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      Does the use of passive or active consent affect consent or completion rates, or dietary data quality? Repeat cross-sectional survey among school children aged 11–12 years

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          Abstract

          Objectives

          An expectation of research is that participants should give fully informed consent. However, there is also a need to maximise recruitment to ensure representativeness. We explored the impact of passive or active parental consent on consent, completion rates and on dietary data quality in a survey among children aged 11–12 years.

          Setting

          Six middle schools in North-East England.

          Participants

          All children aged 11–12 years attending the six middle schools were eligible to participate (n=1141).

          Main outcomes

          Primary outcomes: whether or not each eligible child's parent gave consent and provided a complete dietary diary; whether or not a child completed their dietary diary but only among children who agreed to participate, and whether or not children providing diaries were classified as an under-reporter or not.

          Results

          Parents were more likely to consent passively than actively. This difference was greater among the more deprived: OR 16.9 (95% CI 5.7 to 50.2) in the least and 129.6 (95% CI 39.9 to 420.6) in the most deprived quintile (test for interaction: method of consent by level of deprivation, p=0.02). For all children eligible, completion was more likely if passive consent was used (OR 2.8, 95% CI 2.2 to 3.7). When only children who gave consent are considered, completion was less likely when passive rather than active consent was used (OR 0.6, 95% CI 0.4 to 0.9). Completion rate decreased as level of deprivation increased; we found no evidence that the OR for the method of consent varied by level of deprivation. There was no evidence that the quality of dietary data, as measured by an assessment of under-reporting, differed by method of consent (OR 0.8, 95% CI 0.5 to 1.2).

          Conclusions

          Passive consent led to a higher participation rate and a more representative sample without compromising data quality.

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          Most cited references12

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          Recruiting patients to medical research: double blind randomised trial of "opt-in" versus "opt-out" strategies.

          To evaluate the effect of opt-in compared with opt-out recruitment strategies on response rate and selection bias. Double blind randomised controlled trial. Two general practices in England. 510 patients with angina. Patients were randomly allocated to an opt-in (asked to actively signal willingness to participate in research) or opt-out (contacted repeatedly unless they signalled unwillingness to participate) approach for recruitment to an observational prognostic study of patients with angina. Recruitment rate and clinical characteristics of patients. The recruitment rate, defined by clinic attendance, was 38% (96/252) in the opt-in arm and 50% (128/258) in the opt-out arm (P = 0.014). Once an appointment had been made, non-attendance at the clinic was similar (20% opt-in arm v 17% opt-out arm; P = 0.86). Patients in the opt-in arm had fewer risk factors (44% v 60%; P = 0.053), less treatment for angina (69% v 82%; P = 0.010), and less functional impairment (9% v 20%; P = 0.023) than patients in the opt-out arm. The opt-in approach to participant recruitment, increasingly required by ethics committees, resulted in lower response rates and a biased sample. We propose that the opt-out approach should be the default recruitment strategy for studies with low risk to participants.
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            Changes in consumption of sugars by English adolescents over 20 years.

            Dietary surveys of 11- to 12-year-old Northumbrian children in 1980 and 1990 revealed that consumption of non-milk extrinsic sugars (NMES) was 16-17% of energy intake. This study reports dietary sugars consumption in 2000 and compares it with data collected in 1980 and 1990, using identical methods. A repeat cross-sectional dietary survey of children aged 1-12 years attending the same schools as in the 1980 and 1990 surveys. Seven middle schools in south Northumberland. All children aged 11-12 years old attending the seven schools. Food consumption was recorded using two 3-day diet diaries. Food composition tables were used to calculate energy and nutrient intakes. NMES, and milk and intrinsic sugars were calculated using previously described methods. The numbers of children completing the surveys in 1980, 1990 and 2000 were 405, 379 and 424, respectively; approximately 60-70% of eligible children. Total sugars provided 22% of energy consistently over the three surveys. NMES consumption in 2000 provided 16% of energy compared with 16% in 1980 and 17% in 1990. Sources of NMES changed over the three surveys. NMES from soft drinks doubled from 15 to 31 g day(-1), and from breakfast cereals increased from 2 to 7 g day(-1) over the 20 years. Confectionery and soft drinks provided 61% of NMES. Over 20 years, the proportion of energy from fat decreased by 5% and from starch increased by 4%, creating a welcome tilt in the fat-starch see-saw, without an adverse effect on sugars intake. Consumption of NMES in 2000 was substantially higher than recommended, and there has been little change over 20 years. Continued and coordinated efforts are required at a national, community and individual level to reduce the intake of NMES.
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              Paediatric hospital admissions for rotavirus gastroenteritis and infectious gastroenteritis of all causes in England: an analysis of correlation with deprivation.

              Infectious intestinal diseases cause substantial morbidity and economic loss in the UK. Rotavirus gastroenteritis (RVGE), a form of gastroenteritis, is the primary cause of severe diarrhoea in children. The primary objective of this study was to examine whether hospitalisation for gastroenteritis, and particularly RVGE, is linked to social deprivation. A retrospective study relating to hospital admissions in England with rotavirus, gastroenteritis, or type 1 diabetes mellitus (T1DM) was conducted in children aged under 5 years between 1st April 2009 and 31st March 2010 using the CHKS database. Admissions with selected diagnoses were extracted based on ICD-10 coding. Deprivation data were obtained from the Index of Multiple Deprivation (IMD) 2007 for England. A total of 20,571 unique hospital admissions were made by children, in England, with RVGE (n = 1334; 6.5%) together with a diagnosis of infectious gastroenteritis of all causes (n = 19,237; 93.5%), giving an overall hospital admission rate, for those aged under 5 years, of 65.7 per 10,000 population. With 'rank of average score' and the 'rank of average rank' as measures of deprivation, the rate of hospital admissions with gastroenteritis of all causes decreased by 0.346 and 0.287 per 10,000 (p < 0.001) respectively for every unit increase in deprivation rank (decreasing deprivation), though this trend was not observed in patients admitted with RVGE specifically. Hospital admissions with gastroenteritis of all causes increased as deprivation increased. The implementation of a rotavirus vaccination programme would help to reduce the burden of RVGE and gastroenteritis of all causes, and in the context of gastroenteritis, some elements of health and social inequality may be vaccine preventable. It is possible that the study is limited by the accuracy and completeness of deprivation indices, and coding within CHKS; the existence of the 'ecological fallacy' must also be considered.
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                Author and article information

                Journal
                BMJ Open
                BMJ Open
                bmjopen
                bmjopen
                BMJ Open
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2044-6055
                2015
                13 January 2015
                : 5
                : 1
                : e006457
                Affiliations
                [1 ]Institute of Health & Society, Human Nutrition Research Centre, Newcastle University , Newcastle upon Tyne, UK
                [2 ]Institute of Health & Society, Newcastle University , Newcastle upon Tyne, UK (Visiting Professor)
                [3 ]Fuse, UKCRC Centre for Translational Research in Public Health , Newcastle upon Tyne, UK
                [4 ]School of Mathematics and Statistics, Newcastle University , Newcastle upon Tyne, UK
                Author notes
                [Correspondence to ] Professor John NS Matthews; john.matthews@ 123456ncl.ac.uk
                Article
                bmjopen-2014-006457
                10.1136/bmjopen-2014-006457
                4298110
                25586368
                19bf9e8f-5dd3-4188-a0ef-eac4f1ac5a76
                Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions

                This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

                History
                : 24 August 2014
                : 29 October 2014
                : 30 October 2014
                Categories
                Epidemiology
                Research
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                Medicine
                public health,statistics & research methods,nutrition & dietetics
                Medicine
                public health, statistics & research methods, nutrition & dietetics

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