Objective: Benchmarks for public awareness of pre-exposure prophylaxis (PrEP) and human immunodeficiency virus (HIV) Treatment-as-Prevention (TasP) are sparse, and evidence about whether public health communication campaigns are associated with awareness and use is lacking. This study assessed whether exposure to the Centers for Disease Control and Prevention's (CDC) Let's Stop HIV Together campaign was associated with self-reported PrEP and TasP awareness and PrEP use. Methods: Data were drawn from the 2022-2024 SpringStyles, a probability-based online survey of adults in the United States. Weighted logistic regression models assessed PrEP awareness, TasP awareness, and PrEP use by sociodemographic characteristics, prior HIV testing, and campaign exposure. Results: Awareness of PrEP and TasP increased from 2022 to 2024, reaching 38.0% and 39.0%, respectively. Respondents who recalled the CDC's campaign were significantly more likely to be aware of PrEP (52.9% vs 34.1%) and TasP (55.9% vs 35.8%), and to report PrEP use (1.9% vs. 1.0%). Conclusions: These nationally representative, repeated cross-sectional estimates reveal gains in PrEP and TasP awareness over time. The association of campaign exposure with PrEP and TasP awareness and PrEP use underscores the importance of federally funded health communication initiatives to end the HIV epidemic in the United States.

This study examined women's PrEP awareness, knowledge, and preferences for PrEP modality (daily oral pill or two-month injectable) based on their current contraceptive method and race. Data were from an online survey of 779 women (ages 18-64, 64% Black) in four US counties and were analyzed using descriptive statistics, chi-square tests, and regression models. More Black women reported PrEP awareness than non-Black women (55% vs. 41%). Though most women reported PCPs or OB-GYNs could prescribe PrEP, overall PrEP knowledge was low, with minimal differences by race. Women taking a birth control pill, other birth control, or no birth control preferred PrEP as a pill. Women who reported currently using an injectable form of birth control did not demonstrate a clear preference for injectable PrEP versus PrEP as a pill. There were no significant differences by race. Knowledge about PrEP was limited, indicating a need for awareness campaigns designed to reach all women. Clinicians have the potential to play a pivotal role in promoting PrEP awareness and options to women, emphasizing the importance of health promotion messages that incorporate PrEP-modality preferences and contraceptive use.

Objective Benchmarks for public awareness of pre-exposure prophylaxis (PrEP) and human immunodeficiency virus (HIV) Treatment-as-Prevention (TasP) are sparse, and evidence about whether public health communication campaigns are associated with awareness and use is lacking. This study assessed whether exposure to the Centers for Disease Control and Prevention's (CDC) Let's Stop HIV Together campaign was associated with self-reported PrEP and TasP awareness and PrEP use. Methods Data were drawn from the 2022–2024 SpringStyles, a probability-based online survey of adults in the United States. Weighted logistic regression models assessed PrEP awareness, TasP awareness, and PrEP use by sociodemographic characteristics, prior HIV testing, and campaign exposure. Results Awareness of PrEP and TasP increased from 2022 to 2024, reaching 38.0% and 39.0%, respectively. Respondents who recalled the CDC's campaign were significantly more likely to be aware of PrEP (52.9% vs 34.1%) and TasP (55.9% vs 35.8%), and to report PrEP use (1.9% vs. 1.0%). Conclusions These nationally representative, repeated cross-sectional estimates reveal gains in PrEP and TasP awareness over time. The association of campaign exposure with PrEP and TasP awareness and PrEP use underscores the importance of federally funded health communication initiatives to end the HIV epidemic in the United States.

Low uptake of pre-exposure prophylaxis (PrEP) for HIV prevention among Black women has been partly attributed to barriers related to patient-provider communication. The goal of this paper was to investigate the association between exposure to the #ShesWell campaign and Black women’s communication about PrEP with a healthcare provider (HCP). We conducted a cross-sectional survey of 403 sexually active, Black women after the initial phase of #ShesWell and used multivariable regression models to analyze whether exposure to #ShesWell was associated with talking to an HCP about PrEP or intention to discuss PrEP with an HCP in the future. Approximately 33% of women surveyed reported exposure to #ShesWell. Campaign exposure was significantly associated with talking to an HCP in the past year about PrEP (OR = 4.96, p = 0.001) and intention to discuss PrEP with an HCP in the next six months (B = 0.29, p = 0.038). Stronger beliefs that doctors should initiate sexual health conversations were positively associated with past PrEP conversations (OR = 2.32, p < 0.001) and future intention (B = 0.11, p = 0.029). Greater comfort discussing prevention (B = 0.35, p < 0.001), self-efficacy discussing PrEP (B = 0.29, p = 0.001), and concern about getting HIV (B = 0.51, p < 0.001) were also associated with intention to discuss PrEP with an HCP. Findings highlight the potential for communication campaigns to motivate patient-provider communication about PrEP, addressing a reported barrier to PrEP uptake among Black women.

This study evaluated the initial phase of the #ShesWell campaign, which aimed to increase pre-exposure prophylaxis (PrEP) awareness and uptake among Black women in four Ending the HIV Epidemic jurisdictions. The initial phase of #ShesWell (March to August 2022) sought to increase demand for PrEP among Black women and build the capacity of healthcare providers (HCPs) to prescribe PrEP. In January-March 2023, a cross-sectional survey was conducted 10 months after the campaign was launched. Sexually active women aged 18-64 were recruited from an online panel. Outcome measures included campaign exposure, PrEP attitudinal beliefs, perceived norms toward taking PrEP, perceived behavioral control, and intentions to take PrEP in the next 6 months. A structural equation model analysis was conducted using data from the 396 Black women in the survey sample who were not currently taking PrEP to explore the associations between campaign exposure and the outcome measures. There is evidence of effects of #ShesWell exposure on attitudinal beliefs and norms and a related total effect of exposure on intention. The study confirmed the pathways from exposure to intention posited by the Integrative Model of Behavioral Intention. Specifically, the collective influence of attitudinal beliefs and normative pressure indirectly impacted Black women's intentions to take PrEP after exposure to #ShesWell campaign messaging. To address disparities in PrEP uptake and increase use of PrEP among Black women, communication campaigns should develop messages that speak to women's attitudinal beliefs and norms. HCPs should also endorse these types of messages with their patients.

Objective The rise in direct-to-consumer (DTC) ads for cancer drugs, which often have complex indications, raises concerns about consumer misunderstanding. A drug’s indication must clearly convey its condition(s) of use, which may include elements such as the approved patient population, second-line treatment status, and whether it is adjunctive or concomitant therapy. The study examines whether the modality used to communicate the drug’s indication in DTC television ads affects consumers’ recognition, recall, and comprehension. Methods We conducted two experimental studies testing dual-modality (voiceover and on-screen text) presentations of therapeutic indication information in television ads for non-small cell lung cancer (N = 281) and multiple myeloma (N = 287). In each study, the indication statement for all ads presented the medical condition in dual modality and varied the modality used to present additional elements of the indication (absent, audio-only, text-only, dual-modality). After viewing the ad twice, participants completed a questionnaire that measured indication recognition, recall, and comprehension. Results Dual-modality presentations led to improved communication outcomes relative to the control condition without unintended detrimental effects relative to single-modality presentations. Participants exposed to dual-modality presentations were more likely to correctly recognize the full indication statement and the drug’s intended use. The dual-modality presentation also improved recall and comprehension of the indication’s additional elements in one study, though not consistently across both. No consistent pattern emerged linking specific single modalities to better outcomes. In line with previous research, our results present nuanced outcomes, revealing the superior benefits of dual-modality presentations for some outcomes, but highlighting the influence of moderating factors. Conclusions Dual-modality presentations of indication statements may improve individuals’ recall, recognition, and comprehension of indication statements and facilitate better consumer understanding. Practice Implications These results support stakeholders continuing to investigate how indication statement complexity affects consumer understanding and expectations about drug eligibility.

BACKGROUND:The meaning and characteristics embedded in proprietary drug names have the potential to affect name recall, perceptions of drug benefits and risks, and attitudes toward a drug. In this study, we examined: (1) whether names that reference the drug's medical indication affect consumers' and primary care physicians' (PCPs') perceptions of the drug and (2) whether names that overstate the drug's efficacy affect consumers' and PCPs' perceptions of the drug. METHODS:We conducted an online experiment with 455 PCPs and 450 consumers to test the effects of fictitious proprietary prescription drug names. Participants were randomized to view one neutral drug name, one name that overstated the drug's efficacy, and five names that referenced the drug's medical indication. RESULTS:Names that referenced the drug's medical indication and names that overstated the drug's benefit both influenced perceptions of efficacy and risk compared to neutral names. For several outcomes, names evoking medical indications had similar effects to those designed to overstate the drug's efficacy. The patterns of effects were similar for PCPs and consumers. CONCLUSION:Findings suggest drug names alone can be sufficient to produce attitudes and risk and benefit perceptions about drugs, even in the absence of any information beyond the drug's medical indication.

Background This study examined how people interpret overall survival (OS), overall response rate (ORR), and progression-free survival (PFS) endpoints in the context of direct-to-consumer television ads. Although there is little research on this topic, initial evidence suggests that people can misinterpret these endpoints. We hypothesized that understanding of ORR and PFS would be improved by adding a disclosure (“We currently do not know if [Drug] helps patients live longer”) to ORR and PFS claims. Methods We conducted 2 online studies with US adults examining television ads for fictional prescription drugs indicated to treat lung cancer (N = 385) or multiple myeloma (N = 406). The ads included claims about OS, ORR with and without a disclosure, or PFS with and without a disclosure. In each experiment, we randomized participants to view 1 of 5 versions of a television ad. After viewing the ad twice, participants completed a questionnaire that measured understanding, perceptions, and other outcomes. Results In both studies, participants correctly differentiated between OS, ORR, and PFS via open-ended responses; however, participants in the PFS conditions (versus ORR conditions) were more likely to make incorrect inferences about OS. Supporting the hypothesis, adding a disclosure made expectations around living longer and quality-of-life improvements more accurate. Conclusion Disclosures could help reduce the extent to which people misinterpret endpoints like ORR and PFS. More research is needed to establish best-practice recommendations for using disclosures to improve patient understanding of drug efficacy without changing their perception of the drug in unintended ways.

Federal agencies and self-regulatory bodies help to ensure prescription and nonprescription drug promotion contains accurate information; however, false or misleading claims may cause people to have inaccurate perceptions of a drug and inhibit their ability to make informed decisions. We conducted a systematic review assessing evidence from 2012-2021 on how consumers and healthcare providers (HCPs) interpret claims made indirectly or through inference (implied or implicit claims) as well as synthesizing prescription and nonprescription drug advertising claims that have been the subject of regulatory actions from 2017-2021. Our search identified 16 studies from the peer-reviewed literature and 26 letters or case reports issued by the Food and Drug Administration (FDA) or National Advertising Division (NAD). Results from peer-reviewed studies suggest that implied claims can result in inferences that may not be warranted by the material facts about the drug. Perceptions of a drug's efficacy and, to a lesser extent, risk, are influenced by implied and explicitly false claims in prescription drug promotion. Claims related to implied superiority and overstatement of efficacy were the most prevalent claims flagged for review and examined in the literature. These types of claims were also the subject of many of the compliance actions by the FDA and case reports from the NAD. More research is needed to understand how people interpret varying types of implied claims and the impact of such claims on key outcomes. From a policy standpoint, understanding how people interpret implied claims can inform how the FDA approaches these claims in the marketplace.

Although misleading health information is not a new phenomenon, no standards exist to assess consumers' ability to detect and subsequently reject misinformation. Part of this deficit reflects theoretical and measurement challenges. After drawing novel connections among legal, regulatory, and philosophical perspectives on false, misleading or deceptive advertising and cognitive process models of persuasive communication, we define deception and misinformation rejection. Recognizing that individuals can hold beliefs that align with a persuasive message without those beliefs having been influenced by it, we derive empirical criteria to test for evidence of these constructs that center on yielding or not yielding to misinformation in mediated contexts. We present data from an experimental study to illustrate the proposed test procedure and provide evidence for two theoretically derived patterns indicative of misinformation rejection. The resulting definitions and empirical procedure set the stage for additional theorizing and empirical studies on misinformation in the marketplace.

The US Food and Drug Administration developed the Breakthrough Therapy designation to expedite the development and review of drugs that show a clear advantage over available therapy for serious conditions. Prior research has shown that physicians tend to misunderstand that a drug may receive a Breakthrough Therapy designation based on preliminary clinical evidence (eg, effect on a surrogate endpoint or intermediate clinical endpoint that is likely to predict clinical benefit). The objective of this article is to examine whether physicians' familiarity with and interpretation of the Breakthrough Therapy designation have changed since a survey on the topic was published in 2016. We replicated three of the questions in that study and explored beliefs that a Breakthrough Therapy designation automatically qualifies a drug for accelerated approval. We also draw comparisons by specialization (oncologists vs. primary care physicians). In general, physicians remain more likely than not to misunderstand the Breakthrough Therapy designation.

We define scientific misinformation as publicly available information that is misleading or deceptive relative to the best available scientific evidence and that runs contrary to statements by actors or institutions who adhere to scientific principles. Scientific misinformation violates the supposition that claims should be based on scientific evidence and relevant expertise. As such, misinformation is observable and measurable, but research on scientific misinformation to date has often missed opportunities to clearly articulate units of analysis, to consult with experts, and to look beyond convenient sources of misinformation such as social media content. We outline the ways in which scientific misinformation can be thought of as a disorder of public science, identify its specific types and the ways in which it can be measured, and argue that researchers and public actors should do more to connect measurements of misinformation with measurements of effect.

BACKGROUND:Many research studies fail to enroll enough research participants. Patient-facing electronic health record applications, known as patient portals, may be used to send research invitations to eligible patients.OBJECTIVE:The first aim was to determine if receipt of a patient portal research recruitment invitation was associated with enrollment in a large ongoing study of newborns (Early Check). The second aim was to determine if there were differences in opening the patient portal research recruitment invitation and study enrollment by race and ethnicity, age, or rural/urban home address.METHODS:We used a computable phenotype and queried the health care system's clinical data warehouse to identify women whose newborns would likely be eligible. Research recruitment invitations were sent through the women's patient portals. We conducted logistic regressions to test whether women enrolled their newborns after receipt of a patient portal invitation and whether there were differences by race and ethnicity, age, and rural/urban home address.RESULTS:Research recruitment invitations were sent to 4510 women not yet enrolled through their patient portals between November 22, 2019, through March 5, 2020. Among women who received a patient portal invitation, 3.6% (161/4510) enrolled their newborns within 27 days. The odds of enrolling among women who opened the invitation was nearly 9 times the odds of enrolling among women who did not open their invitation (SE 3.24, OR 8.86, 95% CI 4.33-18.13; P<.001). On average, it took 3.92 days for women to enroll their newborn in the study, with 64% (97/161) enrolling their newborn within 1 day of opening the invitation. There were disparities by race and urbanicity in enrollment in the study after receipt of a patient portal research invitation but not by age. Black women were less likely to enroll their newborns than White women (SE 0.09, OR 0.29, 95% CI 0.16-0.55; P<.001), and women in urban zip codes were more likely to enroll their newborns than women in rural zip codes (SE 0.97, OR 3.03, 95% CI 1.62-5.67; P=.001). Black women (SE 0.05, OR 0.67, 95% CI 0.57-0.78; P<.001) and Hispanic women (SE 0.07, OR 0.73, 95% CI 0.60-0.89; P=.002) were less likely to open the research invitation compared to White women.CONCLUSIONS:Patient portals are an effective way to recruit participants for research studies, but there are substantial racial and ethnic disparities and disparities by urban/rural status in the use of patient portals, the opening of a patient portal invitation, and enrollment in the study.TRIAL REGISTRATION:ClinicalTrials.gov NCT03655223; https://clinicaltrials.gov/ct2/show/NCT03655223.

Background: Consumers and primary care physicians (PCPs) sometimes encounter deceptive promotional claims about prescription drugs. Whether consumers and PCPs can detect deceptive claims or whether those claims negatively affect medical decision making, however, remain important, unanswered research questions. Objectives: This article explores (1) the ability of consumers and PCPs to identify deceptive prescription drug promotion at various levels of deception, (2) the influence of such tactics on obstructing risk recognition, and (3) whether perceived deception mediates relationships between exposure to deceptive tactics and various outcomes (including false-claim acceptance, attitudes, information-seeking intentions, and interest toward the promoted drug). Methods: Two experiments?1 with consumers (N = 366) and 1 with PCPs (N = 378)?were conducted to determine whether participant exposure to deceptive prescription drug website content corresponds to detection and acceptance (or rejection) of claims and tactics. In each experiment, the number of deceptive claims and tactics on a consumer-or PCP-targeted website for a fictitious chronic pain medication were varied, in a 1 ? 3 (none, fewer, more) between-subjects design. Results: Among consumers, exposure to more deceptive claims or tactics did not increase suspicion about the veracity of the website (relative to fewer claims and tactics) and actually had a limited positive direct effect on false-claim acceptance and attitudes toward the drug. Among PCPs, a mediation effect existed such that exposure to more deceptive claims and tactics resulted in higher perceived website deceptiveness relative to those in the fewer deceptive claims condition, which, in turn, resulted in lower acceptance of deceptive claims and tactics, lower perceived drug effectiveness, more negative attitudes toward the drug, and lower interest and intentions. Conclusion: These experiments demonstrate potential differences between consumers and PCPs as well as implications for consumer and PCP vulnerability to website deception.

Abstract Meeting recruitment targets for clinical trials and health research studies is a notable challenge. Unsuccessful efforts to recruit participants from traditionally underserved populations can limit who benefits from scientific discovery, thus perpetuating inequities in health outcomes and access to care. In this study, we evaluated direct mail and email outreach campaigns designed to recruit women who gave birth in North Carolina for a statewide research study offering expanded newborn screening for a panel of rare health conditions. Of the 54,887 women who gave birth in North Carolina from September 28, 2018, through March 19, 2019, and were eligible to be included on the study’s contact lists, we had access to a mailing address for 97.9% and an email address for 6.3%. Rural women were less likely to have sufficient contact information available, but this amounted to less than a one percentage point difference by urbanicity. Native American women were less likely to have an email address on record; however, we did not find a similar disparity when recruitment using direct‐mail letters and postcards was concerned. Although we sent letters and emails in roughly equal proportion by urbanicity and race/ethnicity, we found significant differences in enrollment across demographic subgroups. Controlling for race/ethnicity and urbanicity, we found that direct‐mail letters and emails were effective recruitment methods. The enrollment rate among women who were sent a recruitment letter was 4.1%, and this rate increased to 5.0% among women who were also sent an email invitation. Study Highlights WHAT IS THE CURRENT KNOWLEDGE ON THE TOPIC? Under‐representation by traditionally underserved populations in clinical trials and health research is a challenge that may in part reflect inequitable opportunities to participate. WHAT QUESTION DID THIS STUDY ADDRESS? Are direct‐mail and email outreach strategies effective for reaching and recruiting women from traditionally underserved and rural populations to participate in large‐scale, population‐based research? WHAT DOES THIS STUDY ADD TO OUR KNOWLEDGE? Despite sending recruitment letters and email invitations in roughly equal proportion by urbanicity and race/ethnicity, women living in rural areas were less likely to enroll (2.8%) than women from urban areas (4.2%). Additionally, enrollment rates decreased as the probability that women were members of a racial or ethnic minority group increased. HOW MIGHT THIS CHANGE CLINICAL PHARMACOLOGY OR TRANSLATIONAL SCIENCE? Results from this study might encourage researchers to take a holistic and participant‐centered view of barriers to study enrollment that may disproportionately affect underserved communities, including differences in willingness to participate, trust, and access to resources needed for uptake.

Direct-to-consumer prescription-drug television advertisements often contain superimposed text (supers) to convey information about the advertised product. This randomized experiment examined three size levels of supers and two levels of background contrast in direct-to-consumer advertisements. Participants (N = 1,272) watched different versions of a television advertisement for a fictitious asthma drug on either a flat-screen television or a tablet computer. Larger supers were more noticeable and memorable than smaller supers. High-contrast supers were less noticeable. Tablet users had more favorable views of the advertisement. Results have implications for the communication of important medical information in direct-to-consumer advertisements.

BACKGROUND:Little is known about how physicians interpret data displays that depict preliminary or exploratory clinical data in physician-targeted sales aids for oncology drugs. Using three factorial experiments, we examined whether disclosures of data limitations and clinical uncertainty adequately communicate the limitations and practical utility of this type of data.SUBJECTS, MATERIALS, AND METHODS:The studies used a 2 (disclosure of data limitations: technical, nontechnical) × 2 (disclosure of clinical uncertainty: present, absent) + 1 (control: no disclosure) between-subjects experimental design to examine the impact of disclosures as they relate to presentations of preliminary or exploratory data in promotional communications for oncology products. In each experiment, we randomized oncologists and primary care physicians with oncology experience to view one version of a two-page sales aid. Following this exposure, physicians completed a web-based survey. The design was replicated in three concurrently conducted experiments using sales aids for different fictitious oncology drugs, each featuring one of three common data displays: a forest plot (n = 495), a Kaplan-Meier curve (n = 504), or a bar chart (n = 532).RESULTS:Results provide initial evidence that in some contexts disclosures can improve understanding of the clinical utility of certain information about a drug and the limitations of results presented in a data display. Disclosures can also temper perceptions of how much evidence is presented that supports a conclusion that the drug is an appropriate treatment. In terms of the language used in the disclosure of data limitations, physicians in all three experiments strongly preferred the nontechnical disclosures.CONCLUSION:The findings from the three experiments in this study suggest that disclosures have the potential to increase relevant knowledge, but more research is needed to establish best practice recommendations for using disclosures to convey contextual information relevant for interpreting data displays in promotional communications.IMPLICATIONS FOR PRACTICE:This article reports the results from three large, online experimental studies that address a growing concern that drug companies often share favorable clinical trial results with physicians in promotional materials that lack important context for physicians to interpret the data. This series of studies investigates whether strategic use of two types of disclosures (disclosure of data limitations and a disclosure of clinical uncertainty) improves understanding and reduces misinterpretations among physicians. The results from these studies help identify communication factors that impact how physicians critically appraise preliminary or exploratory clinical trial data to inform policy and regulatory efforts.

Abstract Background Gene therapy offers an etiologically targeted treatment for genetic disorders. Little is known about the acceptance of mortality risk among patients with progressive, fatal conditions. We assessed patients’ and caregivers’ maximum acceptable risk (MAR) of mortality for gene therapy when used to treat Duchenne muscular dystrophy (DMD). Methods The threshold technique was used to assess tolerance for mortality risks using a hypothetical vignette. Gene therapy was described as non‐curative and resulting in a slowing of progression and with a 10‐year benefit duration. MAR was analyzed using interval regression for gene therapy initiated “now”; in the last year of walking well; in the last year of being able to bring arms to mouth; and in newborns (for caregivers only). Results Two hundred eighty‐five caregivers and 35 patients reported the greatest MAR for gene therapy initiated in last year of being able to lift arms (mean MAR 6.3%), followed by last year of walking well (mean MAR 4.4%), when used “now” (mean MAR 3.5%), and when used in the newborn period (mean MAR 2.1%, caregivers only). About 35% would accept ≥200/2000 risk in the last year of being able to lift arms. Non‐ambulatory status predicted accepting 1.8 additional points in MAR “now” compared with ambulatory status (p = 0.010). Respondent type (caregiver or patient) did not predict MAR. Conclusion In this first quantitative study to assess MAR associated with first‐generation DMD gene therapy, we find relatively high tolerance for mortality risk in response to a non‐curative treatment scenario. Risk tolerance increased with disease progression. Patients and caregivers did not have significantly different MAR. These results have implications for protocol development and shared decision making.

The U.S. Food and Drug Administration's (FDA) Bad Ad program provides an avenue for healthcare providers to report false or misleading prescription drug promotion. Yet, whether healthcare providers can detect such promotion, and whether they believe it should be reported to FDA, remain open questions. Consumer audiences may also be capable of detecting such promotion and believe it should be reported, but even less is known about capability and belief in this population. Across two experiments using mock pharmaceutical websites, this research investigated capability to detect and inclination to report deceptive prescription drug promotion among a sample of primary care physicians and consumers. Study 1 varied the number of deceptive claims and tactics on a website for a chronic pain medication, operationalized as none, two, or five. Study 2 varied the type of deceptive content on a website for a weight loss medication, operationalized as none, implicit, or explicit. Findings reveal that, in line with expectations from FDA's Bad Ad program, physicians can detect deceptive promotion and tend to believe it should be reported. Consumers are also capable of detecting deceptive promotion and tend to believe it should be reported, but their capabilities and beliefs regarding reporting are generally lower.