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T H E P U B L I C H E A L T H I M P A C T O F D I R E C T - T O -C O N S U M E R

ADVERTISING OF PRESCRIPTION DRUGS


REPORT TO FUNDERS

Joel S. Weissman, Ph.D.


David Blumenthal, MD
Alvin J. Silk, Ph.D.
Kinga Zapert, Ph.D.
Michael Newman, MPP
Robert Leitman, MA

February 12, 2003


TABLE OF CONTENTS
Page #

Introduction ....................................................................................................................... 2
Background...................................................................................................................... 2
Research Questions......................................................................................................... 2
Project Team.................................................................................................................... 3
Project Responsibility ....................................................................................................... 3
Public Release of Survey Findings ................................................................................... 3

Overview ............................................................................................................................ 4
Sample and Methods ....................................................................................................... 4
Questionnaire development.............................................................................................. 5
Variables and relevant subpopulations............................................................................. 5

Main Findings .................................................................................................................... 8


DTCA as a Source of Information..................................................................................... 8
DTCA-prompted Discussions with Physicians .................................................................. 8
Physician Actions Following DTCA Discussions............................................................. 11
Self-reported Patient Health Outcomes .......................................................................... 14

Methodology.................................................................................................................... 17
Sample Design............................................................................................................... 17
Data Collection & Survey Procedures ............................................................................ 19
Response Rate .............................................................................................................. 21
Weighting the Data......................................................................................................... 25
Reliability of Survey Percentages................................................................................... 26

Appendix A: Questionnaire ........................................................................................... 28

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The Public Health Impact of Direct-to-Consumer Advertising of Prescription Drugs

INTRODUCTION

The Pubic Health Impact of Direct-to-Consumer Advertising of Prescription Drugs was


conducted by Harris Interactive Inc. in partnership with Harvard Medical School. The project
was supported by a grant from the American Medical Association-Industry Roundtable
Steering Committee and selected members of the Ad Hoc Working Group on the Economics
of the Pharmaceutical Industry (AstraZeneca, Aventis, Bristol-Myers Squibb, Johnson &
Johnson, Merck, Pharmacia, Pfizer, Wyeth, and the National Pharmaceutical Council). The
research project included a telephone survey of 3,000 U.S. adults (18 years of age and older),
a mail survey of 600 physicians, and an online survey of 6,000 individuals with selected
chronic conditions (Arthritis, Diabetes, Depression/Anxiety Disorder. The fieldwork for the
cross-section of U.S. adults was conducted between July 9th, 2001 and January 16th, 2002.
This report focuses on results from the survey of the public.

Background
There is scant research on the health effects of direct-to-consumer advertising of prescription
drugs (DTCA). Prior surveys by the FDA, Prevention magazine, and others consider only
indirect effects of DTCA on health by examining consumer understanding of advertisements
and the effect on patient-doctor interactions. From these surveys it is known that most
Americans are aware of DTCA, and that a large minority are having discussions about
advertised drugs with physicians. However, past investigations have not explored the types of
conditions that are discussed with physicians during these conversations, the actions that
result from discussions about DTCA between doctors and patients, and the impact, if any, on
health outcomes.

Research Questions
Using a nationally representative sample of adults who have discussed advertised drugs with
their physicians, this research focuses on health care experiences and outcomes, rather than
opinions and attitudes. The underlying assumption is that DTCA prompts patients to discuss
advertised drugs during physician visits, and leads to actions taken that result in health-related
outcomes. Using patient reports, our research addresses three general questions: 1) What
health care actions are taken by consumers mostly or partly due to DTCA? 2) What actions
are taken by physicians -- including additional tests and treatments and identification of new
diagnoses -- as a result of visits that included DTCA-prompted discussions? 3) What
outcomes of care are associated with these visits?

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The Public Health Impact of Direct-to-Consumer Advertising of Prescription Drugs

Project Team
The authors of this study are Joel Weissman, PhD, and David Blumenthal, M.D. of Harvard
Medical School/Massachusetts General Hospital; Alvin Silk, PhD of the Graduate School of
Business Administration, Harvard University; and Robert Leitman, MA, Kinga Zapert, PhD.,
and Michael Newman, MPP of Harris Interactive.

Project Responsibility
The data reported here are from a telephone survey designed by a team of researchers from
Harvard University and Harris Interactive Inc. The team had full control over the determination
of the topics, question wording, access to the data, and interpretation of the results.

Public Release of Survey Findings


All Harris Interactive surveys adhere to the code of standards of the Council of American
Survey Research Organizations (CASRO) and the code of the National Council of Public Polls
(NCPP). Because data from the survey may be released to the public, any release must
stipulate that the complete report is also available. As with all Harris surveys which are
publicly released, Harris Interactive takes responsibility for insuring that the survey is fair and
balanced, and that it will not mislead the public and policy makers.

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The Public Health Impact of Direct-to-Consumer Advertising of Prescription Drugs

OVERVIEW

Concerns over the costs of Direct-to-Consumer Advertising (DTCA) have prompted actions to
limit access to heavily advertised drugs. Past research on DTCA has focused on economic
trends, consumer attitudes, and content of the advertisements. This study focused on the
effects of DTCA on the health and healthcare of consumers, which has received little attention
in past research. We conducted a telephone survey with a national probability sample of
3,000 adults to elicit healthcare experiences and outcomes associated with DTCA. The
survey identified consumers familiar with DTCA, as well as those who had a physician visit
during which a DTCA-prompted discussion took place. The survey then assessed: 1) health
care actions taken by consumers mostly or partly due to DTCA; 2) actions taken by
physicians, including new diagnoses, new prescriptions, or lifestyle recommendations; and, 3)
improvement or worsening of overall well-being, symptoms, and drug-related side effects, and
compliance with medication regimens.

Among the 86% of respondents who saw or heard an ad in the last year, 20% improved their
diets and 18% became better at taking their drugs, mostly or partly due to DTCA. About one-
third of all respondents were prompted by DTCA to have a discussion about their health during
a visit with a doctor. Twenty percent of patients received a new diagnosis as a result of their
visit. Approximately 36% of new diagnoses and 50% of existing conditions were considered
high priority (arthritis, hypertension, depression, and others) according to a list compiled by at
least one authoritative source. Results generally did not vary for respondents who were
heavily influenced by DTCA to see their doctor.

Among patients who received a prescription and took it as prescribed, about four out of five
reported feeling better after taking the drug, and a similar proportion reported that symptoms
improved and that results of lab tests showed a change for the better. About one-third of all
patients reported experiencing side effects from their new medications. Among patients who
switched drugs as a result of their visit, those who switched to DTCA drugs were more likely to
report a reduction in the severity of side effects compared with those who switched to non-
DTCA drugs (p=.041).

This study demonstrates the positive medical and health effects of DTCA. Many adults are
motivated to engage in healthy behaviors as a result of ads they have seen. Advertisements
also help motivate patients to discuss personal health problems and issues with their
physician. Many patients who discuss health concerns with their physicians as a result of drug
ads that they saw or heard in the media perceive positive health effects to occur from the visit
and few report adverse health consequences from taking DTCA drugs. These effects on
health and healthcare should be considered in future debates about the overall impact of
DTCA.

Sample and Methods


Telephone interviews with a national probability sample of 3000 adults were conducted by
Harris Interactive between July 9, 2001 and January 16, 2002 using random digit dialing and
random household member selection procedures. A number of steps were taken to increase

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The Public Health Impact of Direct-to-Consumer Advertising of Prescription Drugs

response rates. An incentive was offered for completion of the interview. Where telephone
numbers of non-respondents could be matched with an address, letters were mailed to non-
respondents explaining the purpose of the survey and encouraging response. A toll-free
telephone number was made available allowing respondents to complete the survey at a time
convenient to their schedules. In addition, attempts were made to contact non-respondents at
various times of the day and days of the week. The unadjusted response rate was 53%.
Adjustments based on the estimated proportion of cases of eligible households yield a
response rate of 58%.

Questionnaire development
The survey was designed to gather data primarily on specific health care experiences taking
place during ambulatory visits with physicians. To develop the survey questions, we
performed an extensive literature review and then held a focus group run by a professional
facilitator in Boston on January 25th, 2001. The instrument underwent cognitive testing to
ensure good comprehension. The wording of specific questions was revised based upon our
findings, and the revised questionnaire was pilot-tested with 20 respondents.

The survey was initially conceived with the goal of comparing healthcare experiences of
patients who were aware of DTC advertisements with those who were not. However, prior
research from the FDA as well as our own pre-test demonstrated that exposure to DTCA in the
U.S. is nearly universal. An alternative design was tested that would compare patients who
were prompted solely by DTCA to schedule a physician visit with patients who had a physician
visit that was not prompted by DTCA. This also was rejected because our pre-testing
suggested that patients schedule appointments with physicians for a variety of reasons, often
based on multiple sources of health information. Very rarely would consumers identify DTCA
as the sole reason for scheduling the visit. Therefore, the current study focuses for the most
part on the healthcare experiences of patients resulting from physician visits during which they
discussed a health issue or concern partly or wholly attributed to a DTC advertisement.

Variables and relevant subpopulations


The survey was designed to ask specific questions tailored to subpopulations of patients’
defined by their familiarity with DTCA and by relevant medical events. The largest group
included all respondents regardless of medical history (n=3000), who were asked questions
about health status, presence of chronic illnesses, and sociodemographic characteristics (sex;
race/ethnicity, education, insurance status, and drug coverage).

Next, we used questions similar to those employed by the FDA to determine whether
respondents had heard or seen a DTC ad in the last year. Among those responding positively
(86% of all respondents), we asked about actions they took in the past year to improve their
health (exercise, diet, smoking/drinking, becoming better at taking medications as directed,
taking personal control over health), and whether those actions were taken mostly or partly
due to DTCA.

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The Public Health Impact of Direct-to-Consumer Advertising of Prescription Drugs

The third group included respondents who had ever been prompted by a DTC ad in the past
year to talk to a doctor about a DTCA drug or other health issue or concern (35% of
respondents). We refer to these as DTCA discussions or DTCA visits. DTCA visits were
categorized by whether the patient primarily discussed a drug, a new health concern, or a
possible change in treatment for an on-going concern. Subsequent questions focused on the
content of a single DTCA visit, so if patients had more than one, we asked them to choose the
one that was most important to their health. Because pre-testing suggested that patients’
motivation to speak with their physician is multi-factorial, respondents also were asked to
identify other sources of information that influenced their decision to have the discussion with
their doctor (television, internet, print media, friends/family, pharmacists, doctors), and to note
which were the most important.

To learn about patients’ health problems, we relied on self reports. Patients were asked to
identify the condition or problem discussed during the visit, and whether the diagnosis or
condition had ever been confirmed (“Did a doctor or other medical professional ever tell you
that you had <the marker condition>”). These conditions were reviewed by a physician and
coded into a “reason for visit” using the classification system employed by the National
Ambulatory Medical Care Survey (NAMCS).1 A few conditions were either too general (e.g.,
“infections”) or merely mentioned a particular drug (e.g., “Viagra”) and so were not forced into
a NAMCS category.

A series of questions addressed actions taken as a result of the DTCA visit. We asked
whether the physician wrote a prescription or recommended an over-the-counter drug, made a
referral to a specialist, suggested a change in diet or exercise, ordered a laboratory test, or
suggested limitations in smoking or drinking. For respondents who were prescribed a drug,
we asked whether it was the same as in the DTC ad, whether it represented a new therapy,
and whether the patient filled the prescription.

A fourth subgroup included all respondents who were prescribed drugs as a result of their
DTCA visit and took it as prescribed (21% of respondents). They were asked a series of
questions on self-reported outcomes of care including presence of side effects, and
improvement/worsening of overall health, symptoms and laboratory results. Finally, among
respondents who had a DTCA visit and who reported switching medications to treat their
conditions (5% of respondents), we asked which drug had worse side effects (comparing the
“old” drug to the “new” drug) and which drug was easier or more difficult to remember to take
(compliance). If one drug had no side effects and the other did, we assumed that the drug
with side effects was worse.

Analysis

We identified three additional covariates of interest: 1) Health status: Because they may be at
higher risk for poor outcomes, we compared patients in fair or poor health with all other

1
National Center for Health Statistics. 1997 Reason for Visit Classification. CDC/NCHS. Available at:
http://www.cdc.gov/nchs/data/rvc97.pdf. Accessed April 30, 2002.

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The Public Health Impact of Direct-to-Consumer Advertising of Prescription Drugs

patients. 2) DTCA Influence: Because in some cases DTCA may have been only a minor
factor in patients’ decision to speak with their doctor, we analyzed two groups of patients –
those for whom DTCA was one of the two most important sources of information that
influenced them to have the health discussion with their doctor, and all others. 3) High Priority
Conditions: To address whether DTCA resulted in diagnosis of or treatment for conditions of
public health interest, we identified conditions or diagnoses that matched one of 15 “high
priority” conditions identified by the Agency for Healthcare Research and Quality and adopted
by the Institute of Medicine (IOM).2 3

Bivariate distributions were tested for significant differences using the chi-squared statistic.
After analyzing bivariate statistics, we adjusted the responses by direct standardization,
employing logistic regression models. The predicted logits were re-transformed to
percentages. This approach assigns each person the attribute of interest, e.g., fair/poor health
status, but all other characteristics are assumed to be at the sample mean. Statistical
inferences were based on the results of the underlying logistic regressions. Initial runs
included all the variables in Table 1, but since health status and insurance coverage for drugs
were the only variables that were consistently significant, the percentages were adjusted only
for those variables. However, because none of the results changed by more than a
percentage point or two, we present only the unadjusted results.

Analyses were performed with SPSS. To account for non-response, all responses were
weighted so as to represent a national sample, using estimates from the March 2001 Current
Population Survey. To account for possible recall bias, we repeated the analyses for just
those respondents who had a DTCA discussion in the three months prior to the interview.

2
Medical Expenditure Panel Survey. MEPS HC-006R: 1996 Medical Conditions. Available at:
www.meps.ahrq.gov/catlist.htm.
3
Institute of Medicine. Committee on Quality of Health Care in A. Crossing the quality chasm: a new health system
for the 21st century. Washington, D.C.: National Academy Press; 2001.

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The Public Health Impact of Direct-to-Consumer Advertising of Prescription Drugs

MAIN FINDINGS

DTCA as a Source of Information


Advertising is an important information tool for consumers. One-quarter of all adults (26%) say
they often receive information on health care topics from television, radio, or print
advertisements (Exhibit 1). Only physicians are cited more frequently as a health care
information source.
Exhibit 1:
Percentage of adults who receive health care information
Approximately 86% of all
"often" from the following sources adults saw or heard a DTC ad
in the last year.

Doctor These advertisements help


28%
promote healthy activities.
Advertisements 26%
One-quarter of adults who
Family and friends 20% have seen an advertisement in
the last year (26%) have
Newspapers and magazines 16%
started taking more personal
Television or radio 15% control over their health care
“mostly” or “partly” due to
Pamphlets in MDs' office 13%
prescription drug
Pharmacist 11% advertisements they have seen
(Exhibit 2). Other health
Internet 8%
improvement activities that
respondents reported pursuing
“mostly” or “partly” due to
DTCA were: looking for more information about an advertised drug (31%); improving their diet
(20%); improving drug compliance (18%); more exercise (17%); and, improved smoking or
drinking habits (8%).

DTCA-prompted Discussions with Physicians


One-third of adults (35%) have been prompted by a DTC ad to have a discussion about a
DTCA drug or other health concern during a visit with a physician (Exhibit 3). (In this report, we
refer to a physician office visit in which a patient was prompted to discuss a health concern as
a “DTCA visit.”) Most adults (66%) who had a DTCA discussion with their physician were very
satisfied with the way their doctor addressed their concerns (Exhibit 4).

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The Public Health Impact of Direct-to-Consumer Advertising of Prescription Drugs
Exhibit 2:
Among Adults Who Have Seen a DTC Advertisement in \the Last Year, Percentage
that Pursued Selected Health Activities Mostly or Partly Due to DTCA

Looked for more information about an advertised drug 31%

Started taking more personal control over their health 26%

Improved their diet 20%

Became better at taking Rx as prescribed 18%

Began exercising more often 17%

Improved their smoking/drinking habits 8%

Exhibit 3: DTCA Discussions Among All Adults

All Adults
(n=3000)

Adults who have been prompted by DTCA to have a discussion about their health with a doctor (net): 35%

Patient discussed:
A prescription drug 27
A possible change in treatment for an existing medical condition or illness 17
A medical condition, illness or other health concern that they had not discussed with a doctor before 16
Other health concern 2

Nearly two-fifths of adults (37%) who have had


a DTCA visit talked about a prescription drug, Exhibit 4:
about one in five (22%) discussed a new Patient Satisfaction with the Way Physician
Addressed the Health Concern during DTC Visit
concern that they had not previously discussed
with a physician, and about one-third (36%)
talked about a possible change in treatment for
66%
an on-going condition (Exhibit 5).

Of adults with a DTCA visit, about 19% (n=198)


were in fair/poor health and 45% (n=474) were
25%
highly influenced by DTCA to have the
discussion with their physician.4 People in good 8%
health or who were highly influenced by DTCA
were more likely than others to have a DTCA
Very Satisfied Somewhat Somewhat or
discussion about a particular prescription drug satisfied very dissatisfied
rather than about new or on-going health
concerns (p<.01).

4
Respondents were asked what other sources of information besides a DTCA influenced them to have the
discussion with their physician. Respondents who said no other source influenced them, respondents who said
only one other source influenced them, and (among those who said three or more sources influenced them)
respondents who said DTCA was the most influential source were categorized as “highly influenced” by DTCA.

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The Public Health Impact of Direct-to-Consumer Advertising of Prescription Drugs

Exhibit 5: Type of Discussions Among Adults Who Have Had a DTCA Visit

All adults who


Patient’s
have had DTCA
discussion Health Status DTCA Influence
(n=1039) (n= 1035) (n=1022)

Exc/Gd Fair/Poor High Low


(n=837) (n=198) (n=474) (n=548)

Type of DTCA Discussion Reported


About Prescription drug 37.4 40.8 26.1 41.9 34.6
About new health concern 21.9 23.8 19.6 20.0 25.9
About Change for On-going concern 35.6 30.8 45.2 34.5 32.1
Other 5.0 4.5 9.0 3.6 7.4
P = .000 P = .003
# DTCA visits are defined as visits with a physician during which a DTCA-prompted discussion occurred about a DTCA drug or
other health concern.

Exhibit 6: Diagnosis of Discussed Conditions Among Adults Who Have Had a DTCA Visit

All adults who


Patient’s
have had DTCA
discussion Health Status DTCA Influence
(n=1039) (n= 1035) (n=1022)

Exc/Gd Fair/Poor High Low


(n=837) (n=198) (n=474) (n=548)

Conditions and Diagnoses*


Existing condition 46.4 42.4 63.4 48.4 44.9
New diagnosis/condition 24.7 26.5 17.3 21.4 27.8
Condition not confirmed by physician 20.1 22.5 10.9 22.0 18.5
or healthcare worker
Missing /Unknown 8.8 8.7 8.4 8.2 8.8
P = .000 P = .164
# DTCA visits are defined as visits with a physician during which a DTCA-prompted discussion occurred about a DTCA drug or
other health concern.

* Existing conditions refer to conditions, identified by the respondent, that were discussed during the DTCA visit, for which
respondents received confirmation (were ever told by physician or other healthcare worker that they had the condition),
and were reported to exist prior to the visit. New diagnoses / conditions refer to confirmed conditions that the patient
did not know existed or had not been diagnosed prior to the visit, as reported by respondent.

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The Public Health Impact of Direct-to-Consumer Advertising of Prescription Drugs

About one-half (46%) of adults with DTCA visits had previously been diagnosed with the
condition discussed during the visit, and nearly one in four were given diagnoses that were
new to them (Exhibit 6). Thus, nearly one in ten (9%) of all adults have received a new
diagnosis after having a DTCA discussion with their physician (Exhibit 7).

Approximately 43% of new diagnoses and


Exhibit 7:
51% of existing diagnoses were included Diagnosis Resulting from DTC Discussions Among
in the list of 15 “high priority” conditions All Adults
compiled by the Institute of Medicine
(Alzheimer’s disease, arthritis, asthma,
back problems, cancer, depression and Unknown
anxiety disorders, diabetes, emphysema, 3%

gall bladder disease, high cholesterol, Condition


not
HIV/AIDS, hypertension, ischemic heart confirmed
disease, stomach ulcers, and stroke/TIA). 7%
New
New and existing conditions are listed in Diagnosis
the table only if they were confirmed by a No DTC 9%
health professional (according to the discussion
respondent). Notably, 8.8% of patients 65%
did not specify a condition discussed
Existing
during the visit, and an additional 20.1% condition
were not confirmed, that is, the patient did 16%
not recall being told by a physician or
other health professional that they had the
condition that they raised in the
discussion with the physician.

Physician Actions Following DTCA Discussions


Exhibit 8 reports actions taken by physicians (reported by patients) as a result of the DTCA
visit. Nearly three-quarters of respondents with a DTCA visit (73%) received a prescription for
a drug. In about one-fifth of cases (22%) where the physician prescribed a drug, the
prescription represented a change in drug therapy; that is, the patient was taking a prescription
drug to treat the condition prior to the DTC visit and received a prescription for a different
medication after the DTC visit. Two in five (43%) DTCA visits, or over half of the DTCA visits
with a drug prescribed, resulted in a prescription for the DTCA drug that the respondent saw
advertised. Nearly half (48%) of patients who were not prescribed the advertised drug
reported that their physicians told them that the advertised drug was not right for them (Exhibit
8).

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The Public Health Impact of Direct-to-Consumer Advertising of Prescription Drugs

Exhibit 8:
Among Adults Who Were Not Prescribed the Advertised Drug, Percentage Report of
Why the Physician Did Not Prescribe the Advertised Drug

(n=518)
The advertised drug was not right for you 48.3%
Your current drug or treatment works well 37.8
The doctor wanted you to take a different drug 24.3
The doctor said you didn’t need a prescription drug 23.1
You did not have the condition the drug is used to treat 21.1
The doctor said you could use an over-the-counter drug 16.0
The advertised drug had side effects that you were not aware of 15.9
The advertised drug would cost more money 13.7
A less expensive drug was available 13.1
The advertised drug was not covered by insurance 8.4
Other reason 6.1
Not sure 6.3

Beyond prescribing a drug, DTCA visits resulted in other actions taken by physicians, including
referrals to specialists (33% of visits), lab tests (57%), and recommendations for over-the-
counter drugs (19%), lifestyle changes (52%), and reductions in smoking or drinking (34%).

Nearly all adults (95%) with a DTCA visit reported at least one action taken by the physician
on their behalf. Even after not counting respondents who received a prescription for the DTCA
drug they saw or heard advertised, 53% of all DTCA visits still resulted in at least one action
taken by their physician. Persons in fair/poor health and with high priority conditions generally
had more actions taken on their behalf, but they did not differ significantly from their healthier
counterparts in terms of the likelihood of receiving a DTCA drug. Persons highly influenced by
DTCA to have a discussion with their physician about a DTCA drug were no more likely than
others to be prescribed the advertised drug, but they were less likely than others to be referred
to specialists, have a lab test ordered, or have a lifestyle change suggested (p<.001). In
addition, 13% of patients with unconfirmed conditions or diagnoses did not have actions taken
(p<.001, not shown in table).

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The Public Health Impact of Direct-to-Consumer Advertising of Prescription Drugs

Exhibit 9: Actions Taken by Physicians Among Adults who had a DTCA Discussion

All Health Status High Priority Condition Diagnosis DTCA Influence


#
(n=953) (n=952 ) (n=752) (n=949) (n=940)

Fair/ All Exist-


Exc/Gd Poor Major Other ing New None High Low
(n=770) (n=182) P (n=374) (n=378) P (n=481) (n=271) (n=197) P (n=436) (n=504) p
Prescribed Any Drug 72.9 71.0 81.1 .006 81.4 79.8 .563 81.1 80.0 45.7 .000 71.4 73.8 .413
Prescribed DTCA Drug 43.3 43.5 42.9 .876 47.4 47.8 .933 49.1 44.7 28.8 .000 46.9 40.6 .061
Referred to specialist 32.6 27.5 53.5 .000 40.1 31.8 .018 35.8 35.7 21.2 .000 24.6 38.6 .000
Suggested lifestyle change 52.0 49.2 63.9 .000 66.0 42.7 .000 51.7 58.3 45.7 .025 45.2 57.3 .000
Recommended OTC drug 19.1 19.8 16.2 .264 14.4 23.6 .001 18.3 20.4 18.7 .788 19.9 18.4 .572
Ordered lab test 57.3 52.8 76.2 .000 72.1 50.4 .000 58.0 66.3 44.7 .000 50.4 62.3 .000
Suggested quit smoking/drinking 33.9 30.7 47.3 .000 42.0 28.7 .000 35.2 35.0 30.0 .382 31.5 35.9 .161
Patients reporting any action taken 95.2 95.1 95.1 .999 97.7 96.9 .459 96.3 99.2 87.1 .000 94.3 95.7 .315
Patients reporting any action taken
55.8 55.3 57.6 .578 52.7 50.5 .682 50.8 57.1 66.5 .003 51.3 59.1 .019
other than prescription for DTCA drug*
No action taken 4.8 4.9 4.9 .999 2.3 3.1 .459 3.7 0.8 12.9 .000 5.7 4.3 .315

Notes:
OTC drug – Over the counter drug
** - DTCA visits are defined as visits with a physician during which a DTCA-prompted discussion occurred about a DTCA drug or other health concern.
# - Excludes patients who could not identify any condition or reason for visit.
* - To calculate this number, we divided the number of respondents who were not prescribed a DTCA drug but reported at least one other action taken on their behalf by the
number of patients with a DTCA visit.

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The Public Health Impact of Direct-to-Consumer Advertising of Prescription Drugs

Self-reported Patient Health Outcomes


Exhibit 11 presents data on health outcomes for adults with a DTCA visit who received a
prescription drug and took it as prescribed (21% of all adults). About 4 out of 5 (80%) reported
that they felt much better or somewhat better overall, that their symptoms improved, and
among those with lab tests, that their test scores improved. Two-thirds (65%) reported an
increased ability to do their job or carry out their daily routine (Exhibit 10).

None of these effects varied by whether the patient received a DTC or other drug, or whether
they switched to a DTCA drug or to another drug. Furthermore, among patients who switched
prescription drugs for the same condition (5% of all adults), there was no significant advantage
noted by type of drug in the
Exhibit 10: ease of taking the drug
Patient Assessment on the Impact of Taking Prescribed Drug on (p=.712).
Ability to Do Job or Carry Out Daily Routine

About one-third (34%) of


68% adults who took their
Increased 65%
62% prescription drugs reported
Decreased
No impact
side effects, and this
percentage did not differ by
whether the drug was the one
28% 28%
25% they saw advertised, or
another drug. Among
10%
6% 7% patients who switched drugs,
fewer patients switching to
All patients who Patients who Patients who DTCA drugs reported side
received Rx received new switched effects than those switching
diagnosis medications to non-DTCA drugs (23% vs.
37%), but the difference was
only marginally significant
(p=.06). In addition, 37% of switchers reported experiencing side effects from the “old” drug,
but this did not vary by type of drug (p=.65, data not in table). However, when asked to
compare the old drug with the new drug, those who switched to DTCA drugs were less likely
than others to report that the new drug was worse (8% vs 22%), more likely to report that the
old drug was worse (36% vs 28%), and more likely to report an absence of side effects from
both the old and the new drug (55% vs 46%) (overall p=.041).

Because patient reports are subject to recall bias, we repeated the analyses for persons who
had a DTCA visit in the last three months (n=257, 25% of all DTC visits). Virtually all of the
figures were within a few percentage points of the results for the full sample, although fewer
differences were statistically significant due to the smaller sample sizes.

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The Public Health Impact of Direct-to-Consumer Advertising of Prescription Drugs

Exhibit 11: Health Outcomes Reported by Adults who Received a Drug After a DTCA visit
Type of Drug# Switched Drugs##
(n= 650) (n= 154)
To DTCA To Other
ALL DTCA Other Drug Drug
(n=650) (n= 357) (n= 293) (n= 79) (n= 75)
Overall

Much Better 56.3 55.1 57.8 54.2 51.4


Somewhat Better 24.8 26.2 22.7 31.9 26.4

About the Same 12.6 11.0 14.8 9.7 18.1

Somewhat Worse 3.2 3.6 2.9 1.4 2.8

Much Worse 2.1 2.8 1.1 2.8 -

Not sure; Missing 1.1 1.4 0.7 - 1.4

P = .333 P = .351

Results of Lab Tests* (n=217) (n=93) (n=124) (n=17) (n=33)

Change for the Better 84.3 86.2 82.3 93.8 86.7

Change for the Worse 2.8 4.3 1.8 6.3 3.3

No change, Not sure; Missing 12.9 9.6 15.9 - 10.0

P = .250 P= .394

Symptoms (n=650) (n= 357) (n= 293) (n=79) (n=75)

Much Better 56.4 55.8 57.4 57.5 54.2

Somewhat Better 27.4 26.2 28.9 26.0 29.2

About the Same 9.0 9.1 8.7 11.0 9.7

Somewhat Worse 1.8 2.5 1.1 1.4 1.4

Much Worse 0.9 1.1 0.4 1.4 1.4

Not sure/ Too soon/ Missing 4.6 5.2 3.6 2.7 4.2

P = .523 P = .993

Compliance** (n=154) (n=79) (n=75)

New drug is easier 28.2 -- -- 31.1 25.0

New drug is more difficult 8.0 -- -- 8.1 8.3

About the same 63.8 -- -- 60.8 66.7

P = .712

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The Public Health Impact of Direct-to-Consumer Advertising of Prescription Drugs

Exhibit 11: Health Outcomes Reported by Adults who Received a Drug After a DTCA visit
Type of Drug# Switched Drugs##
(n= 650) (n= 154)
To DTCA To Other
ALL DTCA Other Drug Drug
(n=650) (n= 357) (n= 293) (n= 79) (n= 75)
@@
Side Effects (n=650) (n=357) (n=293) (n=79) (n=75)

Yes 34.4 32.5 36.8 23.3 37.5

No 65.4 67.2 61.8 76.7 62.5

Not sure/ Too soon/ Missing 0.2 0.3 - - -

P = .142 P = .063

Side Effects – Which was worse?** (n=154) (n=79) (n=75)

New drug is worse 15.2 -- -- 8.2 22.2

Old drug is worse 32.0 -- -- 35.6 27.8

About the same 2.0 -- -- - 4.2

No side effects from either 49.8 -- -- 54.8 45.8

Not sure/ Too soon/ Missing 0.9 -- -- 1.4 -

P = .041

Notes:
# Type of Drug:
DTCA drug – refers to the advertised drug or drug discussed during the visit.
Other drug – refers to any drug other than the advertised drug discussed during the visit. It is likely that
some of these drugs are also advertised to consumers. Those who were not sure if they received the
advertised drug or another drug were classified in the other drug category.
## Switched Drugs: Patient reported that he or she had been taking a prescription drug for this condition or
problem prior to the visit, and was prescribed a different drug as a result of the visit.
* - Among persons who reported getting lab tests to determine if drug was working
@@ - For patients who switched drugs, this refers to side effects associated with the newer drug.
** - Percentage among those switching drugs.

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The Public Health Impact of Direct-to-Consumer Advertising of Prescription Drugs

METHODOLOGY

Sample Design
Harris Interactive conducted a 20-minute telephone interview with a nationally representative
sample of 3000 adults 18 years of age or older. The interviews were conducted from the
Harris Interactive telephone centers in Rochester, New York and Youngstown, Ohio between
July 9th, 2001 and January 16th, 2002. The study relied upon a stratified sampling process to
produce representative samples of persons in telephone households in the continental United
States (excluding Alaska and Hawaii). Households were selected through computerized
random digit dialing (RDD) generated through the Genesys Sampling System. This selection
process assured that the number of households assigned to each exchange in the
“community” was based on the proportion of households in that exchange. This sample
design ensured proper representation of households in different regions of the country and in
central city, suburban, and rural areas. The use of random-digit selection procedures also
assures sample representation of persons in households with telephone numbers “listed” in
telephone directories, as well as persons in households with telephone numbers that are
“unlisted.”5

To ensure a random selection of respondents at the household level, participants were


selected based on the “youngest male adult” technique that screens for the youngest adult
male adult, 18 years of age or older, living in the household.

Incidence Rates
The interview length varied depending on whether or not a respondent had seen a direct-to-
consumer prescription drug advertisement (DTCA), talked to a physician about information
presented in a DTCA, and the outcome of the discussion. All respondents were asked about
their health status and utilization. As Table 1 shows, 87% of adults have seen an
advertisement or been told about an advertisement by a friend or a relative. These
respondents were asked about their general views of DTCA and the impact of the ads on
health behaviors. Approximately one-third (35%) of adults discussed an advertised drug with
their physician. These respondents were asked detailed questions about physicians’
recommendations that resulted from these conversations, including whether or not they
received a prescription. Approximately, one-fifth (22%) of respondents received a prescription,
filled the prescription and took the drug as prescribed by their physician. These respondents
were asked about health outcomes associated with the drug they used.

5
Some households are “unlisted” as the result of a request for an unlisted phone number by the telephone
subscriber. Other households are “unlisted” in the published directory because the telephone number was
assigned after the publication date of the directory. Samples that are restricted to directory listed numbers only may
contain serious sample biases because of the exclusion of various types of unlisted households.

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The Public Health Impact of Direct-to-Consumer Advertising of Prescription Drugs

Table 1
Incidence Rates for Section Completion by Sample Type
Un-weighted data
N %

Seen or heard or have been told about an advertisement for a prescription drug 2601 87

Seen or heard an advertisement for a prescription drug 2563 85

Talked to physician during visit about health information from a DTCA 1039 35

Prescribed a prescription drug after DTCA discussion and took the drug as prescribed 650 22

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The Public Health Impact of Direct-to-Consumer Advertising of Prescription Drugs

Data Collection & Survey Procedures

The Use of Computer Assisted Telephone Interviewing


The Harris computer assisted telephone interviewing system (CATI) permits on-line data entry
and editing of telephone interviews. Questionnaires are programmed into the system with the
following checks:
1. Question and response series
2. Skip patterns
3. Question rotation
4. Range checks
5. Mathematical checks
6. Consistency checks
7. Special edit procedures
The CATI system reduces clerical error by eliminating the need for keypunching, since
interviewers enter the respondents' answers directly into a computer during the interview itself.
For questions with pre-coded responses, the system only permits answers within a specified
range; for example, if a question has three possible answer choices (e.g., "Provides", "Does
not provide", "Not sure"), the CATI system will only accept coded responses corresponding to
these choices. All data are tabulated, checked for internal consistency and processed by
computer. A series of computer-generated tables is then produced for each sample group
showing the results of each survey question, both by the total number of respondents and by
important subgroups.

Telephone Interviewing Procedures


All survey data collection was conducted from Harris' telephone research centers in
Rochester, New York and Youngstown, Ohio. Interviews were offered in English or Spanish.
Harris’ professional interviewing staff conducted the interviewing for this study and quality was
continuously monitored by the supervisory staff. Through direct supervision of the interviewing
staff and continuous monitoring of the interviews, a uniformity of responses was achieved that
could not have been obtained by other interviewing methods.

Interviewer Training
Interviewers received 2-day project specific training to familiarize them with the survey
instrument, practice techniques to overcome refusals and boost participation.

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The Public Health Impact of Direct-to-Consumer Advertising of Prescription Drugs

Mailings
In order to maximize the response rate, non-respondents for whom we could match an
address with a telephone number were sent a letter explaining the purpose of the survey and
encouraging them to participate. Respondents were offered a $10 incentive upon completion
of the survey. A total of seven mailings took place between July 23, 2001 and December 12,
2001. In addition, approximately halfway through data collection mailing packages that
included another letter and a $2 check were sent to 557 non-responders as an additional
incentive.

Two different types of letter were sent, one to households who had a “phone butler” which had
prevented any direct telephone contact, and one to households without any kind of call
blocking system. The “phone butler” letter explained that Harris had been calling and had
been unable to get through and encouraged the householder to call a toll-free number. The
“non-phone butler” letter reminded the householder that they may have spoken to someone
from Harris about the survey and also encouraged them to call in or agree to participate in the
survey next time an interviewer telephoned them.

Editing and Cleaning the Data


The data processing staff performed computerized edits and additional cleaning for the entire
data set. Our edit programs act as a verification of the skip instructions and other data checks
that are written into the CATI program. The edit programs list any errors by case number,
question number and type. These are then resolved by senior electronic data processing
personnel, who inspect the original file and make appropriate corrections. Complete records
are kept of all such procedures.

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The Public Health Impact of Direct-to-Consumer Advertising of Prescription Drugs

Response Rate

Sample Disposition and Raw Response Rate


Table 4 presents the final disposition of the two samples. The total sample of telephone
numbers was 11,715. Slightly more than half (52%) of the original numbers obtained were
ineligible either because they not working residential numbers (51%) or because of a language
barrier (1%)6.

The raw response rate is calculated by dividing the total number of interviews by the total
sample minus all the ineligible numbers.

Completes
Raw response rate calculation:
Total Sample – Not Eligible

3000
Raw response rate: = 53.37%
11715 – 6094

6
Note: interviews were conducted in English and Spanish. A language barrier was recorded when the selected
respondent spoke neither of these languages.

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The Public Health Impact of Direct-to-Consumer Advertising of Prescription Drugs

Table 4: Call Disposition by Sample Type


N
Interviews 3000

Eligible - no interview
Qualified Refusal (after screener) 142
Qualified Callback (after screener) 364
Subtotal 506

Not eligible WRN


Language Barrier 113
No one over 18 in household 0
Subtotal 113

WRN eligibility unknown


Initial Callback (during preamble) 911
Not Available 1
Phone Butler (Call Rejected) 463
Subtotal 1375

Unknown if WRN (no contact)


7
15 consecutive no answer/phone busy
No answer/answering machine/line busy 740
Subtotal 740

Not WRN
Business 1650
Phone Disconnect 3696
Fax Machine/Computer Tone 578
Cell phone/pay phone 57
Subtotal 5981

Total Sample 11715

WRN = Working residential number

7
Please note, some of these numbers were answered at some point in the dialing history, however, the last 15 calls
were either “no answer” or “phone busy” and therefore these numbers are considered “dead”.

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The Public Health Impact of Direct-to-Consumer Advertising of Prescription Drugs

Adjusted Response Rate


We were unable to determine the eligibility of some phone numbers in the sample. In some
cases (N=740) we were unable to determine if the phone number was a working residential
number. In other cases (N=1,375) we were able to identify the phone number as a working
residential number but we were unable to verify the eligibility of a household member. The
raw response rate was adjusted to account for the likelihood that a certain proportion of these
two groups of phone numbers would be ineligible for this study. After making these
adjustments, a final response rate of 58% was calculated. This section explains in detail this
adjustment.

Table 5 groups the sample disposition codes into four main groups: completes; working
residential numbers (WRN) with an eligible respondent identified or where the eligibility of the
respondent is unknown; ineligible numbers; and numbers where it is unknown whether it is a
residential household or not.

Table 5
Summary Disposition
Completes 3000

A. WRN eligible & eligibility unknown


B. WRN Eligible 506
C. WRN Eligibility unknown 1375
Subtotal 1881

D. Unknown if WRN 740

E. Not eligible
F. Not WRN 5981
G. Not eligible WRN 113
Subtotal 6094

Full Sample 11715

Two ratios were calculated to adjust the raw response rate:


P1: The Eligibility Ratio - the proportion of working residential numbers that are eligible.
This ratio was applied to numbers that are known to be working residential numbers
but it is unknown whether or not they are eligible (row C)
P2: The WRN Ratio – the proportion of numbers in an RDD sample that are working
residential numbers. This ratio was applied to numbers for which it is unknown
whether they are households (row D).

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The Public Health Impact of Direct-to-Consumer Advertising of Prescription Drugs

The final response rate was calculated in the following way.

Completes + WRN eligible


P1: Eligibility ratio =
Completes + WRN eligible + Not eligible WRN

3000 + 506
= 96.88%
3000 + 506 +113

Completes + WRN eligible & Eligibility unknown


P2: WRN ratio =
Completes + WRN eligible & Eligibility unknown + Not eligible

3000 + 1881
= 45.50%
3000 + 1881 + 6094

Adjusted Response Rate =

Completes
Completes + WRN eligible + (P1 x WRN Eligibility unknown) + (P2 x Unknown if WRN)

3000
= 57.97%
3000 + 506 + (0.9668 x 1375) + (0.4550 x 740)

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The Public Health Impact of Direct-to-Consumer Advertising of Prescription Drugs

Weighting the Data

The survey data were weighted by age, race, education, health insurance status (insured or
uninsured), household size and gender to reflect the demographic composition of the U.S.
population using the March 2001 Current Population Survey from the U.S. Census Bureau.
Table 6 presents the demographic profile of the unweighted and weighted data.

Table 6:
Comparison of Weighted and Unweighted Data
Unweighted Weighted
Base 3000 3000

Sex
Male 48 48
Female 52 52

Age
18-24 10.8 14.5
25-34 17.0 17.6
35-44 20.5 20.9
45-54 19.2 18.2
55-64 13.3 12.2
65 + 18.6 16.1

Race
White (non-Hispanic) 75.8 71.7
Black (non-Hispanic) 9.8 11.7
Hispanic 8.0 10.5

Education
Less than HS Graduate 8.7 11.1
HS Graduate 29.4 38.5
Some College 22.8 27.0
College 4 years 27.4 16.4
Post Graduate 11.3 6.6

Health Insurance
Insured 87.6 83.1
Uninsured 12.1 16.6

Adults in Household
1 30.3 16.4
2 51.6 56.3
3 or more 17.3 26.5

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The Public Health Impact of Direct-to-Consumer Advertising of Prescription Drugs

Reliability of Survey Percentages

The results from any survey are subject to sampling variation. The magnitude of this variation
is measurable and is affected both by the number of interviews involved and by the level of the
percentages expressed in the results.

Table A-1 shows the range of sampling variation that applies to percentage results for this
survey. The chances are 95 in 100 that the survey results do not vary, plus or minus, by more
than the indicated number of percentage points, from the results that would have been
obtained had interviews been conducted with all persons in the universe represented by the
sample.

For example, if the response for a sample size of 200 were 30%, then in 95 out of 100 cases
the response of the total population would be between 24% and 36%. Note that survey results
based on subgroups of a small size can be subject to large sampling error.

Sampling tolerances are also involved in the comparison of results from different surveys or from
different parts of a sample (subgroup analysis). Table A-2 shows the percentage difference that
must be obtained before a difference can be considered statistically significant. These figures,
too, represent the 95% confidence level.

For example, suppose one group of 100 has a response of 34% "yes" to a question, and an
independent group of 50 has a response of 28% "yes" to the same question, for an observed
difference of 6 percentage points. According to the table, this difference is subject to a potential
sampling error of 16 percentage points. Since the observed difference is smaller than the
sampling error, the observed difference is not significant.

Sampling error is only one type of error encountered in survey research. Survey research is also
susceptible to other types of error, such as data handling error and interviewer recording error.
The procedures followed by Harris Interactive, however, keep errors of these kinds to a minimum.

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The Public Health Impact of Direct-to-Consumer Advertising of Prescription Drugs

Table A-1
Approximate Sampling Tolerances (at 95% Confidence) to
Use in Evaluating Percentage Results Appearing in This Report
Number of People Survey Survey Survey Survey
Asked Question on Percentage Percentage Percentage Percentage Survey
Which Survey Result Result at 10% Result at 20% Result at 30% Result at 40% Percentage
is Based or 90% or 80% or 70% or 60% Result at 50%

500 3 4 4 4 4

400 3 4 4 5 5

300 3 5 5 6 6

200 4 6 6 7 7

100 6 8 9 10 10

50 8 11 13 14 14

Table A-2
Approximate Sampling Tolerances (At 95% Confidence) To Use in Evaluating
Differences between Two Percentage Results Appearing in This Report
Approximate Sample
Size of Two Groups Survey Survey Survey Survey
Asked Question on Percentage Percentage Percentage Percentage Survey
Which Survey Result is Result at 10% Result at 20% Result at 30% Result at 40% Percentage
Based or 90% or 80% or 70% or 60% Result at 50%

500 vs.500 4 5 6 6 6

200 5 7 8 8 8

100 6 9 10 11 11

50 9 12 13 14 15

200 vs. 200 6 8 9 10 10

100 7 10 11 12 12

50 9 12 14 15 15

100 vs. 100 8 11 13 14 14

50 10 14 16 17 17

50 vs. 50 12 16 18 19 20

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The Public Health Impact of Direct-to-Consumer Advertising of Prescription Drugs

APPENDIX A
QUESTIONNAIRE

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The Public Health Impact of Direct-to-Consumer Advertising of Prescription Drugs

HARRIS INTERACTIVE INC

PUBLIC HEALTH IMPACT OF PRESCRIPTION DRUG ADVERTISING

Field Period: July 5, 2001 – January 16, 2002

SUBJECTS FOR QUESTIONNAIRE

Section 200: Health Status and Utilization


Section 400: Experience with DTC Advertising
Section 600: Visit to Doctor to Discuss Information
Section 700: Outcomes
Section 800: Health Insurance
Section 100: Demographics

SECTION 200: HEALTH STATUS AND UTILIZATION

BASE: POTENTIAL RESPONDENTS


Q201 Hello, I’m _________________________ . On behalf of Harvard Medical School we’re
conducting a survey on health issues. In appreciation of your time, we would like to offer you an
honorarium of $10.00 if you qualify and complete this study. I’d like to speak to the youngest male in
this household 18 or over who is at home now. Would that be you or someone else? (USE
YOUNGEST MALE/ YOUNGEST FEMALE SELECTION METHOD)
(IF NEEDED: The survey takes 15 minutes on average.)
(IF NEEDED: All individual responses will be kept completely confidential. All findings will be analyzed
in the aggregate only and no one will have access to your individual responses. )
(IF NEEDED: Harris Poll and its partners want to know how people in the United States make decisions
about health care, and how Americans feel about the health care available to them.)
(IF NEEDED: Harris Poll is a national, independent research organization. Harris Poll conducts a lot of
research in the area of health and health care.)
(IF NEEDED: Harvard Medical School is part of Harvard University in Boston, Massachusetts.)
(IF NEEDED: Your telephone number was randomly generated by our computer system.)
(INTERVIEWER NOTE: REPEAT TO NEW RESPONDENT IF NECESSARY)

1 Continue JUMP TO Q210


2 Not available - call back SCHEDULE CALLBACK
8 Not sure TERMINATE
9 Decline to answer TERMINATE

BASE: ALL QUALIFIED RESPONDENTS


(INTERVIEWER OBSERVATION)
Q210 Respondent sex:

1 Male 48
2 Female 52

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The Public Health Impact of Direct-to-Consumer Advertising of Prescription Drugs

BASE: ALL QUALIFIED RESPONDENTS


Q214 Overall, how would you describe your health – excellent, very good, good, fair or poor?

1 Excellent 21
2 Very good 30
3 Good 31
4 Fair 12
5 Poor 5
8 Not sure (v) *
9 Decline to answer (v) *

BASE: ALL QUALIFIED RESPONDENTS


Q218 How long has it been since the last time you saw a doctor where you talked about a health
condition or concern of your own, not for a child or parent or someone else? We’re interested in
your last non-emergency visit to a doctor.

1 Within the last three months 52


2 More than three months, but less than one year ago 25
3 More than one year ago 23
8 Not sure (v) *
9 Decline to answer (v) *

BASE: ALL QUALIFIED RESPONDENTS


Q220 Do you have a regular doctor that you usually go to when you are sick or need medical advice?

1 Yes, have a regular doctor 80


2 No, don’t have a regular doctor 20
8 Not sure (v) *
9 Decline to answer (v) *

BASE: ALL QUALIFIED RESPONDENTS


Q230 In this survey, we will be asking a number of questions about prescription drugs and over-the-
counter drugs. Prescription drugs are medicines that you can only get with a doctor’s written
orders. Over-the-counter medicines are drugs that you can buy without written orders from a
doctor. Do you currently take any prescription drug on a regular basis?

1 Yes 49
2 No 50
8 Not sure (v) *
9 Decline to answer (v) *

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The Public Health Impact of Direct-to-Consumer Advertising of Prescription Drugs

BASE: ALL QUALIFIED RESPONDENTS


Q254 Have you ever been told by a doctor or another health professional that you have any of the
following conditions (READ EACH ITEM)?
1 2 8 9
Not Decline to
[RANDOMIZE ITEMS] Yes No Sure Answer

1 Diabetes 7 92 * *
2 Depression 12 87 * *
3 Arthritis 20 80 * *
4 Cancer 6 93 * *
5 Heart disease 8 92 * *
6 Hypertension or high blood pressure 23 77 * *
7 Allergies 26 73 * *
8 High cholesterol 20 79 1 *
9 Asthma or other problems with your lungs 12 88 * *
10 Stroke 3 97 - *
11 Anxiety 11 89 * *
12 Other emotional or mental illness ANCHOR 2 97 * *
13 Any other chronic illness, medical or health condition that
has lasted or is expected to last at least 12 months ANCHOR 15 84 1 *

[PROGRAMMER: IF HAVE CHRONIC CONDITION (Q254/ANY 1-13 AND Q255/1) ASK Q260;
OTHERWISE JUMP TO Q264]

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The Public Health Impact of Direct-to-Consumer Advertising of Prescription Drugs

BASE: HAVE CHRONIC CONDITION (Q254/ANY ITEM 1-13 AND Q255/1)


Q260 Do you take any prescription medications to treat [INSERT CONDITION FROM Q254/1-13 if
Q255/1]?

(PROGRAMMER NOTE: KEEP ONLY RESPONSES SELECTED AT Q254/1-13 if Q255/1 AND


ALWAYS KEEP ITEMS Q254/12 AND 13)
1 2 8 9
Not Decline to
Yes No Sure Answer

1 Diabetes 74 26 - -
2 Depression 52 48 * -
3 Arthritis 36 64 * -
4 Cancer 15 85 - -
5 Heart disease 71 29 * -
6 Hypertension or high blood pressure 78 22 - -
7 Allergies 40 60 * -
8 High cholesterol 48 52 - -
9 Asthma or other problems with your lungs 48 52 - -
10 Stroke 39 58 3 -
11 Anxiety 48 52 * -
12 Other emotional or mental illness ANCHOR 2 64 * *
13 Any other chronic illness, medical or health condition that has
lasted or is expected to last at least 12 months ANCHOR 14 51 * *

BASE: ALL QUALIFIED RESPONDENTS


Q264 I’m going to read a list of sources that provide health care information. How often do you get
information about health care from (INTERVIEWER NOTE: READ EACH ITEM) – often,
sometimes, hardly ever or never?
Q265 1 2 3 4 8 9
Hardly Not Decline to
Often Sometimes Ever Never Sure Answer
[RANDOMIZE ITEMS]

1 Television or radio, not including advertisements 15 31 26 27 1 *


2 Internet websites 8 15 17 59 * *
3 Advertisements on TV or radio, in newspapers or
magazines 26 31 21 21 * *
4 Newspapers or magazines, not including
advertisements 16 30 25 28 1 *
5 Family and friends 20 37 24 19 1 *
6 A pharmacist 11 24 28 37 1 *
7 Pamphlets in a doctor’s office or waiting room 13 36 27 23 1 *
8 A doctor 28 38 21 12 2 *

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The Public Health Impact of Direct-to-Consumer Advertising of Prescription Drugs

SECTION 400: EXPERIENCE WITH DTC ADVERTISING

BASE: ALL QUALIFIED RESPONDENTS


Q400 The next set of questions concerns advertising for prescription drugs, including advertising on
TV, on radio, in magazines and newspapers and in pamphlets found in doctors’ offices or
waiting rooms.

Have you seen or heard an advertisement for a prescription drug within the past 12 months?

1 Yes, seen or heard an ad 83


2 No, have not seen or heard an ad 16
8 Not sure (v) *
9 Decline to answer (v) *

[IF SEEN OR HEARD AD (Q400/1) THEN ASK Q410; OTHERWISE (Q400/2,8,9) JUMP TO Q430]

BASE: SEEN OR HEARD AD (Q400/1)


Q410 Thinking about the advertisements you saw or heard in the past year, tell me whether you
strongly agree, somewhat agree, somewhat disagree or strongly disagree.

Prescription drug advertisements (INTERVIEWER NOTE: READ EACH ITEM)

1 2 3 4 8 9
Strongly Somewhat Somewhat Strongly Not Decline to
[RANDOMIZE ITEMS] Agree Agree Disagree Disagree Sure (v) Answer (v)

1 Made me aware of treatments that I did


not know about 28 43 14 13 2 *

2 Did not provide information on risks and


benefits in a balanced manner 19 31 26 20 3 *

3 Reminded me to follow directions or


advice from my doctor 41 30 12 14 3 *

4 Made me less confident in my


doctor’s judgment 6 13 24 53 4 *

5 Helped me to have better discussions about


my health with a doctor, pharmacist or other
health professional ANCHOR 27 37 16 17 2 *

[JUMP TO Q440]

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The Public Health Impact of Direct-to-Consumer Advertising of Prescription Drugs

BASE: HAVE NOT SEEN OR HEARD AD (Q400/2,8,9)


Q430 In the last 12 months, has a friend or family member told you about an advertisement for a
prescription drug that they saw or heard that they thought might be helpful to you?

1 Yes 9
2 No 90
8 Not sure (v) *
9 Decline to answer (v) *

[PROGRAMMER: IF TOLD ABOUT AD (Q430/1) ASK Q440;


IF NOT TOLD ABOUT AD/NS/DTA (Q430/2,8,9) THEN JUMP TO Q746]

BASE: SEEN OR HEARD OR WAS TOLD ABOUT AD (Q400/1 or Q430/1)


Q440 I am going to read a list of actions people take to improve their health. For each, please tell me
whether you have taken that action in the past 12 months. (INTERVIEWER NOTE: READ
EACH ITEM)
1 2 8 9
Not Decline to
[RANDOMIZE ITEMS] Yes No Sure Answer

1 Began exercising more often 60 40 * -


2 Improved your diet 67 33 * -
3 Improved your smoking or drinking habits 27 71 1 2
4 Became better at taking a prescription medicine as advised 44 54 1 1
5 Started taking more personal control over your health care 75 24 1 *
6 Looked for more information about a drug you saw or
heard advertised ANCHOR 30 70 * *

[PROGRAMMER: IF TAKEN MEDICAL ACTION AS A RESULT OF DTCA (Q440-ANY ITEM


1 to 6 AND Q441/1) ASK Q444; OTHERWISE JUMP TO Q448]

BASE: TAKEN MEDICAL ACTION AS A RESULT OF DTCA (Q440-ANY ITEM 1 TO 5 AND Q441/1)
Q444 Would you say that you (READ EACH ITEM) in the past year mostly due, partly due, or not at
all due to something you or someone else saw in a prescription drug advertisement?

[ONLY ITEMS IN Q440/1-5 & Q441/1 SHOULD APPEAR IN Q444]

Q445 1 2 3 8 9
Mostly Partly Not at (v) (v)
[DO NOT ROTATE ITEMS] Due to Due to all due to Not Decline to
DTCA DTCA DTCA Sure Answer

[PROGRAMMER NOTE: ITEMS SHOULD APPEAR IN THE SAME ORDER AS THEY APPEARTED IN
Q440]

1 Began exercising more often 13 14 72 1 -


2 Improved your diet 13 16 71 * *
3 Improved your smoking or drinking habits 14 14 70 1 *
4 Became better at taking a prescription medicine as advised 22 19 59 * *
5 Started taking more personal control over your health care 17 17 66 * -

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The Public Health Impact of Direct-to-Consumer Advertising of Prescription Drugs

[PROGRAMMER NOTE: ROTATE THE FOLLOWING PAIRS Q448-Q450, Q452-Q454, AND Q456-
Q458]

BASE: SEEN HEARD OR TOLD ABOUT AD (Q400/1 OR Q430/1)


Q448 Has an advertisement for a prescription drug ever prompted you to talk to a doctor about a
prescription drug for yourself?

1 Yes 31
2 No 68
8 Not sure (v) *
9 Decline to answer (v) *

[IF TALKED ABOUT PRESCRIPTION DRUG (Q448/1) ASK Q450; OTHERWISE JUMP TO Q452]

BASE: TALKED TO DOCTOR ABOUT PRESCRIPTION DRUG (Q448/1)


Q450 When was the most recent time you talked to a doctor about a prescription drug as a result of
something you saw or heard in a prescription drug advertisement? Was it within the last three
months, between 4 and 6 months ago, between 7 and 12 months ago, or more than one year
ago?

1 1-3 months ago 30


2 4-6 months ago 23
3 7-12 months ago 16
4 More than one year ago 31
8 Not sure (v) *
9 Decline to answer (v) -

BASE: SEEN HEARD OR TOLD ABOUT AD (Q400/1 OR Q430/1)


Q452 Has an advertisement for a prescription drug ever prompted you to talk to a doctor about a
medical condition, illness or other health concern of your own that you had not discussed with a
doctor before?

1 Yes 19
2 No 80
8 Not sure (v) *
9 Decline to answer (v) *

[IF TALKED ABOUT NEW HEALTH CONCERN (Q452/1) ASK Q454; OTHERIWSE JUMP TO Q456]

BASE: TALKED TO DOCTOR ABOUT NEW MEDICAL CONDITION (Q452/1)


Q454 When was the most recent time you talked to a doctor about a new medical condition, illness or
other health concern of your own as a result of something you saw or heard in a prescription
drug advertisement? Was it within the last three months, between 4 and 6 months ago, between
7 and 12 months ago, or more than one year ago?

1 1-3 months ago 33


2 4-6 months ago 21
3 7-12 months ago 18
4 More than one year ago 28
8 Not sure (v) 1
9 Decline to answer (v) -

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The Public Health Impact of Direct-to-Consumer Advertising of Prescription Drugs

BASE: SEEN HEARD OR TOLD ABOUT AD (Q400/1 OR Q430/1)


Q456 Has an advertisement for a prescription drug ever prompted you to talk to a doctor about a
possible change in treatment for a medical condition or illness that you already had?

1 Yes 20
2 No 79
8 Not sure (v) 1
9 Decline to answer (v) -

[IF TALKED ABOUT CHANGE IN TREATMENT (Q456/1) ASK Q458; OTHERIWSE JUMP TO
PROGRAMMER NOTE BEFORE Q460]

BASE: TALKED TO DOCTOR ABOUT A CHANGE IN TREAMENT (Q456/1)


Q458 When was the most recent time you talked to a doctor about a change in treatment as a result
of something you saw or heard in a prescription drug advertisement? Was it within the last three
months, between 4 and 6 months ago, between 7 and 12 months ago, or more than one year
ago?

1 1-3 months ago 31


2 4-6 months ago 24
3 7-12 months ago 15
4 More than one year ago 29
8 Not sure (v) 1
9 Decline to answer (v) -

[IF DID NOT TALK TO DOCTOR ABOUT PRESCRIPTION DRUG OR NEW HEALTH CONCERN OR
NEW TREATMENT (Q448/2,8,9 AND Q452/2,8,9 AND Q456/2,8,9), ASK Q460; OTHERWISE JUMP
TO PROGRAMMER NOTE AFTER Q462]

BASE: DID NOT TALK TO DOCTOR ABOUT PRESCRIPTION DRUG, NEW HEALTH CONCERN OR NEW
TREATMENT (Q448/2,8,9 AND Q452/2,8,9 AND Q456/2,8,9)
Q460 Has an advertisement for a prescription drug ever prompted you to talk to a doctor about any
other health concern of your own or treatment related to your health?

1 Yes 4
2 No 96
8 Not sure (v) *
9 Decline to answer (v) -

[IF TALKED ABOUT OTHER HEALTH CONCERN OR TREAMENT (Q460/1) ASK Q462; OTHERWISE
JUMP TO PROGRAMMER NOTE AFTER Q462]

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The Public Health Impact of Direct-to-Consumer Advertising of Prescription Drugs

BASE: TALKED TO DOCTOR ABOUT A HEALTH CONCERN OR TREAMENT (Q460/1)


Q462 When was the most recent time you talked to a doctor about a health concern or treatment as a
result of something you saw or heard in a prescription drug advertisement? Was it within the
last three months, between 4 and 6 months ago, between 7 and 12 months ago, or more than
one year ago?

1 1-3 months ago 18


2 4-6 months 11
3 7-12 months ago 18
4 More than one year ago 50
8 Not sure (v) 2
9 Decline to answer (v) -

[PROGRAMMER: IF TALKED TO DOCTOR ONLY ABOUT PRESCRIPTION DRUG (Q448/1) AND


(Q452/2,8,9 AND Q456/2,8,9), ASK Q601;
IF TALKED TO DOCTOR ONLY ABOUT HEALTH CONCERN (Q452/1) AND (Q448/2,8,9 AND
Q456/2,8,9), ASK Q602;
IF TALKED TO DOCTOR ONLY ABOUT TREATMENT CHANGE (Q456/1) AND (Q448/2,8,9 AND
Q452/2,8,9), ASK Q603;
IF TALKED TO DOCTOR ONLY ABOUT OTHER HEALTH CONCERN OR TREATMENT (Q460/1 &
Q448/2,8,9 & Q452/2,8,9 & Q456/2,8,9) ASK Q604;
IF TALKED TO DOCTOR ABOUT MORE THAN ONE HEALTH ISSUE (MORE THAN ONE ITEM
FROM AMONG Q448/1, Q452/1, & Q456/1), ASK Q600;
IF DID NOT TALK TO DOCTOR ABOUT ANY ISSUE (Q448/2,8,9 AND Q452/2,8,9 AND Q456/2,8,9
AND Q460/2,8,9) JUMP TO Q746]

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The Public Health Impact of Direct-to-Consumer Advertising of Prescription Drugs

SECTION 600: VISIT TO DOCTOR TO DISCUSS INFORMATION

BASE: TALKED TO DOCTOR ABOUT MORE THAN ONE HEALTH ISSUE (AT LEAST 2 ITEMS
FROM AMONG Q448/1, Q452/1, AND Q456/1)
Q600 Thinking about these [IF ANY TWO OF Q448/1, Q452/1 OR Q456/1 INSERT THE WORD
“two”; IF ALL THREE OF Q448/1, Q452/1, Q456/1 INSERT THE WORD “three”] situations
when you talked with your doctor, which would you say was more (or most) important to your
overall health? (READ ITEMS)

[PROGRAMMER: ANSWER CHOICE 1 SHOULD APPEAR ONLY IF RESPONDENT ANSWERED


Q448/1; ANSWER CHOICE 2 SHOULD APPEAR ONLY IF RESPONDENT ANSWERED Q452/1:
ANSWER CHOICE 3 SHOULD APPEAR ONLY IF RESPONDENT ANSWERED Q456/1]

1 The discussion about a prescription drug (ASK Q601) 28


2 The discussion about a new medical condition or
illness you didn’t know you had (JUMP TO Q602) 24
3 The discussion about a possible change in treatment
for a medical condition or illness that you knew you already had (JUMP TO Q603) 45
8 Not sure (v) (JUMP TO Q604) 3
9 Decline to answer (v) (JUMP TO Q604) 1

BASE: TALKED TO DOCTOR ABOUT PRESCRIPTION DRUG (Q448/1) OR (Q600/1)


Q601 For the next set of questions, please think about the visits when you talked to a doctor about a
prescription drug as a result of information you saw or heard in a prescription drug
advertisement. Please include the visit when you first talked to a doctor about the prescription
drug as well as any follow-up visits.

[JUMP TO Q606]

BASE: TALKED TO DOCTOR ABOUT NEW HEALTH CONCERN (Q452/1) OR (Q600/2)


Q602 For the next set of questions, please think about the visits when you talked to a doctor about a
health concern as a result of information you saw in a prescription drug advertisement. Please
include the visit when you first talked to a doctor about the health concern as well as any follow-
up visits.

[JUMP TO Q606]

BASE: TALKED TO DOCTOR ABOUT POSSIBLE CHANGE IN TREATMENT (Q456/1) OR (Q600/3)


Q603 For the next set of questions, please think about the visits when you talked to a doctor about a
possible change in treatment for a medical condition or illness that you knew you already had as
a result of information you saw in a prescription drug advertisement. Please include the visit
when you first talked to a doctor about the health concern or treatment as well as any follow-up
visits.

[JUMP TO Q606]

BASE: TALKED TO DOCTOR ABOUT OTHER HEALTH CONCERN OR TREATMENT (Q460/1) OR


NOT SURE/DECLINED TO SELECT THE MOST IMPORTANT DISCUSSION WITH DOCTOR
(Q600/8, 9)
Q604 For the next set of questions, please think about the visits when you talked to a doctor about a
health concern or treatment as a result of information you saw in a prescription drug
advertisement. Please include the visit when you first talked to a doctor about the health
concern or treatment as well as any follow-up visits.

Harris Interactive Inc. 38


The Public Health Impact of Direct-to-Consumer Advertising of Prescription Drugs

BASE: TALKED TO DOCTOR ABOUT DTCA (Q448/1 OR Q452 /1 OR Q456/1 OR Q460/1)


Q606 Other than the prescription drug advertisement you mentioned, did (READ EACH ITEM)
contribute to your decision to speak to your doctor about this (prescription drug/health
concern/treatment change)? (INTERVIEWER NOTE FOR “A DOCTOR”: IF NECESSARY
CLARIFY “A DOCTOR OTHER THAN YOUR OWN”)
Q607 1 2 8 9
Not Decline to
[RANDOMIZE ITEMS] Yes No Sure Answer

1 Television or radio, not including advertisements 40 59 * -


2 Internet websites 16 84 * -
3 Newspapers or magazines, not including
advertisements 34 65 1 -
4 Family and friends 51 48 1 *
5 A pharmacist 17 83 - -
6 Pamphlets in a doctor’s office or waiting room 33 66 * *
7 A doctor 33 66 * -

[PROGRAMMER: IF PROMPTED BY AT LEAST 2 OTHER SOURCES (Q606/AT LEAST


ANY TWO ITEMS 1 TO 7 AND Q607/1) THEN ASK Q608; OTHERWISE JUMP TO Q610]

BASE: PROMPTED BY AT LEAST 2 OTHER SOURCES OF INFORMATION (Q606/AT LEAST ANY


TWO ITEMS 1 TO 7 AND Q607/1)
Q608 Which one of these sources was most important in prompting you to talk to your doctor? (READ
EACH ITEM)
Q609
[PROGRAMMER: KEEP ONLY ITEMS Q606/1 TO 7 AND Q607/1 AND ALWAYS DISPLAY Q608/08,
98, 99]
[SINGLE RESPONSE] [RANDOMIZE ITEMS]

01 Television or radio, not including advertisements 12


02 Internet websites 5
03 Newspapers or magazines, not including advertisements 11
04 Family and friends 30
05 A pharmacist 4
06 Pamphlets in a doctor’s office or waiting room 9
07 A doctor 14
08 An advertisement for a prescription drug 13
98 Not sure (V) 2
99 Decline to answer (V) *

Harris Interactive Inc. 39


The Public Health Impact of Direct-to-Consumer Advertising of Prescription Drugs

BASE: TALKED TO DOCTOR ABOUT DTCA (Q448/1 OR Q452/1 OR Q456/1 OR Q460/1)


Q610 What was the primary medical or health condition that you talked about at these visits?
(INTERVIEWER NOTE: DO NOT READ LIST) (INTERVIEWER NOTE: IF RESPONDENTS
GIVES MORE THAN ONE RESPONSE, ASK FOR HEALTH OR MEDICAL CONDITION THAT
IS MOST IMPORTANT TO THEM)

[SINGLE RESPONSE]
01 Allergies 9
02 Arthritis 6
03 Asthma 4
04 Cancer 2
05 Chronic pain 1
06 Depression 4
07 Diabetes 5
08 Digestive or gastro-intestinal disorder (e.g.,GERD) 2
09 Heart disease 3
10 Heartburn 2
11 HIV/AIDS *
12 Hypertension or high blood pressure 4
13 Incontinence *
14 Indigestion *
15 Insomnia *
16 Lyme disease *
17 Menopause 2
18 Migraine 2
20 Osteoporosis 1
21 Other mental health condition *
22 Overactive bladder *
23 Psoriasis *
24 Sleep disorder 1
25 Ulcer 1
96 Other (SPECIFY AT Q612) 43
98 Not sure (V) 5
99 Decline to answer (V) 3

[PROGRAMMER NOTE: IF OTHER CONDITION TALKED ABOUT (Q610/96) ASK Q612.


OTHERWISE, JUMP TO Q618.]

BASE: INFORMATION WAS FOR OTHER DISEASE OR ILLNESS (Q610/96)


Q612 (SPECIFY OTHER)
[INTERVIEWER NOTE: PROBE FOR CONDITIONS.]

[TEXT BOX]

[PROGRAMMER NOTE: IF Q610/98, 99 THEN JUMP TO Q720]

Harris Interactive Inc. 40


The Public Health Impact of Direct-to-Consumer Advertising of Prescription Drugs

BASE: TALKED TO DOCTOR ABOUT DTCA (Q448/1 OR Q452/1 OR Q456/1 OR Q460/1)


Q618 As a result of this visit and any follow-up visits, did the doctor or other medical professional ever
tell you that you had [INSERT CONDITION FROM Q610/1-25 OR Q612]?

1 Yes JUMP TO Q626 67


2 No ASK Q620 31
8 Not sure (v) ASK Q620 1
9 Decline to answer (v) ASK Q620 *

BASE: NOT DIAGNOSED WITH DISCUSSED CONDITION (Q618/2,8,9)


Q620 As a result of this visit and any follow-up visits did the doctor or other medical professional ever
tell you that you had some other disease or medical condition?

1 Yes ASK Q622 7


2 No JUMP TO Q626 93
8 Not sure (v) JUMP TO Q626 *
9 Decline to answer (v) JUMP TO Q626 -

BASE: RECEIVED A DIAGNOSIS DIFFERENT FROM INITIALLY DISCUSSED CONDITION (Q620/1)


Q622 What disease or medical condition did the doctor say you have? (DO NOT READ LIST)
(INTERVIEWER: IF RESPONDENT GIVES MORE THAN ONE ANSWER, ASK FOR THE
CONDITION THAT IS MOST IMPORTANT TO THEM AND THEIR OVERALL HEALTH.)

[SINGLE RESPONSE]
01 Allergies 4
02 Arthritis 11
03 Asthma -
04 Cancer 7
05 Chronic pain -
06 Depression 3
07 Diabetes 11
08 Digestive or gastro-intestinal disorder (e.g. GERD) -
09 Heart disease 6
10 Heartburn -
11 HIV/AIDS -
12 Hypertension or high blood pressure 3
13 Incontinence -
14 Indigestion -
15 Insomnia -
16 Lyme disease -
17 Menopause -
18 Migraine -
20 Osteoporosis -
21 Other mental health condition 4
22 Overactive bladder -
23 Psoriasis -
24 Sleep disorder -
25 Ulcer -
96 Other (SPECIFY AT Q624) 31
98 Not sure (V) 12
99 Decline to answer (V) 8

[PROGRAMMER NOTE: IF DOCTOR SAID HAVE OTHER CONDITION (Q622/96) ASK Q624; IF
Q622/98,99 THEN JUMP TO Q720; OTHERWISE JUMP TO NOTE AFTER Q624.]

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The Public Health Impact of Direct-to-Consumer Advertising of Prescription Drugs

BASE: OTHER DISEASE OR ILLNESS (Q622/96)


Q624 (SPECIFY OTHER)
[TEXT BOX]

[PROGRAMMER: MARKER CONDITION IS DEFINED AS FOLLOWS:


IF DIAGNOSED WITH ADVERTISED CONDITION (Q618/1) THEN MARKER CONDITION IS
ANSWER FROM Q610/1-25 OR Q612;
IF DIAGNOSED WITH OTHER CONDITION (Q620/1) THEN MARKER CONDITION IS ANSWER
FROM Q622/1-25 OR Q624;
IF NOT DIAGNOSED WITH ANY CONDITION (Q618/2 AND Q620/2) THEN MARKER CONDITION IS
ANSWER FROM Q610/1-25 OR Q612;
ALL OTHERS INSERT “THIS CONDITION”]

BASE: TALKED TO DOCTOR ABOUT DTCA (Q448/1 OR Q452/1 OR Q456/1 OR Q460/1)


Q626 Before you talked to a doctor about this prescription drug or health concern had you ever been
told by a doctor that you had [INSERT MARKER CONDITION]? (IF NECESSARY: BEFORE
THIS VISIT HAD YOU BEEN DIAGNOSED WITH THIS CONDITION BY A DOCTOR)

1 Yes, diagnosed disease/condition 50


2 No, never been told/not diagnosed 49
8 Not sure (v) *
9 Decline to answer (v) *

BASE: TALKED TO DOCTOR ABOUT DTCA (Q448/1 OR Q452/1 OR Q456/1 OR Q460/1)


Q628 Before you talked to a doctor about this prescription drug or health concern, were you (READ
EACH ITEM) to treat [INSERT MARKER CONDITION]? [INTERVIEWER NOTE: CLARIFY
THAT TAKING AN OVER-THE-COUNTER DRUG EITHER DUE TO DOCTOR’S ORDERS OR
ON THEIR OWN QUALIFIES AS A YES]

1 2 8 9
[RANDOMIZE ITEMS] Not Decline to
Yes No Sure Answer

1 Taking a prescription drug 27 72 * -


2 Taking an over-the-counter drug 31 68 * -
3 Following a special diet 21 78 * -
4 Getting more exercise 24 75 1 *

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The Public Health Impact of Direct-to-Consumer Advertising of Prescription Drugs

BASE: TALKED TO DOCTOR ABOUT DTCA (Q448/1 OR Q452/1 OR Q456/1 OR Q460/1)


Q640 As a result of the visit and any follow-up visits you had with your doctor, did your doctor do any
of the following: (READ EACH ITEM)?

Q641 1 2 8 9
Not Decline to
[RANDOMIZE ITEMS] Yes No Sure Answer

1 Prescribe a drug for you 72 27 * -


2 Refer you to a specialist 32 67 * *
3 Suggest a change in your diet or how
much you should exercise 52 48 * -
4 Recommend an over-the-counter drug 19 80 *
5 Order a laboratory or diagnostic test 57 42 * -
6 Suggest that you quit smoking or drinking 33 65 * 1

[PROGRAMMER NOTE: IF AS A RESULT OF THE VISIT OR ANY FOLLOW-UP VISITS DOCTOR DID ANY
ITEM 2-6 (Q640/ANY ITEM 2-6 AND Q641/1) ASK Q650. OTHERWISE JUMP TO PROGRAMMER NOTE
BEFORE Q662]

BASE: DOCTOR MADE RECOMMENDATION OTHER THAN PRESCRIBING A DRUG


(Q640/ANY ITEM 2 TO 6 AND Q641/1)
Q650 As a result of the doctor’s recommendation did you (READ EACH ITEM)?

[PROGRAMMER NOTE: DISPLAY ONLY Q650/2-6 THAT CORRESPONDS TO ITEMS SELECTED AT


Q640/ANY ITEM 2 TO 6 AND Q641/1]
Q651 1 2 8 9
Not Decline to
Yes No Sure Answer

2 Go to a specialist 86 14 * -
3 Change your diet or the amount you exercised 82 18 * -
4 Take an over-the-counter drug 84 15 * -
5 Get a laboratory or diagnostic test 94 6 - -
6 Quit smoking or drinking 32 67 1 *

PROGRAMMER NOTE: HAD BEEN TAKING DRUG FOR CONDITION/PRESCRIBED DRUG AFTER
VISIT ((Q628/1 AND Q629/1) AND (Q640/1 AND Q641/1)), ASK Q662;
IF HAD NOT BEEN/NS/DTA TAKING DRUG FOR CONDITION/PRESCRIBED DRUG AFTER
VISIT ((Q628/1 AND Q629/2,8,9) AND (Q640/1 AND Q641/1)), JUMP TO Q664;
ALL OTHERS JUMP TO PROGRAMMER NOTE BEFORE Q720

Harris Interactive Inc. 43


The Public Health Impact of Direct-to-Consumer Advertising of Prescription Drugs

BASE: HAD BEEN TAKING DRUG FOR CONDITION/PRESCRIBED DRUG AFTER VISIT (Q628/1
AND Q629/1) AND (Q640/1 AND Q641/1)
Q662 You mentioned that you were taking a prescription drug to treat the [INSERT MARKER
CONDITION] before you visited the doctor. Was the drug that the doctor prescribed the same
or different than the one you were taking before the visit? (INTERVIEWER NOTE: IF NEEDED
“Was the drug you were prescribed after you talked with the doctor about the prescription drug
or health concern the same as the drug you were taking before you had these talks?”)

1 Drug was the same 27


2 Drug was different 68
8 Not sure (v) 5
9 Decline to answer (v) 1

BASE: DOCTOR PRESCRIBED DRUG (Q640/1 AND Q641/1)


Q664 Was the drug that your doctor prescribed as a result of the visits the same or different from the
drug that you saw or heard advertised?

1 Drug was the same (JUMP TO Q668) 56


2 Drug was different (ASK Q666) 37
8 Not sure (JUMP TO Q668) 7
9 Decline to answer (JUMP TO Q668) *

BASE: NOT PRESCRIBED ANY DRUG/NS OR DTA IF PRESCRIBED ANY DRUG (Q640/1 AND
Q641/2, 8, 9) OR NOT PRESCRIBED ADVERTISED DRUG (Q664/2)
Q666 Why did the doctor not prescribe the drug that was being advertised? Was it because (READ
LIST)? (MULTIPLE RECORD)

[MULTIPLE RESPONSE]

01 The advertised drug was not right for you 48


02 The advertised drug was not covered by insurance 8
03 The advertised drug would cost more money 14
04 Your current drug or treatment works well 38
05 The doctor wanted you to take a different drug 24
06 The advertised drug had side effects that you were not aware of 16
07 You did not have the condition the drug is used to treat 21
08 A less expensive drug was available 13
09 The doctor said you didn’t need a prescription drug 23
10 The doctor said you could use an over-the-counter drug 16
96 Other (v) 6
98 Not sure (v) E 6
99 Decline to answer (v) E *

[PROGRAMMER NOTE: IF NOT PRESCRIBED A DRUG Q640/1 AND Q641/2, 8, 9 THEN JUMP TO
Q720. OTHERWISE ASK Q668]

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The Public Health Impact of Direct-to-Consumer Advertising of Prescription Drugs

BASE: DOCTOR PRESCRIBED DRUG (Q640/1 AND Q641/1)


Q668 Did you fill the prescription that the doctor ordered?

1 Yes 95
2 No 4
8 Not sure *
9 Decline to answer *

[PROGRAMMER: IF FILLED PRESCRIPTION (Q668/1) ASK Q670; OTHERWISE JUMP TO Q720]

BASE: FILLED PRESCRIPTION (Q668/1)


Q670 Did you take the drug as prescribed by the doctor?

1 Yes 97
2 No 2
8 Not sure *
9 Decline to answer -

[PROGRAMMER: IF TAKE DRUG AS PRESCRIBED (Q670/1) ASK Q700; ALL OTHERS (Q670/2,8,9)
JUMP TO Q720]

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The Public Health Impact of Direct-to-Consumer Advertising of Prescription Drugs

SECTION 700: OUTCOMES

BASE: TOOK DRUG AS PRESCRIBED (Q670/1)


Q700 Overall, do you feel better or worse after taking the prescribed drug? (PROMPT FOR “MUCH”
OR “SOMEWHAT” ANSWER)

1 Much better 56
2 Somewhat better 25
3 Somewhat worse 3
4 Much worse 2
5 About the same (v) 13
8 Not sure (v) 1
9 Decline to answer (v) *

BASE: TOOK DRUG AS PRESCRIBED (Q670/1)


Q702 After taking the prescribed drug, did you have any laboratory or medical tests in order to
determine if the drug was working?

1 Yes ASK Q704 32


2 No JUMP TO Q706 63
3 No tests (v) JUMP TO Q706 4
8 Not sure (v) JUMP TO Q706 1
9 Decline to answer (v) JUMP TO Q706 *

BASE: UNDERWENT DIAGNOSTIC TESTS (Q702/1)


Q704 Did the results of the test show a change for the better or a change for the worse since the
period before you started taking the prescribed drug?

1 Change for the better 84


2 Change for the worse 3
3 No change (v) 9
4 Test have been inconclusive (v) 1
5 Was not shown the results of the tests (v) 2
6 No previous tests (v) -
8 Not sure (v) 1
9 Decline to answer (v) -

BASE: TOOK DRUG AS PRESCRIBED (Q670/1)


Q706 Did taking the drug seem to make the symptoms or problems you have from the [INSERT
MARKER CONDITION] better or worse? (PROMPT FOR “MUCH” OR “SOMEWHAT”
ANSWER)

1 Much better 56
2 Somewhat better 27
3 Somewhat worse 2
4 Much worse 1
5 About the same (v) 9
6 Too soon to tell (v) 1
7 Do not experience symptoms (v) 2
8 Not sure (v) 1
9 Decline to answer (v) *

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The Public Health Impact of Direct-to-Consumer Advertising of Prescription Drugs

BASE: TOOK DRUG AS PRESCRIBED (Q670/1)


Q707 As a result of taking the prescribed drug, are you absent at work less often, more often, or about
as often?

1 Absent less often 28


2 Absent more often 6
3 About as often 37
4 Too soon to tell (v) *
5 Do not work (v) 26
8 Not sure (v) 2
9 Decline to answer (v) 1

BASE: TOOK DRUG AS PRESCRIBED (Q670/1)


Q708 Has the prescribed drug increased, decreased, or had no effect on your ability to do your job or
carry out your daily routine?

1 Increased ability 28
2 Decreased ability 6
3 Had no effect 65
4 Too soon to tell (v) *
8 Not sure (v) 1
9 Decline to answer (v) -

BASE: TOOK DRUG AS PRESCRIBED (Q670/1)


Q712 Some drugs have side effects, that is, they create discomfort or other unexpected problems.
Have you experienced any side effects from taking the prescribed drug?

1 Yes 34
2 No 65
8 Not sure (v) *
9 Decline to answer (v) -

[PROGRAMMER: IF SWITCHED MEDICATIONS AS A RESULT OF VISIT (Q662/2) AND TOOK


DRUG AS PRESCRIBED (Q670/1) ASK Q714; ALL OTHERS JUMP TO Q720]

BASE: SWITCHED MEDICATION AND TOOK DRUG AS PRESCRIBED (Q662/2 AND Q670/1)
Q714 Did you ever have any side effects from the drug you were taking previously?

1 Yes 37
2 No 63
8 Not sure (v) -
9 Decline to answer (v) -

[PROGRAMMER: IF EXPERIENCED SIDE EFFECTS FROM BOTH DRUGS (Q712/1 AND Q714/1)
ASK Q716; OTHERWISE JUMP T0 Q718]

Harris Interactive Inc. 47


The Public Health Impact of Direct-to-Consumer Advertising of Prescription Drugs

BASE: EXPERIENCED SIDE EFFECTS FROM BOTH DRUGS (Q712/1 AND Q714/1)
Q716 Which drug had worse side effects, the new drug or the old drug?

1 New drug 12
2 Old drug 71
3 About the same (v) 12
4 Too soon to tell (v) 5
8 Not sure -
9 Decline to answer -

BASE: SWITCHED MEDICATION AND TOOK DRUG AS PRESCRIBED (Q662/2 AND Q670/1)
Q718 Is the new drug easier, more difficult or about the same to take, or remember to take, than the
drug you had been taking before?

1 Easier to take/remember to take 28


2 More difficult to take/remember to take 8
3 About the same 64
4 Too soon to tell (v) -
8 Not sure (v) -
9 Decline to answer (v) -

BASE: HAD DTCA DISCUSSION (Q448/1 OR Q452/1 OR Q456/1 OR Q460/1)


Q720 How satisfied were you with the way your doctor addressed the health concern you raised –
very satisfied, somewhat satisfied, somewhat dissatisfied, or very dissatisfied?

1 Very satisfied 67
2 Somewhat satisfied 25
3 Somewhat dissatisfied 5
4 Very dissatisfied 4
8 Not sure (v) *
9 Decline to answer (v) *

[JUMP TO Q748]

BASE: HAVE NOT SEEN, HEARD OR BEEN TOLD ABOUT AD/NS/DTA (Q400/2,8,9 & Q430/2,8,9)
OR DID NOT HAVE DTCA DISCUSSION/NS/DTA (Q400/2,8,9 AND Q430/2,8,9) OR (Q448/2,8,9 AND
Q452/2,8,9 AND Q456/2,8,9 AND Q460/2,8,9)
Q746 Thinking about the last visit you had with a doctor where you raised a health concern, how
satisfied were you with the way your doctor addressed the health concern you raised – very
satisfied, somewhat satisfied, somewhat dissatisfied, or very dissatisfied?

1 Very satisfied 63
2 Somewhat satisfied 26
3 Somewhat dissatisfied 5
4 Very dissatisfied 3
8 Not sure (v) 2
9 Decline to answer (v) *

Harris Interactive Inc. 48


The Public Health Impact of Direct-to-Consumer Advertising of Prescription Drugs

BASE: ALL QUALIFIED RESPONDENTS


Q748 Now think about any visit that you have had with your doctor, [PROGRAMMER NOTE: IF
Q400/1 OR Q430/1 INSERT “not just the set of visits that we have been discussing”]. Have you
ever asked for a prescription for a specific drug from a doctor?

1 Yes (ASK Q750) 27


2 No (JUMP TO Q805) 72
8 Not sure (v) (JUMP TO Q805) *
9 Decline to answer (JUMP TO Q805) *

BASE: REQUESTED A DRUG (Q748/1)


Q750 Has a doctor ever refused to prescribe a drug that you asked for?

1 Yes (ASK Q752) 24


2 No (JUMP TO Q805) 75
8 Not sure (v) (JUMP TO Q805) 1
9 Decline to answer (JUMP TO Q805) -

BASE: DOCTOR REFUSED TO PRESCRIBE DRUG (Q750/1)


Q752 Did you ask about this drug because you saw an advertisement for it?

1 Yes 40
2 No 59
8 Not sure (v) 1
9 Decline to answer -

BASE: DOCTOR REFUSED TO PRESCRIBE DRUG (Q750/1)


Q754 Did you switch doctors or go to see a new doctor as a result of this?

1 Yes 14
2 No 85
8 Not sure (v) -
9 Decline to answer -

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The Public Health Impact of Direct-to-Consumer Advertising of Prescription Drugs

SECTION 800: HEALTH INSURANCE

BASE: ALL QUALIFIED RESPONDENTS


Q805 Are you, yourself, now covered by any form of health insurance or health plan—this would
include any private insurance through your employer or that you purchase yourself, as well as
government programs like Medicare or Medicaid—or don’t you have any health insurance at
this time?

1 Yes, insured 83
2 No, not insured 17
8 Not Sure (v) *
9 Decline to answer (v) *

[PROGRAMMER: IF INSURED (Q805/1) ASK Q820; IF UNINSURED OR NS/DTA IF INSURED


(Q805/2,8,9) JUMP TO Q100]

BASE: INSURED (Q805/1)


Q820 Does your insurance or health plan pay for all, some, or none of the costs of prescription drugs
you get at the pharmacy or through the mail? This does not include prescription drugs you may
get in the hospital. Please keep in mind that having a copayment is not the same thing as
paying full price for a prescription drug. (CLARIFY FOR ALL QUALIFIED RESPONDENTS
THAT A COPAYMENT IS A FLAT FEE REQUIRED BY SOME HEALTH PLANS THAT IS PAID
BY THE PATIENT EACH TIME HE OR SHE FILLS A PRESCRIPTION.)

1 All 16
2 Some 73
3 None 8
8 Not Sure (v) 2
9 Decline to answer (v) *

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The Public Health Impact of Direct-to-Consumer Advertising of Prescription Drugs

SECTION 100: DEMOGRAPHICS

BASE: ALL RESPONDENTS


Q100 The next few questions ask for your demographic information.

BASE: ALL RESPONDENTS (WEIGHTING ITEM)


Q104 What is your year of birth? <I>Please enter as a four-digit number, e.g., 1963.</I>

[RANGE: 1901-1983]

|__|__|__|__|

BASE: ALL RESPONDENTS


Q109 Which of these best describes you - - are you married, not married but living with a partner,
divorced, separated, widowed, or single and never married? (SINGLE RECORD)

01 Married 55
02 Living with a partner 7
03 Divorced 8
04 Separated 2
05 Widowed 6
06 Single, never married 20
98 Not sure (v) *
99 Decline to answer (v) *

BASE: ALL RESPONDENTS


Q110 What is the highest level of education you have completed or the highest degree you have
received?

01 Less than high school 4


02 Completed some high school 7
03 High school graduate or equivalent (e.g., GED) 38
04 Completed some college, but no degree 27
05 College graduate (e.g., B.A., A.B., B.S.) 16
06 Completed some graduate school, but no degree 1
07 Completed graduate school (e.g., M.S., M.D., Ph.D.) 7
98 Not sure (v) *
99 Decline to answer (v) *

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BASE: ALL RESPONDENTS


Q112 What is your employment status?

[MULTIPLE RESPONSE]
[DO NOT ROTATE]
[PROGRAMMER NOTE: CANNOT CHOOSE 4 AND 1, 2, 3, OR 5; OR 5 AND 1, 2, 3, OR 4.]

01 Employed full time 48


02 Employed part time 10
03 Self-employed 7
04 Not employed, but looking for work 5
05 Not employed and not looking for work 4
06 Retired 17
07 Student 4
08 Homemaker 8
98 Not sure (v) *
99 Decline to answer (v) *

BASE: MORE THAN ONE IN Q112


Q114 Which one of the following best describes your employment status? (SINGLE RESPONSE)

[PROGRAMMER NOTE: KEEP ONLY RESPONSES SELECTED AT Q112. IF ONLY ONE RESPONSE
SELECTED AT Q112, FORCE THAT RESPONSE AT Q114 WITHOUT ASKING QUESTION.]

01 Employed full time 47


02 Employed part time 9
03 Self-employed 7
04 Not employed, but looking for work 5
05 Not employed and not looking for work 4
06 Retired 17
07 Student 3
08 Homemaker 7
98 Not sure (v) *
99 Decline to answer (v) *

BASE: ALL RESPONDENTS


Q120 Are you of Hispanic origin, such as Mexican American, Latin American, Puerto Rican, or
Cuban?

1 Yes, of Hispanic origin 10


2 No, not of Hispanic origin 88
8 Not sure (v) *
9 Decline to answer (v) 1

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The Public Health Impact of Direct-to-Consumer Advertising of Prescription Drugs

BASE: ALL RESPONDENTS


Q122 Do you consider yourself…?

01 White JUMP 128 75


02 Black JUMP 128 7
03 African American JUMP 128 5
04 Asian or Pacific Islander JUMP 128 2
05 Native American or Alaskan native JUMP 128 1
06 Mixed racial background JUMP TO Q126 3
96 Other race (v) [SPECIFY AT Q124] ASK Q124 5
98 Not sure (v) ASK Q128 1
99 Decline to answer (v) ASK Q128 1

BASE: OTHER RACE (Q122/96)


Q124 Please specify what race you consider yourself.

[TEXT BOX]

[JUMP TO Q128]

BASE: MIXED RACIAL BACKGROUND RESPONDENTS (Q122/06)


Q126 You indicated that you consider yourself of a mixed racial background. With which of the
following racial groups do you most closely identify?

[MULTIPLE RESPONSE]

01 White 48
02 Black 6
03 African American 5
04 Asian or Pacific Islander 6
05 Native American or Alaskan native 14
06 Other race (v) 22
98 Not sure (v) 3
99 Decline to answer (v) *

BASE: ALL RESPONDENTS (ONLINE WEIGHTING ITEM)


Q128 Excluding email, how many hours a week do you spend on the Internet or World Wide Web?

|_|_|_| [RANGE: 0-168]

BASE: ALL RESPONDENTS


Q130 Which one is closer to your views -- Rules are there for people to follow or people should
constantly try to question why things are the way they are?

1 Rules are there for people to follow. 50


2 People should constantly try to question
why things are the way they are. 43
8 Not sure (v) 6
9 Decline to answer (v) 1

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The Public Health Impact of Direct-to-Consumer Advertising of Prescription Drugs

BASE: ALL RESPONDENTS


Q131 Do you own a non-retirement investment account, or not?

1 Yes 39
2 No 58
8 Not sure (v) 2
9 Decline to answer (v) 1

BASE: ALL RESPONDENTS


Q132 In the last month have you (INTERVIEWER NOTE: READ ITEM), or not?

1 2 8 9
Not Decline to
[ROTATE ROWS] Yes No Sure (v) Answer (v)

01 Read non-sports magazines 63 36 * *


02 Gone to a rock/pop concert 10 90 - *
03 Watched TV situation comedies 77 23 * *

BASE: ALL RESPONDENTS


Q134 Some people say that there is too much information being generated these days, considering all
the TV news shows, magazines, newspapers, and computer information services. Others say
that they like having so much information available. Do you feel overloaded with information or
do you like having so much information available?

1 Feel overloaded 25
2 Like having information available 72
8 Not sure (v) 3
9 Decline to answer (v) 1

BASE: ALL RESPONDENTS


Q135 Most companies today want to know about the individual interests and lifestyle of their
customers so they can tailor their information services and products to each customer's
personal preferences. In general, do you see such personalization as a good thing?

1 Yes 71
2 No 23
8 Not sure (v) 5
9 Decline to answer (v) 1

BASE: ALL RESPONDENTS


Q140 Including yourself, how many adults, 18 and over, live in this household? (Household members
include people who think of this household as their usual place of residence. It includes
persons who usually stay in the household but are temporarily away on business, vacation, in a
hospital or away at school.) (ENTER “98” for “Not sure” and “99” for “Decline to answer.”)

[Range 00-20, 98, 99]

|__|__| Average 2.2


Median 2.1

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The Public Health Impact of Direct-to-Consumer Advertising of Prescription Drugs

BASE: ALL RESPONDENTS


Q141 How many children under the age of 18 live in this household? (ENTER “98” for “Not sure” and
“99” for “Decline to answer.”)

|__|__| [Range 00-20, 98, 99]


Average .8
Median -

BASE: QUALIFIED RESPONDENTS


Q142 Which of the following income categories best describes your total 2000 household income
before taxes? (READ OUT LIST UNTIL REACH CATEGORY)

01 Less than $15,000 11


02 $15,000 to $24,999 13
03 $25,000 to $34,999 15
04 $35,000 to $49,999 16
05 $50,000 to $74,999 16
06 $75,000 to $99,999 9
07 $100,000 to $124,999 4
08 $125,000 to $149,999 2
09 $150,000 to $199,999 1
10 $200,000 to $249,999 1
11 $250,000 or more 1
98 Not sure (v) 4
99 Decline to answer (v) 7

BASE: ALL RESPONDENTS


Q60 Status of respondent (Does not appear on screen)

[PROGRAMMER NOTE: ONLY COMPLETES OF RESPONDENTS AT LEAST 18 YEARS OF AGE


(Q201/1) ARE QUALIFIED COMPLETES.

1 QUALIFIED COMPLETE
2 NON-QUALIFIED

BASE: QUALIFIED RESPONDENTS (Q60/1)


Q196 In appreciation of your time, we would like to offer you an honorarium of $10. Could I have your
name and address so that I can send you your check? [TEXT BOX]

(INTERVIEWER RECORD FULL NAME AND ADDRESS)

1 Information given 96
2 Refused to give information 4

BASE: QUALIFIED RESPONDENTS (Q60/1)


Q197 INTERVIEWER RECORD: INTERVIEW CONDUCTED IN

1 English 97
2 Spanish 3

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