Letter Grading and Transparency Promote Restaurant Food Safety in New York City.

Each year in New York City (NYC), more than 6,000 people end up hos­ pitalized for foodborne illness (New York City Department of Health and Mental Hygiene, 2014). Although the proportion of illness caused by food prepared away from the home is uncertain, the food service set­ ting is associated with 68% of nationally reported foodborne illness outbreaks where food was prepared in one place (Gould et al., 2013). New Yorkers eat out nearly one bil­ lion times a year (New York City Department of Health and Mental Hygiene, 2011), and two-thirds eat meals from a restaurant, deli, coffee shop, or bar at least once per week, so the potential public health impact of unsafe food handling practices in NYC restaurants is enormous (Wong et al., 2015). Improving food handling practices across the approximately 24,000 restaurants that operate in NYC on any given day can reduce risks of foodborne illness. Not having a certi­ fied kitchen manager on site, employees work­ ing while ill, limited food handler knowledge of food safety, and food workers touching food with their bare hands have been identified as factors that increase the risk of restaurantrelated foodborne illness (Gould et al., 2013; Hedberg et al., 2006). In an effort to prevent these and other unsafe food handling prac­ tices, the New York City Department of Health and Mental Hygiene launched the restaurant letter grading program in July 2010. The pro­ gram requires restaurants to post a letter grade that reflects their most recent sanitary inspec­ tion results in a visible window location. It also targets the poorest performers with more frequent inspections. The premise of the NYC letter grading pro­ gram is that consumer access to inspection results will encourage restaurant operators to better comply with food safety rules. In addi­ tion to a conspicuously posted letter grade, the NYC Health Department has increased the transparency of restaurant inspection results by making them available in detail on a searchable Web site and a free smartphone app (“ABCEats,” available for download on iTunes and Google Play). Both of these data resources provide maps and street views of establishments and allow users to filter res­ taurants by zip code, cuisine type, and grade. The NYC letter grading program also supports industry by using a dual inspec­ tion approach that allows restaurants to improve before being graded. If a restaurant does not earn an A grade on its initial unan­ nounced inspection, it receives a reinspec­ tion approximately 7–30 days later, at which point the grade is issued. Restaurants that earn an A grade at initial or reinspection do not pay fines for sanitary violations cited. Those that do not earn an A grade have the