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Zuercher MD, Cohen JFW, Hecht CA, Hecht K, Orta-Aleman D, Patel A, Olarte DA, Chapman LE, Read M, Schwartz MB, Ritchie LD, Gosliner W. Parent Perceptions of School Meals Influence Student Participation in School Meal Programs. J Nutr Educ Behav 2024; 56:230-241. [PMID: 38583880 DOI: 10.1016/j.jneb.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 01/05/2024] [Accepted: 01/10/2024] [Indexed: 04/09/2024]
Abstract
OBJECTIVE To evaluate if parent perceptions of school meals influence student participation. DESIGN In May 2022, an online survey was used to evaluate parents' perceptions of school meals and their children's participation. PARTICIPANTS A total of 1,110 California parents of kindergarten through 12th-grade students. MAIN OUTCOME MEASURES Student participation in school lunch and breakfast. ANALYSIS Principal component analysis and Poisson regression models. RESULTS Three groups of parental perceptions were identified: (1) positive perceptions (eg, liking school meals and thinking that they are tasty and healthy), (2) perceived benefits to families (eg, school meals save families money, time, and stress), and (3) negative (eg, concerns about the amount of sugar in school meals and stigma). More positive parental perceptions about school meals and their benefits to families were associated with greater student meal participation. In contrast, more negative parental perceptions were associated with reduced student participation in school meals (P < 0.05). CONCLUSION AND IMPLICATIONS Parent perceptions of school meals may affect student participation in school meal programs. Working to ensure parents are familiar with the healthfulness and quality of school meals and the efforts schools are making to provide high-quality, appealing meals may be critical for increasing school meal participation rates.
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Affiliation(s)
- Monica D Zuercher
- Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, Berkeley, CA.
| | - Juliana F W Cohen
- Center for Health Inclusion, Research, and Practice, Department of Public Health and Nutrition, Merrimack College, North Andover, MA; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Christina A Hecht
- Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, Berkeley, CA
| | - Kenneth Hecht
- Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, Berkeley, CA
| | - Dania Orta-Aleman
- Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, Berkeley, CA
| | - Anisha Patel
- Stanford Pediatrics, Stanford University, Palo Alto, CA
| | - Deborah A Olarte
- Center for Health Inclusion, Research, and Practice, Department of Public Health and Nutrition, Merrimack College, North Andover, MA
| | - Leah E Chapman
- Center for Health Inclusion, Research, and Practice, Department of Public Health and Nutrition, Merrimack College, North Andover, MA
| | - Margaret Read
- Partnership for a Healthier America, Prince Frederick, MD
| | - Marlene B Schwartz
- Rudd Center for Food Policy & Health University of Connecticut, Hartford, CT
| | - Lorrene D Ritchie
- Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, Berkeley, CA
| | - Wendi Gosliner
- Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, Berkeley, CA
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Au LE, Whaley SE, Hecht CA, Tsai MM, Anderson CE, Chaney AM, Vital N, Martinez CE, Ritchie LD. A Qualitative Examination of California WIC Participants' and Local Agency Directors' Experiences during the COVID-19 Pandemic. J Acad Nutr Diet 2022; 122:2218-2227.e21. [PMID: 35811065 PMCID: PMC9259507 DOI: 10.1016/j.jand.2022.07.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 07/01/2022] [Accepted: 07/05/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND The U.S. Department of Agriculture granted waivers to allow flexibility in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) operations during the COVID-19 pandemic, however research examining the associations between waiver introduction and changes in perceptions, practices, and challenges of WIC participants' and agency directors' experiences is limited. OBJECTIVE The objective of this study was to assess California WIC participants' and agency directors' perceptions and practices of remote WIC services during the COVID-19 pandemic. A secondary aim was to understand other COVID-19 challenges related to maintaining access to healthy foods by WIC participants. DESIGN A qualitative study which included semi-structured interviews was conducted between June 2020-March 2021. PARTICIPANTS /Setting: 182 WIC participants with a child 0-5 years old from 3 regions of California (southern, central, northern) and 22 local WIC agency directors across the state were interviewed. MAIN OUTCOME MEASURES WIC participants' and agency directors' perceptions, practices, and other challenges during COVID-19. STATISTICAL ANALYSES Interviews were recorded, transcribed, and analyzed using a grounded theory approach. RESULTS Participants shared that they valued the information received from WIC and were very satisfied with remote WIC services. Participants reported that enrolling in WIC remotely was easier than coming in-person. All waivers and changes to WIC operations, namely the physical presence, remote benefit issuance, and separation of duties waivers, and remote work and remote delivery of nutrition education, were largely viewed by WIC agency directors as options that should be continued post-pandemic. Further, a majority (63%) of households reported experiencing food insecurity, and half of respondents received food from a food bank or pantry during the pandemic. CONCLUSIONS Findings suggest WIC will attract and retain the most families by offering a 'hybrid' model of services, incorporating both on-site services and remote options in order to work more efficiently and effectively.
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Affiliation(s)
- Lauren E Au
- Department of Nutrition, University of California, Davis, Davis, California.
| | - Shannon E Whaley
- Director of Research and Evaluation, Public Health Foundation Enterprises WIC, Irwindale, California
| | - Christina A Hecht
- Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, Oakland, California
| | - Marisa M Tsai
- Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, Oakland, California
| | - Christopher E Anderson
- Director of Research and Evaluation, Public Health Foundation Enterprises WIC, Irwindale, California
| | - Alana M Chaney
- Department of Nutrition, University of California, Davis, Davis, California
| | - Nicole Vital
- Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, Oakland, California
| | - Catherine E Martinez
- Director of Research and Evaluation, Public Health Foundation Enterprises WIC, Irwindale, California
| | - Lorrene D Ritchie
- Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, Oakland, California
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Grummon AH, Sokol RL, Goodman D, Hecht CA, Salvia M, Musicus AA, Patel AI. Storybooks About Healthy Beverage Consumption: Effects in an Online Randomized Experiment With Parents. Am J Prev Med 2022; 62:183-192. [PMID: 34688521 PMCID: PMC8748291 DOI: 10.1016/j.amepre.2021.07.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 06/29/2021] [Accepted: 07/28/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Parents spend substantial time reading to their children, making storybooks a promising but understudied avenue for motivating parents to serve their children healthier beverages. This study examines parents' reactions to messages promoting healthy beverage consumption embedded in a children's storybook. METHODS In 2020, a total of 2,164 demographically diverse parents of children aged 6 months to 5 years participated in an online survey. Participants were randomized to view control messages (school readiness) or 1 of 3 beverage message topics (sugary drink discouragement, water encouragement, or combined discouragement and encouragement) presented as pages from the storybook Potter the Otter. Survey items assessed parents' reactions to the messages and their perceptions, beliefs, and intentions regarding sugary drinks and water. Data were analyzed in 2021. RESULTS Compared with control messages, exposure to the beverage messages led to higher discouragement from serving children sugary drinks and higher encouragement to serve children more water (p<0.001). The beverage messages also elicited more thinking about beverages' health impacts and led to stronger perceptions that sugary drinks are unhealthy (p<0.001). Moreover, the beverage messages led to higher intentions to limit serving children sugary drinks and higher intentions to serve children more water (p≤0.02). Parents' reactions to the beverage messages did not differ by most demographic characteristics. Few differences in outcomes were observed among the 3 beverage message topics. CONCLUSIONS Embedding beverage messages in storybooks is a promising, scalable strategy for motivating parents from diverse backgrounds to serve children more water and fewer sugary drinks.
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Affiliation(s)
- Anna H Grummon
- Harvard Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Cambridge, Massachusetts; Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts.
| | - Rebeccah L Sokol
- School of Social Work, Wayne State University, Detroit, Michigan
| | - Dina Goodman
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Christina A Hecht
- Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, Oakland, California
| | - Meg Salvia
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Aviva A Musicus
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Anisha I Patel
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California; Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California
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Sharma P, Altman EA, Hampton KE, Moreno GD, Hecht CA, Patel AI. Strength and Comprehensiveness of Drinking Water Language in California School District Wellness Policies. J Nutr Educ Behav 2021; 53:870-879. [PMID: 34167919 DOI: 10.1016/j.jneb.2021.04.466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 04/14/2021] [Accepted: 04/25/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE(S) Assess the quality of water language in California school district wellness policies and examine how language quality relates to school drinking water access. DESIGN Cross-sectional study. PARTICIPANTS Random sample of 240 schools selected from all California public schools, stratified by geography and grades served. VARIABLES MEASURED Policies (2016-2018) were coded for quality (strength and comprehensiveness) using an adapted school wellness policy tool. School administrators completed phone interviews about drinking water access on their campus. ANALYSIS Descriptive statistics (eg, means, standard deviations) summarized school-level characteristics and main outcomes. Mixed-effects linear regression models were used to examine the relationship between the strength and comprehensiveness of water policy language and water access. RESULTS On a scale of 0-100, mean strength was 11.3 (SD, 5.7), and mean comprehensiveness was 28.8 (SD, 8.7). There was an inverse association between the quality of water language in policies and excellence in drinking water access in schools. CONCLUSIONS AND IMPLICATIONS The strength and comprehensiveness of water language in California school district wellness policies were low. Districts would benefit from improving the quality of water language in their wellness policies and examining challenges to implementing policies.
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Affiliation(s)
- Priyanka Sharma
- School of Medicine, University of California Irvine, Irvine, CA
| | - Emily A Altman
- School of Medicine, Stanford University, Stanford, CA; School of Public Health, University of California Berkeley, Berkeley, CA
| | | | - Gala D Moreno
- School of Medicine, Stanford University, Stanford, CA; School of Medicine, University of California San Francisco, San Francisco, CA
| | - Christina A Hecht
- Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California Berkeley, Berkeley, CA
| | - Anisha I Patel
- School of Medicine, Stanford University, Stanford, CA; Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA.
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Altman EA, Lee KL, Hecht CA, Hampton KE, Moreno G, Patel AI. Drinking water access in California schools: Room for improvement following implementation of school water policies. Prev Med Rep 2020; 19:101143. [PMID: 32577338 PMCID: PMC7305375 DOI: 10.1016/j.pmedr.2020.101143] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 04/20/2020] [Accepted: 06/04/2020] [Indexed: 10/28/2022] Open
Abstract
This study aims to investigate how access to free drinking water in California public schools changed after implementation of 2010 federal and state school water policies. Repeated cross-sectional surveys were conducted with administrators in a random sample of California public schools, stratified by school type and urban-centric geography, from 2010 to 2011 (n = 240) and from 2016 to 2018 (n = 240). Surveys assessed excellence in drinking water access, defined as 1) providing water in 4 of 5 key school locations, 2) having a high density of free water available, 3) providing water via a non-fountain source, 4) providing water that is perceived as safe, and 5) offering water sources that are reported as clean and functioning. Multivariate logistic regression was used to examine changes in excellence in drinking water access after implementation of school drinking water policies. Analysis was completed in 2019. In 2010-2011, 5% of schools met all water excellence criteria; in 2016-2018, 18% of schools met all excellence criteria. In adjusted models, post-legislation schools had 4 times the odds of meeting all drinking water excellence criteria compared to pre-legislation schools (OR: 4.34; 95% confidence interval = 2.07, 9.10). There were significant increases in public schools meeting the criteria for excellence in free drinking water access after school water policies were implemented; however, a majority of schools still lacked excellent water access. Findings suggest that policies mandating free water access in schools may help to improve excellence in access, and more work is needed to help all schools excel in this area.
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Affiliation(s)
- Emily A Altman
- School of Medicine, Stanford University, Stanford, CA, USA.,School of Public Health, University of California Berkeley, Berkeley, CA, USA
| | - Kevin L Lee
- Department of Urban Studies and Planning, Massachusetts Institute of Technology, Cambridge, MA, USA.,California Food Policy Advocates, Oakland, CA, USA
| | - Christina A Hecht
- Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, Berkeley, CA, USA
| | | | - Gala Moreno
- School of Medicine, Stanford University, Stanford, CA, USA.,School of Medicine, University of California, San Francisco, CA, USA
| | - Anisha I Patel
- School of Medicine, Stanford University, Stanford, CA, USA.,Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA
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Grummon AH, Sokol RL, Hecht CA, Patel AI. Measuring beverage consumption in US children and adolescents: a systematic review. Obes Rev 2018; 19:1017-1027. [PMID: 29938891 PMCID: PMC6103833 DOI: 10.1111/obr.12692] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 02/19/2018] [Accepted: 02/22/2018] [Indexed: 01/14/2023]
Abstract
Beverage consumption habits are associated with weight outcomes for children and adolescents. Many studies have examined youth's beverage consumption, but little is known about what methods are commonly used to assess youth beverage consumption and whether these strategies are valid and reliable. This study aimed to systematically review articles assessing beverage consumption among children and adolescents. We searched PubMed and Scopus for English-language articles published between February 2007 and February 2017 that measured and reported on American youth's (ages 2-18 years) beverage consumption. Searches yielded 17,165 articles, of which 589 articles describing 615 measures were extracted. We examined the types of assessment methods used, characteristics of these methods (e.g. validity, reliability, and literacy level), characteristics of study samples, and beverages assessed. The most common assessment methods were questionnaires/screeners (used by 65.4% of articles) and recalls (24.4%). About three-quarters of articles did not address validity (70.5%) or reliability (79.5%) of any measures used. Study populations were diverse: 54.7% of articles included low-income children, and 90.2% included non-White children. The most commonly assessed beverage category was sugar-sweetened beverages. Findings suggest that improved measurement techniques and reporting are both needed to track progress towards a goal of ensuring all youth have healthy beverage consumption.
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Affiliation(s)
- A H Grummon
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA.,Carolina Population Center, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA
| | - R L Sokol
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA
| | - C A Hecht
- Division of Agriculture and Natural Resources, University of California, Berkeley, Berkeley, CA, USA
| | - A I Patel
- Department of Pediatrics, School of Medicine, University of California, San Francisco, San Francisco, CA, USA.,Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
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7
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Carothers AD, Hecht CA, Hook EB. International variation in reported livebirth prevalence rates of Down syndrome, adjusted for maternal age. J Med Genet 1999; 36:386-93. [PMID: 10353785 PMCID: PMC1734363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
Reported livebirth prevalence of Down syndrome (DS) may be affected by the maternal age distribution of the population, completeness of ascertainment, accuracy of diagnosis, extent of selective prenatal termination of affected pregnancies, and as yet unidentified genetic and environmental factors. To search for evidence of the latter, we reviewed all published reports in which it was possible to adjust both for effects of maternal age and for selective termination (where relevant). We constructed indices that allowed direct comparisons of prevalence rates after standardising for maternal age. Reference rates were derived from studies previously identified as having near complete ascertainment. An index value significantly different from 1 may result from random fluctuations, as well as from variations in the factors listed above. We found 49 population groups for which an index could be calculated. Methodological descriptions suggested that low values could often be attributed to under-ascertainment. A possible exception concerned African-American groups, though even among these most acceptable studies were compatible with an index value of 1. As we have reported elsewhere, there was also a suggestive increase in rates among US residents of Mexican or Central American origin. Nevertheless, our results suggest that "real" variation between population groups reported to date probably amounts to no more than +/-25%. However, reliable data in many human populations are lacking including, surprisingly, some jurisdictions with relatively advanced health care systems. We suggest that future reports of DS livebirth prevalence should routinely present data that allow calculation of an index standardised for maternal age and adjusted for elective prenatal terminations.
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Affiliation(s)
- A D Carothers
- MRC Human Genetics Unit, Western General Hospital Edinburgh, UK
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Abstract
BACKGROUND Maternal age-specific rates of Down syndrome livebirths are widely utilized in personal and policy decisions concerning provision of and election of prenatal cytogenetic diagnostic services. The only extensive reference data available are on those of primarily European ancestral origin. In the absence of definitive evidence of any ethnic, racial or environmental influence upon rates (other than those associated with age) these rate schedules have been widely applied to those of all national origins. METHODS Available material age-specific data on livebirths from intensive studies on those of Hispanic (primarily of Mexican and Central American background) and of other origin in populations in the U.S.A. with likely complete ascertainment were analysed. The numbers observed were compared with (i) those predicted from established published rate schedules in those of primarily European origin, and (ii) with the observations on livebirths of non-Hispanic European origin in the same population as the Hispanic live births. RESULTS In comparisons with the numbers predicted from published rates, observed numbers of case among Hispanic live births were increased by 19 per cent (SE 0.06) in younger mothers, 23 per cent in older mothers (SE 0.07) and 20 per cent (SE 0.04) in those of all ages. Comparisons with observed rates in those of Hispanic origin with those observed in non-Hispanic births in the same time intervals and populations indicated that the excess rates in Hispanics were not attributable to some local factor increasing rates in all ethnic groups at least among those under 35. CONCLUSIONS Data on mothers of Mexican and Central American origin residing in the U.S.A. indicate maternal age-specific rates of Down syndrome in live births about 20 per cent greater than those in published rate schedules on Down syndrome, widely used in decisions concerning election or provison of prenatal diagnostic services. The reason for this difference remains unknown.
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Affiliation(s)
- E B Hook
- School of Public Health, University of California, Berkeley 94720-7360, USA.
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Hecht CA, Hook EB. Rates of Down syndrome at livebirth by one-year maternal age intervals in studies with apparent close to complete ascertainment in populations of European origin: a proposed revised rate schedule for use in genetic and prenatal screening. Am J Med Genet 1996; 62:376-85. [PMID: 8723068 DOI: 10.1002/(sici)1096-8628(19960424)62:4<376::aid-ajmg10>3.0.co;2-l] [Citation(s) in RCA: 86] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Precision and accuracy in determining rates of Down syndrome at livebirth are indispensible to algorithms which determine eligibility for prenatal cytogenetic diagnostic services. We derived Down syndrome rates by single year of maternal age which we propose as a revised rate schedule for background risk. Data on European-origin populations were obtained from 5 sources judged most likely to have complete ascertainment of cases. A "constant plus exponent" regression model and variants extending the analysis to higher powers of maternal age were applied to several ranges of maternal age. Confidence intervals about the rates were calculated. This analysis results in rates significantly higher than those in widespread use though the confidence intervals show a need for caution in assuming precision. Sources of variation in rates are also considered.
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Affiliation(s)
- C A Hecht
- School of Public Health, University of California, Berkeley 94720, USA
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Hecht CA, Hook EB. The imprecision in rates of Down syndrome by 1-year maternal age intervals: a critical analysis of rates used in biochemical screening. Prenat Diagn 1994; 14:729-38. [PMID: 7991514 DOI: 10.1002/pd.1970140814] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Current algorithms to determine eligibility for prenatal cytogenetic diagnostic services depend critically on the accuracy and precision of the underlying rates of cytogenetic abnormality used in the calculations. We examine the maternal age-specific rates of Down syndrome livebirths in eight studies of European-origin populations, pooled rates from which are widely used for baseline calculations in biochemical screening. These studies vary significantly in such factors as methods of ascertainment of cases, likelihood of complete ascertainment, and methods of correction, if any, for underascertainment. Restriction of analysis to those two studies among the eight whose methods suggest the greatest likelihood of complete ascertainment for Down syndrome generates rates significantly higher than those in widespread use. Confidence intervals about previously reported and currently derived rates indicate that even with large-scale data, there is considerable residual uncertainty in derived rates.
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Affiliation(s)
- C A Hecht
- School of Public Health, University of California, Berkeley 94720
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