <fpage>2147</fpage>
          <lpage>2157</lpage>
          <comment>
            <ext-link ext-link-type="uri" xlink:type="simple" xlink:href="https://linkinghub.elsevier.com/retrieve/pii/S0362-028X(22)10363-7"/>
          </comment>
          <pub-id pub-id-type="doi">10.4315/JFP-19-488</pub-id>
          <pub-id pub-id-type="medline">32692821</pub-id>
          <pub-id pub-id-type="pii">S0362-028X(22)10363-7</pub-id>
        </nlm-citation>
      </ref>
      <ref id="ref20">
        <label>20</label>
        <nlm-citation citation-type="journal">
          <person-group person-group-type="author">
            <name name-style="western">
              <surname>Aaker</surname>
              <given-names>D</given-names>
            </name>
          </person-group>
          <article-title>The value of brand equity</article-title>
          <source>J Bus Strategy</source>
          <year>1992</year>
          <month>04</month>
          <volume>13</volume>
          <issue>4</issue>
          <fpage>27</fpage>
          <lpage>32</lpage>
          <pub-id pub-id-type="doi">10.1108/eb039503</pub-id>
        </nlm-citation>
      </ref>
      <ref id="ref21">
        <label>21</label>
        <nlm-citation citation-type="journal">
          <person-group person-group-type="author">
            <name name-style="western">
              <surname>Winters</surname>
              <given-names>L</given-names>
            </name>
          </person-group>
          <article-title>Brand equity measures: some recent advances</article-title>
          <source>Mark Res</source>
          <year>1991</year>
          <volume>3</volume>
          <fpage>70</fpage>
        </nlm-citation>
      </ref>
      <ref id="ref22">
        <label>22</label>
        <nlm-citation citation-type="journal">
          <person-group person-group-type="author">
            <name name-style="western">
              <surname>Koike</surname>
              <given-names>N</given-names>
            </name>
            <name name-style="western">
              <surname>Yamamoto</surname>
              <given-names>Y</given-names>
            </name>
            <name name-style="western">
              <surname>Demura</surname>
              <given-names>K</given-names>
            </name>
          </person-group>
          <article-title>Measuring Japanese consumer's evaluation on regional brand power of agricultural products: an approach using Internet research methodology</article-title>
          <source>Rev Agric Econ Hokkaido Univ</source>
          <year>2006</year>
          <volume>62</volume>
          <fpage>129</fpage>
          <lpage>139</lpage>
        </nlm-citation>
      </ref>
      <ref id="ref23">
        <label>23</label>
        <nlm-citation citation-type="journal">
          <person-group person-group-type="author">
            <name name-style="western">
              <surname>Akahane</surname>
              <given-names>M</given-names>
            </name>
            <name name-style="western">
              <surname>Maeyashiki</surname>
              <given-names>A</given-names>
            </name>
            <name name-style="western">
              <surname>Tanaka</surname>
              <given-names>Y</given-names>
            </name>
            <name name-style="western">
              <surname>Imamura</surname>
              <given-names>T</given-names>
            </name>
          </person-group>
          <article-title>The impact of musculoskeletal diseases on the presence of locomotive syndrome</article-title>
          <source>Mod Rheumatol</source>
          <year>2019</year>
          <month>01</month>
          <volume>29</volume>
          <issue>1</issue>
          <fpage>151</fpage>
          <lpage>156</lpage>
          <pub-id pub-id-type="doi">10.1080/14397595.2018.1452173</pub-id>
          <pub-id pub-id-type="medline">29529893</pub-id>
        </nlm-citation>
      </ref>
      <ref id="ref24">
        <label>24</label>
        <nlm-citation citation-type="journal">
          <person-group person-group-type="author">
            <name name-style="western">
              <surname>Min</surname>
              <given-names>YH</given-names>
            </name>
            <name name-style="western">
              <surname>Lee</surname>
              <given-names>JW</given-names>
            </name>
            <name name-style="western">
              <surname>Shin</surname>
              <given-names>Y</given-names>
            </name>
            <name name-style="western">
              <surname>Jo</surname>
              <given-names>M</given-names>
            </name>
            <name name-style="western">
              <surname>Sohn</surname>
              <given-names>G</given-names>
            </name>
            <name name-style="western">
              <surname>Lee</surname>
              <given-names>J</given-names>
            </name>
            <name name-style="western">
              <surname>Lee</surname>
              <given-names>G</given-names>
            </name>
            <name name-style="western">
              <surname>Jung</surname>
              <given-names>KH</given-names>
            </name>
            <name name-style="western">
              <surname>Sung</surname>
              <given-names>J</given-names>
            </name>
            <name name-style="western">
              <surname>Ko</surname>
              <given-names>BS</given-names>
            </name>
            <name name-style="western">
              <surname>Yu</surname>
              <given-names>J</given-names>
            </name>
            <name name-style="western">
              <surname>Kim</surname>
              <given-names>HJ</given-names>
            </name>
            <name name-style="western">
              <surname>Son</surname>
              <given-names>BH</given-names>
            </name>
            <name name-style="western">
              <surname>Ahn</surname>
              <given-names>SH</given-names>
            </name>
          </person-group>
          <article-title>Daily collection of self-reporting sleep disturbance data via a smartphone app in breast cancer patients receiving chemotherapy: a feasibility study</article-title>
          <source>J Med Internet Res</source>
          <year>2014</year>
          <month>05</month>
          <day>23</day>
          <volume>16</volume>
          <issue>5</issue>
          <fpage>e135</fpage>
          <comment>
            <ext-link ext-link-type="uri" xlink:type="simple" xlink:href="https://www.jmir.org/2014/5/e135/"/>
          </comment>
          <pub-id pub-id-type="doi">10.2196/jmir.3421</pub-id>
          <pub-id pub-id-type="medline">24860070</pub-id>
          <pub-id pub-id-type="pii">v16i5e135</pub-id>
          <pub-id pub-id-type="pmcid">PMC4051741</pub-id>
        </nlm-citation>
      </ref>
      <ref id="ref25">
        <label>25</label>
        <nlm-citation citation-type="journal">
          <person-group person-group-type="author">
            <name name-style="western">
              <surname>Akahane</surname>
              <given-names>M</given-names>
            </name>
            <name name-style="western">
              <surname>Maeyashiki</surname>
              <given-names>A</given-names>
            </name>
            <name name-style="western">
              <surname>Yoshihara</surname>
              <given-names>S</given-names>
            </name>
            <name name-style="western">
              <surname>Tanaka</surname>
              <given-names>Y</given-names>
            </name>
            <name name-style="western">
              <surname>Imamura</surname>
              <given-names>T</given-names>
            </name>
          </person-group>
          <article-title>Relationship between difficulties in daily activities and falling: loco-check as a self-assessment of fall risk</article-title>
          <source>Interact J Med Res</source>
          <year>2016</year>
          <month>06</month>
          <day>20</day>
          <volume>5</volume>
          <issue>2</issue>
          <fpage>e20</fpage>
          <comment>
            <ext-link ext-link-type="uri" xlink:type="simple" xlink:href="https://www.i-jmr.org/2016/2/e20/"/>
          </comment>
          <pub-id pub-id-type="doi">10.2196/ijmr.5590</pub-id>
          <pub-id pub-id-type="medline">27323871</pub-id>
          <pub-id pub-id-type="pii">v5i2e20</pub-id>
          <pub-id pub-id-type="pmcid">PMC4932242</pub-id>
        </nlm-citation>
      </ref>
      <ref id="ref26">
        <label>26</label>
        <nlm-citation citation-type="journal">
          <person-group person-group-type="author">
            <name name-style="western">
              <surname>Akahane</surname>
              <given-names>T</given-names>
            </name>
            <name name-style="western">
              <surname>Nakanishi</surname>
              <given-names>Y</given-names>
            </name>
            <name name-style="western">
              <surname>Yoshiji</surname>
              <given-names>H</given-names>
            </name>
            <name name-style="western">
              <surname>Akahane</surname>
              <given-names>M</given-names>
            </name>
          </person-group>
          <article-title>Esophagogastroduodenoscopy screening intentions during the COVID-19 pandemic in Japan: web-based survey</article-title>
          <source>JMIR Cancer</source>
          <year>2022</year>
          <month>11</month>
          <day>11</day>
          <volume>8</volume>
          <issue>4</issue>
          <fpage>e40600</fpage>
          <comment>
            <ext-link ext-link-type="uri" xlink:type="simple" xlink:href="https://cancer.jmir.org/2022/4/e40600/"/>
          </comment>
          <pub-id pub-id-type="doi">10.2196/40600</pub-id>
          <pub-id pub-id-type="medline">36343187</pub-id>
          <pub-id pub-id-type="pii">v8i4e40600</pub-id>
          <pub-id pub-id-type="pmcid">PMC9662288</pub-id>
        </nlm-citation>
      </ref>
    </ref-list>
  </back>
</article>
