Of the 8,052 original comments received by the FDA in response to this request for comment, less than 2.5% (n=191) were submitted by health professionals (Table 2). A little more than half of health professional commenters (55.5%) reported living in the U.S., with the majority also specifying their state of residence. Nearly one in ten (9.4%) of these health professional commenters reported residing in a “dairy state”. The remainder did not report their location (44.0%) or reported a location outside of the U.S. (0.5%).
Half of all commenters (49.7%) and 42.4% of health professional commenters described a preference for PB dairy alternatives. Only 7.4% of all commenters and 11.0% of health professionals indicated a preference for dairy products. A substantial portion of all commenters (41.3%) and health professional commenters (46.6%) did not indicate a preference for dairy vs. dairy alternatives. Compared to non-health professional commenters, a smaller proportion of health professionals supported the use of dairy terms in PB product labels (68.9% vs. 64.9%; X2=27.53, p<0.001; data not shown).
Table 2: Characteristics of Federal Register commenters.
Variable
|
Total commenters
|
Health professionals
|
|
n
|
%
|
n
|
%
|
Location
|
|
|
|
United States
|
3779
|
46.9
|
106
|
55.5
|
|
Dairy State
|
776
|
20.5
|
10
|
9.4
|
|
Other State
|
2623
|
69.4
|
83
|
78.3
|
|
Did not specify
|
380
|
10.1
|
13
|
12.3
|
|
Other country
|
150
|
1.9
|
1
|
0.5
|
|
Did not specify
|
4123
|
51.2
|
84
|
44.0
|
Product preference
|
|
|
|
|
|
Prefer dairy products
|
599
|
7.4
|
21
|
11.0
|
|
Prefer PB products
|
4000
|
49.7
|
81
|
42.4
|
|
Unclear or neutral preference
|
3453
|
42.9
|
89
|
46.6
|
Position on labeling
|
|
|
|
|
|
Support use of dairy terms in PB labeling
|
5674
|
70.4
|
124
|
64.9
|
|
Oppose use of dairy terms in PB labeling
|
1021
|
12.7
|
47
|
24.6
|
|
Unclear or neutral position on PB labeling
|
1357
|
16.9
|
20
|
10.5
|
Note. N = 8052, n = 191 for health professionals.
Most survey respondents were female (91.5%), non-Hispanic white (87.5%), and under age 55 (82.2%) (Table 3). Forty-six percent were from a “dairy state”, reflecting the additional recruitment conducted in Vermont. The sample consisted of 350 practicing health professionals and 67 students hereafter collectively referred to as “health professionals”. RDNs and dietetics students made up 44.4% of the sample, and other health professionals or students made up the remainder. Nurses or nursing students comprised the largest population of other health professionals (74.1%; data not shown).
Table 3: Characteristics of survey respondents.
Variable
|
n
|
%
|
Age
|
|
|
|
18-34
|
181
|
43.4
|
|
35-54
|
161
|
38.6
|
|
Over 55
|
75
|
18.0
|
Female
|
301
|
91.8
|
Non-Hispanic white a
|
275
|
87.9
|
Location
|
|
|
|
Dairy state
|
150
|
46.0
|
|
Other state
|
176
|
54.0
|
Health profession
|
|
|
Dietetics professional or student
|
185
|
44.4
|
Other health professional or student
|
232
|
56.6
|
Note. N = 417. Totals for gender identity (n=328), race/ethnicity (n=313), and location
(n=326) are smaller because response to these questions was optional.
a The small number of BIPOC respondents inhibited the disaggregation of analyses by
race/ethnicity.
Key nutrition and health themes of dairy and PB alternatives discussed in Federal Register comments and open-ended survey responses
Federal Register comments. Sixty-four percent of health professionals who commented on the Federal Register (n=123) mentioned nutrition and health aspects of dairy and/or PB dairy alternatives within their comment, either describing the nutritional merits or demerits of PB dairy alternatives. Interestingly, of health professionals who supported the use of dairy terms on PB labels, 57% commented on their nutrition and health aspects, compared to 87% of those who opposed the use of dairy terms on PB labels. In order, the most common nutrition and health topics mentioned by health professionals were the general nutrition or healthfulness of either product; micronutrient content, including mentions of calcium, vitamin D, and potassium; protein content; other nutrition or health aspects, such as chronic disease; allergy; and digestion. Additionally, a substantial minority of health professionals mentioned that they believe consumers are confused about the nutritional differences between products, and some mentioned that they believe current labeling is contributing to this confusion. Illustrative quotes for each theme and subtheme are presented in Table 4.
Among those who mentioned nutrition and health, 62% of health professionals discussed the nutritional merits of PB dairy alternatives, and 35% of health professionals discussed the nutritional demerits of PB dairy alternatives (Table 4). A small remainder were neutral. Those who discussed the nutritional merits believed these products can be part of a healthy diet. About half of those who discussed their nutritional merits argued that PB dairy alternatives are nutritionally adequate replacements for dairy for certain individuals, such as those with an allergy, intolerance, or elevated risk for cardiovascular disease, and about half stated they are nutritionally superior to dairy. Some of these health professionals also believed that dairy is harmful to human health, contributing to chronic disease risk. Health professionals who discussed the nutritional demerits of PB dairy alternatives believed that they are not nutritionally equal and/or that dairy products are superior nutrient sources, especially in relation to protein. Few mentioned bioavailability differences.
Table 4: Key themes discussed in comments submitted to the FDA.
Theme
|
Subtheme
|
Example quotes
|
Nutritional merits of PB dairy alternatives
|
1. PB dairy alternatives are a healthy choice.
|
“These are healthy alternatives with superior nutritional quality.”
“The general public has finally been educated about plant-based milk being healthier for humans…”
|
|
2. PB dairy alternatives provide an adequate source of essential micronutrients for individualized dietary needs.
|
“Its still a great calcium source, and its useful for those (especially kids) who cant tolerate or dont like cows milk.”
“Take any one of my patients with high cholesterol; I will tell them to choose some dairy alternatives, fortified with those essential nutrients, including vitamins and minerals…”
|
|
3. Dairy is harmful to human health.
|
“Animal products are directly linked with hypercholesterolemia, a major contributor to cardio-vascular disease, morbidity and mortality.”
“Healthcare professionals like myself are making strong inroads into convincing the public of the deleterious health effects of the ingestion of any form of animal products…”
|
Nutritional demerits of PB dairy alternatives
|
1. Dairy and PB alternatives do not have equal nutritional profiles.
|
“Every week, patients tell me they are using almond milk or some other nut milk as an alternative to dairy, with no clue that these are not nutritionally equivalent products.”
“There is a substantial difference in the nutritional content of these two products, and consumers are understandably confused by the name "milk" on non-dairy products.”
|
|
2. Dairy provides a superior source of essential micronutrients.
|
“We know from extensive research on the benefits of dairy milk including calcium, potassium, and vitamin D, in addition to many other important micronutrients.”
“I have cared for too many patients that have fractures that could have been prevented by a higher calcium intake from dairy products. The plant based beverages do not contain naturally occurring calcium…”
|
|
3. The protein content in dairy is superior to PB alternatives.
|
“As a dietitian it saddens me to see parents giving rice or coconut milk to children... less than 1 gm protein.”
“The nutritional value of nut milk isn’t the same as cows milk, and the biggest difference is in the protein content. Most nut milks are not a good source of protein, and people think they are getting the same amount of protein that they would in cows milk.”
|
Survey responses. The most common nutrition and health topic mentioned by survey respondents was nutrient value, specifically protein and calcium. Other top nutrition and health aspects discussed include the general nutrition or healthfulness of either product and other nutrition and health issues such as chronic disease and inflammation. Table 5 presents representative quotes for each theme. Many comments discussed the high nutrient value of dairy, most mentioning that dairy has a higher nutrient content and/or quality when compared to PB alternatives (Table 5). Almost all comments on protein described dairy as a good source of protein, with many stating dairy’s protein quality is superior to PB alternatives. Many comments that mentioned calcium stated that dairy provides more calcium than PB alternatives, some stating that calcium from PB sources is less bioavailable. Less than one-third of comments discussed the nutritional merits of PB alternatives in terms of protein, calcium, and overall nutrient content, often referencing the fortification of PB products. Few comments stated that dairy consumption is associated with disease risk.
Regarding general nutrition and healthfulness, many health professionals commented that neither product can be deemed nutritionally superior to the other, saying both have advantages and disadvantages. Of note, some respondents shared that achieving nutrient adequacy is dependent on more than just dairy product consumption, discussing that nutrients can be obtained from many other sources with a balanced diet. No major differences were identified in themes discussed by dietetics professionals compared to other health professionals.
Table 5: Key themes discussed among survey respondents.
Theme
|
Example quotes
|
Dairy has a superior overall nutrient value compared to PB dairy alternatives.
|
“cows milk has a standard of identity and assures the same nutrient content regardless of brand, city, state it was produced in; plant based beverages nutrient content varies by brand and only certain brands of soy beverages come close in matching the nutrient content of cows milk”
“I think that even fortified plant-based products don't contain the same amount of calcium as dairy products and because dairy products are also naturally high in 8 other essential nutrients.”
|
The protein content and quality in dairy products is superior to PB dairy alternatives.
|
“Most plant-based beverages are very low in protein as well (for example, almond milk) which is important for children and elderly as it is common for these age groups to struggle with protein intake. Cow’s milk has more of the building block proteins that humans need in their diet.”
“Dairy products tend to be a higher source of quality protein…”
|
Both products have nutritional advantages and disadvantages.
|
“They both have nutritional benefits and deficits. I think the determining factor is the specific patients dietary needs/restrictions”
“I think each have different nutrition facts. Broadly grouping them makes it hard to say they are superior. They all provide nutrients.”
|
Nutritional adequacy is dependent upon the whole diet.
|
“Cows milk is not the sole source of vitamins and minerals. Eating a balanced diet including fruits, vegetables and whole grains will satisfy your dietary needs.”
“With a healthy diet a person can get most of the nutrients needed. Plant based or not.”
|
Note. Themes were not separated between those discussing the nutritional merits vs. demerits of PB alternatives due to the small number of total comments discussing nutritional merits of PB alternatives.
Survey respondents’ perceptions and concerns about nutrition quality of dairy and PB alternatives
Top reasons identified by health professionals for why some consumers choose PB dairy alternatives over dairy were nutrition and health concerns (85.0%), dairy allergy or intolerance (82.4%), and animal welfare concerns (64.9%) (Table 6). About one-third (32.8%) believed dairy products were nutritionally superior to PB dairy alternatives, and 14.2% believed PB dairy alternatives were nutritionally superior to dairy products. About half (53.0%) did not believe that either was nutritionally superior. Most (77.2%) believed that consumers do not understand the nutritional differences between dairy products and PB alternatives, and many (65.4%) also believed the use of dairy names on PB product labels affects consumers’ understanding of these products. Just one survey respondent reported submitting a comment to the FDA’s request on this topic. Responses were split on if the FDA should permit PB dairy alternatives to be labeled with the names of dairy foods, with 39.7% saying yes, 36.4% saying no, and 23.9% remaining unsure.
Table 6: Survey responses to PB dairy alternative questions.
Variable
|
n
|
%
|
Consumer reasons a
|
|
|
|
Nutrition and health concerns
|
324
|
85.0
|
|
Animal welfare concerns
|
244
|
64.9
|
|
Environmental concerns
|
194
|
50.9
|
|
Dairy allergy or intolerance
|
314
|
82.4
|
|
Food safety concerns
|
32
|
8.4
|
|
Hormone and/or antibiotic concerns
|
205
|
53.8
|
|
Taste
|
131
|
34.4
|
|
Other
|
25
|
6.6
|
Nutritionally superior products
|
|
|
|
Dairy products
|
122
|
32.8
|
|
PB products
|
53
|
14.2
|
|
Neither or unsure
|
197
|
53.0
|
Consumer understanding
|
|
|
|
Yes
|
23
|
6.8
|
|
No
|
260
|
77.2
|
|
Unsure
|
54
|
16.0
|
PB label effect
|
|
|
|
Yes
|
225
|
65.4
|
|
No
|
70
|
20.3
|
|
Unsure
|
49
|
14.2
|
Allow dairy terms on PB labels
|
|
|
|
Yes
|
136
|
39.7
|
|
No
|
125
|
36.4
|
|
Unsure
|
82
|
23.9
|
Note. Consumer reason n=381; Nutritionally superior product n=372; Consumer understanding n=337; PB label effect n=344; Allow dairy terms in PB labeling n=343.
a Reflects frequency of respondents who selected this reason.
In response to the question about nutrients of concern in diets that replace dairy with PB alternatives, 40.1% of health professionals believed calcium intake may be a concern, and about one-third believed vitamin D and protein intake may be of concern (Figure 1). Conversely, 35% of health professionals believed none of the nutrients listed were of concern in diets replacing dairy with PB alternatives.
Figure 1: Which nutrients may be of concern for PB dairy alternative consumers? (n=334)
Perceptions of dairy and PB alternatives by health professional category and demographics
Multivariate logistic regression analyses examined demographic and professional factors associated with the belief that dairy or PB dairy alternatives are nutritionally superior (Table 7). As compared to respondents aged 18-24 years, those aged 55 years and older were more likely to believe dairy products were nutritionally superior to PB dairy alternatives (OR 2.99; 95% CI 1.44-6.21, p=0.003). Those from a dairy state were less likely to believe PB dairy alternatives are nutritionally superior to dairy (OR 0.26; 95% CI 0.11-0.59, p=0.001). Dietetics professionals were more likely than other health professionals to believe dairy is nutritionally superior to PB dairy alternatives (OR 2.27; 95% CI 1.33-3.87, p=0.003), and less likely to believe PB dairy alternatives are nutritionally superior to dairy (OR 0.19; 95% CI 0.08-0.50, p=0.001).
Table 7: Factors associated with the belief that dairy or PB dairy alternatives are nutritionally superior (n=302).
Variables
|
b
|
SE
|
OR
|
CI
|
p value
|
Dairy products are nutritionally superior to PB milk products
|
|
|
|
|
|
Age (ref=18-34)
|
|
|
|
|
|
|
35-54
|
0.51
|
0.30
|
1.67
|
0.93-2.99
|
0.085
|
|
Over 55
|
1.10
|
0.37
|
2.99
|
1.44-6.21
|
0.003
|
Race/ethnicity (ref=Not BIPOC)
|
|
|
|
|
|
|
BIPOC
|
-0.26
|
0.43
|
0.77
|
0.33-1.78
|
0.539
|
Location (ref=Not Dairy State)
|
|
|
|
|
|
|
Dairy state
|
-0.05
|
0.27
|
0.95
|
0.56-1.61
|
0.861
|
Health professional type (ref=non-dietetics professional)
|
|
|
|
|
|
|
Dietetics professional
|
0.82
|
0.27
|
2.27
|
1.33-3.87
|
0.003
|
|
|
|
|
|
|
PB milk products are nutritionally superior to dairy products
|
|
|
|
|
|
Age (ref=18-34)
|
|
|
|
|
|
|
35-54
|
-0.01
|
0.43
|
0.99
|
0.42-2.30
|
0.976
|
|
Over 55
|
0.53
|
0.52
|
1.71
|
0.62-4.73
|
0.305
|
Race/ethnicity (ref=Not BIPOC)
|
|
|
|
|
|
|
BIPOC
|
0.51
|
0.52
|
1.67
|
0.60-4.63
|
0.328
|
Location (ref=Not Dairy State)
|
|
|
|
|
|
|
Dairy state
|
-1.35
|
0.42
|
0.26
|
0.11-0.59
|
0.001
|
Health professional type (ref=non-dietetics professional)
|
|
|
|
|
|
|
Dietetics professional
|
-1.64
|
0.49
|
0.19
|
0.08-0.50
|
0.001
|
Note. Adjusted logistic regression models are presented above. The models used “neither or unsure” as the reference category of the dependent variable.
Multivariate logistic regression analyses also were used to identify demographic and professional factors associated with the belief that the diets of consumers of PB alternatives are lacking in specific nutrients (Table 8). Respondents aged 55 years and older were more likely than those aged 18-34 years to believe vitamin A would be a nutrient of concern for individuals that replace dairy with PB alternatives (OR 5.23; 95% CI 1.81–15.06, p=0.002). Dietetics professionals were more likely than other health professionals to believe protein (OR 2.02 95% CI 1.22–3.34, p=0.006), vitamin D (OR 2.46; 95% CI 1.48-4.09, p=0.001), and potassium (OR 7.18; 95% CI 2.35–21.95, p=0.001) would be a nutrient of concern for individuals that replace dairy with PB alternatives. Conversely, they were less likely than other health professionals to believe that none of the nutrients were of concern for these individuals (OR 0.49; 95% CI 0.29-0.81, p=0.005).
Table 8: Factors associated with the belief that diets of PB dairy alternative consumers lack specific nutrients (n=299).
Nutrient of concern
|
b
|
SE
|
OR
|
CI
|
p value
|
Calcium
|
|
|
|
|
|
Age (ref=18-34)
|
|
|
|
|
|
|
35-54
|
0.32
|
0.27
|
1.38
|
0.81-2.33
|
0.235
|
|
Over 55
|
0.28
|
0.34
|
1.33
|
0.69-2.57
|
0.397
|
Race/ethnicity (ref=Not BIPOC)
|
|
|
|
|
|
|
BIPOC
|
-0.28
|
0.38
|
0.76
|
0.36-1.58
|
0.456
|
Location (ref=Not Dairy State)
|
|
|
|
|
|
|
Dairy state
|
0.05
|
0.24
|
1.05
|
0.66-1.70
|
0.830
|
Health professional type (ref=non-dietetics professional)
|
|
|
|
|
|
|
Dietetics professional
|
0.41
|
0.24
|
1.513
|
0.95-2.43
|
0.085
|
|
|
|
|
|
|
|
Potassium
|
|
|
|
|
|
Age (ref=18-34)
|
|
|
|
|
|
|
35-54
|
0.50
|
0.52
|
1.65
|
0.60-4.53
|
0.334
|
|
Over 55
|
1.08
|
0.60
|
2.95
|
0.91-9.61
|
0.072
|
Race/ethnicity (ref=Not BIPOC)
|
|
|
|
|
|
|
BIPOC
|
0.96
|
0.55
|
2.62
|
0.90-7.65
|
0.078
|
Location (ref=Not Dairy State)
|
|
|
|
|
|
|
Dairy state
|
-0.21
|
0.46
|
0.81
|
0.33-2.00
|
0.650
|
Health professional type (ref=non-dietetics professional)
|
|
|
|
|
|
|
Dietetics professional
|
1.97
|
0.57
|
7.18
|
2.35-21.95
|
0.001
|
|
|
|
|
|
|
|
Protein
|
|
|
|
|
|
Age (ref=18-34)
|
|
|
|
|
|
|
35-54
|
0.19
|
0.29
|
1.21
|
0.69-2.13
|
0.508
|
|
Over 55
|
0.56
|
0.35
|
1.75
|
0.88-3.46
|
0.111
|
Race/ethnicity (ref=Not BIPOC)
|
|
|
|
|
|
|
BIPOC
|
-0.40
|
0.42
|
0.67
|
0.30-1.52
|
0.339
|
Location (ref=Not Dairy State)
|
|
|
|
|
|
|
Dairy state
|
0.17
|
0.26
|
1.18
|
0.72-1.96
|
0.513
|
Health professional type (ref=non-dietetics professional)
|
|
|
|
|
|
|
Dietetics professional
|
0.70
|
0.26
|
2.02
|
1.22-3.34
|
0.001
|
|
|
|
|
|
|
|
Vitamin A
|
|
|
|
|
|
Age (ref=18-34)
|
|
|
|
|
|
|
35-54
|
0.92
|
0.50
|
2.50
|
0.93-4.76
|
0.070
|
|
Over 55
|
1.65
|
0.54
|
5.23
|
1.81–15.06
|
0.002
|
Race/ethnicity (ref=Not BIPOC)
|
|
|
|
|
|
|
BIPOC
|
0.28
|
0.60
|
1.32
|
0.41-4.27
|
0.639
|
Location (ref=Not Dairy State)
|
|
|
|
|
|
|
Dairy state
|
0.41
|
0.41
|
1.50
|
0.68-3.34
|
0.318
|
Health professional type (ref=non-dietetics professional)
|
|
|
|
|
|
|
Dietetics professional
|
0.75
|
0.41
|
2.13
|
0.96-4.76
|
0.067
|
|
|
|
|
|
|
|
Vitamin D
|
|
|
|
|
|
Age (ref=18-34)
|
|
|
|
|
|
|
35-54
|
0.08
|
0.29
|
1.08
|
0.61-1.91
|
0.788
|
|
Over 55
|
0.58
|
0.36
|
1.79
|
0.89-3.59
|
0.101
|
Race/ethnicity (ref=Not BIPOC)
|
|
|
|
|
|
|
BIPOC
|
0.17
|
0.39
|
1.19
|
0.56-2.54
|
0.656
|
Location (ref=Not Dairy State)
|
|
|
|
|
|
|
Dairy state
|
-0.39
|
0.26
|
0.68
|
0.41-1.13
|
0.135
|
Health professional type (ref=non-dietetics professional)
|
|
|
|
|
|
|
Dietetics professional
|
0.90
|
0.26
|
2.46
|
1.48-4.09
|
0.001
|
|
|
|
|
|
|
|
None
|
|
|
|
|
|
Age (ref=18-34)
|
|
|
|
|
|
|
35-54
|
-0.42
|
0.28
|
0.66
|
0.38-1.14
|
0.137
|
|
Over 55
|
-0.41
|
0.35
|
0.66
|
0.33-1.33
|
0.25
|
Race/ethnicity (ref=Not BIPOC)
|
|
|
|
|
|
|
BIPOC
|
-0.15
|
0.40
|
0.86
|
0.40-1.86
|
0.698
|
Location (ref=Not Dairy State)
|
|
|
|
|
|
|
Dairy state
|
-0.23
|
0.26
|
0.79
|
0.48-1.31
|
0.368
|
Health professional type (ref=non-dietetics professional)
|
|
|
|
|
|
|
Dietetics professional
|
-0.72
|
0.26
|
0.49
|
0.29-0.81
|
0.005
|
Note. Adjusted logistic regression models are presented above. The models used not selecting that nutrient/response as the reference category of the dependent variable.
Multivariate logistic regression analyses also identified factors associated with the belief that consumers understand the nutritional differences between PB products and their dairy counterparts (Table 9). Those from a dairy state were less likely to agree (OR 0.30; 95% CI 0.10-0.86; p=0.025) or disagree (OR 0.39; 95% CI 0.19-0.77; p=0.007) that consumers understand the nutritional differences between the products and were more likely to remain unsure. Compared to other health professionals, dietetics professionals were more likely to say that consumers do not understand the nutritional differences between dairy products and their PB counterparts (OR 3.44; 95% CI 1.65-7.21; p=0.001). Multivariate analyses examining factors associated with beliefs on whether the use of dairy terms in PB labeling affects consumer understanding and whether the FDA should permit PB products to use dairy names in their labeling can be found in Additional File 3.
Table 9: Factors associated with the belief that consumers understand the nutritional differences between products (n=299).
Consumer understanding
|
b
|
SE
|
OR
|
CI
|
p value
|
Yes
|
|
|
|
|
|
Age (ref=18-34)
|
|
|
|
|
|
|
35-54
|
-0.30
|
0.61
|
0.74
|
0.22-2.45
|
0.620
|
|
Over 55
|
0.12
|
0.69
|
1.13
|
0.29-4.38
|
0.865
|
Race/ethnicity (ref=Not BIPOC)
|
|
|
|
|
|
|
BIPOC
|
0.79
|
0.78
|
2.19
|
0.48-10.10
|
0.313
|
Location (ref=Not Dairy State)
|
|
|
|
|
|
|
Dairy state
|
-1.22
|
0.55
|
0.30
|
0.10-0.86
|
0.025
|
Health professional type (ref=non-dietetics professional)
|
|
|
|
|
|
|
Dietetics professional
|
0.25
|
0.58
|
1.29
|
0.41-4.03
|
0.663
|
No
|
|
|
|
|
|
Age (ref=18-34)
|
|
|
|
|
|
|
35-54
|
0.17
|
0.39
|
1.18
|
0.56-2.52
|
0.660
|
|
Over 55
|
0.08
|
0.46
|
1.09
|
0.44-2.69
|
0.858
|
Race/ethnicity (ref=Not BIPOC)
|
|
|
|
|
|
|
BIPOC
|
0.20
|
0.59
|
1.22
|
0.39-3.86
|
0.733
|
Location (ref=Not Dairy State)
|
|
|
|
|
|
|
Dairy state
|
-0.95
|
0.36
|
0.38
|
0.19-0.77
|
0.007
|
Health professional type (ref=non-dietetics professional)
|
|
|
|
|
|
|
Dietetics professional
|
1.24
|
0.38
|
3.44
|
1.65-7.21
|
0.001
|
Note Adjusted logistic regression models are presented above. The models used “unsure” as the reference category of the dependent variable.