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Szczepanski e al. BMC Nu i ion (2025) 11:101
h ps://doi.o g/10.1186/s40795-025-01072-8 BMC Nu i ion
*Co espondence:
Lena Szczepanski
lena.szczepanski@uni-osnab ueck.de
1Biology Didac ics, Depa men o Biology/Chemis y, Osnab ück
Uni e si y, Osnab ück, Ge many
Abs ac
Backg ound Consuming al e na i es o cow’s milk (CM) could help coun e ac cu en en i onmen al p oblems.
Plan -based milk al e na i es (PBMA) and p ecision e men a ion-based milk al e na i es–also called “animal- ee
milk” (AFM)–a e po en ially mo e sus ainable al e na i es o CM. The e o e, ou s udy aimed o analyze young
peoples’ a i udes owa d PBMA and AFM and hei mo i es o /agains consuming hese milk al e na i es.
Me hods Fo his pu pose, semi-s uc u ed in e iews we e conduc ed wi h adolescen s om Ge many (N = 25;
MAge = 17.6). The da a we e analyzed using quali a i e con en analysis.
Resul s The esul s show ha he young people in ou s udy ha e posi i e a i udes owa d PBMA, as hey pe cei e
PBMA as heal hy and en i onmen ally iendly. In addi ion, hey ha e p edominan ly posi i e a i udes owa d AFM, as
hey pe cei e AFM as an en i onmen ally iendly and sui able al e na i e o CM. Animal wel a e and en i onmen al
p o ec ion mo i a e he young people in ou s udy o consume hese milk al e na i es. In con as , senso y p ope ies
(PBMA) and ood sa e y conce ns (AFM) we e iden i ied as ba ie s o he consump ion o milk al e na i es.
Conclusions Adolescen s gene ally ha e posi i e a i udes owa d milk al e na i es, mo i a ed by pe cei ed heal h,
en i onmen al, and animal wel a e bene i s. Howe e , senso y p ope ies and p oduc ion- ela ed unce ain ies
a e ba ie s o consump ion. These indings highligh he impo ance o add essing hese conce ns o os e he
accep ance o sus ainable milk al e na i es among young people.
Keywo ds Consume esea ch, Quali a i e esea ch, Sus ainable nu i ion, Dai y al e na i es, Animal- ee dai y, Young
people, Ge many
A i udes owa d milk al e na i es
and mo i es o (non-)consump ion:
an in e iew s udy wi h adolescen s
om Ge many
LenaSzczepanski1* , Lau a-Ma ieBahlmann1, Co innaRö ke 1, AnnikeEyle ing1 and Flo ianFiebelko n1
Page 2 o 21Szczepanski e al. BMC Nu i ion (2025) 11:101
Backg ound
Food p oduc ion and li es ock a ming con ibu e sig-
ni ican ly o cu en en i onmen al p oblems, such as
clima e change and biodi e si y loss [1–5]. Li es ock
a ming accoun s o app oxima ely 60% o he an h o-
pogenic g eenhouse gas emissions o ood p oduc ion. I
also con ibu es abou 9% o o al global CO₂ emissions
and 40% o global an h opogenic me hane emissions [5–
7]. Fu he mo e, li es ock a ming equi es 61–83% o
he wo ld’s a mland [4, 8, 9].
The consump ion o cow’s milk (CM) emains consis-
en ly high wo ldwide and in Eu ope [10–12]. Howe e ,
he ecommended daily consump ion amoun s o milk
and dai y p oduc s ou lined in he na ional die a y guide-
lines o Eu opean coun ies a y g ea ly be ween 200
and 600g [13]. In Ge many, o example, milk is a s aple
ood and an es ablished elemen o people’s die s wi h
a ecommended consump ion o wo po ions pe day,
which can be one slice o cheese (30g) and one po ion
o milk (250g) [14, 15]. Ge many is also he la ges milk
p oduce in he Eu opean Union [16]. In 2022, abou
32.4million ons o CM we e p oduced in Ge many, and
he a e age pe -pe son consump ion o CM in Ge many
has been a ound 50kg pe yea o e he las wen y yea s
[16–18].
The e a e wo po en ially mo e sus ainable al e na-
i es o CM: Plan -based milk al e na i es (PBMA)
and “animal- ee milk” (AFM) [1, 4, 19, 20]. PBMA a e
de ined as suspensions o wa e and c ushed o dissol ed
plan ma e ials [21–23]. In gene al, PBMA a e ca ego-
ized acco ding o whe he hey a e made om ce eals,
legumes, nu s, oilseeds, o pseudo-ce eals [21, 23–26].
PBMA, such as oa , soy, o almond milk, a e in ended
o be simila o CM in appea ance, senso y p ope ies,
and possible uses [22, 23]. The p oduc ion o oa , soy,
o almond milk causes h ee imes less g eenhouse gas
emissions han he p oduc ion o con en ional CM, o
example [1, 4]. Howe e , he mac o- and mic onu ien s
in oa , soy, o almond milk do no co espond o hose
in CM, no does he ene gy, a , i amin (e.g., B12), and
o he mine al (e.g., calcium) con en [26–28]. Some p o-
duce s hus en ich PBMA wi h calcium and/o i amins
[23].
In addi ion o con inuously op imizing hei PBMA
po olios, a ious companies a e wo king on p oduc-
ing ano he milk al e na i e e med “animal- ee milk”
(AFM), which is equi alen o CM in appea ance, senso y
p ope ies, and nu ien s [20, 29–31]. Like CM, AFM
mainly consis s o wa e and he CM p o eins casein and
whey p o ein, which a e p oduced ia p ecision e men-
a ion. Du ing p ecision e men a ion, mic oo ganisms
(e.g., ungi o yeas s) a e gene ically modi ied o exp ess
casein and whey p o ein, which a e hen mixed wi h min-
e als, suga , wa e , and ege able a s o p oduce he AFM
[20, 29, 30, 32–34]. While he i s al e na i e dai y p od-
uc s made wi h p ecision e men a ion echnology ha e
been a ailable in he Uni ed S a es, Singapo e, and Hong
Kong since 2021, hese p oduc s a e no ye a ailable on
he Eu opean ma ke [34–36]. In Ge many, only he ood
echnology company Fo mo is wo king on he p oduc ion
o cheese al e na i es (i.e., “animal- ee cheese”) using
p ecision e men a ion echnology [34, 37]. In gene al,
in o ma ion abou he po en ial sus ainabili y o dai y
p oduc s made wi h p ecision e men a ion echnology
should be conside ed ca e ully because companies a e
cu en ly esea ching and de eloping animal- ee dai y
p oduc s and a e hus unwilling o publish he de ails o
hei p oduc ion p ocesses [38]. Fu he mo e, compa ed
o he p oduc ion o con en ional CM, he p oduc ion o
AFM is es ima ed o emi 35–97% less g eenhouse gases
and equi es 77–97% less land [20, 35, 39, 40]. In addi-
ion o he lowe en i onmen al impac o AFM com-
pa ed o con en ional CM, i s as e, appea ance, and uses
a e equi alen o hose o con en ional CM, which could
encou age people o make changes o hei die a y hab-
i s by educing hei consump ion o animal-based oods
[31, 41].
In he Eu opean Union, 28% o all adul s al eady con-
sume PBMA [42, 43], while in Ge many, 33–38% o peo-
ple do [43, 44]. The mos consumed PBMA in Ge many
a e oa , soy, and almond milk [11, 45]. Whe he people
would be willing o consume AFM has no ye been
in es iga ed, hough. To da e, only he willingness o con-
sume o he animal- ee dai y p oduc s, such as cheese,
has been in es iga ed [31, 32, 46–49]. Fo ins ance, a
s udy wi h young adul s om he Uni ed S a es showed
ha 64% o pa icipan s would be willing o buy p oduc s
c ea ed wi h p ecision e men a ion echnology [46]. In
Ge many, Zollman Thomas and B yan [31] showed ha
75.9% o adul consume s would y animal- ee cheese,
62.7% would buy i , and 36.1% would buy i egula ly. To
analyze consume in en ions and beha io s in ela ion o
he consump ion o milk al e na i es, consume s’ a i-
udes and mo i es ha e o en been examined in exis ing
esea ch [50–52].
A i udes owa d milk al e na i es
A i udes a e de ined as an o e all e alua ion o an a i-
ude objec [53–55]. Acco ding o he ABC model o
a i udes, hey consis o h ee componen s: a ec i e
(A), beha io al (B), and cogni i e (C) componen s. The
a ec i e componen comp ises a consume ’s eelings o
emo ional eac ions o an a i ude objec (e.g., “Oa milk
is delicious”). The beha io al componen comp ises a
consume ’s beha io o beha io al in en ions owa d
an a i ude objec (e.g., “I would ne e d ink oa milk”).
The cogni i e componen comp ises a consume ’s belie s
abou an a i ude objec , i.e., wha hey hink abou he
Page 3 o 21Szczepanski e al. BMC Nu i ion (2025) 11:101
a i ude objec in e ms o ac (e.g., “Oa milk is heal h-
ie han CM”) [54, 55]. Consume s’ a i udes owa d a
p oduc canno be de e mined simply by iden i ying
hei belie s [53, 54]. Unde s anding consume s’ a i udes
owa d milk al e na i es could p o ide aluable insigh s
in o hei decision-making p ocesses, which can hen
be used o de elop educa ion and ma ke ing campaigns
[56].
The cu en esea ch ocuses on adul s’ a i udes
owa d PBMA, mos ly in compa ison o CM [50–52, 56–
60]. O e all, mos s udies ha e demons a ed ha PBMA
a e pe cei ed less posi i ely han CM [50, 51, 57, 59].
Speci ically, PBMA—in compa ison o CM—a e con-
sis en ly e alua ed as unheal hie , less nu i ious, wo se
o he bones [50], and mo e expensi e [51, 56]. To ou
knowledge, only wo s udies ha e in es iga ed adoles-
cen s’ a i udes owa d PBMA. Palacios e al. [61] showed
ha adolescen s om he Uni ed S a es a ed soy milk
sligh ly mo e nega i ely han CM, whe eby un la o ed
CM was a ed less a o ably han chocola e- la o ed soy
milk [61]. In Ge many, a hi d o adolescen s ha e exhib-
i ed a posi i e a i ude owa d PBMA [62].
A i udes owa d AFM ha e no ye been in es iga ed.
B oad e al. [32], Zollman Thomas and B yan [31], and
Zollman Thomas and Dilla d [63] we e he only s udies
ha examined adul s’ pe cep ions o animal- ee dai y
p oduc s. In he s udy by Zollman Thomas and B yan
[31], animal- ee cheese was e alua ed as less as y and
na u al han con en ional cheese. Zollman Thomas and
Dilla d [63] showed ha po en ial consume s om he
Uni ed S a es o Ame ica and Ge many, o example,
pe cei ed he p oduc ion o animal- ee dai y p oduc s
as echnical and sca y. Howe e , animal- ee cheese
was e alua ed as he mos e hical and en i onmen ally
iendly p oduc compa ed o con en ional and egan
cheese. Among Ge man adul s, he pe cep ion o ani-
mal- ee cheese as e hical, as y, and heal hy posi i ely
a ec ed hei willingness o consume animal- ee cheese
[31]. To ou knowledge, young people’s a i udes owa d
AFM o dai y p oduc s ha e no ye been in es iga ed.
Mo i es o /agains he consump ion o (o willingness o
consume) milk al e na i es
In addi ion o a i udes owa d a p oduc , mo i es play
a decisi e ole in consume s’ decision-making as hey
a ec a i udes [64, 65]. In gene al, mo i es a e de ined
as a pe son’s easons o a speci ic beha io [66]. The e-
o e, consume s’ mo i es in ood selec ion co espond o
hei goals: Mo i es desc ibe wha he consume wan s
o achie e in o wi h hei ood consump ion [54]. Food
choice mo i es in luence consume s’ a i udes owa d a
p oduc [50, 64]. Consume s a e o en unawa e o hei
ood choice mo i es. Howe e , hey can be made awa e
o hei mo i es h ough e lec ion o ques ioning [67].
Insigh s in o consume s’ ood choice mo i es can be used
o de elop and op imize ma ke ing s a egies by add ess-
ing (po en ial) consume s’ mo i es in ma ke ing commu-
nica ion o inc ease hei consump ion o (o willingness
o consume) ce ain p oduc s [54]. In addi ion o physi-
ological ac o s, heal h, con enience, na u al con en ,
p ice, weigh con ol, amilia i y, and e hical conce ns a e
mo i es ha a ec ood choices. Fu he mo e, consume
beha io can be de e mined by social mo i es [65]. Fo
Eu opean consume s, p ice, senso y appeal, and na u al
con en a e he mos impo an ood choice mo i es [68].
Rega ding he consump ion o milk al e na i es, cu -
en esea ch ocuses on adul s’ mo i es o and agains
he consump ion o PBMA [44, 51, 52, 57–59, 69–73].
Adul s om he Uni ed S a es o Ame ica, Aus ia, and
Ge many, o example, o en ci e heal h, en i onmen-
al, and e hical aspec s as mo i es o consuming PBMA
[50–52, 57–59, 69, 73]. Adul s in Ge many indica e spe-
ci ic die s and heal h easons, as well as en i onmen al
and animal p o ec ion as mo i es o no consuming milk
and dai y p oduc s [44].
Mo i es o and agains he consump ion o AFM ha e
no ye been in es iga ed. Howe e , a ew s udies exis
ha examine adul s’ mo i es o hei willingness o con-
sume animal- ee dai y p oduc s. Animal wel a e and
en i onmen al p o ec ion ha e been iden i ied as mo i es
o he willingness o consume animal- ee dai y p od-
uc s among adul s. Unce ain ies ega ding ood sa e y
we e iden i ied as mo i es agains he willingness o con-
sume animal- ee dai y p oduc s [32, 46, 63].
S udy aims and esea ch ques ions
To os e a change in die a y habi s, we mus analyze he
consump ion o o willingness o consume mo e sus ain-
able milk al e na i es. A i udes and mo i es o e a ou e
o analyze his consump ion o willingness o consume.
The exis ing esea ch has ocused on adul s’ a i udes
owa d PBMA and hei consump ion mo i es. A i udes
owa d PBMA ha e o en been in es iga ed quan i a i ely
ia a i ude s a emen s o seman ic di e en ials o de e -
mine consume s’ pe cep ions. To da e, limi ed esea ch
has been conduc ed on he speci ic belie s and eelings
abou he consump ion o milk al e na i es ha unde lie
posi i e o nega i e a i udes owa d hem. In addi ion,
mo i es o o agains he consump ion o PBMA ha e
a ely been su eyed compa ed o he cu en consump-
ion o PBMA.
The e o e, he i s aim o ou s udy is o iden i y how
PBMA and AFM a e e alua ed, and which belie s and
eelings de e mine a posi i e o nega i e e alua ion. The
second aim o ou s udy is o de e mine he mo i es o
and agains he consump ion o (o willingness o con-
sume) PBMA and AFM based on he cu en consump-
ion (o willingness). A quali a i e esea ch app oach was
Page 4 o 21Szczepanski e al. BMC Nu i ion (2025) 11:101
chosen o allow pa icipan s o exp ess and explain hei
belie s, eelings, and mo i es o consuming o being will-
ing o consume milk al e na i es [67, 74].
In his s udy, we ocus on adolescen s in Ge many, as
hey ha e no been in es iga ed and ep esen a c ucial
g oup o shaping u u e die a y ends as hei die a y
habi s a e less en enched and easie o in luence han
hose o adul s [75, 76].
This esul s in he ollowing esea ch ques ions:
Resea ch Ques ion 1: Wha a e adolescen s’ a i-
udes owa d milk al e na i es?
Resea ch Ques ion 1.1: How do adolescen s e alu-
a e PBMA?
Resea ch Ques ion 1.2: How do adolescen s e alu-
a e AFM?
Resea ch Ques ion 2: Wha a e adolescen s’ mo i es
o /agains he consump ion o (o willingness o
consume) milk al e na i es?
Resea ch Ques ion 2.1: Wha a e adolescen s’
mo i es o /agains he consump ion o PBMA?
Resea ch Ques ion 2.2: Wha a e adolescen s’
mo i es o /agains hei willingness o consume
AFM?
Me hods
The me hods a e desc ibed ollowing he “Quali a i e
Design Repo ing S anda ds (JARS-Qual)” [77] and he
c i e ia o epo ing quali a i e esea ch (COREQ) [78].
Selec ion o pa icipan s, cha ac e is ics o he
pa icipan s, and ec ui men
Fo sample cons uc ion, he induc i e sampling me hod
o explo a o y s udies acco ding o Reinde s [79] was
chosen. The sample was selec ed based on h ee c i-
e ia. Fi s ly, adolescen s needed o a end uppe sec-
onda y school because hey need biological knowledge
abou gene ics o unde s and he p oduc ion o AFM,
which is co e ed in he uppe seconda y school biology
cu iculum in Ge many [80]. Secondly, he adolescen s
needed o iden i y as di e en gende s, and, hi dly,
consume CM o PBMA o allow us o iden i y hei a i-
udes owa d milk al e na i es and hei mo i es o and
agains consump ion ac oss gende s ( emale, male, and
o he ) and consume g oups (CM consume s and PBMA
consume s).
The inal sample consis ed o 25 adolescen s 16 o 19
yea s old (N = 25; MAge = 17.60 yea s; SDAge = 0.63 yea s;
60% emale). The adolescen s came om i e second-
a y schools in he ci y and dis ic o Osnab ück (Lowe
Saxony, Ge many) and we e in he ele en h o hi een h
g ades (uppe seconda y school) a he ime o da a
collec ion. Desc ip i e s a is ics o he sample and hei
sel - epo ed consump ion o CM, PBMA, and hei will-
ingness o consume AFM a e p esen ed in Table1. All
names ha e been eplaced wi h pseudonyms o ensu e
anonymi y.
To ec ui pa icipan s, he school p incipals o all
seconda y schools in he ci y and dis ic o Osnab ück
we e con ac ed by email wi h an in i a ion o pa ici-
pa e in his s udy. The school p incipals o wa ded he
email o he biology eache s a hei schools and asked
he biology eache s o eques olun a y pa icipan s
om hei uppe seconda y school cou ses. The biol-
ogy eache s we e ins uc ed o ensu e an equal dis i-
bu ion o gende s and consump ion o PBMA and CM
when selec ing pa icipan s.
The in e iews we e always scheduled in blocks by
he eache s so ha he pa icipan s om he same
school we e in e iewed on he same day and one a e
he o he . A e each in e iew block, he i s and
hi d au ho s ( wo code s) discussed con en sa u a-
ion. The code s used he deduc i e ca ego y sys em
as a basis and he audio eco dings o discuss whe he
new con en and induc i e codes had been added.
Con en sa u a ion occu ed a e 21 in e iews. A
his poin , ou mo e in e iews we e planned, which
we e subsequen ly conduc ed and a o al o 25 in e -
iews we e analyzed.
Be o e he da a we e collec ed, bo h he school p in-
cipals and he s uden s (and hei pa en s, o s uden s
unde he age o 18) signed a decla a ion o consen .
The s uden ’s pa en s also ecei ed an in o ma i e le -
e explaining he s udy’s aim, ha pa icipa ion was
olun a y, and ha he da a would be anonymized.
Be o e he in e iews began, s uden s’ (and pa en s’)
signed decla a ion o consen was e iewed and con-
i med e bally. Pa icipa ion in he in e iews was
olun a y and anonymous. All s uden s had he oppo -
uni y o decline pa icipa ion a any ime wi hou
consequences.
Da a collec ion occu ed in Sep embe and Oc obe
2022. The i s au ho (cha ac e is ics: emale; quali i-
ca ion: physics and biology eache wi h wo yea s o
eaching expe ience; cu en occupa ion: PhD s uden
and esea ch assis an ) conduc ed all in e iews in a
quie oom in he s uden s’ schools. The in e iews
we e eco ded wi h a digi al audio eco de (Olym-
pus LS-P1). They anged om 29.33 o 51.63 min
(MDu a ion = 41.83min; SDDu a ion = 6.07min).
S udy design and in e iew p ocedu e
We chose a quali a i e app oach wi h in-dep h semi-
s uc u ed in e iews o be e unde s and ado-
lescen s’ a i udes and mo i es in ela ion o he
consump ion o PBMA and AFM since quali a i e
Page 5 o 21Szczepanski e al. BMC Nu i ion (2025) 11:101
me hods allow o a de ailed in es iga ion o indi idual
associa ions, belie s, and eelings, which a e di icul o
assess h ough s anda dized ques ionnai es [64]. Fo
ou s udy, he i s au ho , in coope a ion wi h biology
didac ics expe s, biology eache s, and psychologis s,
de eloped an in e iew guide based on (consume )
psychological heo ies [53, 54, 64]. We decided o use
a semi-s uc u ed in e iew guide o allow o mo e
lexibili y and o enable pa icipan s o exp ess hei
hough s mo e eely [79]. To gain a deepe unde -
s anding o pa icipan s a i udes and consump ion
mo i es, we mainly asked “why” ques ions [54, 64].
To op imize he in e iew ques ions and p ocess, he
in e iew guide was es ed in a pilo s udy wi h ou
s uden s aged 17 o 18 be o e da a collec ion [81, 82].
Minimal adjus men s we e made o he ques ions
based on he pilo s udy esul s. No ably, he pilo
in e iews we e no included in he inal sample.
In e iews we e di ided in o ou b oad phases:
(1) he in oduc ion, (2) he main phase on PBMA,
(3) he main phase on AFM, and (4) he conclusion
wi h a sho ques ionnai e (Fig.1). Du ing da a col-
lec ion, he o de o he second and hi d phases was
swi ched a e each pa icipan o minimize any possi-
ble in luence o he o de o he phases on pa icipan s’
esponses. The second and hi d phases we e di ided
in o h ee subphases: (1) concep ions o PBMA/AFM
and hei /i s p oduc ion, (2) a i udes owa d PBMA/
AFM (RQs 1.1 and 1.2), and (3) mo i es o and agains
he consump ion o PBMA/AFM (RQs 2.1 and 2.2;
Fig. 1). To answe he esea ch ques ions, only da a
on a i udes and mo i es om he second and hi d
phases we e analyzed. The comple e in e iew guide,
Table 1 O e iew o he sample o adolescen s (N = 25)
Name aGende Age Residence bIn e iew du a ion Die cConsump ion
CM dConsump ion
PBMA eWillingness o consume AFM
Liam male 17 u ban a ea 50.30min omni o ous daily ne e willing
Sophia emale 17 u al a ea 43.11min omni o ous weekly casual (mon hly) willing
Alexande male 17 u ban a ea 47.63min omni o ous daily ne e no willing
Emma emale 17 u al a ea 45.11min ege a ian mon hly egula (daily) willing
Elias male 18 u al a ea 39.01min ege a ian mon hly casual (mon hly) no willing
Ma hys male 17 u al a ea 29.33min omni o ous daily ne e willing
Mason male 17 u ban a ea 46.80min omni o ous weekly egula (daily) willing
Benjamin male 16 u ban a ea 41.13min o he weekly casual (weekly) willing
Oli e male 17 u al a ea 41.40min o he ne e egula (weekly) willing
Emilia emale 17 u al a ea 32.32min ege a ian mon hly egula (weekly) willing
Mila emale 18 u al a ea 38.01min omni o daily ne e willing
Lily emale 18 u al a ea 35.07min ege a ian weekly egula (daily) willing
Sophie emale 18 u ban a ea 40.47min omni o ous ne e casual (weekly) willing
Mia emale 19 u ban a ea 49.21min ege a ian mon hly egula (daily) willing
Isabella emale 18 u al a ea 50.67min omni o ous daily ne e willing
Maëlys emale 18 u ban a ea 42.56min ege a ian weekly ne e willing
Jack male 18 u al a ea 34.73min omni o ous daily egula (daily) willing
Samuel male 18 u ban a ea 46.07min omni o ous ne e casual (weekly) willing
Ella emale 18 u ban a ea 51.63min omni o ous weekly casual (weekly) willing
Oli ia emale 18 u al a ea 47.87min ege a ian weekly casual (weekly) willing
Emmy emale 17 u ban a ea 46.07min egan ne e egula (weekly) willing
Amelia emale 18 u al a ea 39.88min omni o ous daily ne e willing
Cha lo e emale 18 u ban a ea 35.73min omni o ous daily ne e willing
Emily emale 18 u al a ea 35.78min omni o ous weekly egula (weekly) willing
Lucas male 18 u ban a ea 37.63min omni o ous daily egula (daily) willing
Mean alue 17.60 41.86min
S anda d de ia ion 00.63 06.07min
Minimum 16.00 29.33min
Maximum 19.00 51.63min
No es. a Randomly selec ed pseudonym acco ding o he mos popula i s names in 2022 in he Uni ed S a es o Ame ica. b The adolescen s we e asked abou hei
a ea o esidence a e he in e iew and could choose ei he u ban a ea o u al a ea. c The adolescen s we e asked abou hei die s a e he in e iew and could
choose omni o ous, ege a ian, egan, o o he . d The adolescen s we e asked abou hei consump ion o CM a e he in e iew and could choose daily, weekly,
mon hly, o ne e . e Du ing he in e iew, he adolescen s we e asked o desc ibe hei consump ion o PBMA and, on his basis, classi y hei consump ion as egula ,
casual, o ne e . The equency o consump ion is gi en in pa en heses. Du ing he in e iew, he adolescen s ecei ed an in o ma i e ex abou AFM and we e
asked o decide acco dingly whe he hey we e willing o unwilling o consume AFM.

Page 6 o 21Szczepanski e al. BMC Nu i ion (2025) 11:101
Fig. 1 Key ques ions and esea ch in e es s in he main phases o he in e iews abou milk al e na i es
No es. This s udy did no analyze phase 1 o he main phases o he in e iew. In he i s phase, he adolescen s we e asked abou hei concep ions o PBMA and AFM and hei p oduc ion
Page 7 o 21Szczepanski e al. BMC Nu i ion (2025) 11:101
including guiding ques ions and p omp s, is p o ided
in he supplemen a y ma e ial (Supplemen a y Ma e-
ial 1).
Be o e he i s phase, he in e iewe alked wi h he
pa icipan abou how hey we e doing and b ie ly in o-
duced he sel (a PhD s uden a a uni e si y esea ching
“sus ainable nu i ion”). The in e iewe cla i ied ha
he in e iew opic was “milk al e na i es” and poin ed
ou ha he in e iew was no abou hei knowledge
bu hei hough s on he opic. Pa icipan s we e also
in o med ha he collec ed da a would be ea ed con i-
den ially, meaning ha hei eache s would no ecei e
any o he da a, and hey we e encou aged o say any-
hing ha came o mind.
Du ing he i s phase, pa icipan s we e asked abou
hei concep ions o PBMAs and AFM, hei ing edien s,
and hei p oduc ion; his phase is no included in his
a icle. Addi ionally, pa icipan s we e shown he lis o
ing edien s o a ca on o oa d ink (wa e , oa s [12%],
sun lowe oil, and sea sal ) so ha hey could discuss
hei concep ions o he p oduc ion o PBMAs. A e his
i s phase, pa icipan s we e gi en no u he in o ma-
ion abou he p oduc ion o PBMAs.
Du ing he second phase, pa icipan s we e asked o
e alua e PBMAs o AFM o e all as “( a he ) posi i e” o
“( a he ) nega i e” o assess hei a i udes owa d milk
al e na i es [53]. Pa icipan s we e hen asked o explain
hei posi i e o nega i e e alua ion using h ee p oduc -
ela ed a ibu es o iden i y he belie s and eelings abou
PBMAs o AFM ha de e mined hei posi i e o nega-
i e e alua ion [55]. Since AFM is no ye a ailable on he
Eu opean ma ke and he public is less amilia wi h dai y
p oduc s p oduced wi h p ecision e men a ion echnol-
ogy [31, 32], pa icipan s we e gi en a b ie in o ma i e
ex de ailing wha AFM is and how i is p oduced o help
hem e alua e i (Supplemen a y Ma e ial 2).
Du ing he hi d phase, pa icipan s we e i s asked
abou hei consump ion o PBMA o hei willing-
ness o consume AFM. Thei cu en consump ion o
PBMA was assessed by asking, “Do you d ink PBMA as
an al e na i e o CM?” I pa icipan s al eady consumed
PBMA, hey we e asked o p o ide he equency o con-
sump ion and ypes o PBMA consumed du ing a ypi-
cal school week. In addi ion, pa icipan s we e asked o
classi y hei consump ion o PBMA as “ egula ,” “casual,”
o “ne e ” based on hei sel - epo ed consump ion e-
quency. Pa icipan s we e also asked whe he hey would
be willing o consume AFM as an al e na i e o CM i
i became a ailable in all supe ma ke s and es au an s.
Based on hei esponses o his ques ion, pa icipan s’
mo i es o and agains he consump ion o milk al e -
na i es we e assessed wi h he ques ions, “Why do you
ne e /casually/ egula ly d ink PBMA as an al e na i e o
CM?” and “Why a e you (no ) willing o consume AFM
as an al e na i e o CM?” [64]. Du ing he in e iew,
he in e iewe asked indi idual, hough -p o oking
ques ions o iden i y pa icipan s’ eelings, belie s, and
hough s abou he opic (see Supplemen a y Ma e ial
1). A he end o he in e iew, pa icipan s we e asked
o comple e a sho ques ionnai e on hei sociodemo-
g aphic da a and consump ion o milk (al e na i es; Sup-
plemen a y Ma e ial 1).
Da a analysis
The audio eco dings we e ansc ibed acco ding
o D esing and Pehl [83]. The ansc ip s we e no
e u ned o he pa icipan s o commen s o co ec-
ions. In he nex s ep, he ansc ip s we e edac ed
acco ding o G opengieße ’s [84] guidelines o imp o e
eadabili y and educe he esea ch ques ion con-
en in he ansc ip s. The ansc ip ion and edac-
ion ules a e p o ided in he supplemen a y ma e ial
(Supplemen a y Ma e ial 3). The edac ed da a we e
analyzed in MAXQDA [85] wi h quali a i e con en
analysis acco ding o Kucka z and Rädike [86] which
enables a sys ema ic bu lexible analysis o quali a i e
da a h ough a combina ion o deduc i e and induc i e
coding.
As we ollowed a quali a i e in e iew app oach, we
do no ha e a ep esen a i e sample o adolescen s in
Ge many. The e o e, we do no in end o make gene -
alized s a emen s o adolescen s (in Ge many) wi h
ou quali a i e esul s. As pa o he con en analysis,
we use equencies o illus a e ends wi hin ou sam-
ple [77].
Acco ding o he esea ch ques ions and he in e -
iew phases, a deduc i e ca ego y sys em was c ea ed
wi h he ollowing supe o dina e ca ego ies: (1.1) “A i-
udes owa d PBMA,” (1.2) “A i udes owa d AFM,”
(2.1) “Mo i es o /agains PBMA consump ion,” and
(2.2) “Mo i es o /agains he willingness o consume
AFM” (Figs. 2 and 3). The supe o dina e ca ego ies
“A i udes owa d PBMA” and “A i udes owa d AFM”
we e each deduc i ely di ided in o wo subca ego ies,
“Posi i e a i udes owa d PBMA/AFM” and “Nega i e
a i udes owa d PBMA/AFM”. Wi hin each o hese
subca ego ies, deduc i e codes we e de i ed om he
cu en s a e o esea ch, and induc i e codes (*) we e
de i ed om pa icipan s’ s a emen s du ing he da a
analysis (Fig.2).
The supe o dina e ca ego ies “Mo i es o /agains
PBMA consump ion” and “Mo i es o /agains he will-
ingness o consume AFM” we e also each deduc i ely
di ided in o wo subca ego ies (“Mo i es o PBMA
consump ion/ he willingness o consume AFM” and
“Mo i es agains PBMA consump ion/ he willingness
o consume AFM”). Wi hin each o hese subca ego ies,
deduc i e codes we e de i ed om he cu en s a e o
Page 8 o 21Szczepanski e al. BMC Nu i ion (2025) 11:101
esea ch, and induc i e codes (*) we e de i ed om pa -
icipan s’ s a emen s du ing he da a analysis (Fig.3).
The comple e ca ego y sys em is p o ided in he sup-
plemen a y ma e ial (Supplemen a y Ma e ial 4). The
analysis o he en i e quali a i e da a was ca ied ou
by he i s au ho . To a i m he in e nal consis ency o
he coding, 20% o all s a emen s ha we e ele an o
answe ing he esea ch ques ions we e also coded wi h
he comple e ca ego y sys em by he second au ho [86].
To assess in e code ag eemen , he kappa coe icien
was calcula ed in MAXQDA acco ding o B ennan and
Fig. 2 Ca ego y sys ems o analyzing adolescen s’ a i udes owa d milk al e na i es
No es. * Induc i ely coded ca ego ies. PBMA = plan -based milk al e na i es; AFM = animal- ee milk
Page 9 o 21Szczepanski e al. BMC Nu i ion (2025) 11:101
P edige [87]. The kappa alue is 0.79, which indica es
subs an ial in e code ag eemen [87].
Resul s
In o al, se en een o he 25 adolescen s s a ed hey
al eady consumed plan -based al e na i es o CM. O
hese, se en s a ed ha hey consumed PBMA casually,
and en egula ly. The egula consume s in ou s udy
said ha hey used PBMA h ee o se en days a week,
while he casual consume s used PBMA wo o ou days
a week. The egula and casual consume s epo ed ha
hey mos equen ly consumed oa milk (n = 15), ol-
lowed by almond milk (n = 5). Eigh o he adolescen s
s a ed ha hey did no consume any plan -based al e na-
i es o CM. O hese, six said ha hey had no ye ied
any PBMA (Table1). Conce ning AFM, 23 o he adoles-
cen s said ha hey would be willing o y, buy, o d ink
AFM as an al e na i e o CM. Two adolescen s s a ed
ha hey would no be willing o y AFM (Table1).
Fig. 3 Ca ego y sys ems o analyzing adolescen s’ mo i es o and agains he consump ion o (o willingness o consume) milk al e na i es
No es. * Induc i ely coded ca ego ies. PBMA = plan -based milk al e na i es; AFM = animal- ee milk
Page 16 o 21Szczepanski e al. BMC Nu i ion (2025) 11:101
was conside ed a heal hy al e na i e o CM since i has
lowe calo ie and a con en .
Animal wel a e was also a c ucial mo i e o consume
PBMA among ou pa icipan s and was linked o he
mo al s ance agains he abuse o animals o ood p o-
duc ion. Adul s also conside animal wel a e o be one
o he mos impo an conside a ions when buying dai y
p oduc s o plan -based dai y al e na i es [44, 101]. The
g owing awa eness o heal h, animal wel a e, and he
en i onmen is also e lec ed in he dynamic de elop-
men o young people’s die a y habi s in Ge many. Young
people (aged 15 o 30) a e inc easingly a oiding he con-
sump ion o animal p oduc s o clima e and animal wel-
a e [62, 102].
Mo i es agains consuming PBMA
As ou esul s show, he senso y cha ac e is ics o PBMA
a e a majo ba ie o hei consump ion [59, 72, 103,
104]. Ame ican child en and adolescen s (aged 8 o 16),
o example, a ed lac ose- ee milk as be e , in gene al,
han soy milk since lac ose- ee milk had be e senso y
p ope ies, such as as e and mou h eel [61]. In addi ion,
he p ice o PBMA compa ed o ha o CM—pe cei ed
o eal—was a mo i e agains he consump ion o PBMA.
This mo i e is impo an o younge people, as hey ha e
limi ed incomes and depend on hei amily’s shopping
and die a y habi s [99] and since one in i e young people
in Ge many g ows up in a low-income household [105].
In addi ion o indi idual ac o s, en i onmen al ac o s
a ec sus ainable ood consump ion [106]. We ound
ha social in luence and social no ms ela ed o he con-
sump ion o CM a e also ba ie s o he consump ion o
PBMA, as CM consump ion is o en conside ed “no mal”
and an in eg al die a y habi [71, 97, 107].
Mo i es o he willingness o consume AFM
The willingness o ou pa icipan s o consume AFM
depended mainly on indi idual ac o s, such as a conce n
o animal wel a e. Animal wel a e was a key mo i e o
consume milk al e na i es (AFM and PBMA) among ou
pa icipan s, as hey ques ioned he necessi y and condi-
ions o con empo a y li es ock a ming. The impo ance
o animal wel a e o younge people when making ood
choices is e lec ed in Gene a ion Z’s inc easing com-
mi men o animal wel a e [99, 108]. Simila ly, Zollman
Thomas and Dilla d [63] showed ha p omo ing animal
wel a e o educing animal su e ing in li es ock a m-
ing is he s onges mo i a ion o adul s’ consump ion
o animal- ee dai y (e.g., cheese o milk). The eeling o
unease abou li es ock a ming d i es he need o p o-
ec animal wel a e and hus a oid consuming animal
p oduc s. This unease can be enhanced by p esen ing
in o ma ion abou o showing pic u es o he condi ions
o dai y a ms (“animal wel a e aming”), which could
encou age consume s o consume animal- ee dai y [63].
Mo i es agains he willingness o consume AFM
Fi s , mos o ou pa icipan s we e e y in e es ed in
ying AFM and ga e ew mo i es agains consuming i .
Rega ding hei jus i ica ions o hei nega i e a i udes
owa d AFM, unce ain ies abou i s sa e y o human
heal h we e men ioned. Zollman Thomas and Dilla d [63]
obse ed ha unce ain ies abou dai y p oduc s p o-
duced wi h p ecision e men a ion hinde hei accep-
ance. The Eu opean Food Sa e y Au ho i y’s (EFSA)
app o al o AFM o sale on he Eu opean ma ke could
help o educe unce ain ies abou AFM. In addi ion, all
companies and ma ke ing campaigns should use a con-
sis en desc ip ion o he p oduc ion p ocess o AFM o
minimize unce ain ies and acili a e unde s anding o
“animal- ee dai y” as a p oduc ca ego y [63].
Sugges ions o ma ke ing and policy
Young people’s g owing awa eness o heal h, animal wel-
a e, and he en i onmen , as well as hei doub s abou
ou cu en ood sys em [99, 102], could be a good s a -
ing poin o de eloping ma ke ing campaigns o CM
al e na i es. Based on ou esul s, ma ke ing campaigns
should be aimed a emphasizing he heal h, e hical, and
en i onmen al bene i s o consuming PBMA ins ead o
CM and di ec ly add essing misconcep ions (e.g., ain o -
es de o es a ion o p oduce soya milk). Since ou esul s
show a disc epancy be ween young people’s a i udes
owa d and consump ion o PBMA (a i ude–beha io
gap), we should conside how exis ing ba ie s can be
o e come.
The ba ie o la o and consis ency may esul om
he pe cep ion o CM as “nice,” while PBMA do no mee
senso y expec a ions in compa ison [59, 69, 71]. This
ba ie among “CM lo e s” may be o e come by p oduc-
ing PBMA wi h senso y p ope ies simila o hose o
CM. One example o his is Alp o’s “No Milk,” which is
a ailable on he Ge man ma ke and is ad e ised wi h
he slogan “No milk, bu i as es like milk” [109]. Ad e -
ising ha highligh s milk al e na i es’ simila i y o CM
could be pa icula ly impo an o people who ha e no
ye been able o elimina e CM since hey p e e i s la o .
Ano he ba ie o he consump ion o PBMA is cos .
PBMA a e cu en ly axed a 19% in Ge many, while CM
is axed a 7% since i is conside ed a s aple ood he e.
Equalizing axes on CM and PBMA is one way o lowe
he p ice ba ie [110]. Fu he mo e, he po en ial o
he social en i onmen o p omo e he consump ion o
PBMAs should be conside ed since amily and iends
in luence adolescen s’ ood choices [111]. Adolescen s
also in luence each o he ’s die s and ood choices (e.g.,

Page 17 o 21Szczepanski e al. BMC Nu i ion (2025) 11:101
ia social media) [112]. This could be used o ac i ely
d i e he no maliza ion o PBMA consump ion.
The app o al o animal- ee dai y p oduc s in Eu ope
could allay sa e y conce ns. Hence, communica ion
should be ocused on he ad an ages o AFM, as p e i-
ous esea ch has shown ha he pe cei ed bene i s o
animal- ee cheese ha e a posi i e e ec on he willing-
ness o buy i [47]. In addi ion, p e ious s udies ha e sug-
ges ed ha companies should make i clea when AFM
has no been p oduced using gene ically modi ied o gan-
isms (GMOs), as associa ing AFM wi h GMOs could
ha e a nega i e impac on isk pe cep ion and willingness
o consume [49, 63, 113]. Open, anspa en communica-
ion abou he new p oduc ca ego y o animal- ee dai y
p oduc s could also help o inc ease amilia i y, which is
c ucial o he willingness o consume no el oods [98].
Fu he mo e, a en ion should be paid o he placemen
o AFM in he supe ma ke when i is in oduced; o
example, placing AFM close o CM could p omo e amil-
ia i y wi h he p oduc [32]. In summa y, AFM could
become a sui able milk al e na i e among younge people
[31]. Mos o ou pa icipan s al eady pe cei ed AFM as
a easonable milk al e na i e. Whe he hey will in eg a e
AFM in o hei die s will mainly depend on hei ood
choice mo i es, such as p ice and as e, and he assuaging
o unce ain ies abou AFM in ma ke ing campaigns.
Limi a ions
Since we used a quali a i e in e iew app oach and had
speci ic inclusion c i e ia o ou sample, we did no aim
o a sample ha was ep esen a i e o young people in
Ge many. The e o e, based on ou esul s, we could no
make gene alized s a emen s abou young people’s a i-
udes owa d milk al e na i es and hei mo i es o o
agains consuming hem [82]. Fu u e s udies could exam-
ine a i udes owa d milk al e na i es and mo i es o o
agains consuming hem among adul s o young people
ollowing ano he ea ing cul u e. Ano he idea o u he
esea ch would be o examine he a i udes o young peo-
ple om he Uni ed S a es, whe e AFM is al eady a ail-
able on he ma ke . Mo eo e , all ou pa icipan s we e
engaged in highe educa ion (uppe seconda y le el),
which may ha e a ec ed ou esul s since p e ious s ud-
ies ha e shown ha people wi h high le els o educa ion
a e mo e likely o adop sus ainable die a y habi s [114,
115].
In addi ion, only he mos equen ly men ioned p od-
uc a ibu es and mo i es o consuming milk al e -
na i es we e p esen ed and discussed in de ail. Less
equen ly men ioned ca ego ies we e only men ioned,
bu no u he explained wi h ancho quo a ions, which
ep esen s a me hodological limi a ion. I is impo an o
conside his me hodological limi a ion when in e p e -
ing he esul s.
Sel -selec ion bias was ano he majo limi a ion o his
s udy. Pa icipa ion in he s udy was olun a y, which
could ha e biased he sample since only s uden s in e -
es ed in sus ainable ood choices olun ee ed o pa -
icipa e. In his con ex , he esul s may also ha e been
dis o ed by social desi abili y–pa icula ly in esponses
abou he willingness o consume AFM. O he 25 pa -
icipan s, 23 we e willing o consume AFM, which
could ha e been as a esul o an imp o emen in sel -
p esen a ion [116]. Addi ionally, ood choices a e no
only de e mined by cogni i e ac o s such as willingness
o consume; hey a e also de e mined by pe sonal (e.g.,
psychological componen s and habi s), ex e nal (e.g., he
social en i onmen ), and sociocul u al (e.g., cul u e, eco-
nomic a iables) ac o s [117]. These ac o s should be
conside ed when in e p e ing ou esul s since he e may
ha e been di e ences be ween pa icipan s’ s a emen s
abou hei consump ion o milk al e na i es and hei
ac ual beha io .
Fu he mo e, 24 o he 25 pa icipan s s a ed ha hey
ha e he igh o co-de e mina ion when making pu -
chases. Pa icipan s’ oppo uni ies, cul u al backg ound,
and le el o educa ion should be conside ed when in e -
p e ing ou esul s since ou esul s do no apply o ado-
lescen s om o he educa ional backg ounds, younge
people, o people om di e en cul u al backg ounds.
Di e ences in pe cep ions o PBMA and AFM can occu
due o adi ions and cul u es [31, 57]. In addi ion, ado-
lescen s a e la gely inancially dependen on hei pa en s
and do no ha e o make hei own pu chases. The e o e,
young people’s a i udes and consume beha io could
change a e hey lea e hei pa en s’ homes. Pa icula ly
du ing he ansi ion om school o uni e si y, new li e-
s yles o en de elop, and exis ing habi s a e econside ed
[118].
Labeling milk p oduced ia p ecision e men a ion as
“AFM” was ano he me hodological limi a ion. Zollman
Thomas and Dilla d [63] demons a ed ha using di e -
en names o dai y p oduc s p oduced wi h p ecision
e men a ion has di e en e ec s on po en ial consum-
e s. Following Zollman Thomas and Dilla d’s [63] ecom-
menda ions, we used he e m “AFM” because i is simple
and clea ly di e en ia es AFM om CM. Ne e heless,
he use o he English e m “AFM” may ha e con used
pa icipan s du ing he in e iews, wi h some mis akenly
hinking ha i e e ed o PBMAs.
Conclusions
Ou esul s showed ha he adolescen s in ou s udy
gene ally had posi i e a i udes owa d PBMA and AFM.
Howe e , unce ain ies abou he p oduc ion o AFM
and i s sa e y o human heal h diminished hei posi-
i e a i udes. In addi ion, ou esul s indica ed ha ado-
lescen s’ decisions o consume PBMA we e d i en by
Page 18 o 21Szczepanski e al. BMC Nu i ion (2025) 11:101
en i onmen al p o ec ion and heal h p omo ion mo i es.
The main mo i es o consume AFM we e animal wel a e
and he equi alency o AFM o CM (e.g., in as e and
consis ency). Despi e he pe cei ed bene i s o PBMA
and AFM, hei pe cei ed senso y p ope ies, cos s, and
p oduc ion unce ain ies ep esen ed ba ie s o hei
consump ion.
Based on ou esul s, we de i ed implica ions o u -
he esea ch, educa ion, and he ood indus y. Fu u e
s udies could compa a i ely analyze young people’s
and adul s’ a i udes owa d CM and dai y al e na i es,
as well as hei mo i es o o agains consuming hese
p oduc s. Ano he idea o u he esea ch would be
o compa e he a i udes and mo i es o young people
in a coun y wi h a s ong adi ion o consuming dai y
p oduc s, such as Ge many, wi h hose o young people
in a coun y wi h a weake adi ion o consuming dai y
p oduc s. Fu he mo e, we ecommend ha as he ange
o al e na i e p oduc s g ows, he en i onmen al impac
and nu i ional alues o adi ional oods and al e na-
i e p oduc s be discussed in mo e dep h in he con ex
o Educa ion o Sus ainable De elopmen o educe mis-
concep ions abou milk and milk al e na i es and p o-
mo e in o med ood choices. Fo he ood indus y, ou
esul s sugges ha p oduc communica ion o PBMA
should be ocused on he heal h bene i s o such p oduc s
and anspa ency in he unique nu i ional p o iles o
a ious milk al e na i es. Fo AFM, he posi i e a i udes
o ou sample p o ide a good s a ing poin o ma ke
in oduc ion. Tha is, du ing i s in oduc ion, i s simila i-
ies o adi ional milk, as well as i s en i onmen al ben-
e i s, should be emphasized. To o e come sa e y conce ns
abou AFM, he EFSA’s app o al o AFM o sale on he
Eu opean ma ke is essen ial.
Supplemen a y In o ma ion
The online e sion con ains supplemen a y ma e ial a ailable a h p s : / / d o i . o
g / 1 0 . 1 1 8 6 / s 4 0 7 9 5 - 0 2 5 - 0 1 0 7 2 - 8.
Supplemen a y Ma e ial 1
Supplemen a y Ma e ial 2
Supplemen a y Ma e ial 3
Supplemen a y Ma e ial 4
Supplemen a y Ma e ial 5
Supplemen a y Ma e ial 6
Acknowledgemen s
We wan o hank he headmas e s, eache s, and s uden s a he pa icipa ing
schools o hei coope a ion in he p esen s udy. We acknowledge suppo
om he Deu sche Fo schungsgemeinscha (DFG) and he Open Access
Publishing Fund o Osnab ück Uni e si y.
Au ho con ibu ions
LS: Concep ualiza ion, Da a Cu a ion, Me hodology, In es iga ion, Fo mal
Analysis, W i ing– O iginal D a P epa a ion, W i ing– Re iew & Edi ing.
LMB: Fo mal Analysis, W i ing– O iginal D a P epa a ion. CR: Fo mal
Analysis, W i ing– O iginal D a P epa a ion. AE: W i ing– Re iew & Edi ing.
FF: Concep ualiza ion, W i ing– Re iew & Edi ing, P ojec Adminis a ion,
Resou ces, Supe ision.
Funding
Open Access unding enabled and o ganized by P ojek DEAL. The au ho (s)
disclosed eceip o he ollowing inancial suppo o he esea ch,
au ho ship and/o publica ion o his a icle: This wo k was unded by
Deu sche Fo schungsgemeinscha (DFG) and he Open Access Publishing
Fund o Osnab ück Uni e si y.
Da a a ailabili y
The da ase s used and/o analyzed du ing he cu en s udy a e a ailable om
he co esponding au ho upon easonable eques .
Decla a ions
E hics app o al and consen o pa icipa e
The s udy was ca ied ou ollowing he na ional and ins i u ional guidelines,
he Decla a ion o Helsinki, he Ge man Resea ch Founda ion, and he
Ame ican Psychological Associa ion [119–121]. The e hics app o al o
he p esen s udy was issued by he Regional S a e O ice o Schools and
Educa ion Osnab ueck (OS 1 R.24–0541 2/N). Pa icipan s ga e hei w i en
in o med consen o pa icipa e.
Consen o publica ion
No applicable.
Compe ing in e es s
The au ho s decla e no compe ing in e es s.
Clinical ial numbe
No applicable.
Recei ed: 17 Janua y 2025 / Accep ed: 21 Ap il 2025
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