The effects of information sources on consumer reactions to direct-to-consumer (DTC) prescription drug advertising: a consumer socialization approach.

After the recent Vioxx recall incident, direct-to-consumer (DTC) advertising for prescription drugs now faces increasing criticism at various levels of society. DTC advertising of prescription drugs refers to any promotional effort by a pharmaceutical company to present prescription drug information to the general public through consumer-oriented media (Pierpaoli 1986). DTC advertising spending by pharmaceutical companies has increased exponentially from $791 million in 1996 to $2.5 billion in 2000 (National Institute for Health Care Management Research and Educational Foundation 2000), and is now projected to reach $4.4 billion in 2005 (Kamp 2005). This dramatic growth in DTC advertising of prescription drugs reflects the belief of pharmaceutical manufacturers that DTC advertising positively affects retailers' margins and patients' awareness of specific brands of drugs (Kopp and Sheffet 1997).

Nevertheless, a sharp contrast remains between proponents and opponents of DTC advertising. Briefly, proponents argue that DTC advertising plays an educational role and promotes patient-physician discussion by providing consumers with information about medical conditions and treatments (e.g., Weissman et al. 2003). From this perspective, DTC advertising is seen as a powerful source of consumer health information that empowers patients in the patient--physician relationship as patients influence their physicians in prescription decisions (Lee 2003). By contrast, opponents address concerns about safety, increased costs, and interference with the doctor-patient relationship (Baukus 2004). Since most DTC advertising fails to inform consumers about the potential for drug misuse and directions for proper usage (Roth 1996), it can be seen as disseminating inadequate information about the risks/contraindications associated with prescription drugs, and it overstates the efficacy of these drugs (Paul, Handlin, and Stanton 2002). Notably, each side of this debate assumes that DTC advertising has a powerful impact on consumers' attitudes and behaviors regarding drug prescriptions--as if DTC advertising were the only information source available to consumers, and as if consumers' exposure to DTC advertising would stimulate an instantaneous reaction. In the cluttered media environment, consumers are bombarded with a flood of information delivered via various mediated and interpersonal channels. Mass media and interpersonal channels enable consumers to learn and to socialize their attitudes and behaviors related to a variety of communication and consumption activities. Accordingly, it is critical to know how, and to what extent, such information sources are associated with consumers' attitudes toward DTC ads and with their subsequent reactions and discussions with their physicians regarding the advertised prescription drug.

The main purpose of this study is to investigate the process by which, and the extent to which, consumer responses to DTC advertising are formulated by the degrees of consumer use of mass and interpersonal communications for health information. More specifically, we ask the following research questions: (1) How is consumers' use of mass media and interpersonal channels for health information associated with their attitude toward DTC advertising? (2) How is consumers' use of the two information channels for health information related to their active discussion with their physicians regarding the drug advertised? (3) Which information channel has a relatively stronger association with consumer attitudes toward DTC advertising and behavioral outcome?

In this task, the consumer socialization perspective is used as a conceptual framework. This perspective has provided useful explanations of individuals' communication and consumption behaviors, but it has not yet been applied to DTC advertising research.

Analyzing a large collection of national consumer data, this study captures a broader picture of how consumers gain health information and how consumers' socialization through different communication channels is related to their attitude toward DTC advertising and behavioral outcomes. Our findings will provide implications for practitioners to adopt integrated marketing communications using various media for pharmaceutical drugs and for DTC advertising researchers to explore various processes through which consumers respond to DTC advertising.

REVIEW OF PAST STUDIES ON DTC ADVERTISING

The dramatic growth of DTC advertising spending has accompanied a number of studies focusing on various aspects of DTC advertising since the mid-1980s. These aspects include the following: types and contents of DTC ads (Kaphingst et al. 2004; Roth 1996); consumer preferences for drug information (Doucette and Schommer 1998); consumers' awareness of DTC ads (Alperstein and Peyrot 1993); consumers' perceptions of DTC ads (Huh, DeLorme, and Reid 2004); consumers' attitudes toward DTC ads (Desphande et al. 2004; Mehta and Purvis 2003; Williams and Hensel 1995); physicians' attitudes toward DTC ads (Paul, Handlin, and Stanton 2002); health effects of DTC ads (Peyrot et al. 1998; Weissman et al. 2003); economic impact of DTC ads (Kopp and Sheffet 1997); and policy and regulation of DTC ads (Calfee 2002).

These studies have looked at various features of the information that DTC advertising delivers, in terms of target patient, indication, and balance between benefit and risk (Roth 1996). It may be doubtful, though, whether these ads provide proper detailed product information (Kaphingst et al. 2004). On the other hand, consumers who remember and understand information provided by DTC advertising tend to discuss the advertised drugs more actively with their doctors (Mehta and Purvis 2003). But degrees of consumer responses to DTC advertising seem to vary across different demographics (Peyrot et al. 1998; Williams and Hensel 1995) and across consumers' perceptions of the credibility and informativeness of DTC ads (Huh, DeLorme, and Reid 2004), as well as across perceived quality and value of information provided by DTC ads (Deshpande et al. 2004).

Meanwhile, ever since the pharmaceutical company Merck recalled its prescription drug Vioxx from the market after the drug was shown to increase the risk of heart attack and stroke, suspicion and criticism of DTC advertising has surfaced. Also, a ban on consumer advertising for new prescription drugs has been proposed. The misperception surrounding DTC advertising includes an assumed strong, direct impact of DTC advertising on consumers and on the patient-physician relationship. But this assumption about strong impact overlooks how other sources--for example, news and entertainment programs and consumers' interpersonal channels--could also disseminate information regarding certain prescription drugs and other health-related information. Although past studies show a wide spectrum of DTC advertising research, few studies have taken a more comprehensive approach to understand the process through which consumers form their attitudes toward DTC advertising and what drives their active discussions with their doctors. For achieving such a comprehensive understanding, the consumer socialization perspective may be one useful framework.

THE CONSUMER SOCIALIZATION THEORETICAL FRAMEWORK

Consumer socialization has been defined as "the processes by which young people acquire skills, knowledge, and attitudes relevant to their functioning as consumers in the marketplace" (Ward 1974, p. 2). Typically, this literature emphasizes the influence of socialization agents (people or organizations) in conveying consumer norms, attitudes, and behaviors to the individual (Churchill and Moschis 1979; Moschis and Churchill 1978). Consumer socialization research has investigated the influence of family, mass media, schools, and peers on the childhood consumer socialization process (e.g., Bush, Smith, and Martin 1999; Mangleburg, Grewal, and Bristol 1997; Moore et al. 2002; Moschis and Churchill 1978).

It is certainly not the case, however, that socialization is a process limited to children or youths. Socialization, as Brim indicated, is "continuous throughout life, and the socialization experienced in childhood is not enough to fulfill the demands of the later years" (1968, p. 184).

Socialization over an individual's life cycle can be explained in terms of two main models of human learning: the cognitive development model and the social learning model. The cognitive development model views learning as a cognitive-psychological process of adjustment to one's environment, emphasizing the interaction of personal and environmental factors

(Moschis and Churchill 1978). As Moschis and Churchill (1978) have noted, the theories of …