Factors Affecting Adherence to Governmental Health Warnings and the Case of Over-the- Counter Cough and Cold Medications (OTCCCM) in Children Under Two - Innovation and Marketing in the Pharmaceutical Industry - page 342

include four sample warnings (Samples A through D). We go on to evaluate the
specifi c case of the 2008 United States Food and Drug Administration (FDA)
warning against administration of over-the-counter cough and cold medication
(OTC-CCM) to children under age 2 (FDA 2008 ). The FDA warning serves as a
prime illustrative case and nicely captures many of the issues relevant to health
warning effectiveness identifi ed by earlier literature. We describe the results of three
studies, two conducted in the USA and one in the UK, that examine whether parents
had heard about OTC-CCM warnings and whether they intended to adhere to them.
Finally, we make recommendations for optimizing the design and dissemination of
similar warnings in light of the literature reviewed.

12.1 Factors Infl uencing Adherence to Health Warnings

12.1.1 Trust of the Source Issuing the Warning

Trust of the individual or institution issuing a health warning has been shown a key
aspect of health-related decision making (O'Neill 2002 ; Mechanic 2004 ; Hanoch
et al. 2010 ). Even if a warning with the appropriate content reaches and is under-
stood by its target audience, recipients may still not know what to believe if com-
municators are perceived to have a vested interest (Morgan et al. 2002 ; Jackson
et al. 2004 ). Mechanic ( 2004 ) suggests trust in large organizations is equivalent to
trust in government and business, which tends to be low. Walls et al. ( 2004 ) cite
various studies indicating that trust falls as the level of abstraction of the institution
goes up (e.g., “government scientists” or “local authorities” vs. “department of
health”). Similarly, Brown and Calnan ( 2010 ) suggest that trust is low for broad
systems/institutions, in part, because they are faceless to consumers. In contrast,
patients seem to trust doctors over health care institutions, possibly due to their
personal relationship (Mechanic 2004 ) and direct interaction (Brown 2009 ). In the
UK, for example, parents' decisions not to vaccinate against measles, mumps, and
rubella (MMR) despite assurances and campaigns to the contrary by the UK gov-
ernment stemmed largely from lack of trust in messages about the safety of these
vaccines (Casiday 2007 ; Casiday et al. 2006 ; Hobson-West 2007 ). Similar issues
have been studied in the context of genetic technology (Barnett et al. 2007 ), and
there is a growing literature on trust as important to the link between risk perception
and decision making (Williams and Noyes 2007 ).

12.1.2 (Safe) Experience with the Risk-Causing Agent

A growing body of literature has shown that people rarely incorporate information
about negative rare events into their decision-making process (Barron and Erev
2003 ; Erev and Barron 2005 ; Fox and Hadar 2006 ; Hertwig et al. 2004 ; Kahneman