title: Framing optional genetic testing in the context of mandatory newborn screening tests.
abstract: BACKGROUND
  Parents are increasingly faced with decisions about optional newborn bloodspot screening (NBS) despite no consistent policy for communicating information about such testing. We examined whether framing optional NBS alongside mandatory NBS influenced intention to participate in optional NBS.
  
  
  METHODS
  For this Internet-administered study, 2,991 adults read a hypothetical vignette in which optional NBS for Duchenne muscular dystrophy (DMD) was either presented by itself (in isolation), alongside a description including the total number of mandatory NBS tests ("bundled" mandatory context), or alongside a listing of each mandatory NBS test ("unbundled" mandatory context). We assessed associations with participants' intended participation using ordered logistic regression models, and associations with attitudes towards optional DMD NBS and subjective norms using Analysis of Variance.
  
  
  RESULTS
  Participants were more likely to choose optional DMD NBS if they also read information about mandatory NBS (either bundled or unbundled) versus when DMD NBS was presented in isolation. Participants who read about optional DMD NBS in isolation also reported such testing to be less important and that they would worry more about the results than those who also saw mandatory NBS information.
  
  
  CONCLUSIONS
  Future NBS programs should pay attention to the framing of optional testing communication, as it influences parental behavior. Predictors of NBS uptake will become increasingly important as NBS programs continue expanding.
authors.affiliation: Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, USA. sarah.lillie@va.gov.
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Lillie
authors.affiliation: Child Health Evaluation and Research (CHEAR) Unit, Department of Pediatrics, University of Michigan, Ann Arbor, USA.|Division of General Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, USA.
authors.forename: Beth A
authors.initials: BA
authors.lastname: Tarini
authors.affiliation: Department of Health Behavior & Health Education, School of Public Health, University of Michigan, Ann Arbor, USA.
authors.forename: Nancy K
authors.initials: NK
authors.lastname: Janz
authors.affiliation: Division of General Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, USA.|Department of Health Behavior & Health Education, School of Public Health, University of Michigan, Ann Arbor, USA.|Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, USA.|Risk Science Center, School of Public Health, University of Michigan, Ann Arbor, USA.
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Zikmund-Fisher
mesh_terms: D000328:Adult; D003657:Decision Making; D005820:Genetic Testing / Q000592:standards*; D058015:Health Communication / Q000592:standards*; D006801:Humans; D007231:Infant, Newborn; D020407:Internet; D020388:Muscular Dystrophy, Duchenne / Q000175:diagnosis; D015997:Neonatal Screening / Q000592:standards*; D010290:Parents; D011897:Random Allocation