Data were collected from 201 women and 128 men (n= 329). The greater proportion of women in the sample (61%) reflects both a higher refusal rate among men and more difficulty in reaching male targets (54% of adults in the survey population are women). Approximately 77% of the sample was white, compared with a population value of 75%. The age profile of the sample was as follows: 18–29 years (21%), 30–39 years (18%), 40–49 years (22%), 50–59 years (16%), 60–69 years (11%), 70 years and older (12%), declined to answer (<1%). Seniors were slightly overrepresented in the sample, owing perhaps to their greater accessibility. About 19% of respondents reported household incomes under $30,000; 25% were in the $30,000 to $44,999 range; 29% were in the confines of $45,000 to $59,999; 26% had household incomes of $60,000 or higher; and slightly more than 1% declined to answer the income question (comparable income data were not available for the population as a whole). Approximately 58% of respondents had a high school diploma or less and 42% were college graduates; census data reveal that 23% of the survey population held college degrees. At the time of the survey, 58% of respondents were taking at least one prescription drug, 93% were covered by a health plan, and 84% received their health care from the same doctor or team of doctors.
Are Consumers Aware of DTC Advertising?
Ad awareness data for the 10 drugs ()) suggest that DTC promotions receive substantial attention, although there was great variation in awareness for the drug advertising campaigns examined. Recognition varied from 8% for Buspar to 72% for Claritin. There did not appear to be any widespread tendency to exaggerate knowledge on the part of these respondents, as only 3% reported having seen an advertisement for the bogus drug “Influgone.” On average, respondents reported being aware of advertising for 3.72 (2.23, SD) of the 10 drugs. Women reported having seen advertisements for 4 of the 10 drugs, compared with 3.31 drugs for men (p < .006). Significant sex differences (p < .05 criterion) favoring women were found for Claritin (79% vs 63%), Fosamax (28% vs 16%), and Imitrex (40% vs 20%); for no drug were men significantly more aware of advertising than were women. The sex difference on the Ad Awareness Index remained significant even when removing the female-oriented drug Fosamax (osteoporosis) from the Index, and even after controlling for demographic variables, health perceptions, health care access, and media exposure.
Ad Awareness Rates, Disease Diagnosis Rates, and Ad Awareness Stratified by Diagnosis
compares ad awareness rates of individuals affected by the health conditions examined with rates of respondents without the conditions. For instance, 70.5% of asthmatic subjects reported being aware of an advertisement for the asthma drug Accolate, compared with only 41.5% of nonasthmatic subjects. Significantly greater awareness among diagnosed individuals was found for 8 of the 10 drugs; these differences were usually substantial in magnitude.
The Ad Awareness Index was significantly, though modestly, correlated with 7 of the 12 predictors. Individuals most aware of DTC advertisements tended to be taking prescription drugs at the time of the survey (point biserial r= .24, p < .001), had greater exposure to magazines (point biserial r= .24, p < .001), were more frequent viewers of television (point biserial r= .24, p < .001), had a more positive attitude toward DTC advertising (r= .20, p < .001), were more likely to be female (point biserial r= −.15, p= .006), evaluated their general health less positively (r= −.12, p= .04), and believed that their health plan would cover drug costs (point biserial r= .11, p= .03).
Ten separate stepwise logistic regression analyses were carried out, one for each drug, to profile the multivariate predictors of individual ad awareness.15
Awareness was treated as a dichotomous dependent variable (0 = unaware/unsure, 1 = aware). The dichotomous independent variables in the analyses included diagnosis of the ailment for which the drug was advertised, current prescription drug use, magazine reading, television viewing, insurance status, continuity of care, race, education, and sex. Also included were the variables attitude toward DTC advertising, faith in regulation, age, and income. summarizes the odds ratios (and 95% confidence intervals) for the analyses. For the sake of clarity and brevity, we have excluded from those independent variables that failed to emerge as a significant predictor in any of the analyses.
Estimated Odds Ratios (and 95% Confidence Intervals) for Significant Predictors of Ad Awareness for 10Brand-name Prescription Drugs
Of most interest are patterns of significant associations that cut across the 10 brand-name drugs examined. The most frequent multivariate predictor of ad awareness for these drugs was a diagnosis of the condition for which the drugs were promoted as treatments (7 of 10 brands); in contrast, general health perceptions failed to enter into any of the equations, suggesting that awareness is motivated more by specific medical concerns than by general health worries. Magazine exposure was the second most consistent predictor of awareness (6 of 10 brands)—and a more consistent predictor than television viewing (3 of 10 brands), which may reflect the industry's greater current reliance on print advertising. One of the three brands predicted by television viewing, Prozac, has not, to our knowledge, been advertised on television; however, its print advertising was receiving television news attention at the time of the survey. Attitudes were associated significantly with awareness for four drugs; with the exception of Prozac, more positive attitudes were associated with greater ad awareness. People using prescription drugs at the time of the survey were more aware of advertising campaigns for two of the drugs. Continuity of care was predictive of awareness of advertisements only for the osteoporosis treatment Fosamax. Insurance status was not associated with ad awareness for any drugs, but the low proportion of uninsured individuals in this sample did not provide much statistical power for this predictor. Faith in regulation failed to enter into the equations because of the stronger, overlapping influence of attitudes.
Demographic characteristics were not often related to awareness, but significant relations were sometimes obtained. For instance, women were more likely to be aware of advertisements for treatments for seasonal allergies, osteoporosis, and migraine headaches; and older respondents were more aware of advertisements for osteoporosis and hypercholesterolemia. Education was associated positively with awareness of Buspar, but negatively with awareness of Accolate.
Do Consumers Understand the Nature of Drug Advertising?
Many respondents harbored incorrect beliefs about the regulation of DTC advertising. Approximately 50% thought that DTC advertisements had to be submitted to the government for prior approval, 43% thought that only “completely safe” prescription drugs could be advertised directly to the consumer, 21% believed that only “extremely effective” drugs could be so marketed, and 22% believed that the advertising of prescription drugs with serious side effects had already been banned. The Faith in Regulation Index correlated positively with the Attitudes Toward DTC Advertising Scale (r= .38, p < .001), suggesting that those holding positive opinions about such advertisements may be uninformed in their assumptions about regulatory controls. In addition, minorities were significantly more misinformed about the regulation of DTC advertising than were white respondents (means, 1.80 vs 1.22, p < .001).
How Do Consumers Feel About Drug Advertising?
The mean on the Attitude Toward DTC Advertising measure was 3.15 (0.82, SD) on the underlying 5-point scale, indicating a neutral sentiment for the sample as a whole. Approximately 13% of respondents had scores less than 2.0, which can reasonably be considered a disapproving attitude; 24% had scores greater than 4.0, an approving view. Attitude, in addition to being associated with undue faith in DTC advertising regulation as noted above, was correlated positively with the Ad Awareness Index (r= .20, p < .001).
Do Drug Advertisements Affect Consumers' Behaviors?
Approximately 19% of respondents reported having asked for a prescription as a result of a DTC advertisement, while 35% claimed to have asked a physician for more information because of an advertisement. A total of 56% reported having read a DTC advertisement carefully, “from beginning to end,” and 17% had clipped a DTC promotion for later reference. Only 9% reported ever calling a toll-free number presented in a DTC advertisement. Thus, DTC advertisements have led some of these respondents to request prescriptions, but the most frequent effect has been to induce individuals to use their physicians as sources of information.
We also examined variations in behavioral responses to DTC advertisements. People who had been influenced by DTC advertisements in the past were more likely to be aware of current advertising appeals (r= .39, p < .001), to have a positive attitude toward DTC advertising (r= .26, p < .001), to evaluate their health less positively (r= −.18, p < .001), to have greater exposure to magazines (point biserial r= .18, p < .001), to overestimate the extent of FDA oversight of such advertisements (r= .16, p= .004), to belong to a health insurance plan (point biserial r= .16, p= .004), to believe their insurance provided good coverage of prescription drugs (r= .13, p= .02), to be taking prescription drugs at the time of their interview (point biserial r= .13, p= .02), and to be female (point biserial r= −.12, p= .03).