“When Diet and Exercise Are Not Enough”: An Examination of Lifestyle Change Inefficacy Claims in Direct-to-Consumer Advertising

Abstract

Previous research suggests that direct-to-consumer (DTC) advertisements for pharmaceutical drugs have the potential to influence consumers’ perceptions of whether symptoms should be treated medically and/or through behavior change. However, the relative frequency of messages emphasizing these approaches in pharmaceutical advertising remains largely unknown. A content analysis of print and television advertisements for cholesterol management medication between 1994 and 2005 (for print) and between 1999 and 2007 (for television) was conducted. First, the extent to which established theoretical constructs drawn from health communication scholarship are depicted in the content of DTC cholesterol advertisements is quantified. Second, specific claims about behavior change inefficacy when a pharmaceutical alternative is available are identified. Findings indicate that DTC ads offer many mixed messages about the efficacy of diet and exercise in reducing cholesterol and risk of heart disease. Theoretical and practical implications of this work are discussed.

Notes

¹Using the Simmons National Survey, the creators of the PhADS archive generated a list of the most frequently read magazines by individuals classified in the following demographic groupings: classified by gender (2 categories), race (3 categories), age (4 categories), and income (5 categories). There was significant overlap in these lists, resulting in 25 consumer magazines that included the top 10 most frequently read magazines by all groups defined by the (2 × 3 × 4 × 5) cross classification. The archived consumer magazines consist of national issues of the magazines. Independent data from TNS Media Intelligence indicate that 93.48% of all prescription (Rx)/over-the-counter (OTC) pharmaceutical advertising appears in national issues of consumer magazines. The magazines included in this content analysis are Better Homes and Gardens, Black Enterprise, Business Week, Ebony, Essence, Family Circle, Good Housekeeping, Jet, McCall's, Money, Modern Maturity, National Geographic, Newsweek, People, Reader's Digest, Sports Illustrated, Time, TV Guide, US News and World Report, Women's Daily.

²For a small number of ads in the sample, the quality of the ad was so poor that it compromised full contact coding (the coders could hear the entire audio clearly and see many of the images, but could not determine that the ad was an exact repeat of another ad or whether it had been altered or edited). Therefore, these ads were coded only for the “hook” (see later discussion) and are missing data indicating if the construct occurred as a more minor element elsewhere in the ad. This type of file occurred 49 times (13.6% of unique ads).

³Examples of ads are available upon request.

⁴These portrayals included images of people eating healthy foods or engaged in physical activity with text or voice-over indicating that their LDL cholesterol level was too high.