Project Summary/Abstract To reduce risks of food borne illness resulting from poor sanitary practices in restaurants, the New York City (NYC) Department of Health and Mental Hygiene is scheduled to require public posting of restaurant sanitary scores in the form of letter grades beginning July 2010. The rationale behind this effort is that increased public access to restaurant scores will compel restaurant operators to better comply with regulations designed to reduce risks of food borne illness. We propose to evaluate the extent to which grade-posting improves restaurant hygiene and reduces food borne illness in NYC. We also propose to use results from the evaluation to improve the effectiveness of practices within the NYC restaurant inspection program. To conduct this evaluation, we will use data from five sources: I. New York City restaurant inspection database ('FACTS') - to monitor restaurant hygiene at baseline and over time. II. New York City Community Health Survey (CHS) - to track frequency of restaurant dining and awareness of inspection results among resident NYC adults. III. Restaurant Operator and Diner Surveys - two new surveys developed to measure restaurant industry and diner response to grade-posting. IV. New York State Statewide Planning and Research Cooperative System (SPARCS) inpatient hospital discharge and emergency department visit data - to track the occurrence of serious food borne illness in NYC. V. NYC Syndromic Surveillance System - to track the occurrence of diarrheal illness in NYC. We will conduct statistical analyses to describe and test for changes over time in metrics we have developed to represent a range of issues including restaurant compliance with critical food safety parameters, the occurrence of food borne illness in NYC, the impact of grade cards on public awareness of restaurant hygiene, the impact of grade cards on influencing restaurant choice, and the NYC restaurant industry's response to grade-posting. We will incorporate information from this evaluation into restaurant inspector and restaurant operator training programs and online resources.