Bridging the Knowledge–Behavior Gap: A Cross-Sectional Study on Food Safety and Pesticide Exposure Among Migrant Workers in Chiang Mai

Pesticide contamination in fruits and vegetables remains a critical food safety concern in Northern Thailand, posing risks to environmental and human health. Improving knowledge, attitude, and behavior (KAB) in food safety is essential for reducing pesticide exposure, particularly among migrant workers. This cross-sectional study evaluates food safety knowledge, attitude, behavior, and pesticide exposure among Myanmar migrant workers in Chiang Mai Province. Face-to-face interviews were conducted with 137 participants between August and September 2025 in Mueang, Mae Rim, and San Sai districts. Mann–Whitney U test and linear regression were used to explore demographic differences and associated factors of knowledge, attitude, and safety behavior. Most participants demonstrated adequate knowledge (65.7%) and positive attitude (80.3); however, 78.1% reported only moderate safety behavior. Higher knowledge and more favorable attitudes were observed among non-Shan ethnic groups and participants with higher education (p < 0.001). Women and non-farming workers exhibited significantly safer behavior (p < 0.05). Knowledge and attitude were strongly correlated (ρ = 0.556, p < 0.01), but neither was associated with safety behavior. Most participants had cholinesterase activity within the normal reference range (73.0% cellular AChE; 81.0% plasma BChE). Low enzyme activity was observed in 13.9% and 6.6% of participants, respectively. Enzyme activity did not differ significantly by occupation, sex, or ethnicity and was not significantly associated with KAB scores. Linear regression analyses identified ethnicity as significantly associated with knowledge and attitude; whereas, sex and occupation were significantly associated with safety behavior. These findings suggest that individual-level knowledge and attitude may not be sufficient to drive protective behavior among migrant workers, though the cross-sectional study design limits causal inference and generalizability.