Class of 2009 Abstract / OBJECTIVES: The purpose of this study was to expand the current knowledge regarding opinions about the consequences of DTCA, specifically in terms of their implications for pharmacy practice. We evaluated this by examining student pharmacist attitudes toward DTCA and their perception of its practical ramifications as they progressed through pharmacy coursework. We also compared attitudes of student pharmacists’ with those of practicing pharmacists’ as previously published. METHODS: Students at the University of Arizona College of Pharmacy, enrolled in their 1st, 2nd, and 3rd year of coursework, completed a questionnaire with 16 Likert-scale items soliciting levels of agreement with statements regarding DTCA. Two direct questions about overall support for DTCA and experience with patient questions regarding DTCA were included. Demographic data was also collected. RESULTS: No difference was found between groups of students with respect to attitudinal statements regarding DTCA when analyzed by ANOVA (p>0.05). Similar results were found for overall support for DTCA as analyzed by Chi-square (p>0.05). There was a statistically significant difference in overall support for DTCA between students and pharmacists when assessed by Chi-square (p<0.05). CONCLUSIONS: Pharmacists are more likely to not support DTCA, whereas student pharmacists are more likely to be uncertain of whether or not they support it. An obvious difference between these groups is practice experience, which probably increases exposure to DTCA. Though it is difficult to discern the cause of this difference in opinion, it may suggest a link between experience and attitudes toward advertising policy.

This study intended to examine the effects of Direct-to-Consumer prescription drug advertising (DTCA). Looking specifically for the behavioral effects that exposure to DTCA had on consumers, data was collected about respondents’ actions after seeing or hearing an advertisement for a prescription drug. Application of the Theory of Planned Behavior and the Theory of Uses and Gratifications demonstrated the potential psychological factors at play throughout consumers’ decision making process. Advertising congruence with media use was an important aspect of the study as well as grasping respondents’ perception of behavioral control with regard to requesting prescription drugs from their doctor. A small portion of this study examined how physician prescribing behavior was affected by DTCA. / text

Although direct-to-consumer (DTC) prescription drug advertising is regulated by the U.S. Food and Drug Administration, content analyses (Baird-Harris, 2009; Frosch, Krueger, Hornik, Cronbolm, & Berg, 2007; Kaphingst, DeJong, Rudd, & Daltroy, 2004; Wilkes, Bell, & Kravitz, 2000) and other studies (Davis, 2000, 2007) have suggested that advertisers may not disclose drug risks to the same extent that they describe drug benefits. This study builds on previous studies by Baird-Harris and Smith and Shaffer (2000) and aims to test the relationship between image congruency in televised DTC advertisements, recall of risks and benefits, and perceived ad persuasiveness. Advertisements for Nexium, Advair, and Lunesta were shown to college students in either their original (i.e., image incongruent) or modified (i.e., image neutral) form. In general, risks were easier to recall with image neutral advertisements (which were considered to be less persuasive), although results were not statistically significant. Gender had a significant interaction effect, suggesting that males and females process risks differently depending on images in a DTC advertisement. Despite its lack of significant findings, this study explores an underdeveloped area of research and provides a model for future studies.

While a significant amount of research has been produced in Canada on direct-to-consumer advertising (DTCA) of prescription drugs in general, very little work has been undertaken specifically with regard to the role of social media and emerging Internet technologies. While Health Canada has reaffirmed that existing DTCA regulations apply to new Internet and social media technologies, there are several unique features of these technologies that make the application of existing regulations an uncertain process. Further, given the difficulties Health Canada has faced in directly regulating DTCA in traditional media, there is significant skepticism around whether government regulators have the resources or political will to effectively monitor new digital media. Consequently, independent third party oversight and industry self-regulation may play an important role in regulating digital channels. Finally, regulators should not simply be limited to regulating online DTCA; social media is equally available to government for use in health promotion.

While a significant amount of research has been produced in Canada on direct-to-consumer advertising (DTCA) of prescription drugs in general, very little work has been undertaken specifically with regard to the role of social media and emerging Internet technologies. While Health Canada has reaffirmed that existing DTCA regulations apply to new Internet and social media technologies, there are several unique features of these technologies that make the application of existing regulations an uncertain process. Further, given the difficulties Health Canada has faced in directly regulating DTCA in traditional media, there is significant skepticism around whether government regulators have the resources or political will to effectively monitor new digital media. Consequently, independent third party oversight and industry self-regulation may play an important role in regulating digital channels. Finally, regulators should not simply be limited to regulating online DTCA; social media is equally available to government for use in health promotion.

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There are many differentiated product industries in which firms offer multiple products in the same market. In making strategic decisions regarding entry, quality and quantity to be supplied for their multiple products firms must consider the competition with rivals as well as cannibalization of their own products that are close substitutes. In this setting, understanding the relationship between the behavior of consumer demand and firms decisions' regarding product characteristics and strategic variables like advertising are fundamental issues in industrial organization. This dissertation empirically explores these fundamental issues in the pharmaceutical and airline industries. The first paper of my dissertation estimates consumer demand for different anti-cholesterol drugs using panel data on a nationally representative sample of individuals who were diagnosed with cholesterol problems in the period 1996-2002. The data provides detailed information on individuals' medical conditions, medical and drug insurance coverage, drug purchases (if any), and other demographic and medical information. Individuals choose whether to purchase an anti-cholesterol rug and, if so, which drug to buy. The model permits flexible substitution patterns among drug choices and persistence in those choices by incorporating both observed and unobserved consumer heterogeneity. The estimates suggest that lower income patients without prescription drug insurance are very price sensitive: they are less likely to use drugs and, if they do use them, they tend to purchase the less expensive drugs. I find that roughly 500 thousand individuals without drug insurance who are currently not purchasing anti-cholesterol drugs would do so in the counterfactual world in which they are given the standard co-payment plan. The second paper also looks at consumer demands for anti-cholesterol drugs. While the first paper focused on the differentiated products, this paper explores the market expansion effects of direct-to-consumer advertising (DTCA). The study combines the individual data used in the first paper with monthly expenditure data on DTCA for the period 1996-2002. The dynamic demand model estimated in this paper explores the heterogeneous effects of DTCA. Overall, I find a positive effect from DTCA with short term elasticity of 0.107. Through persistence in consumer demand this effect lasts over multiple time periods. I find that individuals not taking a cholesterol drug respond more to advertising than those on the drug. In addition, I find that less educated individuals, those that may be unaware of their health condition, and those without health insurance are most responsive to DTCA. Finally, the third paper studies the effect of product ownership and quality on entry in the airline industry. Specifically, this paper empirically examines the decision of an airline to offer high quality nonstop service between cities given that the airline may or may not be offering lower quality one-stop service. I find that airlines that offer one-stop service through a hub are less likely to enter that same market with nonstop service than those that do not. In addition, the quality of the one-stop service is another determinant of entry. Airlines are more likely to enter a market with nonstop service if their own or their rival's one-stop service in the market are of lower quality. / text

Known as direct-to-consumer advertising (DTCA), pharmaceutical companies in the United States are permitted to advertise prescription drugs directly to consumers. The purpose of this quantitative study was to determine if an association exists between DTCA and health care-seeking behaviors. The theoretical framework for this study involved social learning theory, information integration theory, and prospect theory. The research questions identified if exposure to DTCA (a) is associated with physician office visits, (b) influences a patient/physician conversation regarding a prescription, (c) influences requesting a prescription, and (d) has an impact on patients' ratings of the overall interaction with the physician. Data were derived from an online survey adapted from the U.S. Food and Drug Administration. Participants included 235 college-affiliated adults. Data were analyzed using descriptive statistics and analysis of variance. The Bonferroni correction was used to control the family-wise Type I error rate. The most significant findings of this study are that DTCA is associated with patients asking more questions, having more office visits, and patients having a lower overall health status. Future researchers should consider a non-college-affiliated sample and the post-implementation impact of the Affordable Care Act. This study helps to address the community challenges of how DTCA impacts prescription drug use and costs, as well as patients' understanding of the associated risks. Having knowledge of the impact of DTCA can help patients and their communities, employers, and governments make more informed decisions that will positively impact their health, wellbeing, and prescription expenses.