Familial Risk Cues in Direct-to-Consumer Prescription Drug Advertisements: Impacts on Intentions to Adopt Healthy Lifestyles and Pharmaceutical Choices

Abstract

This study assessed the effects of cues of family history as a risk factor in direct-to-consumer advertisements. An experiment with a sample of 395 adults found significant impacts of familial risk cues on self-efficacy and behavioral intentions. Specifically, familial risk cues strengthened both intention to engage in healthy lifestyles and intention to seek advertised medications, partly through enhanced efficacy. Effects on perceived genetic risk for health conditions or belief in genetic determinism were not found. The findings suggest that familial risk cues incorporated in pharmaceutical appeals can enhance behavioral intentions in response to risk, without increasing a sense of fatalism. Theoretical and practical implications of the study are discussed.

Keywords:

• Family History
• Genetic Risk
• DTCA
• Behavioral Intention
• Efficacy

Acknowledgements

This publication was made possible by grant number P50CA095856 from the National Cancer Institute, and its contents are solely the responsibility of the authors and do not represent the views of the National Cancer Institute

Notes

1. This measure should have been framed in a better way such as “how likely is it that you would ask your physicians to prescribe the product if it were necessary?” Despite this limitation, we believe this measure can make a valid distinction between the intention to adopt pharmacological solutions and the intention to enact healthy lifestyles.

2. Prior ad exposure was controlled due to its difference across the conditions. There was a statistically significant difference in self-reported prior exposure to Vytorin ads between the familial risk condition (M =2.60, SD =1.43) and the control condition (M =2.21, SD =1.35), p <.01; a marginally significant difference in prior exposure to Bayer ads (M =2.91, SD =1.31 in the familial risk; M =2.68, SD =1.28 in the control), p =.08; no significant discrepancy in exposure to Actonel ads (M =2.47, SD =1.34 in the familial risk; M =2.35, SD =1.23 in the control). When responses to the three items were averaged into an index, it differed by conditions, p <.05.

3. All of the excluded came from the control condition, and the level of correct recall was lower in the control condition (M=3.5, SD=1.4) than the familial risk condition (M=4.1, SD=.9), t (393) = 5.27, p <.001. This may have resulted from two factors: prior exposure to the ads and acquiescence bias. The original ads that appeared in the media for all three medications involved familial risk cues, with the Actonel ad using both familial risk and non-familial risk versions. Prior exposure to the original ads could have influenced participants' recall of the content of the ads in our experiment. Among those in the control condition, the higher their prior exposure, the less accurate their recall of the manipulated ads (r =–.30, p <.001), whereas this finding was not observed in the familial risk condition. Secondly, the manipulation check items were likely to be biased in favor of incorrect responses in the control condition. Saying “yes” to three items were incorrect responses in the control condition, whereas saying “yes” to these questions were correct responses in the familial risk condition. It is likely that participants agreed to items regardless of the content, as known as the acquiescence bias in survey research (Friborg, Martinussen, & Rosenvinge, 2006; Wright, 1975). To deal with the difference in recall about manipulation between conditions, we controlled prior exposure to the ads and excluded those who made extremely inaccurate recall from the analyses. Restricting the sample in this way did not introduce any detectable biases in the comparability of the sample across conditions. Out of 38 possible factors available in the survey, including exposure to magazines or newsletters focusing on health and exposure to DTCA regarding cholesterol, only one differentiated the two conditions in the restricted sample—internal locus of control, which also differentiated the conditions in the entire sample.

4. Additional tests were run to see whether individuals' intention to seek to purchase medications would undermine their intention to engage in healthy lifestyles, or vice versa. We entered intention to engage in healthy lifestyles in the regression model as another predictor of intention to seek medications, but found no significant relationship between them. Adding medication intention to the regression predicting lifestyle intention also did not produce a significant result.

5. Genetic determinism was not associated with prior ad exposure (ß=.00, ns), and females showed less strong belief in genetic determinism than males (ß=−.11, p =.046).

6. Additionally, we employed the bootstrapping approach for assessing moderated mediation hypotheses (using the SPSS macro provided by Preacher, Rucker, & Hayes, 2007, available at http://www.comm.ohio-state.edu/ahayes/SPSS%20programs/modmed.htm). Findings were consistent with those from the path analysis in OLS regressions.

Additional information

Notes on contributors

Minsun Shim

Minsun Shim is at Department of Speech Communication, University of Georgia

Joseph N. Cappella

Joseph N. Cappella is at Annenberg School for Communication, University of Pennsylvania

Caryn Lerman

Caryn Lerman is at Annenberg School for Communication and Department of Psychiatry, University of Pennsylvania