Drug companies spend over $2 billion each year on television airtime for advertisements in the US, according to the New York–based consumer data company Nielson Media Research. Most of these commercials are geared toward adults, but a growing number feature medicines regularly prescribed to teens. As a result, the US Food and Drug Administration (FDA) announced in late October that it would study the effect of prescription drug advertising on adolescents as part of its larger effort to determine the impact of direct-to-consumer (DTC) marketing of drugs to various audiences. “I think the American public needs to understand the role of advertising in our lives and how uniquely vulnerable children and adolescents are to it,” says Victor Strasburger, a pediatrician at the University of New Mexico in Albuquerque who is not involved in the FDA's research. Differences in cognitive abilities between adults and teenagers are largely responsible for the vulnerabilities to which Strasburger refers. The FDA itself points to studies that have shown that the maturation of social, emotional and developmental brain processes occurs at different speeds as a child progresses into adulthood (J. Res. Adolesc. 21, 211–224, 2011 ). This can have a large effect on decision making, the agency stated in its 31 October announcement, yet marketing researchers often fail to consider this distinction. To study the effect of drug ads on adolescents, the FDA is proposing to conduct an online survey in which 5,120 participants will be asked to view a web advertisement for one of two fictitious drugs—either an acne drug or a medication for attention deficit hyperactivity disorder. The participants will include two adolescent groups: one composed of 13- to 15-year-olds and one composed of 16- to 19-year-olds. Using the answers provided in the survey, these groups' reactions to the fake drug ads will be compared to a third group made up of 25- to 30-year-olds. Teenage wasteland: The effect of pharmaceutical advertising on teens has never been studied. Credit: Robin Beckham / BEEPstock / Alamy The study proposal must undergo a 60-day public comment period before it can receive approval from the Federal Office of Management and Budget. The US is one of only two countries in the world that allow DTC drug advertising on television (the other being New Zealand). ## Vulnerable youth Although there has been little research into the effects of drug advertising on adolescents to date, a large body of work has examined how the marketing of cigarettes and alcohol influences this age group. According to one study published in Tobacco Control more than a decade ago, adolescents who are regularly exposed to high levels tobacco advertising have a 70% chance of taking up smoking, whereas those with low levels of exposure have an 11% chance (Tob. Control 9, 163–168, 2000). Whether teens are uniquely impressionable when it comes to pharmaceutical ads remains a large question for the new FDA study to explore. “This particular research study is one among several that will help us explore the impact of DTC advertising on various audiences, in this case potentially vulnerable youth,” says FDA spokesperson Andrea Fischer. Citing acne medication as an example, the study proposal argues that the social stigma surrounding pimples among adolescents might be enough to “minimize the attention given to any risk information provided” during acne medication advertisements if they also feature “subtle references” to concerns about peer perception. Acne medication, however, is not one of the most widely prescribed drug classes among teenagers. Those happen to include painkillers, sleeping pills and anti-anxiety medications (J. Adolesc. Health 40, 76–83, 2007). And these categories of drugs are regularly represented in Nielson's lists of the biggest pharmaceutical marketing campaigns in the US for any given year. Ad spending for Eli Lilly's antidepressant Cymbalta (duloxetine), for example, topped$46 million during the first three months of 2012 alone.

If the FDA's study ends up revealing drug marketing's stronger influence on teenagers, the agency could restrict the appearance of drug advertising during certain television shows and during certain times of day, suggests Guy David, a health economist at the University of Pennsylvania in Philadelphia. “But ultimately,” he says, “I'm not sure whether most of the ads that target minors are performing any type of public service.”

Notably, a sample of parents will also be included in the FDA study to explore the similarities and differences in perceptions among the two generations. That's important, says David, the because “mothers tend to be the primary healthcare decision makers.” He suggests that ads that appear to be geared solely toward adolescents might actually be targeting concerned parents as well, and perhaps more strongly.

Until the study's results are released in the spring or summer of 2015, it's unlikely that the FDA will make policy changes to DTC advertising based on pure speculation about how teenagers perceive drug advertisements. But for Strasburger, the FDA's willingness to look into possible effects is a good sign. “It's a great idea,” he says, “that should have been done years ago.”