Professional Documents
Culture Documents
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
Methodology.................................................................................................................... 17
Sample Design............................................................................................................... 17
Data Collection & Survey Procedures ............................................................................ 19
Response Rate .............................................................................................................. 21
Weighting the Data......................................................................................................... 25
Reliability of Survey Percentages................................................................................... 26
INTRODUCTION
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?
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.
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.
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.
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.
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.
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.
MAIN FINDINGS
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
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.
Exhibit 5: Type of Discussions Among Adults Who Have Had a DTCA Visit
Exhibit 6: Diagnosis of Discussed Conditions Among Adults Who Have Had a DTCA Visit
* 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.
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).
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).
Exhibit 9: Actions Taken by Physicians Among Adults who had a DTCA Discussion
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.
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
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.
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
P = .333 P = .351
P = .250 P= .394
Not sure/ Too soon/ Missing 4.6 5.2 3.6 2.7 4.2
P = .523 P = .993
P = .712
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)
P = .142 P = .063
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.
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
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.
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
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
Interviewer Training
Interviewers received 2-day project specific training to familiarize them with the survey
instrument, practice techniques to overcome refusals and boost participation.
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.
Response Rate
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.
Eligible - no interview
Qualified Refusal (after screener) 142
Qualified Callback (after screener) 364
Subtotal 506
Not WRN
Business 1650
Phone Disconnect 3696
Fax Machine/Computer Tone 578
Cell phone/pay phone 57
Subtotal 5981
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”.
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
E. Not eligible
F. Not WRN 5981
G. Not eligible WRN 113
Subtotal 6094
3000 + 506
= 96.88%
3000 + 506 +113
3000 + 1881
= 45.50%
3000 + 1881 + 6094
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)
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
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.
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
100 7 10 11 12 12
50 9 12 14 15 15
50 10 14 16 17 17
50 vs. 50 12 16 18 19 20
APPENDIX A
QUESTIONNAIRE
1 Male 48
2 Female 52
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) *
1 Yes 49
2 No 50
8 Not sure (v) *
9 Decline to answer (v) *
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]
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 * *
Have you seen or heard an advertisement for a prescription drug within the past 12 months?
[IF SEEN OR HEARD AD (Q400/1) THEN ASK Q410; OTHERWISE (Q400/2,8,9) JUMP TO Q430]
1 2 3 4 8 9
Strongly Somewhat Somewhat Strongly Not Decline to
[RANDOMIZE ITEMS] Agree Agree Disagree Disagree Sure (v) Answer (v)
[JUMP TO Q440]
1 Yes 9
2 No 90
8 Not sure (v) *
9 Decline to answer (v) *
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?
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]
[PROGRAMMER NOTE: ROTATE THE FOLLOWING PAIRS Q448-Q450, Q452-Q454, AND Q456-
Q458]
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]
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]
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]
[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]
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)
[JUMP TO Q606]
[JUMP TO Q606]
[JUMP TO Q606]
[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
[TEXT BOX]
[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.]
1 2 8 9
[RANDOMIZE ITEMS] Not Decline to
Yes No Sure Answer
Q641 1 2 8 9
Not Decline to
[RANDOMIZE ITEMS] Yes No Sure Answer
[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]
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
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?”)
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]
[PROGRAMMER NOTE: IF NOT PRESCRIBED A DRUG Q640/1 AND Q641/2, 8, 9 THEN JUMP TO
Q720. OTHERWISE ASK Q668]
1 Yes 95
2 No 4
8 Not sure *
9 Decline to answer *
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]
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) *
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) *
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) -
1 Yes 34
2 No 65
8 Not sure (v) *
9 Decline to answer (v) -
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]
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 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) *
1 Yes 40
2 No 59
8 Not sure (v) 1
9 Decline to answer -
1 Yes 14
2 No 85
8 Not sure (v) -
9 Decline to answer -
1 Yes, insured 83
2 No, not insured 17
8 Not Sure (v) *
9 Decline to answer (v) *
1 All 16
2 Some 73
3 None 8
8 Not Sure (v) 2
9 Decline to answer (v) *
[RANGE: 1901-1983]
|__|__|__|__|
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) *
[MULTIPLE RESPONSE]
[DO NOT ROTATE]
[PROGRAMMER NOTE: CANNOT CHOOSE 4 AND 1, 2, 3, OR 5; OR 5 AND 1, 2, 3, OR 4.]
[PROGRAMMER NOTE: KEEP ONLY RESPONSES SELECTED AT Q112. IF ONLY ONE RESPONSE
SELECTED AT Q112, FORCE THAT RESPONSE AT Q114 WITHOUT ASKING QUESTION.]
[TEXT BOX]
[JUMP TO Q128]
[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) *
1 Yes 39
2 No 58
8 Not sure (v) 2
9 Decline to answer (v) 1
1 2 8 9
Not Decline to
[ROTATE ROWS] Yes No Sure (v) Answer (v)
1 Feel overloaded 25
2 Like having information available 72
8 Not sure (v) 3
9 Decline to answer (v) 1
1 Yes 71
2 No 23
8 Not sure (v) 5
9 Decline to answer (v) 1
1 QUALIFIED COMPLETE
2 NON-QUALIFIED
1 Information given 96
2 Refused to give information 4
1 English 97
2 Spanish 3