Association of Direct-to-Consumer Advertising of Prescription Drugs With Consumer Health-Related Intentions and Beliefs Among Individuals at Risk of Cardiovascular Disease

IMPORTANCE: Consumers in the US are exposed to unprecedented high levels of direct-to-consumer advertising (DTCA) for prescription drugs, yet there is limited evidence regarding their effect on health-related intentions and beliefs. OBJECTIVE: To provide evidence on the association of DTCA for prescription drugs with consumer health-related intentions and beliefs. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study recruited participants from a nationally representative sample of individuals at high risk of cardiovascular disease. Participants were randomly assigned into 1 of 3 study arms: (1) exposure to DTCA for heart disease medications (treatment 1 [n = 926]), (2) exposure to DTCA for heart disease medications with price disclosure (treatment 2 [n = 921]), (3) and exposure to nonpharmaceutical advertising (control group [n = 902]). Each study arm viewed five 1-minute video advertisements, totaling 5 minutes of advertising exposure. The 2 treatment arms viewed pharmaceutical advertising videos for 4 heart disease medications, and the control arm viewed nonpharmaceutical advertising videos. Participants then completed a survey questionnaire to measure medication- and lifestyle-related intentions and health-related beliefs and perceptions. EXPOSURES: Direct-to-consumer advertising for heart disease medications (treatment 1), DTCA for heart disease medications with price disclosure (treatment 2), and nonpharmaceutical advertising (control group). MAIN OUTCOMES AND MEASURES: The primary outcomes included ordinal measures of medication- and lifestyle-related intentions, health-related beliefs, and brand perceptions. RESULTS: Among the 2874 included participants (mean [SD] age, 53.8 [7.1] years; 1549 [54%] male) χ(2) tests confirmed that there were no statistically significant differences in baseline demographic characteristics across study arms. There was a positive association between DTCA and medication-related behavioral intentions, including intention to switch medication (marginal effect [ME] = 0.004; P = .002) and engage in information-seeking behaviors (ME = 0.02; P = .01). There was no evidence that pharmaceutical DTCA discouraged use of nonpharmacological lifestyle interventions that can help manage heart disease (eg, diet and exercise), and DTCA exposure also had a positive association with consumers’ favorable perceptions of pharmaceutical manufacturers (competence: ME = 0.03; P = .01; innovative: ME = 0.03; P = .008). There was no evidence for differential associations of price disclosures in DTCA. CONCLUSIONS AND RELEVANCE: In this cross-sectional study, results showed that brief exposure to pharmaceutical DTCA had a large and positive association with medication-related demand intentions with no offsetting negative spillovers on lifestyle-related intentions. Lack of associations with price disclosure in DTCA suggests that policy makers should consider alternative strategies to promote value-based decision-making for prescription drugs.