Doohee Lee,
Lee Ph.D.
Ph D
Graduate School of Management
Lewis College of Business
Marshall University
Charles E. Begley, Ph.D.
Department of Health Management & Policy
The University of Texas, School of Public Health
1
RACE & ETHNICITY
DISPARITIES IN DIRECTDIRECT-TO
TO-CONSUMER ADVERTISING
(DTCA)
(
)
2
Backgrounds
g

DTCA refers to advertising for prescription drugs on TV,
on radio, in magazines and newspapers, and in pamphlets
found in doctors’
doctors offices or waiting rooms

United States and New Zealand are the only two
industrialized countries in the world allowing DTCA (US
GAO 2006)
GAO,

DTCA has been a popular topic but disparities in how
Americans experience DTCA at the national level have
been lightly investigated
3
Backgrounds
g
(cont.)
(
)

Racial/ethnic disparities may be important in DTCA for at
l
least
t two
t
different
diff
t reasons:

Exposure
p
to DTCA may
y be beneficial to minorities in
terms of inspiring them to seek needed care from
th i physicians
their
h i i
and
d th
thereby
b h
helping
l i tto close
l
th
the
treatment gap between minorities and whites.

DTCA may have an ability to help draw hard-to-reach
patients
i
to needed
d d medical
di l care (K
(Kelly,
ll 2004)
2004).
4
Backgrounds
g
(cont.)
(
)

Phone-surveying
y g 500 Colorado residents,, Robinson et
al. (2004) found minorities are more likely report that
DTCA motivated
ti t d th
them tto seekk medical
di l care

DTCA mayy be less effective with some minorities
 Those
who are uncomfortable speaking English
 Those
unable to access the potential risks and
benefits of advertised drugs and hence become
possible victims of DTCA
5
Backgrounds
g
(cont.)
(
)

Another concern with DTCA is the possible threat to
the physician-patient relationship. Several studies
suggest a negative impact on minority patients’
patients
relationship with physicians because of a greater
likelihood than Whites of being denied a request for
prescription drugs by their doctors (Murray et al
al., 2004)
6
Research Questions

Are there differences in DTCA exposure among
Hispanics and AA patients compared to Whites?

Are there differences among
g these g
groups
p in talking
g to
a physician about advertised drugs, and the perception
off the
th health
h lth benefit
b
fit off DTCA?
7
Methods
et ods

Secondary data analysis of “Public Health Impact of
Direct to Consumer Advertising of Prescription Drugs
Direct-to-Consumer
Survey”

Cross-sectional study (2001-2002) by researchers at
Harvard University/ Massachusetts General Hospital
and Harris Interactive

National p
phone survey
y data of 2,814
,
Americans ((>=18
yrs) with 53.37% response rate

Hispanics (n=314) and AA (n=345) compared to Whites
(n=2,155)
8
Methods
et ods (cont.)
(co t )


Three dependent variables (categorical)

DTCA exposure last
l t year (yes/no)
(
/ )

DTCA prompted patients to talk to doctors about
drug advertising last year (yes/no)

DTCA
C p
prompted
o pted patients
pat e ts to ta
talk to docto
doctorss about
treatment change last year (yes/no)
Covariate variables

Race (Whites, AA, Hispanics), gender (male/female),
age (18+), education, health insurance (yes/no)
9
Methods
et ods (cont.)
(co t )

All of the data analysis was fully adjusted, using the
weight variable given in the data, in order to be
representative of the general population

Multivariate regression analysis

Odds ratios (OR) and confidence intervals (95%) are
reported in the regression model
10
RESULTS
11
Sample Characteristics
Age
18-34
35-64
65+
Female
Race/ethnicity
Whites
African Americans
Hispanics
Education
Less than high school
HS or some college
g graduate
g
College
Uninsured
Weighted Total (%)
Total U.S. Population
(2008) (%)*
31.6%
51.9%
16.4%
52.5%
24.3
39.9
12.3
50.9
76.6
12 2
12.2
11.2
75
12 4
12.4
15.4
11.1
65.9
22.9
16.3
14.2
58.9
26.9
15.4
* The U.S. Census Bureau (www.census.gov)
12
DTCA Exposure (Last year)***
100
90
80
70
60
50
40
30
20
10
0
Whites
***p< .001
Hispanics
Blacks
13
Response to DTCA (n=2,814) (%)
Whites
Hispanics
Blacks
90
80
70
60
50
40
30
20
10
0
Exercising more Taking medicine Personal control
***
***
over health
care***
***p< .001
Improved diet
14
Response to DTCA (n=2,814) (%) (cont.)
Whites
Hispanics
Blacks
45
40
35
30
25
20
15
10
5
0
Prompted people
to talk to doctors
about advertised
drugs**
***p< .001, **p<.01
Prompted people
to talk to doctors
about treatment
change***
Looked for more Improved smoking
info on drug they or drinking habits
saw or heard
advertised***
15
DTCA Drug Request Refusal Ever * (%)
40
35
30
25
20
15
10
5
0
Whites
***p= .011
Hispanics
Blacks
16
Response to DTCA (mean) (cont.)
Whites
Hispanics
Blacks
3.5
3
2.5
2
1.5
1
0.5
0
Made me Didn’t provide Reminded me Made me less Having better
aware of
info on
to follow
confident in discussions
treatment I risks/benefits directions*** my doctor’s
about my
did not know in a balanced
judgment*
health with
about***
manner***
HC
profsnal***
*p< .05, **p<.01, ***p<.001
17
Odd Ratios of DTCA Exposure and Other
DTCA Effects (n=2,814)
(n 2,814)
Variable
Race
White
AA
Hispanics
DTCA exposure
((95% CI))
DTCA prompted people to DTCA prompted people to
talk to their physicians
speak to their physicians
about a p
about advertised drugs
g
possible change
g in
(95% CI)
treatment (95% CI)
1.0
0 3 (0
0.3
(0.2,
2 0
0.3)***
3)***
0.7 (0.5, 1.0)*
1.0
1 0 (0
1.0
(0.8,
8 1
1.4)
4)
0.7 (0.5, 1.0)
1.0
1 3 (0
1.3
(0.9,
9 1
1.8)
8)
0.6 (0.4, 1.0)*
Male
Female
Age
18-34
35-64
65+
1.0
1 5 (1
1.5
(1.2,
2 1
1.8)
8)**
1.0
1 5 (1
1.5
(1.2,
2 1
1.7)
7)***
1.0
1 5 (1
1.5
(1.2,
2 1
1.8)
8)***
1.0
0.5 (0.3, 0.6)***
0.4 (0.3, 0.5)***
1.0
0.8 (0.6, 1.1)
0.7 (0.6, 1.0)*
1.0
1.7 (1.2, 2.4)***
1.1 (0.8, 1.5)
Education
<High school
H S or some college
H.S.
ll
College graduate
1.0
6 5 (4
6.5
(4.3,
3 9
9.7)
7) ***
2.0 (1.4, 2.8)***
1.0
0 8 (0
0.8
(0.5,
5 1
1.1)
1)
0.8 (0.6, 0.9)*
1.0
0 74 (0
0.74
(0.5,
5 1
1.1)
1)
0.87 (0.7, 1.1)
Health insurance
Yes
No
1.0
1
0
0.5 (0.4, 0.6)***
1.0
1
0
0.8 (0.6, 1.0)
1.0
1
0
1.1 (0.8, 1.5)
***p< .001, **p<.01, *p<.05
18
Study Limitations

Excluded Asian Americans and other race/ethnicity
groups

Findings are based on self-report, which may not be
accurate when trying to capture accurate response of
how people felt and thought of DTCA related events over
the past year

A cross-sectional study not for the causation

Th age off the
The
h data
d
may hamper
h
the
h reliability
li bili off our
findings
19
Summary & Policy Implications

Our findings suggest more benefits of DTCA among
minorities

Racial/ethnic disparities exist in DTCA

Hispanics and AA were less likely than Whites to be
exposed
d tto DTCA,
DTCA were more lik
likely
l tto b
be iinfluenced
fl
d
by DTCA, and were more positive about the health
benefits of DTCA exposure.

AA were more likely
lik l to ask
k their
h i physicians
h i i
ffor a
DTCA-recommended prescription drug and be
refused.
20