Advertising as a Determinant of Health




Summary

This article has provided a conceptual and empirical framework through which to study the economics of advertising in the context of markets for health inputs. The Dorfman–Steiner model positively relates advertising intensity to the advertising-sales elasticity and negatively relates it to the price elasticity of demand. The competing informative and persuasive views of advertising are explored, in addition to the view of advertising simply as a complement to the advertised good. Search and experience goods are distinguished and briefly discussed. These attributes, combined with the product’s price and advertising elasticities, generally determine the advertising intensity of the product.

An analysis of advertising in select health markets is covered, with a focus on selective versus primary demand effects and relevance for public health. Econometric studies typically find effects on consumption for tobacco, soft drinks, fast-food restaurants, and prescription drugs, which reflect an advertising induced industry expansion effect. For the alcohol industry, there is some evidence of small positive overall demand effects for certain segments of the population such as problem drinkers and youth. More empirical research, however, needs to be conducted, particularly addressing the potential endogeneity of advertising. A key obstacle for researchers is the high price of acquiring detailed advertising data. Currently, advertising data are only provided by a few companies, including Nielsen and TNS (now part of Kantar Media).




Future research in this area will increasingly stress the roles of online advertising, which allows greater targeting of the product to the potential user, and neuroeconomics, which may yield insights on the pathways underlying the consumer response. The emerging research combining behavioral economics and neuroscience is timely, for instance, as online purchases made after exposure to advertising may have higher probabilities of being ‘hot state,’ impulsive purchases. Some thoughts are provided on new directions for research in these increasingly important topic areas.

Bibliography:

  1. Adamy, J. (2010). Coming soon: Theaters, airplanes to post calories. Wall Street Journal. Available at: https://www.wsj.com/articles/SB10001424052748704323704575462021475610064.
  2. Anderson, P., de Bruijin, A., Angus, K., Gordon, R. and Hastings, G. (2009). Impact of alcohol advertising and media exposure on adolescent alcohol use: A systematic review of longitudinal studies. Alcohol and Alcoholism 44(3), 229–243.
  3. Andreyeva, T., Kelly, I. R. and Harris, J. (2011). Exposure to food advertising on television: Associations with children’s fast food and soft drink consumption and obesity. Economics and Human Biology 9(3), 221–233.
  4. Avery, R. J., Kenkel, D. S., Lillard, D. and Mathios, A. (2007). Private profits and public health: Does advertising smoking cessation products encourage smokers to quit? Journal of Political Economy 115(3), 447–481.
  5. Bagwell, K. (2007). The economic analysis of advertising. In Armstrong, M. and Porter, R. (eds.) Handbook of Industrial Organization, vol. III. North-Holland: Amsterdam.
  6. Barr-Anderson, D. J., Larson, N. I., Nelson, M. C., Neumark-Sztainer, D. and Story, M. (2009). Does television viewing predict dietary intake five years later in high school students and young adults? International Journal of Behavioral Nutrition and Physical Activity 6, 7.
  7. Becker, G. S. and Murphy, K. M. (1993). A simple theory of advertising as a good or bad. Quarterly Journal of Economics 108, 941–964.
  8. Benham, L. (1972). The effect of advertising on the price of eyeglasses. Journal of Law and Economics 15, 337–352.
  9. Berndt, E., Bui, L., Reiley, D. and Urban, G. (1995). Information, marketing and pricing in the US antiulcer drug market. American Economic Review 85(2), 100–105.
  10. Berndt, E. R. (2006). The United States experience with direct-to-consumer advertising of prescription drugs: What have we learned? In Sloan, F. A. and Hsieh, C. R. (eds.) Promoting and coping with pharmaceutical innovation: An international perspective. New York: Cambridge University Press.
  11. Bernheim, B. and Rangel, A. (2004). Addiction and cue-triggered decision processes. American Economic Review 94(5), 1558–1590.
  12. Bernheim, B. and Rangel, A. (2005). From neuroscience to public policy: A new economic view of addiction. Swedish Economic Policy Review 12, 99–144.
  13. Bhattacharya, J. and Vogt, G. (2003). A simple model of pharmaceutical price dynamics. Journal of Law and Economics 46(2), 599–626.
  14. Bittlingmayer, G. (2008). Advertising. The concise encyclopedia of economics. Library of Economics and Liberty. Available at: https://www.econlib.org/library/Enc1/Advertising.html.
  15. Bollinger, B., Leslie, P. and Sorensen, A. (2011). Calorie posting in chain restaurants. American Economic Journal: Economic Policy 3(1), 91–128.
  16. Borden, N. H. (1942). The economic effects of advertising. Chicago: Richard D. Irwin, Inc.
  17. Bradford, W. D., Kleit, A. N., Nietert, P. J., et al. (2006). Effects of direct-to-consumer advertising of hydroxymethylglutaryl coenzyme A reductase inhibitors on attainment of LDL-C goals. Clinical Therapaeutics 28(12), 2105–2118.
  18. Brown, R. S. (1978). Estimating advantages to large-scale advertising. Review of Economics and Statistics 60, 428–437.
  19. Bureau of the Census, US Department of Commerce (2007). Economic census. Washington, DC: US Government Printing Office.
  20. Cawley, J., Rosemary, A. and Matthew E. (2010). Effect of advertising and deceptive advertising on consumption: The case of over-the-counter weight loss products. Presented at the City University of New York Graduate Center, October 1.
  21. Chaloupka, F. and Warner, K. (2000). Economics of smoking. In Newhouse, J. and Culyer, A. (eds.) Handbook of health economics, vol. IB. North-Holland: Amsterdam.
  22. Chamberlin, E. (1933). The theory of monopolistic competition. Cambridge, MA: Harvard University Press.
  23. Chou, S., Rashad, I. and Grossman, M. (2008). Fast-food restaurant advertising on television and its influence on childhood obesity. Journal of Law and Economics 51, 599–618.
  24. Council of Better Business Bureaus (2009). Children’s food and beverage advertising initiative. Available at: https://bbbprograms.org/programs/all-programs/cfbai
  25. Darby, M. R. and Karni, E. (1973). Free competition and the optimal amount of fraud. Journal of Law and Economics 16(1), 67–88.
  26. Dave, D. and Saffer, H. (2012). Impact of direct-to-consumer advertising on pharmaceutical prices and demand. Southern Economic Journal 79(1), 97–126.
  27. Dave, D. and Saffer, H. (2013). Demand for smokeless tobacco: Role of advertising. Journal of Health Economics 32(4), 682–697.
  28. David, G., Markowitz, S. and Richards-Shubik, S. (2010). The effects of pharmaceutical marketing and promotion on adverse drug events and regulation. American Economic Journal: Economic Policy 2(4), 1–25.
  29. Donohue, J. M., Berndt, E. R., Rosenthal, M., Epstein, A. M. and Frank, R. G. (2004). Effects of pharmaceutical promotion on adherence to the treatment guidelines for depression. Medical Care 42(12), 1176–1185.
  30. Donohue, J. M., Cevasco, M. and Rosenthal, M. B. (2007). A decade of direct-to-consumer advertising of prescription drugs. New England Journal of Medicine 357(7), 673–681.
  31. Dorfman, R. and Steiner, P. O. (1954). Optimal advertising and optimal quality. American Economic Review 44, 826–836.
  32. Doyle, P. (1968). Advertising expenditure and consumer demand. Oxford Economic Papers 20(3), 394–415.
  33. Eckard, Jr., E. W. (1991). Competition and the cigarette TV advertising ban. Economic Inquiry 29, 119–133.
  34. Elbel, B., Kersh, R., Brescoll, V. L. and Dixon, L. B. (2009). Calorie labeling and food choices: A first look at the effects on low-income people in New York city. Health Affairs 28(6), w1110–w1121.
  35. Emery, S., Wakefield, M. A., Terry-McElrath, Y., et al. (2005). Televised state sponsored anti-tobacco advertising and youth smoking beliefs and behavior in the United States, 1999–2000. Archives of Pediatrics and Adolescent Medicine 159, 639–645.
  36. Epstein, L. H., Roemmich, J. N., Robinson, J. L., et al. (2008). A randomized trial of the effects of reducing television viewing and computer use on body mass index in young children. Archives of Pediatrics and Adolescent Medicine 162, 239–245.
  37. Federal Trade Commission (2000). Advertising and marketing on the internet: Rules of the road. Available at: https://www.ftc.gov/business-guidance/resources/advertising-marketing-internet-rules-road.
  38. Fisher, J. C. and Cook, P. A. (1995). Advertising, alcohol consumption, and mortality: An empirical investigation. Westport, CT: Greenwood Press.
  39. Gasmi, F., Laffont, J. J. and Vuong, Q. (1992). Econometric analysis of collusive behavior in a soft-drink market. Journal of Economics and Management Strategy 1, 277–311.
  40. Glazer, A. (1981). Advertising, information, and prices – A case study. Economic Inquiry 19, 661–671.
  41. Goel, R. K. and Morey, M. J. (1995). The interdependence of cigarette and liquor demand. Southern Economic Journal 62(2), 451–459.
  42. Goldman, L. K. and Glantz, S. A. (1998). Evaluation of antismoking advertising campaigns. Journal of the American Medical Association 279(10), 772–777.
  43. Grewal, D. and Levy, M. (2009). Marketing. 2nd ed, Irwin: McGraw-Hill.
  44. Halford, J. C. G., Boyland, M. J., Hughes, G., Oliveira, L. P. and Dovey, T. M. (2007). Beyond-brand effect of television (TV) food advertisement/commercials on caloric intake and food choice of 5-7-year-old children. Appetite 49, 263–267.
  45. Halford, J. C. G., Gillespie, J., Brown, V., et al. (2004). Effect of television advertisements for foods on food consumption in children. Appetite 42, 221–225.
  46. Hamilton, W. L., Turner-Bowker, D. M., Celebucki, C. C. and Connolly, G. N. (2002). Cigarette advertising in magazines: The tobacco industry response to the master settlement agreement and to public pressure. Tobacco Control 11, 54–58.
  47. Harris, J. L., Pomeranz, J. L., Lobstein, T. and Brownell, K. D. (2009). A crisis in the marketplace: How food marketing contributes to childhood obesity and what can be done. Annual Review of Public Health 30, 211–225.
  48. Iizuka, T. and Jin, G. Z. (2005). The effect of prescription drug advertising on doctor visits. Journal of Economics and Management Strategy 14(3), 701–727.
  49. Iizuka, T. and Jin, G. Z. (2007). Direct to consumer advertising and prescription choice. Journal of Industrial Economics 55(4), 771.
  50. Institute of Medicine (2006). Food Marketing to children and youth: Threat or opportunity? Washington, DC: National Academy of Sciences, Committee on Food Marketing and the Diets of Children and Youth.
  51. Ippolito, P. M. and Mathios, A. D. (1990). Information, advertising and health choices: A study of the cereal market. RAND Journal of Economics 21, 459–480.
  52. Jernigan, D. and O’Hara, J. (2004). Alcohol advertising and promotion. In Bonnie, R. J. and O’Connell, M. E. (eds.) Reducing underage drinking: A collective responsibility. Washington, DC: National Academies Press.
  53. Kaiser Family Foundation (2004). The role of media in childhood obesity. Menlo Park, CA: Kaiser Family Foundation.
  54. Kaldor, N. and Silverman, R. (1948). A statistical analysis of advertising expenditure and of the revenue of the press. Cambridge, UK: University Press.
  55. Kaldor, N. V. (1950). The economic aspects of advertising. Review of Economic Studies 18, 1–27.
  56. Kravitz, R. L., Epstein, R. M., Feldman, M. D., et al. (2005). Influence of patients’ requests for direct-to-consumer advertised antidepressants: A randomized controlled trial. Journal of the American Medical Association 293(16), 1995–2002, (Erratum in: Journal of the American Medical Association 294(19), 2436).
  57. Kunkel, D., McKinley, C. and Wright, P. (2009). The impact of industry self-regulation on the nutritional quality of foods advertised on television to children. Available at: http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.665.9456&rep=rep1&type=pdf.
  58. Kwong, W. J. and Norton, E. C. (2007). The effect of advertising on pharmaceutical promotion. Review of Industrial Organization 31, 221–236.
  59. Law, M. R., Soumerai, S. B., Adams, A. S. and Majumdar, S. R. (2009). Costs and consequences of direct-to-consumer advertising for Clopidogrel in Medicaid. Archives of Internal Medicine 169(21), 1969–1974.
  60. Lewit, E. M., Coate, D. and Grossman, M. (1981). The effects of government regulation on teenage smoking. Journal of Law and Economics 24(3), 545–569.
  61. Li, H. and Leckenby, J. (2006). Internet advertising formats and effectiveness. In Schumann, D. and Thorson, E. (eds.) Internet Advertising, Theory and Research. Mahwah, NJ: Lawrence Erlbaum Associates.
  62. Lipsitz, A., Brake, G., Vincent, E. J. and Winters, M. (1993). Another round for the brewers: Television ads and children’s alcohol expectancies. Journal of Applied Social Psychology 23(6), 439–450.
  63. Merriam-Webster (2011). Advertising. Available at: https://www.merriam-webster.com/dictionary/advertising.
  64. Milyo, J. and Waldfogel, J. (1999). The effect of price advertising on prices: Evidence in the wake of 44 Liquormart. American Economic Review 89(5), 1081–1096.
  65. Nelson, P. (1970). Information and consumer behavior. Journal of Political Economy 78, 311–329.
  66. Nelson, P. (1974). Advertising as information. Journal of Political Economy 82, 729–754.
  67. Nelson, P. (1975). The economic consequences of advertising. Journal of Business 48, 213–241.
  68. Nelson, P. and Moran, J. R. (1995). Advertising and U.S. alcohol beverage demand: System-wide estimates. Applied Economics 27(12), 1225–1236.
  69. Ozga, S. A. (1960). Imperfect markets through lack of knowledge. Quarterly Journal of Economics 74, 29–52.
  70. Pew Research Center (2011). Three Technology Revolutions. Available at: https://www.pewresearch.org/internet/three-technology-revolutions/.
  71. Powell, L. M., Schermbeck, R. M., Szczypka, G., Chaloupka, F. J. and Braunschweig, C. L. (2011). Trends in the nutritional content of television food advertisements seen by children in the United States. Archives of Pediatrics and Adolescent Medicine 165(12), 1078–1086.
  72. Rizzo, J. (1999). Advertising and competition in the ethical pharmaceutical industry: The case of hypertensive drugs. Journal of Law and Economics 42(1), 89–116.
  73. Roberts, M. J. and Samuelson, L. (1988). An empirical analysis of dynamic, nonprice competition in an oligopolistic industry. RAND Journal of Economics 19(2), 200–220.
  74. Robinson, J. (1933). Economics of Imperfect Competition. London: MacMillan and Co.
  75. Rodgers, S. and Thorson, E. (2000). The interactive advertising model: How users perceive and process online ads. Journal of Interactive Advertising 1(1), 42–61.
  76. Rosenthal, M. B., Berndt, E. R., Donohue, J. M., Epstein, A. M. and Frank, R. G. (2003). Demand effects of recent changes in prescription drug promotion. In Cutler, D. M. and Garber, A. M. (eds.) Frontiers in health policy research, vol. 6. Cambridge, MA: MIT Press.
  77. Ross, H. and Chaloupka, F. J. (2002). Economics of tobacco control. Chicago, IL: International Tobacco Evidence Network.
  78. Ruhm, C. (2012). Understanding overeating and obesity. Journal of Health Economics 31(6), 781–796.
  79. Saffer, H. (1991). Alcohol advertising bans and alcohol abuse: An international perspective. Journal of Health Economics 10, 65–79.
  80. Saffer, H. (1997). Alcohol advertising and motor vehicle fatalities. Review of Economics and Statistics 79(3), 431–442.
  81. Saffer, H. (2000). Tobacco advertising and promotion. In Jha, P. and Chaloupka, F. (eds.) Tobacco Control Policies in Developing Countries. New York: Oxford University Press.
  82. Saffer, H. (2011). New approaches to alcohol marketing research. Addiction 106, 472–479.
  83. Saffer, H. and Chaloupka, F. (2000). The effect of tobacco advertising bans on tobacco consumption. Journal of Health Economics 19(6), 1117–1137.
  84. Saffer, H. and Dave, D. (2006). Alcohol advertising and alcohol consumption by adolescents. Health Economics 15, 617–637.
  85. Sass, T. R. and Saurman, D. S. (1995). Advertising restrictions and concentration: The case of malt beverages. Review of Economics and Statistics 77, 66–81.
  86. Schmalensee, R. (1972). The Economics of Advertising. Amsterdam: North-Holland.
  87. Schonfeld & Associates (2010). Advertising ratios and budgets. Libertyville, IL: Schonfeld & Associates, Inc., June 1.
  88. Scott Morton, F. M. (2000). Barriers to entry, brand advertising, and generic entry in the U.S. pharmaceutical industry. International Journal of Industrial Organization 18(7), 1085–1104.
  89. Slater, M., Rouner, D., Domenech-Rodriquez, M., et al. (1997). Adolescent responses to TV beer ads and sports content/context: Gender and ethnic differences. Journalism and Mass Communication Quarterly 74, 108–122.
  90. Solving the Problem of Childhood Obesity within a Generation (2010). White House Task Force on Childhood Obesity Report to the President, Washington, DC. May.
  91. Statistical Abstract of the United States (2009). Information & communications. Internet Publishing and Broadcasting and Internet Usage. Available at: https://www.census.gov/library/publications/2008/compendia/statab/128ed.html.
  92. Stigler, G. J. (1961). The economics of information. Journal of Political Economy 69, 213–225.
  93. Stigler, G. J. and Becker, G. S. (1977). De gustibus non est disputandum. American Economic Review 67, 76–90.
  94. Termini, R. B., Roberto, T. A. and Hostetter, S. G. (2011). Should congress pass legislation to regulate child-directed food advertising? Food and Drug Policy Forum 1, 9), Available at https://papers.ssrn.com/sol3/papers.cfm?abstract_id=1848164.
  95. Thomas, L. G. (1989). Advertising in consumer good industries: Durability, economies of scale, and heterogeneity. Journal of Law and Economics 32, 164–194.
  96. Tremblay, V. J. and Okuyama, K. (2001). Advertising restrictions, competition, and alcohol consumption. Contemporary Economic Policy 19(3), 313–321.
  97. Variyam, J.N. and Cawley J. 2006. Nutrition labels and obesity. National Bureau of Economic Research Working Paper No. 11956. Cambridge, MA: National Bureau of Economic Research.
  98. Verma, V. K. (1980). A price theoretic approach to the specification and estimation of the sales-advertising function. Journal of Business 53, S115–S137.
  99. Wilcox, G. B., Sara Kamal and Gangadharbatla, H. (2009). Soft drink advertising and consumption in the United States 1984–2007. International Journal of Advertising 28(2), 351–367.
  100. Wilde, P. E. (2006). Federal communication about obesity in the dietary guidelines and checkoff programs. Obesity 14(6), 967–973.
  101. Wilde, P. (2007). Plowing through the politics of agriculture. Tufts Nutrition 9(1), 15.
  102. Baltagi, B. H. and Levin, D. (1986). Estimating dynamic demand for cigarettes using panel data: The effects of bootlegging, taxation, and advertising reconsidered. Review of Economics and Statistics 68(1), 148B55.
  103. Chaloupka, F. J., Grossman, M. and Saffer, H. (2002). The effects of price on alcohol consumption and alcohol-related problems. Alcohol Research and Health 26, 22–34.
  104. Duffy, M. (1996). Econometric studies of advertising, advertising restrictions, and cigarette demand: A survey. International Journal of Advertising 15, 1–23.
  105. Federal Trade Commission (2008). Marketing food to children and adolescents. a review of industry expenditures, activities, and self-regulation. A Report to Congress. Available at https://www.ftc.gov/reports/marketing-food-children-adolescents-review-industry-expenditures-activities-self-regulation-federal.
  106. Frank, R. G. Berndt, E. R. Donohue, J. M. Epstein, A. and Rosenthal, M. (2002). Trends in direct-to-consumer advertising of prescription drugs. Kaiser Family Foundation.
  107. General Accounting Office (2002). Prescription drugs: FDA oversight of direct-toconsumer advertising has limitations. Report to Congressional Reporters. Washington, DC: U.S. General Accounting Office.
  108. Grabowski, H. G. (1976). The effect of advertising on the inter-industry distribution of demand. Explorations in Economic Research 3, 21–75.
  109. Hamilton, J. L. (1972). Advertising, the health scare, and the cigarette advertising ban. Review of Economics and Statistics 54, 401–411.
  110. Kalyanaram, G. (2008). The order of entry effect in prescription (Rx) and over-thecounter (OTC) pharmaceutical drugs. International Journal of Pharmaceutical and Healthcare Marketing 2(1), 35–46.
  111. Kalyanaram, G. (2009). The endogenous modeling of the effect of direct advertising to consumers (DTCA) in prescription drugs. International Journal of Pharmaceutical and Healthcare Marketing 3(2), 137–148.
  112. National Institute on Alcohol Abuse and Alcoholism (2000). Alcohol and Health, 10th Special Report to Congress. Washington, DC: U.S. Department of Health and Human Services.
  113. Pollay, R. W. (1994). Promises, promises: Self-regulation of the U.S. cigarette broadcast advertising in the 1960s. Tobacco Control 3, 134–144.
  114. Posner, R. (1973). Regulation and advertising by the FTC. Washington, DC: American Enterprise Institute.
  115. Saffer, H. (1993). Alcohol advertising bans and alcohol abuse: Reply. Journal of Health Economics 12(2), 229–234.
  116. Saffer, H. (1998). Economic issues in cigarette and alcohol advertising. Journal of Drug Issues 28(3), 781–793.
  117. Saffer, H. and Dave, D. (2002). Alcohol consumption and alcohol advertising bans. Applied Economics 34, 1325–1334.
  118. Seldon, B. J. and Doroodian, K. (1989). A simultaneous model of cigarette advertising: Effects on demand and industry response to public policy. Review of Economics and Statistics 71, 673B7.
  119. Thomas, L. A. (1999). Incumbent firms’ response to entry: Price, advertising and new product introduction. International Journal of Industrial Organization 17, 527–555.
  120. Wilcox, G. B. and Vacker, B. (1992). Cigarette advertising and consumption in the United States. International Journal of Advertising 11, 269–278.
  121. Young, D. (1993). Alcohol advertising bans and alcohol abuse: Comment. Journal of Health Economics 12, 213–228.
Addiction and Health
Health at Advanced Ages