The entire thesis text is included in the research.pdf file; the official abstract appears in the short.pdf file; a non-technical public abstract appears in the public.pdf file. Title from PDF of title page (University of Missouri--Columbia, viewed on November 13, 2009). Thesis advisor: Dr. Glenn Leshner. Includes bibliographical references.

As patient access to laboratory testing outside the clinic grows, healthcare providers can expect to confront increasing questions about the utility and interpretation of consumer-initiated laboratory tests, including germline genetic testing. The aim of this study was to characterize the current marketplace diversity of what has traditionally been labeled “direct-to-consumer” genetic testing options. A horizon scan was carried out with lab tests meeting the following criteria: (1) available for purchase in U.S. between October 1, 2019, and September 30, 2021, (2) capable of using germline genetic testing to assess risk of at least one diagnosable health condition, and (3) ability to purchase without visiting a provider. We will refer to these tests as “consumer-initiated tests”. Searches were completed of the National Center for Biotechnology Information’s Genetic Test Registry, the U.S. Food and Drug Administration’s list of nucleic acid-based tests, and the International Society of Genetic Genealogy Wiki webpages. In addition, searches were performed on the three largest U.S. search engines and the three largest online retailers. In the initial search, 300 labs were identified. The websites of these laboratories were then reviewed for test offerings that matched the criteria for this study; labs without tests meeting these criteria were eliminated. Information regarding the ordering process, test characteristics, and return of results was abstracted from and validated by the webpages, sample test reports, and lab contacts through email and/or phone. In the final review of 21 laboratories that offered these tests, two primary models of testing were identified. In Model 1, a participant could pay for testing without any provider involvement. In Model 2, a participant could order a test after electing review by a company-affiliated healthcare provider. Methodologies varied from array-based genotyping to whole genome sequencing, and companies reported individual variants, complex traits, or both. Several labs also offered report customization, reporting of variants of uncertain significance, raw data downloads, and added health reports. The market for participant-initiated genetic testing for health risks continues to grow as patients seek information about their disease predisposition outside of traditional healthcare settings. Moreover, these patients can obtain raw data for reinterpretation through these testing modalities. Understanding these many test offerings can better equip primary care providers in fielding patient questions on resources such as this.

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Hochschule, Diplomarbeit]--Pforzheim. / Literaturverz. S. 111 - 120. Text in dt., Zsfassung in engl.

Purpose: To evaluate the factors that influence potential orthodontic patients choosing between an orthodontist, general dentist, and direct-to-consumer (DTC) aligners for their treatment, and to determine the demand for each provider type. Methods: An electronic survey was administered to 250 individuals among the general population of adults in the United States. Questions were designed to determine the respondent’s level of interest in pursuing orthodontic treatment with each provider type, evaluate their current level of knowledge concerning provider options, and identify factors influencing their selection. Pearson’s chi-squared test and ANOVA were used to evaluate the factors influencing patients in their selection. Results: When asked their preference in provider type, 43.8% of respondents selected orthodontist, 34.1% selected DTC aligners, and 22.1% selected general dentist. Among respondents with the highest level of interest in pursuing orthodontic treatment, 50% selected an orthodontist and 27% selected DTC aligners. For respondents with moderate levels of interest in pursuing treatment, only 21% selected an orthodontist and 48% selected DTC aligners. The biggest perceived advantage of treatment with an orthodontist was quality of treatment, and the biggest disadvantage was cost. For DTC aligners, the biggest perceived advantage was convenience, followed by cost, and the biggest disadvantage was quality of treatment. Among adults with children, 34% selected DTC aligners for themselves and only 16% selected DTC aligners when selecting for their children. Conclusion: Adults in the United States have similar levels of interest in pursuing orthodontic treatment with orthodontists and DTC aligners and, to a lesser degree, general dentists. A significant portion of those who select DTC aligners for their treatment are patients who would not have otherwise undergone treatment with an orthodontist. Patients tend to select orthodontists due to quality of treatment, whereas DTC aligners are selected due to convenience, followed by cost. Even among parents who prefer DTC aligners for their own treatment, parents tend to select an orthodontist for their child’s treatment.

Some owners of small-farm wineries have moved to direct and alternative revenue management strategies to generate revenue and create brand awareness because of increased competition and regulatory changes. Research has revealed that owners of small-farm wineries remain financially reliant on direct-to-consumer sales through tasting rooms that represent an estimated 70% of their total revenue generated. This qualitative multiple case study was an exploration of how revenue management decisions of small-farm winery owners may contribute to long-term survival in a regulated industry. Dynamic capabilities concept was the conceptual framework for this study. The study population consisted of 3 small-farm winery owners in Connecticut who have operated a winery with Connecticut Grown designation for at least 10 years. Data were collected through semistructured interviews, organizational documents, observation notes, and review of each winery's website. Three themes emerged from data analysis: focus on brand and customer base, constraints consideration, and competitors' impact. The findings and recommendations from this study may further small-farm winery owners' understanding of revenue management strategies they can use to overcome constraint challenges and mitigate competitors' impact. As small-farm winery owners improve profitability and sustain long-term survival, subsequent positive social change, such as small business development and increased employment opportunities, may lead to economic prosperity for the local community and financial stability of community residents.

Thesis (MA)--University of Montana, 2009. / Contents viewed on November 24, 2009. "Major Subject: Communication Studies" Title from author supplied metadata. Includes bibliographical references.

This thesis explores the subject positions available to users of genetic tests for bipolar disorder in the United States. In advanced liberal societies, tests for genetic susceptibility to complex disorders may be promoted and used as means of performing responsible citizenship through the consumption of health care services. In the context of mental illness, however, key assumptions about the characteristics of consumers may not be met. The research found that because the category of “potential test user” substantially overlaps with the category of “mental health care user,” both the rationality and autonomy of these individuals is subject to question. Test users are framed in relational terms: as family members, as patients, and as consumers – but the last of these relational frames is considered problematic. Therefore, while the tests are framed as tools for proactive health management, responsibilities surrounding their use are largely allocated to family members and doctors.

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.