Loading…

Children's Fruit "Juice" Drinks and FDA Regulations: Opportunities to Increase Transparency and Support Public Health

To compare children's drink products that contain or purport to contain juice and evaluate labels in light of US Food and Drug Administration (FDA) regulations. In 2019, we analyzed federal law for drinks that contain or purport to contain juice by using LexisNexis and FDA's Web site, iden...

Full description

Saved in:
Bibliographic Details
Published in:American journal of public health (1971) 2020-06, Vol.110 (6), p.871-880
Main Authors: Pomeranz, Jennifer L, Harris, Jennifer L
Format: Article
Language:English
Subjects:
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
cited_by cdi_FETCH-LOGICAL-c424t-41dbbc082c83b8c29722149fa9cea0ede2359d54422afb1644d11f8836f8ce5d3
cites cdi_FETCH-LOGICAL-c424t-41dbbc082c83b8c29722149fa9cea0ede2359d54422afb1644d11f8836f8ce5d3
container_end_page 880
container_issue 6
container_start_page 871
container_title American journal of public health (1971)
container_volume 110
creator Pomeranz, Jennifer L
Harris, Jennifer L
description To compare children's drink products that contain or purport to contain juice and evaluate labels in light of US Food and Drug Administration (FDA) regulations. In 2019, we analyzed federal law for drinks that contain or purport to contain juice by using LexisNexis and FDA's Web site, identified top-selling children's "juice" drinks in fruit punch flavors, gathered labels in store and online, and extracted data from the principal display and information panels. FDA regulations permit a wide range of names, claims, and fruit vignettes on drinks that contain or purport to contain juice, reflecting the product's flavor and not necessarily its ingredients. We identified 39 brands of children's drinks, including 100% juice (n = 7), diluted juices (n = 11), juice drinks (n = 8), fruit-flavored drinks (n = 8), and flavored waters (n = 5), with nonuniform statements of identity; vitamin C and low-sugar claims; and fruit vignettes representing 19 fruits. Many products contained added sugar and nonnutritive sweeteners but little to no juice. Principal display panels rendered it difficult to differentiate among product types, identify those with added sweeteners, and distinguish healthier products. Revised labeling regulations are warranted to support public health.
doi_str_mv 10.2105/AJPH.2020.305621
format article
fullrecord <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_7204473</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2391977523</sourcerecordid><originalsourceid>FETCH-LOGICAL-c424t-41dbbc082c83b8c29722149fa9cea0ede2359d54422afb1644d11f8836f8ce5d3</originalsourceid><addsrcrecordid>eNpdkcFv0zAUhy0EYmVw54SscYBLy_OzkzgckKqO0k2TNsE4W47jrB6pHewYaf896Tom4OQn-fv99J4-Ql4zWCCD4sPy_GqzQEBYcChKZE_IjBWCzQGEfEpmADVMMy-PyIuUbgEYqwv2nBxxxFoyiTOSV1vXt9H6d4muY3YjPTnPztgTehqd_5Go9i1dny7pV3uTez264NNHejkMIY7Zu9HZRMdAz7yJVidLr6P2adBTobm7z37L9yy9yk3vDN1Y3Y_bl-RZp_tkXz28x-T7-vP1ajO_uPxytlpezI1AMc4Fa5vGgEQjeSMN1hUiE3Wna2M12NYiL-q2EAJRdw0rhWgZ66TkZSeNLVp-TD4deofc7GxrrB-j7tUQ3U7HOxW0U__-eLdVN-GXqhCEqPhU8P6hIIaf2aZR7Vwytu-1tyEnhbxmdVUVuEff_ofehhz9dJ5CAQJkKUs2UXCgTAwpRds9LsNA7Z2qvVO1d6oOTqfIm7-PeAz8kch_A0JgnVw</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2404086861</pqid></control><display><type>article</type><title>Children's Fruit "Juice" Drinks and FDA Regulations: Opportunities to Increase Transparency and Support Public Health</title><source>EBSCOhost SPORTDiscus with Full Text</source><source>Open Access: PubMed Central</source><source>Business Source Ultimate</source><source>Social Science Premium Collection</source><source>ABI/INFORM Global</source><source>American Public Health Association</source><source>Politics Collection</source><source>PAIS Index</source><creator>Pomeranz, Jennifer L ; Harris, Jennifer L</creator><creatorcontrib>Pomeranz, Jennifer L ; Harris, Jennifer L</creatorcontrib><description>To compare children's drink products that contain or purport to contain juice and evaluate labels in light of US Food and Drug Administration (FDA) regulations. In 2019, we analyzed federal law for drinks that contain or purport to contain juice by using LexisNexis and FDA's Web site, identified top-selling children's "juice" drinks in fruit punch flavors, gathered labels in store and online, and extracted data from the principal display and information panels. FDA regulations permit a wide range of names, claims, and fruit vignettes on drinks that contain or purport to contain juice, reflecting the product's flavor and not necessarily its ingredients. We identified 39 brands of children's drinks, including 100% juice (n = 7), diluted juices (n = 11), juice drinks (n = 8), fruit-flavored drinks (n = 8), and flavored waters (n = 5), with nonuniform statements of identity; vitamin C and low-sugar claims; and fruit vignettes representing 19 fruits. Many products contained added sugar and nonnutritive sweeteners but little to no juice. Principal display panels rendered it difficult to differentiate among product types, identify those with added sweeteners, and distinguish healthier products. Revised labeling regulations are warranted to support public health.</description><identifier>ISSN: 0090-0036</identifier><identifier>EISSN: 1541-0048</identifier><identifier>DOI: 10.2105/AJPH.2020.305621</identifier><identifier>PMID: 32298182</identifier><language>eng</language><publisher>United States: American Public Health Association</publisher><subject>AJPH Open-Themed Research ; Ascorbic acid ; Beverages ; Caregivers ; Children ; Children &amp; youth ; Childrens health ; Descriptive labeling ; Federal legislation ; Federal regulation ; Flavor ; Flavors ; Food ; Fruit juices ; Fruits ; Government ; Health Law ; Health Policy ; Ingredients ; Internet ; Juices ; Labeling ; Labels ; Names ; Nutrition ; Nutrition/Food ; Other Child and Adolescent Health ; Panels ; Public health ; Qualitative research ; Regulations ; Regulatory agencies ; Sugar ; Sweeteners ; Vitamins ; Websites</subject><ispartof>American journal of public health (1971), 2020-06, Vol.110 (6), p.871-880</ispartof><rights>Copyright American Public Health Association Jun 2020</rights><rights>American Public Health Association 2020 2020</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c424t-41dbbc082c83b8c29722149fa9cea0ede2359d54422afb1644d11f8836f8ce5d3</citedby><cites>FETCH-LOGICAL-c424t-41dbbc082c83b8c29722149fa9cea0ede2359d54422afb1644d11f8836f8ce5d3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.proquest.com/docview/2404086861/fulltextPDF?pq-origsite=primo$$EPDF$$P50$$Gproquest$$H</linktopdf><linktohtml>$$Uhttps://www.proquest.com/docview/2404086861?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>230,314,727,780,784,885,3994,11687,21386,21393,27865,27923,27924,33610,33611,33984,33985,36059,36060,43732,43947,44362,53790,53792,74092,74339,74766</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32298182$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Pomeranz, Jennifer L</creatorcontrib><creatorcontrib>Harris, Jennifer L</creatorcontrib><title>Children's Fruit "Juice" Drinks and FDA Regulations: Opportunities to Increase Transparency and Support Public Health</title><title>American journal of public health (1971)</title><addtitle>Am J Public Health</addtitle><description>To compare children's drink products that contain or purport to contain juice and evaluate labels in light of US Food and Drug Administration (FDA) regulations. In 2019, we analyzed federal law for drinks that contain or purport to contain juice by using LexisNexis and FDA's Web site, identified top-selling children's "juice" drinks in fruit punch flavors, gathered labels in store and online, and extracted data from the principal display and information panels. FDA regulations permit a wide range of names, claims, and fruit vignettes on drinks that contain or purport to contain juice, reflecting the product's flavor and not necessarily its ingredients. We identified 39 brands of children's drinks, including 100% juice (n = 7), diluted juices (n = 11), juice drinks (n = 8), fruit-flavored drinks (n = 8), and flavored waters (n = 5), with nonuniform statements of identity; vitamin C and low-sugar claims; and fruit vignettes representing 19 fruits. Many products contained added sugar and nonnutritive sweeteners but little to no juice. Principal display panels rendered it difficult to differentiate among product types, identify those with added sweeteners, and distinguish healthier products. Revised labeling regulations are warranted to support public health.</description><subject>AJPH Open-Themed Research</subject><subject>Ascorbic acid</subject><subject>Beverages</subject><subject>Caregivers</subject><subject>Children</subject><subject>Children &amp; youth</subject><subject>Childrens health</subject><subject>Descriptive labeling</subject><subject>Federal legislation</subject><subject>Federal regulation</subject><subject>Flavor</subject><subject>Flavors</subject><subject>Food</subject><subject>Fruit juices</subject><subject>Fruits</subject><subject>Government</subject><subject>Health Law</subject><subject>Health Policy</subject><subject>Ingredients</subject><subject>Internet</subject><subject>Juices</subject><subject>Labeling</subject><subject>Labels</subject><subject>Names</subject><subject>Nutrition</subject><subject>Nutrition/Food</subject><subject>Other Child and Adolescent Health</subject><subject>Panels</subject><subject>Public health</subject><subject>Qualitative research</subject><subject>Regulations</subject><subject>Regulatory agencies</subject><subject>Sugar</subject><subject>Sweeteners</subject><subject>Vitamins</subject><subject>Websites</subject><issn>0090-0036</issn><issn>1541-0048</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>7TQ</sourceid><sourceid>ALSLI</sourceid><sourceid>DPSOV</sourceid><sourceid>M0C</sourceid><sourceid>M2L</sourceid><sourceid>M2R</sourceid><recordid>eNpdkcFv0zAUhy0EYmVw54SscYBLy_OzkzgckKqO0k2TNsE4W47jrB6pHewYaf896Tom4OQn-fv99J4-Ql4zWCCD4sPy_GqzQEBYcChKZE_IjBWCzQGEfEpmADVMMy-PyIuUbgEYqwv2nBxxxFoyiTOSV1vXt9H6d4muY3YjPTnPztgTehqd_5Go9i1dny7pV3uTez264NNHejkMIY7Zu9HZRMdAz7yJVidLr6P2adBTobm7z37L9yy9yk3vDN1Y3Y_bl-RZp_tkXz28x-T7-vP1ajO_uPxytlpezI1AMc4Fa5vGgEQjeSMN1hUiE3Wna2M12NYiL-q2EAJRdw0rhWgZ66TkZSeNLVp-TD4deofc7GxrrB-j7tUQ3U7HOxW0U__-eLdVN-GXqhCEqPhU8P6hIIaf2aZR7Vwytu-1tyEnhbxmdVUVuEff_ofehhz9dJ5CAQJkKUs2UXCgTAwpRds9LsNA7Z2qvVO1d6oOTqfIm7-PeAz8kch_A0JgnVw</recordid><startdate>202006</startdate><enddate>202006</enddate><creator>Pomeranz, Jennifer L</creator><creator>Harris, Jennifer L</creator><general>American Public Health Association</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>0-V</scope><scope>0U~</scope><scope>1-H</scope><scope>3V.</scope><scope>7RV</scope><scope>7TQ</scope><scope>7WY</scope><scope>7WZ</scope><scope>7X7</scope><scope>7XB</scope><scope>87Z</scope><scope>88A</scope><scope>88C</scope><scope>88E</scope><scope>88G</scope><scope>88I</scope><scope>88J</scope><scope>8AF</scope><scope>8AO</scope><scope>8C1</scope><scope>8FE</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8FL</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>ALSLI</scope><scope>ATCPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BEC</scope><scope>BENPR</scope><scope>BEZIV</scope><scope>BHPHI</scope><scope>CCPQU</scope><scope>DHY</scope><scope>DON</scope><scope>DPSOV</scope><scope>DWQXO</scope><scope>FRNLG</scope><scope>FYUFA</scope><scope>F~G</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>HCIFZ</scope><scope>K60</scope><scope>K6~</scope><scope>K9-</scope><scope>K9.</scope><scope>KB0</scope><scope>KC-</scope><scope>L.-</scope><scope>L.0</scope><scope>LK8</scope><scope>M0C</scope><scope>M0R</scope><scope>M0S</scope><scope>M0T</scope><scope>M1P</scope><scope>M2L</scope><scope>M2M</scope><scope>M2O</scope><scope>M2P</scope><scope>M2R</scope><scope>M7P</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PATMY</scope><scope>PQBIZ</scope><scope>PQBZA</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PSYQQ</scope><scope>PYCSY</scope><scope>Q9U</scope><scope>S0X</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>202006</creationdate><title>Children's Fruit "Juice" Drinks and FDA Regulations: Opportunities to Increase Transparency and Support Public Health</title><author>Pomeranz, Jennifer L ; Harris, Jennifer L</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c424t-41dbbc082c83b8c29722149fa9cea0ede2359d54422afb1644d11f8836f8ce5d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>AJPH Open-Themed Research</topic><topic>Ascorbic acid</topic><topic>Beverages</topic><topic>Caregivers</topic><topic>Children</topic><topic>Children &amp; youth</topic><topic>Childrens health</topic><topic>Descriptive labeling</topic><topic>Federal legislation</topic><topic>Federal regulation</topic><topic>Flavor</topic><topic>Flavors</topic><topic>Food</topic><topic>Fruit juices</topic><topic>Fruits</topic><topic>Government</topic><topic>Health Law</topic><topic>Health Policy</topic><topic>Ingredients</topic><topic>Internet</topic><topic>Juices</topic><topic>Labeling</topic><topic>Labels</topic><topic>Names</topic><topic>Nutrition</topic><topic>Nutrition/Food</topic><topic>Other Child and Adolescent Health</topic><topic>Panels</topic><topic>Public health</topic><topic>Qualitative research</topic><topic>Regulations</topic><topic>Regulatory agencies</topic><topic>Sugar</topic><topic>Sweeteners</topic><topic>Vitamins</topic><topic>Websites</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Pomeranz, Jennifer L</creatorcontrib><creatorcontrib>Harris, Jennifer L</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Social Sciences Premium Collection【Remote access available】</collection><collection>Global News &amp; ABI/Inform Professional</collection><collection>Trade PRO</collection><collection>ProQuest Central (Corporate)</collection><collection>ProQuest Nursing &amp; Allied Health Database</collection><collection>PAIS Index</collection><collection>ProQuest_ABI/INFORM Collection</collection><collection>ABI/INFORM Global (PDF only)</collection><collection>Health &amp; Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>ABI/INFORM Collection</collection><collection>Biology Database (Alumni Edition)</collection><collection>Healthcare Administration Database (Alumni)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Psychology Database (Alumni)</collection><collection>Science Database (Alumni Edition)</collection><collection>Social Science Database (Alumni Edition)</collection><collection>STEM Database</collection><collection>ProQuest Pharma Collection</collection><collection>ProQuest Public Health Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ABI/INFORM Collection (Alumni Edition)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest One Sustainability</collection><collection>ProQuest Central</collection><collection>Social Science Premium Collection</collection><collection>Agricultural &amp; Environmental Science Collection</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>eLibrary</collection><collection>AUTh Library subscriptions: ProQuest Central</collection><collection>Business Premium Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>ProQuest One Community College</collection><collection>PAIS International</collection><collection>PAIS International (Ovid)</collection><collection>Politics Collection</collection><collection>ProQuest Central Korea</collection><collection>Business Premium Collection (Alumni)</collection><collection>Health Research Premium Collection</collection><collection>ABI/INFORM Global (Corporate)</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Business Collection (Alumni Edition)</collection><collection>ProQuest Business Collection</collection><collection>Consumer Health Database (Alumni Edition)</collection><collection>ProQuest Health &amp; Medical Complete (Alumni)</collection><collection>Nursing &amp; Allied Health Database (Alumni Edition)</collection><collection>ProQuest Politics Collection</collection><collection>ABI/INFORM Professional Advanced</collection><collection>ABI/INFORM Professional Standard</collection><collection>Biological Sciences</collection><collection>ABI/INFORM Global</collection><collection>Consumer Health Database</collection><collection>Health &amp; Medical Collection (Alumni Edition)</collection><collection>Healthcare Administration Database</collection><collection>PML(ProQuest Medical Library)</collection><collection>Political Science Database</collection><collection>Psychology Database</collection><collection>ProQuest Research Library</collection><collection>Science Database</collection><collection>Social Science Database</collection><collection>Biological Science Database</collection><collection>Research Library (Corporate)</collection><collection>Nursing &amp; Allied Health Premium</collection><collection>Environmental Science Database</collection><collection>One Business</collection><collection>ProQuest One Business (Alumni)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest One Psychology</collection><collection>Environmental Science Collection</collection><collection>ProQuest Central Basic</collection><collection>SIRS Editorial</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>American journal of public health (1971)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Pomeranz, Jennifer L</au><au>Harris, Jennifer L</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Children's Fruit "Juice" Drinks and FDA Regulations: Opportunities to Increase Transparency and Support Public Health</atitle><jtitle>American journal of public health (1971)</jtitle><addtitle>Am J Public Health</addtitle><date>2020-06</date><risdate>2020</risdate><volume>110</volume><issue>6</issue><spage>871</spage><epage>880</epage><pages>871-880</pages><issn>0090-0036</issn><eissn>1541-0048</eissn><abstract>To compare children's drink products that contain or purport to contain juice and evaluate labels in light of US Food and Drug Administration (FDA) regulations. In 2019, we analyzed federal law for drinks that contain or purport to contain juice by using LexisNexis and FDA's Web site, identified top-selling children's "juice" drinks in fruit punch flavors, gathered labels in store and online, and extracted data from the principal display and information panels. FDA regulations permit a wide range of names, claims, and fruit vignettes on drinks that contain or purport to contain juice, reflecting the product's flavor and not necessarily its ingredients. We identified 39 brands of children's drinks, including 100% juice (n = 7), diluted juices (n = 11), juice drinks (n = 8), fruit-flavored drinks (n = 8), and flavored waters (n = 5), with nonuniform statements of identity; vitamin C and low-sugar claims; and fruit vignettes representing 19 fruits. Many products contained added sugar and nonnutritive sweeteners but little to no juice. Principal display panels rendered it difficult to differentiate among product types, identify those with added sweeteners, and distinguish healthier products. Revised labeling regulations are warranted to support public health.</abstract><cop>United States</cop><pub>American Public Health Association</pub><pmid>32298182</pmid><doi>10.2105/AJPH.2020.305621</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record>
fulltext fulltext
identifier ISSN: 0090-0036
ispartof American journal of public health (1971), 2020-06, Vol.110 (6), p.871-880
issn 0090-0036
1541-0048
language eng
recordid cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_7204473
source EBSCOhost SPORTDiscus with Full Text; Open Access: PubMed Central; Business Source Ultimate; Social Science Premium Collection; ABI/INFORM Global; American Public Health Association; Politics Collection; PAIS Index
subjects AJPH Open-Themed Research
Ascorbic acid
Beverages
Caregivers
Children
Children & youth
Childrens health
Descriptive labeling
Federal legislation
Federal regulation
Flavor
Flavors
Food
Fruit juices
Fruits
Government
Health Law
Health Policy
Ingredients
Internet
Juices
Labeling
Labels
Names
Nutrition
Nutrition/Food
Other Child and Adolescent Health
Panels
Public health
Qualitative research
Regulations
Regulatory agencies
Sugar
Sweeteners
Vitamins
Websites
title Children's Fruit "Juice" Drinks and FDA Regulations: Opportunities to Increase Transparency and Support Public Health
url http://sfxeu10.hosted.exlibrisgroup.com/loughborough?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-08T06%3A32%3A50IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Children's%20Fruit%20%22Juice%22%20Drinks%20and%20FDA%20Regulations:%20Opportunities%20to%20Increase%20Transparency%20and%20Support%20Public%20Health&rft.jtitle=American%20journal%20of%20public%20health%20(1971)&rft.au=Pomeranz,%20Jennifer%20L&rft.date=2020-06&rft.volume=110&rft.issue=6&rft.spage=871&rft.epage=880&rft.pages=871-880&rft.issn=0090-0036&rft.eissn=1541-0048&rft_id=info:doi/10.2105/AJPH.2020.305621&rft_dat=%3Cproquest_pubme%3E2391977523%3C/proquest_pubme%3E%3Cgrp_id%3Ecdi_FETCH-LOGICAL-c424t-41dbbc082c83b8c29722149fa9cea0ede2359d54422afb1644d11f8836f8ce5d3%3C/grp_id%3E%3Coa%3E%3C/oa%3E%3Curl%3E%3C/url%3E&rft_id=info:oai/&rft_pqid=2404086861&rft_id=info:pmid/32298182&rfr_iscdi=true