Restaurants are associated with a significant number of foodborne illness outbreaks in the United States. Certification of kitchen managers through an accredited training and testing program may help improve food safety practices and thus prevent foodborne illness. In this study, relationships between the results of routine restaurant inspections and the presence of a certified kitchen manager (CKM) were examined. We analyzed data for 4,461 restaurants in Iowa that were inspected during 2005 and 2006 (8,338 total inspections). Using logistic regression analysis, we modeled the outcome variable (0 = no critical violations [CVs]; 1 = one or more CVs) as a function of presence or absence of a CKM and other explanatory variables. We estimated separate models for seven inspection categories. Restaurants with a CKM present during inspection were less likely to have a CV for personnel (P < 0.01), food source or handling (P < 0.01), facility or equipment requirements (P < 0.05), warewashing (P < 0.10), and other operations (P < 0.10). However, restaurants with a CKM present during inspection were equally likely to have a CV for temperature or time control and plumbing, water, or sewage as were restaurants without a CKM present. Analyses by type of violation within the temperature and time control category revealed that restaurants with a CKM present during inspection were less likely to have a CV for hot holding (P < 0.05), but the presence of a CKM did not affect other types of temperature and time control violations. Our analyses suggest that the presence of a CKM is protective for most types of CVs, and we identify areas for improving training of CKMs.Food prepared outside of the home is a significant source of foodborne illness in the United States (15). Of the 9,040 foodborne disease outbreaks reported to the Cen ters for Disease Control and Prevention (CDC) from 1998 to 2004, 52% were associated with food service establish ments, including restaurants, delicatessens, cafeterias, and hotels (15). Case-control studies conducted by the CDC Foodborne Diseases Active Surveillance Network (FoodNet) and other researchers have revealed significant associations between eating food prepared outside the home and an increased risk of foodborne illness. For example, in a study of persons infected with Escherichia coli O157:H7, eating at a table-service restaurant was a risk factor for infection (17), in a study of people infected with Salmo nella Enteritidis, consumption of eggs prepared outside of the home was a risk factor for infection (18), and in a study of people infected with Campylobacter, consumption of chicken prepared at a restaurant was a risk factor for infec tion (24).Many Americans consume meals prepared outside the home. spent on food in the United States (27). On average, one of five meals consumed by Americans (4.2 meals per week) is prepared outside the home (9). Two previous studies revealed that unsafe food han dling practices are common in restaurants. A telephone sur vey revealed that risky food...