Television advertising and childrens' attitudes toward proprietary medicine

ABSTRACT The effect of exposure to television drug advertising on children's attitudes toward proprietary medicines and medicine use was investigated in two experiments. The first experiment presented the commercials in a realistic program context fashion. The second experiment presented the commercials in a more direct and controlled manner. Using drug questionnaires, the subjects were assessed for their attitudes regarding the use of proprietary drugs. The results of both studies indicated that exposure to drug advertising had l i t t le influence on children's attitudes. Furthermore, children preferred not to watch drug commercials in comparison to a TV program or other types of commercials.

Television Advertising and Childrens' Attitudes Toward Proprietary Medicine

Matt J. Rossano Eliot J. Butter University of Dayton

Recent history has seen the medium of television become an increasingly important factor in the daily lives of adults and children. The impact of television upon the viewing audience is still a controversial subject. One aspect of the televised media that has been

Psychology & Marketing 0 1987 John Wiley & Sons, Inc.

Vol. 4(3): 213-224 (1987) CCC 07426O46/8 710302 13-1 2504.00

TELEVISION ADVERTISING

of particular concern to psychologists, sociologists and television in- dustry officials has been drug advertising and its influence on young viewers. Because of children’s immature cognitive capacities regarding the processing of televised information (Collins, 1979 ; Collins, Karasov, and Westby, 1978), it is held that they are especially vul- nerable to televised drug advertising. It is feared that children lack the experience and evaluative capacity to deal with drug commercials as effectively as adults. The messages expressed and implied in many television drug commercials could easily be misinterpreted by children (Atkin, 1978). Furthermore, the average child has been found to be exposed to over 700 proprietary medicine commercials a year, or a little more then two commercials a day (Robertson, Rossiter, and Gleason, 1979). Considering the potential for misinterpretation and the large degree of exposure, the pain, pill, pleasure model (Berger, 1974) repeatedly expressed by television drug advertisements has engendered worry over its possible relationship to increasing drug abuse among youngsters (Robertson, 1980).

Past research on the influence of television drug commercials on children has typically been correlational in nature. The NBC study (Milavsky, Pekowsky, and Stipp, 1975- 1976) found a significant relationship between exposure to proprietary drug advertising and the reported use of drugs among teenage boys. In a similar type study, (Atkin, 1978) it was reported that younger children’s (fifth, sixth, and seventh graders) exposure to television drug commercials was positively related to their perception of the occurrence of illness in people and the use of drugs to alleviate that illness. In addition, other significant positive relationships were found between exposure to televised drug commercials and confidence in the effectiveness of drugs, concern over illness, and approval of medicine use. Robertson, Rossiter, and Gleason (1 979) found that attitudes and requests for medicines on the part of children were related to estimated exposure to television drug advertising. Subjects in this study were third, fifth, and seventh graders, with the greatest relationship found in the old- est children and the smallest relationship occurring in the youngest children. , The authors suggested that the increased correlation between TV attitudes on the part of older children could be a result of a loosening of parental control over the dispensing of medicines to older children. In addition, they claimed that the results indicated that attitudes of children toward proprietary medicine develop independently of parental attitudes. Further work of Rossiter and Robertson (1 979) supported this contention.

If the attitudes of children concerning proprietary medicines do develop independently of their parents, then other influences such as television advertising could help mold those attitudes. How-

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ever, criticisms can be made of past studies investigating TV’s influence on attitudes and usage of proprietary medicine. These investiga- tions have all used correlational designs and thus do not allow for causal statements. Prior studies have also used an estimate of e x p e sure to drug advertising based on total amount of TV viewing and correlated this estimate with questionnaire responses. The validity of these estimates is questionable. Furthermore, the correlations obtained in these studies, though significant, have all been small (e.g. r = 0.12, 0.14). The fact that these were significant relationships could be the result of either a true relationship in the population or it could be a statistical artifact caused by the large sample sizes used (e.g. 822, 256, 673 subjects).

The purpose of the present research is to evaluate the potential meaningfulness of the significant relationships found in past research. An experimental manipulation of TV exposure would further eluci- date the true nature of the relationship between TV drug advertising and children’s attitudes. The present research uses a more stringent application of experimental procedures than has been used in past studies. Two experiments were conducted involving the direct, controlled manipulation of television drug commercials and the assessment of children’s attitudes concerning medicines and medicine use.

The question addressed in the first study was whether direct exposure to television drug commercials would affect the post-test responses of children compared to their pre-test responses. In other words, would children become more likely to use drugs (as measured by a questionnaire) after viewing drug advertising? In addition, would the drug exposure treatment groups show a greater degree of willingness to use drugs compared to a non-drug advertising control group?

EXPERJMENT 1

Method

Subjects, design and apparatus. Subjects were from two middle class, predominantly white, Catholic schools in a midwestern city. 73 third and 69 sixth-graders (68 males, 74 females) were used. In- formed consent was obtained from parents through letters sent home with children prior to the experiment. The design of the study was a pre-test post-test with subjects at each age randomly assigned to one of three conditions. In the first condition, subjects watched a Laverne and Shirley videotape (about 20 minutes long with three

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commercial breaks contained within) while supposedly waiting for another experiment to begin. Each commercial break was located as typically seen in the program and contained three proprietary drug commercials and one non-drug commercial in varying orders. For example, the first break might start with a commercial for aspirin followed by a non-drug commercial for orange juice, and then end with a commercial for cough syrup and one for stomach antacid. The next break would contain different commercials, in a different se- quence but with the same drug to non-drug ratio. After the subjects had been exposed to nine drug and three non-drug commercials, the tape was interrupted by the experimenter who informed the subjects that it was time to move on to the other experiment. The second condition was identical except that different drug commercials were presented. This condition was employed to increase the generalizability of any effect found. Condition three was the control condition where subjects were shown twelve non-drug commercials only. In each condition the same Laverne and Shirley show was presented with the appropriate commercials edited in.

Drug Questionnaire. Subjects were assessed for their willingness to use proprietary medicines in different situations. This assessment consisted of responding to 25 questions using a five point Likert scale. As part of the instructions, the children were asked to pretend that they were a parent with a child about their own present age. This was done to increase the child’s sense of responsibility for ren- dering aid in the given situation. An example of one of the questionnaire items is as follows: “Your child has burned his/her finger on the stove. You would be (how likely) to give medicine. An answer of 1 = not likely. An answer of 5 = very likely. Other questions dealt with situations such as, earaches, laziness, sleeplessness, sore eyes and muscles, poison ivy, and coughs. The children had no difficulty understanding the questionnaire or the Likert scale responses.

Procedure. Subjects were group administered the questionnaire which served as a pre-test of attitudes toward drug usage. Based on the pretest scores three equivalent groups were formed. A matched randomization procedure was then used to assign subjects to one of the three conditions. About three weeks after the pre-test, subjects were individually administered the treatment and post-test. The post-test consisted of the same questionnaire used for the pre-test, readministered after television commercial exposure.

Results and Discussion

Questionnaires were scored by totaling the Likert scale responses across the 25 questions. Average totals on the pre-test were,

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69 for group one, 68.55 for group two, and 68.46 for group three, indicating no pre-test differences. A 4-way mixed design ANOVA was used to analyze the data. Tape shown to subjects (drug commercials vs. non-drug commercials), sex and grade were between subjects variables while test administration (pre- and post-test) was the within subjects variable. Likert scale questionnaire responses constituted the dependent variable. The F ratio obtained for the main effect of tape was non-significant F(2,130) = 0.34, p > 0.7. Furthermore, the interaction between tape and pre- and post-test scores was also found to be non-significant F(2,130) = 1.6 p > 0.206. This indicated that groups did not vary significantly on the post-test as a function of the tape shown. Two significant findings were uncovered in the data analysis. A significant pre- to post-test main effect was found F( 1 , 130) = 3 1.4 p < 0.0000 1, indicating a significant decrease inthe willingness of subjects to use drugs on the post-test (pre-test X = 68.83, post-test x = 63.8). A significant grade main effect was also found F(1,130) = 19.56 p < 0.001. This was indicative of the fact that sixth grade subjects were significantly less willing to use drugs (3rd grade x = 71.84, 6th grade 3 = 61.72). Thus it was found that subjects tended to decrease in their willingness to use medicine on the post-test as compared to the pre-test, and sixth grade subjects tended to be lower in their measured willingness to use proprietary medicine. However, in neither case did the variable of TV exposure (tape) have any significant influence on these tendencies.

There is no simple explanation for the findings of Experiment 1. The general tendency of subjects to become less willing to use proprietary medicine on the post-test is very interesting. It is possible that some sensitization effect occurred for the subjects. The initial test may have raised some issues concerning medicine and health care that children had not considered before. In taking the post-test children may have re-evaluated their initial responses and considered alternatives to taking medicine. Hence, a reduction in the measured willingness to use medicine on the post-test. The over-all decrease in the willingness of sixth graders to use drugs compared to third graders represents an interesting developmental difference that is worthy of future research. It may be that as children get older they gain increasing knowledge about the operations of the body and the effects of medicine (good and bad). This may cause them to become more cautious in the use of medicine. This speculation needs further empirical study for validation.

In the first experiment the variable of exposure to drug commercials had no consistent effect on the responses that subjects gave on the post-test. Two important procedural components could have contributed to the lack of significance. The pre-post design seemed

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to have some sensitization effect on the subjects. Subjects may have been responding on the post-test with some residual influence of the pre-test present. A second problem was one of attentiveness to the commercials themselves. The experimenters observed that the subjects paid little attention to the content of the commercials when compared to the actual television program that was viewed. This is quite understandable. The television program was directed at kids, while the commercials for drugs were adult-oriented. Thus, children often attended to the TV program and gazed off uncaringly when the more mundane commercials appeared. Any influential messages that the commercials attempted to expound were lost by their relative lack of humor and excitement when compared to the program.

EXPERIMENT 2

In an attempt to address the limitations of Experiment 1, and make a more definitive statement regarding the potential influence of television drug commercials, a second experiment was conducted. A number of procedural changes were instituted. Experiment 2 employed a post-test only design to avoid the possible sensitization effect of the first experiment. Additionally, Experiment 2 forced closer attention to the drug commercials in order to eliminate the lack of attention noticed in the first study. In study 1 it was also found that older children tended to be less willing to use medicine than younger children. This increases the likelihood that older childrens’ attitudes may be influenced by television commercials. In study 2 only fifth graders were used. This was done to avoid potential ceiling effects of younger subjects.

Method

Subjects and design. 60 fifth-graders from two middle class Catholic schools served as voluntary participants. Informed consent was obtained in the same manner as study 1. All subjects were assessed for predisposition toward the use of proprietary medicine prior to the beginning of the experiment. The instrument used for the assessment of predisposition and the division into groups was the same measure used as the pre-test and post-test in Experiment 1. This initial test was given to approximately 100 fifth-graders. From this sample three groups were constructed by totaling each subject’s score, rank ordering the totals, and dividing the sample into thirds. To avoid possible ceiling effects, in terms of predisposition, only the two lower groups were used in the study. These groups were labeled

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“low” and “medium” in their measured predisposition toward the use of proprietary medicines. Using a matched randomization tech- nique, the members of the two predisposition groups were assigned to either a treatment condition or a control condition, with 15 subjects in each of the four conditions.

Apparatus. The treatment condition of Experiment 2 involved the exposure to six videotaped “blocks” of commercials with no program material. Three of the six commercial “blocks” contained three drug commercials and one non-drug commercial. The other three “blocks” contained two drug commercials and two non-drug commercials. Most commercials were 30 seconds in length. It should be pointed out that one of the blocks labeled as two drug commercials and two non-drug commercials actually contained three different drug commercials. However, because two 15-second commercials were presented back to back, they were considered one commercial. All of the commercials were taped off the air during the later months of 1984, and the early months of 1985. An attempt was made to represent a number of different types of medicines in the commercials shown. Medicines for upset stomach, cold, flu, skin rashes, coughs, diarrhea, and numerous other ailments were shown in an effort to increase generalizability. Furthermore, a number of the commercials (both non-drug and drug) contained children. It was hoped that this would make the commercials more appealing to children. The non-drug commercials shown were chosen for their appro- priateness within the context of the study. They consisted of advertisements for gum, orange juice, breath mints, and other non-drug related products. None of the non-drug commercials were specifically aimed at children. All commercial “blocks” were approximately the same in length and were presented using the same VCR and monitor.

Drug Questionnaire. The drug questionnaire consisted of 2 1 questions or statements with three responses provided. This questionnaire was structured in a fashion similar to the Atkin (1 978) questionnaire. The questions covered the range of products presented in the television commercials. That is, for any advertised drug product presented to the subjects, there was at least one question addressing that product on the post-test. Each response was labeled either the drug response, the non-drug response or the neutral response. The drug response represented either the use of some medicine to deal with the given situation, or a more positive, accepting attitude toward the use of medicine compared to the other responses. The non- drug response represented the use of some alternative to a medicine to deal with the given situation, or a less positive, accepting attitude toward the use of drugs compared to the other responses. The neutral response was an alternative that was reasonable under the cir-

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cumstances but did not involve the use of some medicine or medicine alternative, nor did it represent a strong positive or negative attitude toward the use of medicine. For example, “For someone who is trying to lose weight it is best to: A) go to the store and get some diet pills, B) eat more sensibly and try to get more exercise, C) get a scale to keep an accurate record of weight change.” In this example response A would be the “drug” response (the use of diet pills), response B would be the “non-drug” response (alternatives to the use of drugs), response C would be the neutral response. Approximately half of the post-test items addressed the children indirectly (“If a friend has a sore throat, he/she should:. . .”), and about half of the items addressed the children directly (“If you have a stomach ache, you should:. . .”).

Procedure. Subjects in the treatment group were individually shown the six “blocks” of commercials. They were instructed that the experimenters were conducting research into what children thought about television commercials. Therefore, each subject was told to watch the commercials closely because after each block the experimenter was going to ask the subject which commercial was his/ her favorite and why. These instructions were given in order to assure attentiveness to the commercials. After each commercial “block” was shown the experimenter stopped the VCR and asked the subject which of the four commercials was his or her favorite. The experimenter recorded the responses and went on to the next block. After the commercial presentation the drug questionnaire was administered. Subjects in the control condition received only the questionnaire with no exposure to drug commercials.

Results

Based on the initial assessment of medicine predisposition, four equivalent groups were formed. The mean total score for the “medium” group was 68.4 (68.3 for treatment group and 68.47 for control group). The mean total score for the “low” group was 56.3 (56.3 for the treatment group and 56.27 for the control group). The number of drug responses given by each group on the post-test was analyzed in order to determine the effect of exposure to commercials. Sub- jects exposed to television commercials selected more drug responses than the control group (treatment total = 177, control total = 171). However, a 2(level of predisposition) X 2(level of exposure) ANOVA showed the main effect of exposure to be non-significant F( 1,56) = 0.6, p > 0.7, Those subjects determined to be medium in their predisposition toward the use of proprietary medicines who were exposed to drug .commercials chose more drug responses than their

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control counterparts (treatment total = 100, control total = 84). However, the reverse was true for the low predisposition group (treatment total = 77, control total = 87). The interaction between the variables, however, was found to be non-significant F(1,56) = 1.85, p > 0.17.

Non-parametric tests were used to analyze the subjects’ choices of preferred commercials. Since an unequal ratio of drug to non-drug commercials was shown, it was expected that with only chance factors operating 62.5% of the subjects’ choices should have been drug commercials, while non-drug commercials should have been picked 37.5% of the time. However, it was found that subjects chose drug commercials as favorites with only 40.2% frequency, and chose non- drug commercials with 58.9% frequency. A chi-square analysis on this data was highly significant x2 (1 JV = 30) = 37.89 p < 0.0000. A binomial test of probabilities was used to determine if the choice of non-drug commercials was significantly above chance expectations for each subject. Over 33% of the subjects chose significantly more non-drug commercials as favorites, while no subjects chose significantly more drug commercials as favorites.

In an attempt to explain the sources of the drug responses given by the subjects, additional post-hoc correlations were computed. Measures were obtained for children’s knowledge of medicine alternatives and average amount of daily television viewing. Additionally, parents were given the same drug questionnaire used as the post-test to determine their influence on their children’s questionnaire responses. None of these additional measures correlated significantly with the drug responses given by the subjects.

GENERAL DISCUSSION

Exposure to television drug commercials did not increase the willingness of children to use proprietary medicines and engender a more accepting, positive attitude toward medicine in general. This finding was supported by the results of both studies and seems to cast doubt upon some of the findings of earlier correlational studies. In a short term experimental setting, exposure to television drug commercials had no influence on children’s attitudes. Though long term correlational measures have resulted in significant relationships (Atkin, 1978; Milavsky et al., 1975; Robertson et al., 1979), the results of this research indicate that previous findings could be due to factors other than a real influence of television commercials. Immediate measures of television’s influence find no effect. Long term measures find small correlations using large sample sizes. The

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combination of these results tends to mitigate the role of TV advertising in the development of children’s attitudes toward proprietary medicine.

Experiment 1 employed a realistic viewing situation, where viewers were exposed to three blocks of commercials while watching an age appropriate TV show. In this situation it appeared that little attention was paid to the drug commercials by the third and sixth graders. They appeared to be waiting until the program returned and not really processing the advertised material, which was more directed at adults. Subjects in experiment 2 were required to pay close attention to the drug commercials, however, they overwhelmingly indicated a preference for the non-drug commercials. It is likely that the children were physically attending to the drug commercials but were not processing the content of those commercials as deeply as those they claimed as their favorites. This information raises questions concerning the estimates of drug advertising exposure used in past correlational studies. A reported monthly average of television viewing time may not accurately reflect the exposure to drug commercials nor the amount of mental effort being expended by the viewer.

Research by Salomon (1 983) has indicated that children tend to process television with very little mental effort. The results of the present research support this hypothesis. To say that a child has been exposed to 700 television drug commercials in a year is much different from claiming that a child has processed the messages from 700 TV drug commercials. Furthermore, Salomon (1 983) has described the effect of perceived demand characteristics (PDC) on the amount of mental effort expended by the viewer. When subjects in his study were instructed to try to learn from a television program, they reported investing more mental effort in processing the show than when subjects were instructed to simply watch the show for fun. The PDC in experiment 1 was low-subjects thought the show was just a time filler. In experiment 2, the PDC was high-subjects were told to pay close attention and evaluate the commercials. However, in neither situation did the PDC have any effect on the influence of the commercials. I t is unlikely that in normal viewing of TV commercials a high PDC is present (parents typically do not instruct children to pay close attention to commercials). Therefore, in order for the estimates of TV exposure used in previous research to be accurate and valid, a qualitative aspect of the children’s viewing as well as a quan- titative must be included.

The fact that TV drug commercials are not appealing to children should not be surprising. One need only examine the content of most drug advertisements to understand why a child would find

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them unattractive. Drug commercials are not aimed at the young audience. Most drug commercials contain adult figures presenting the product in a rather dry, serious, and uneventful fashion. Furthermore, Anderson and his associates (Anderson, Lorch, Field, and Sanders, 198 1) have shown that the understandability of television content can affect the amount of visual attention a child gives to it. The present results suggest that children may not feel able to understand TV drug commercial content, and therefore do not process the material deeply. Further research on children’s comprehension of TV drug advertising is needed to clarify the issue.

For any persuasive message to impact a viewer, the message must be attended to and processed. These two activities are related in children’s viewing of television. The present research indicates a lack of attention, and suggests that the orientation of the content of TV drug advertising may account for it. For influential messages to have more impact, the advertisers’ approach to drug commercials needs to be brought down to a more childlike level. However, at this point it appears that children’s attentional biases protect them from what some have considered to be a harmful influence: television drug commercials.

REFERENCES

Anderson, D. R., Lorch, E. P., Field, D. E., and Sanders, J. (1981). The effects of TV program content comprehensibility on children’s visual attention to television. Child Development, 17, 446-453.

Atkin, C. K. (1 978). Effects of drug commercials on young viewers. Journal of Communication, 28, 71-79.

Berger, A. A. (1 974). Drug advertising and the pain, pill, pleasure model. Journal of Drug Issues, 4, 208-2 12.

Collins, W. A. (1979). Children’s comprehension of television content. In E. War- tella (Ed.), Children’s communicating: Media and development of thought, speech, and understanding. Beverly Hills, CA. : Sage Publications.

Collins, W. A., Karasov, R., and Westby, S. (1 978). Effects of previewing instrue tions on children’s retention and inferences following a dramatic television program. Unpublished manuscript, University of Minnesota.

Milavsky, J. R., Pekowsky, B., and Stipp, H. (1975-1976). TV drug advertising and proprietary and illicit drug use among teenage boys. Public Opinion Quarterly, 39, 457-48 1.

Robertson, T. S. (1980). The impact of proprietary medicine advertising on children. In R. Adler et al., (Eds.), The effect of television advertising on children: Review and recommendations. Lexington, Mass.: Lexington Books.

Robertson, T. S., Rossiter, T. C., and Gleason, T. C. (1979). Children’s receptiv- ity to proprietary medicine advertising. Journal of Consumer Research, 6,

Rossiter, J. R., and Robertson, T. S. (1979). Children’s independence from parental mediation in learning about OTC drugs. In N. Beckwith, M. Houston,

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R. Mittelstaedt, K . B. Monroe, and S. Ward (Eds.), The 1979 Educator’s Conference Proceedings. Chicago: American Marketing Association.

Salomon, G . ( 1 983). Television watching and mental effort: A social psychologi- cal view. In J . Bryant and D. Anderson (Eds.), Children’s understanding of’ television. New York: Academic Press.

Requests for reprints should be addressed to Eliot J. Butter, Department of Psychology, University of Dayton, Dayton, Ohio, 45469.

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Television advertising and childrens' attitudes toward proprietary medicine