80_FR_80155 80 FR 79909 - Agency Information Collection Activities; Submission for Office of Management and Budget Review; Comment Request; Hearing, Aging, and Direct-to-Consumer Television Advertisements

80 FR 79909 - Agency Information Collection Activities; Submission for Office of Management and Budget Review; Comment Request; Hearing, Aging, and Direct-to-Consumer Television Advertisements

DEPARTMENT OF HEALTH AND HUMAN SERVICES
Food and Drug Administration

Federal Register Volume 80, Issue 246 (December 23, 2015)

Page Range79909-79912
FR Document2015-32251

The Food and Drug Administration (FDA) is announcing that a proposed collection of information has been submitted to the Office of Management and Budget (OMB) for review and clearance under the Paperwork Reduction Act of 1995.

Federal Register, Volume 80 Issue 246 (Wednesday, December 23, 2015)
[Federal Register Volume 80, Number 246 (Wednesday, December 23, 2015)]
[Notices]
[Pages 79909-79912]
From the Federal Register Online  [www.thefederalregister.org]
[FR Doc No: 2015-32251]



[[Page 79909]]

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Food and Drug Administration

[Docket No. FDA-2015-N-2163]


Agency Information Collection Activities; Submission for Office 
of Management and Budget Review; Comment Request; Hearing, Aging, and 
Direct-to-Consumer Television Advertisements

AGENCY: Food and Drug Administration, HHS.

ACTION: Notice.

-----------------------------------------------------------------------

SUMMARY: The Food and Drug Administration (FDA) is announcing that a 
proposed collection of information has been submitted to the Office of 
Management and Budget (OMB) for review and clearance under the 
Paperwork Reduction Act of 1995.

DATES: Submit either electronic or written comments on the collection 
of information by January 22, 2016.

ADDRESSES: To ensure that comments on the information collection are 
received, OMB recommends that written comments be faxed to the Office 
of Information and Regulatory Affairs, OMB, Attn: FDA Desk Officer, 
FAX: 202-395-7285, or emailed to oira_submission@omb.eop.gov. All 
comments should be identified with the OMB control number 0910-New and 
title ``Hearing, Aging, and Direct-to-Consumer Television 
Advertisements.'' Also include the FDA docket number found in brackets 
in the heading of this document.

FOR FURTHER INFORMATION CONTACT: FDA PRA Staff, Office of Operations, 
Food and Drug Administration, 8455 Colesville Rd., COLE-14526, Silver 
Spring, MD 20993-0002, PRAStaff@fda.hhs.gov.

SUPPLEMENTARY INFORMATION:

I. Background

    In compliance with 44 U.S.C. 3507, FDA has submitted the following 
proposed collection of information to OMB for review and clearance.

Hearing, Aging, and Direct-to-Consumer Television Advertisements

OMB Control Number 0910--NEW
    Section 1701(a)(4) of the Public Health Service Act (42 U.S.C. 
300u(a)(4)) authorizes the FDA to conduct research relating to health 
information. Section 1003(d)(2)(C) of the Federal Food, Drug, and 
Cosmetic Act (the FD&C Act) (21 U.S.C. 393(b)(2)(c)) authorizes FDA to 
conduct research relating to drugs and other FDA regulated products in 
carrying out the provisions of the FD&C Act.
    Older adults use a disproportionate number of prescription drugs 
(Ref. 1) and watch more television than other age groups (Ref. 2). Age-
related changes in hearing are common (Refs. 3-5) and, depending on 
their severity, influence the understanding of speech. Direct-To-
Consumer (DTC) television advertisements (ads) contain large amounts of 
complex information about prescription drug treatments that may be 
particularly relevant to a population that is experiencing some level 
of hearing loss. Moreover, much of the information in these ads is 
conveyed by voiceover, meaning that the audio channel is the only way 
to receive the information. Although people with serious hearing loss 
may compensate by using closed captioning (which may or may not be 
available for ads) or hearing aids, some individuals experience the 
effects of hearing loss without realizing that it is the cause and 
others choose not to use external compensatory aids (Ref. 6). For these 
reasons, FDA is proposing research to investigate how people at various 
ages and levels of hearing ability comprehend DTC ads.
    Sponsors of DTC ads cannot control the hearing abilities of their 
audiences. Nonetheless, researchers have identified several aspects of 
DTC ads within their control that influence the understanding of speech 
in individuals who experience aging-related hearing loss. First, 
frequency thresholds differ as people age--that is, older adults are 
not able to hear higher frequencies as well (Refs. 7, 8). Second, DTC 
television ads contain a risk statement of the most serious and most 
common side effects, called ``the major statement.'' FDA regulations 
require that the major statement must be included in at least the audio 
portion of the ad (Ref. 9). The risks of a medical product often 
include highly technical medical terms that should be transformed into 
consumer-friendly language to convey the risks appropriately. This is 
easier in some cases than in others. In addition, there are techniques 
to help reduce the complexity of the major statement, such as 
maintaining active voice, reducing instances where words need 
clarification from other later words in the broadcast, and using 
shorter sentences. Third, television ad spots are typically bought in 
increments of 15 seconds, leading to a preponderance of 30- and 60-
second ads, and some 75-second ads when risk information is especially 
dense. In order to fit the required information into this time frame, 
the audio presentation speed may be adjusted to be faster or slower. 
Research has shown that fast speech is more difficult to understand 
than slower speech, even for healthy young adults (Ref. 10).
    Thus, we propose to examine the effects of three aspects of DTC ads 
(voice frequency, complexity of major statement, and speed of major 
statement) on the comprehension of the ads among four different age 
groups of individuals. Because hearing losses begin to occur as people 
age, we will examine a group of middle-aged adults (40-50 years), 
young-old adults (60-74 years), and old-old adults (75+ years), and a 
group of young adults (18-25 years) as a control. The use of young 
adults as a control group is common in studies of age changes in 
memory, cognition, and hearing (Refs. 11-14). We expect a progression 
of hearing loss across the lifespan, but that is not the focus of this 
study. Our primary outcomes will be verbatim and gist memory, and 
confidence in memory judgments, but we will also seek to apply findings 
from previous studies showing age changes in hearing ability (Refs. 15, 
16) to the particular situation of DTC ad viewing.
    It is important to note that despite hearing and cognitive losses, 
older adults generally use linguistic context well. That is, they are 
as good as or even better than younger adults at using context to 
determine what they are hearing. They are also skilled at using the 
intonation of words, which words are stressed, where pauses occur, and 
how words are lengthened before pauses, all components of something 
called the prosody of language (Ref. 17). Thus, even though older 
adults generally perform worse than younger adults with rapid speech, 
older adult recall of sentences is still relatively high, at 80 
percent, presumably because older adults use linguistic context. 
Moreover, to approximate real DTC ads, participants will view an ad 
that has a typical amount of superimposed text, some of which may 
repeat the information in the audio. Our task thus involves viewing 
realistic DTC ads, which provide more context than lists of unrelated 
words or sentences, as often found in laboratory experiments. Thus, it 
is an open question whether hearing loss will impede the comprehension 
of DTC ads or whether the ability to make use of context will 
counteract these decrements across the lifespan.

II. General Research Questions

    1. How do hearing and cognitive declines in older adults affect 
comprehension of DTC television ads, and the major statement in 
particular?

[[Page 79910]]

    2. How do the frequency, speed, and complexity of the major 
statement influence the comprehension of the major statement and DTC 
ads as a whole?
    3. How do hearing and cognitive declines interact with the 
frequency, speed, and complexity of the major statement to affect the 
comprehension of DTC ads?

III. Design

    To test these research questions, we will examine four groups of 
adults and manipulate three variables as shown in table 1.

                                                     Table 1
----------------------------------------------------------------------------------------------------------------
                                                                       Voiceover frequency
                                                          --------------------------------------------
                                                           Male (low frequency)      Female (high
                                                          ----------------------      frequency)
                Age                         Speed             Organization of   ----------------------   Total
                                                              major statement       Organization of
                                                          ----------------------    major statement
                                                                                ----------------------
                                                             Simple    Complex     Simple    Complex
----------------------------------------------------------------------------------------------------------------
Young Adults (18-25)..............  Low Speed............         33         33         33         33        132
                                    High Speed...........         33         33         33         33        132
Middle-Aged (40-50)...............  Low Speed............         33         33         33         33        132
                                    High Speed...........         33         33         33         33        132
Young-Older (60-75)...............  Low Speed............         33         33         33         33        132
                                    High Speed...........         33         33         33         33        132
Old-Older (OO; 75+)...............  Low Speed............         33         33         33         33        132
                                    High Speed...........         33         33         33         33        132
                                                          ------------------------------------------------------
    Total.........................  .....................        264        264        264        264      1,056
----------------------------------------------------------------------------------------------------------------

    Pretesting will take place before the main study to evaluate the 
hearing assessment procedures and questionnaire measures used in the 
main study. We will recruit adults who fall into one of four age 
brackets shown in table 1. We will exclude individuals who work in 
healthcare or marketing settings because their knowledge and 
experiences may not reflect those of the average consumer. A priori 
power analyses revealed that we need 640 participants for the pretest 
to obtain 80 percent power to detect a small effect size, and 1,056 
participants for the main study to obtain 90 percent power to detect a 
small effect size. Data collection will take place in person.
    For the pretest and main study, within each age group, participants 
will be randomly assigned to one of eight experimental conditions in a 
2 (speed) x 2 (frequency) x 2 (complexity) design, as depicted in table 
1. The study will include audiometric measurement of individual hearing 
ability to help determine if hearing declines account for any age group 
differences in reported comprehension or retention of ad information. 
During the scheduled appointment time, participants will receive a 
complete audiometric test performed by audiologists from the University 
of North Carolina Hearing and Communication Center, watch a fictitious 
DTC television ad twice, and answer questions in a survey. 
Participation is estimated to take approximately 45 minutes.
    Questionnaire measures are designed to assess, for both risk and 
benefit information, verbatim memory, comprehension, gist memory, and 
confidence in memory and comprehension judgments. The draft 
questionnaire is available upon request.
    To examine differences between experimental conditions, we will 
conduct inferential statistical tests such as analysis of variance 
(ANOVA).
    In accordance with 5 CFR 1320.8(d), FDA published a 60-day notice 
for public comment in the Federal Register of June 25, 2015 (80 FR 
36545). Two comments were received. We will address the issues raised 
in each comment subsequently, beginning with those of AbbVie.
    (Comment 1) The Agency should place research results in the context 
that older adults are diverse and increasingly involved in new 
technologies.
    (Response 1) We agree that older adults are not homogenous. 
Regarding our focus on television ads, the fact that older people are 
increasingly able to look at advertisements online does not eliminate 
the fact that many continue to be exposed to television advertising and 
that advertising is not always presented with closed-captioning. We 
will ensure that we frame our research results in the proper context.
    (Comment 2) A bias may exist in asking survey participants to self-
declare ``a hearing loss'' as hearing loss can be viewed as a negative 
consequence/indicator of aging. Thus, those in older age groups may 
underestimate their true hearing loss as well as the need for some type 
of hearing aid or assistance.
    (Response 2) We will not rely solely on self-reported hearing loss. 
We have arranged for trained audiologists to conduct in-person 
audiological assessments with validated approaches as well.
    (Comment 3) As the Agency plans to test multiple variables and age 
groups, it is important to test these variables independently; testing 
only in combination with other variables or aggregating across age 
groups or variables may mask true drivers. Individual cells with a 
sample size of 33 are too small to compare to other individual cells. A 
minimum of 50 is necessary to understand individual variables within 
and across age groups.
    (Response 3) We are aware of no statistical or research standard 
that specifies that groups must contain 50 individuals. We conducted 
power analyses to determine that 33 individuals per cell is adequate 
and statistically defensible for our study goals.
    (Comment 4) The Introduction and Debriefing state that the study 
``involves information about a drug that is not yet available for 
sale.'' However, survey questions 8, 10, 18, and 30 refer to 
respondents having access to the drug with verbiage such as ``even if 
you have never taken the drug,'' ``ask the doctor to prescribe Drug 
X,'' and ``have you seen any advertising for Drug X before today.'' Yet 
none of these could happen if Drug X is not yet available for sale.
    (Response 4) We acknowledge that we are posing hypothetical 
possibilities in some questions that respondents should

[[Page 79911]]

not have previously experienced. We have changed the introduction to 
reference ``advertising for a new product'' rather than ``information 
about a drug that is not yet available for sale.'' However, using 
language such as ``even if you have never taken the drug'' will assure 
respondents that their answers are welcome even if they do not have 
direct experience with the drug. The question about asking the doctor 
to prescribe the drug measures behavioral intentions, not actual 
behavior related to the drug. The question asking whether they have 
seen an ad for the drug will allow us to capture false reporting 
tendencies.
    (Comment 5) Question 13 refers to ``claims''. We suspect ``claim'' 
is not as readily understood by consumers as is the more general term 
``information'' used in Question 17. Also, there are only minor 
differences in the wording of two recognition choices for Questions 13a 
vs. 13b; was this intended?
    (Response 5) Thank you for your close review of the questionnaire. 
The two ad versions (simple and complex) are designed to include the 
same information but stated differently. Thus, these two questions 
(then 13a and 13b; now 14a and 14b) should be similar in nature and 
only two of the sub-items are stated differently (#2 and #4). 
Participants will see either question 14a or 14b depending on their 
experimental condition.
    The next responses address issues raised by Eli Lilly and Company.
    (Comment 6) What are the objectives of the pretest? The proposed 
sample size for the pretest (n = 640) appears excessive to test the 
procedural flow and survey procedures.
    (Response 6) The pretest will be used to assess whether the 
instrument as a whole as well as individual sections work equally well 
across respondent groups (e.g., age). In addition, the pretest will 
include manipulation checks as a main function of the task. The sample 
size for the pretest (640 participants equally split across the four 
age groups) was determined based on an assumption of a need for 80 
percent power with an alpha of 0.10 to detect a small effect size. With 
eight experimental conditions across four age groups, the calculation 
resulted in a need for 20 individuals per cell, or 640 total 
participants.
    (Comment 7) The age groups selected are logical, but why are people 
aged 51-59 excluded and why are 18-25 year olds selected as the 
control? ``Although 18-25 year olds as a control group might be common 
in studies of age changes in memory and hearing, this age group does 
not seem as relevant for pharmaceutical advertisements about 
cholesterol lowering drugs.'' Also, the age group of 60-75 should be 
capped at 74 to make sure the groups are mutually exclusive.
    (Response 7) We agree that there is a likely slow progression of 
age-related hearing loss across the lifespan and if our focus was on 
this progression, we would want to include 50-59 year olds. The 
approach we are taking will ensure that we can see contrasts between 
younger and older people. We also have a middle-aged group to see 
whether any contrast between the youngest and oldest groups appears to 
be relatively linear or is curvilinear. Including the 50-59 year age 
group would not add substantial information to this design, although we 
do acknowledge that we will not be able to address when decline occurs 
if it appears to drop dramatically from our middle-aged group to our 
young-older age group.
    We are including participants between 18-25 years as a baseline for 
our measurement of hearing ability, as that is an integral part of this 
research. The entire sample will be drawn from the general population, 
and although there may be distinct differences in potential interest in 
the advertised drug, we feel the addition of this younger group is 
worth measurement. We have included a question to assess whether 
participants have been diagnosed with high cholesterol and can use that 
as a proxy for interest, regardless of age. Thank you for pointing out 
the need to cap the young-old age group at 74 rather than 75 to ensure 
the groups are mutually exclusive.
    (Comment 8) We advise caution in reporting results for individual 
cells (e.g., 40-50 year old respondents who see an ad with a male 
voice, simple statement, low speed) due to the low sample size (n = 
33). We recommend excluding results for a sample that has fewer than 50 
respondents.
    (Response 8) We are aware of no statistical or research standard 
that specifies that groups must contain 50 individuals. We conducted 
power analyses to determine that 33 individuals per cell is adequate 
and statistically defensible for our study goals.
    (Comment 9) Because the Summary Brief of the project does not 
adequately provide details regarding the individual ads to be tested, 
we seek clarification on whether multiple ads will be tested and the 
variability of ad content. With greater variability of the ads tested, 
there is potential for a new source of bias to be introduced into the 
study.
    (Response 9) We agree that extraneous variability should be kept to 
a minimum. For this study, the same base ad will be manipulated such 
that all else remains constant except for the gender of the voiceover 
announcer, the complexity of the risk information, and the speed at 
which it is stated. The visuals will be as similar as possible except 
for minimal differences in length of time on screen to account for the 
different lengths of the voiceover. The same male and female voice 
actors will record all variations of the ad.

IV. External Reviewers

    In addition to public comment, Office of Prescription Drug 
Promotion solicited peer-review comments from academic researchers in 
fields relevant to the communication of DTC prescription drug 
information. We received responses and incorporated the thoughts of the 
following individuals:

Dr. Susan Blalock, University of North Carolina at Chapel Hill, 
School of Pharmacy
Dr. Robert McKeever, University of South Carolina, School of 
Journalism and Mass Communications

    To examine differences between experimental conditions, we will 
conduct inferential statistical tests such as analysis of variance 
(ANOVA). With the sample size described in table 2, we will have 
sufficient power to detect small-to-medium sized effects in the main 
study.
    FDA estimates the burden of this collection of information as 
follows:

                                 Table 2--Estimated Annual Reporting Burden \1\
----------------------------------------------------------------------------------------------------------------
                                                 Number of
          Activity               Number of     responses per   Total annual   Average burden per    Total hours
                                respondents     respondent       responses         response
----------------------------------------------------------------------------------------------------------------
Cognitive Interview screener              96               1              96    0.08 (5 minutes)               8
Cognitive Interviews........               9               1               9      1 (60 minutes)               9
Pretest screener............           1,280               1           1,280    0.08 (5 minutes)             102

[[Page 79912]]

 
Pretest.....................             640               1             640   0.75 (45 minutes)             480
Main Study Screener.........           2,112               1           2,112    0.08 (5 minutes)             169
Main Study..................           1,056               1           1,056   0.75 (45 minutes)             792
                             -----------------------------------------------------------------------------------
    Total...................           5,193               1           5,193  ..................           1,560
----------------------------------------------------------------------------------------------------------------
\1\ There are no capital costs or operating and maintenance costs associated with the collection of information.

V. References

    The following references are on display in the Division of Dockets 
Management (HFA-305), Food and Drug Administration, 5630 Fishers Lane, 
Rm. 1061, Rockville, MD 20852, and are available for viewing by 
interested persons between 9 a.m. and 4 p.m., Monday through Friday; 
they are also available electronically at http://www.regulations.gov. 
FDA has verified the Web site addresses, as of the date this document 
publishes in the Federal Register, but Web sites are subject to change 
over time.
1. Zhong W., H. Maradit-Kremers, J.L. St. Sauver, et al., ``Age and 
Sex Patterns of Drug Prescribing in a Defined American Population.'' 
Mayo Clinic Proceedings. 88(7):697-707, 2013.
2. Depp C.A., D.A. Schkade, W.K. Thompson, D.V. Jeste. ``Age, 
Affective Experience, and Television Use.'' American Journal of 
Preventative Medicine. 39:173-8, 2010.
3. Agrawal Y., E.A. Platz, J.K. Niparko. ``Prevalence of Hearing 
Loss and Differences by Demographic Characteristics Among US 
Adults.'' Archives of Internal Medicine. 168(14):1522-30, 2008.
4. Cruickshanks K.J., T.L. Wiley, T.S. Tweed, et al., ``Prevalence 
of Hearing Loss in Older Adults in Beaver Dam, Wisconsin.'' American 
Journal of Epidemiology. 148(9):879-86, 1998.
5. Lin FR, R. Thorpe, S. Gordon-Salant, L. Ferrucci. ``Hearing Loss 
Prevalence and Risk Factors Among Older Adults in the United 
States.'' The Journals of Gerontology Series A: Biological Sciences 
and Medical Sciences. 66A(5):582-90, 2011.
6. Garstecki DC, S.F. Erler. ``Hearing Loss, Control, and 
Demographic Factors Influencing Hearing Aid Use Among Older 
Adults.'' Journal of Speech, Language, and Hearing Research. 41:527-
37, 1998.
7. Gates G.A., J.C. Cooper. ``Incidence of Hearing Decline in the 
Elderly.'' Acta Oto-laryngol. 111:240-8, 1991.
8. Humes L.E. ``Speech Understanding in the Elderly.'' Journal of 
the American Academy of Audiology. 7:161-7, 1996.
9. U.S. Food and Drug Administration. Code of Federal Regulations. 
Prescription drug advertisements, 21 CFR Sect. 202.1. 2013. (http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfCFR/CFRSearch.cfm?fr=202.1)
10. Wingfield A., L.W. Poon, L. Lombardi, D. Lowe. ``Speed of 
Processing in Normal Aging: Effects of Speech Rate, Linguistic 
Structure, and Processing Time.'' The Journals of Gerontology. 
40(5):579-85, 1985.
11. Kramer A.F., S. Hahn, D. Gopher. ``Task Coordination and Aging: 
Explorations of Executive Control Processes in the Task Switching 
Paradigm.'' Acta Psychologica. 101:339-78, 1999.
12. Naveh-Benjamin M., J. Guez, A. Kilb, S. Reedy. ``The Associative 
Memory Deficit of Older Adults: Further Support Using Face-Name 
Associations.'' Psychology and Aging. 19(3):541-6, 2004.
13. Sommers M.S., N. Tye-Murray, B. Spehar. ``Auditory-Visual Speech 
Perception and Auditory-Visual Enhancement in Normal-Hearing Younger 
and Older Adults.'' Ear and Hearing. 26(3):263-75, 2005.
14. Watson J.M., K.B. McDermott, D.A. Balota. ``Attempting to Avoid 
False Memories in the Deese/Roediger-McDermott Paradigm: Assessing 
the Combined Influence of Practice and Warnings in Young and Old 
Adults.'' Memory and Cognition. 32(1):135-41, 2004.
15. Gates G.A., M.P. Feeney, D. Mills. ``Cross-Sectional Age-Changes 
of Hearing in the Elderly.'' Ear and Hearing. 29(6):865-74, 2008.
16. Morrell C.H., S. Gordon-Salant, J.D. Pearson, L.J. Brant, J.L. 
Fozard. ``Age- and Gender-Specific Reference Ranges for Hearing 
Level and Longitudinal Changes in Hearing Level.'' Journal of the 
Acoustical Society of America. 100(4)Pt. 1:1949-67, 1996.
17. Cutler A., D. Dahan, W. van Donselaar. ``Prosody in the 
Comprehension of Spoken Language: A Literature Review.'' Language 
and Speech. 40(2):141-201, 1997.

    Dated: December 15, 2015.
Leslie Kux,
Associate Commissioner for Policy.
[FR Doc. 2015-32251 Filed 12-22-15; 8:45 am]
BILLING CODE 4164-01-P



                                                                       Federal Register / Vol. 80, No. 246 / Wednesday, December 23, 2015 / Notices                                           79909

                                              DEPARTMENT OF HEALTH AND                                regulated products in carrying out the                Research has shown that fast speech is
                                              HUMAN SERVICES                                          provisions of the FD&C Act.                           more difficult to understand than slower
                                                                                                         Older adults use a disproportionate                speech, even for healthy young adults
                                              Food and Drug Administration                            number of prescription drugs (Ref. 1)                 (Ref. 10).
                                              [Docket No. FDA–2015–N–2163]
                                                                                                      and watch more television than other                     Thus, we propose to examine the
                                                                                                      age groups (Ref. 2). Age-related changes              effects of three aspects of DTC ads
                                              Agency Information Collection                           in hearing are common (Refs. 3–5) and,                (voice frequency, complexity of major
                                              Activities; Submission for Office of                    depending on their severity, influence                statement, and speed of major
                                              Management and Budget Review;                           the understanding of speech. Direct-To-               statement) on the comprehension of the
                                              Comment Request; Hearing, Aging,                        Consumer (DTC) television                             ads among four different age groups of
                                              and Direct-to-Consumer Television                       advertisements (ads) contain large                    individuals. Because hearing losses
                                              Advertisements                                          amounts of complex information about                  begin to occur as people age, we will
                                                                                                      prescription drug treatments that may                 examine a group of middle-aged adults
                                              AGENCY:    Food and Drug Administration,                be particularly relevant to a population              (40–50 years), young-old adults (60–74
                                              HHS.                                                    that is experiencing some level of                    years), and old-old adults (75+ years),
                                              ACTION:   Notice.                                       hearing loss. Moreover, much of the                   and a group of young adults (18–25
                                                                                                      information in these ads is conveyed by               years) as a control. The use of young
                                              SUMMARY:    The Food and Drug                           voiceover, meaning that the audio
                                              Administration (FDA) is announcing                                                                            adults as a control group is common in
                                                                                                      channel is the only way to receive the                studies of age changes in memory,
                                              that a proposed collection of                           information. Although people with
                                              information has been submitted to the                                                                         cognition, and hearing (Refs. 11–14). We
                                                                                                      serious hearing loss may compensate by                expect a progression of hearing loss
                                              Office of Management and Budget                         using closed captioning (which may or
                                              (OMB) for review and clearance under                                                                          across the lifespan, but that is not the
                                                                                                      may not be available for ads) or hearing              focus of this study. Our primary
                                              the Paperwork Reduction Act of 1995.                    aids, some individuals experience the
                                              DATES: Submit either electronic or
                                                                                                                                                            outcomes will be verbatim and gist
                                                                                                      effects of hearing loss without realizing             memory, and confidence in memory
                                              written comments on the collection of                   that it is the cause and others choose not
                                              information by January 22, 2016.                                                                              judgments, but we will also seek to
                                                                                                      to use external compensatory aids (Ref.               apply findings from previous studies
                                              ADDRESSES: To ensure that comments on                   6). For these reasons, FDA is proposing               showing age changes in hearing ability
                                              the information collection are received,                research to investigate how people at                 (Refs. 15, 16) to the particular situation
                                              OMB recommends that written                             various ages and levels of hearing ability
                                                                                                                                                            of DTC ad viewing.
                                              comments be faxed to the Office of                      comprehend DTC ads.
                                              Information and Regulatory Affairs,                        Sponsors of DTC ads cannot control                    It is important to note that despite
                                              OMB, Attn: FDA Desk Officer, FAX:                       the hearing abilities of their audiences.             hearing and cognitive losses, older
                                              202–395–7285, or emailed to oira_                       Nonetheless, researchers have identified              adults generally use linguistic context
                                              submission@omb.eop.gov. All                             several aspects of DTC ads within their               well. That is, they are as good as or even
                                              comments should be identified with the                  control that influence the understanding              better than younger adults at using
                                              OMB control number 0910–New and                         of speech in individuals who experience               context to determine what they are
                                              title ‘‘Hearing, Aging, and Direct-to-                  aging-related hearing loss. First,                    hearing. They are also skilled at using
                                              Consumer Television Advertisements.’’                   frequency thresholds differ as people                 the intonation of words, which words
                                              Also include the FDA docket number                      age—that is, older adults are not able to             are stressed, where pauses occur, and
                                              found in brackets in the heading of this                hear higher frequencies as well (Refs. 7,             how words are lengthened before
                                              document.                                               8). Second, DTC television ads contain                pauses, all components of something
                                                                                                      a risk statement of the most serious and              called the prosody of language (Ref. 17).
                                              FOR FURTHER INFORMATION CONTACT: FDA
                                                                                                      most common side effects, called ‘‘the                Thus, even though older adults
                                              PRA Staff, Office of Operations, Food                                                                         generally perform worse than younger
                                              and Drug Administration, 8455                           major statement.’’ FDA regulations
                                                                                                      require that the major statement must be              adults with rapid speech, older adult
                                              Colesville Rd., COLE–14526, Silver                                                                            recall of sentences is still relatively
                                              Spring, MD 20993–0002, PRAStaff@                        included in at least the audio portion of
                                                                                                      the ad (Ref. 9). The risks of a medical               high, at 80 percent, presumably because
                                              fda.hhs.gov.                                                                                                  older adults use linguistic context.
                                                                                                      product often include highly technical
                                              SUPPLEMENTARY INFORMATION:                              medical terms that should be                          Moreover, to approximate real DTC ads,
                                              I. Background                                           transformed into consumer-friendly                    participants will view an ad that has a
                                                                                                      language to convey the risks                          typical amount of superimposed text,
                                                 In compliance with 44 U.S.C. 3507,                   appropriately. This is easier in some                 some of which may repeat the
                                              FDA has submitted the following                         cases than in others. In addition, there              information in the audio. Our task thus
                                              proposed collection of information to                   are techniques to help reduce the                     involves viewing realistic DTC ads,
                                              OMB for review and clearance.                           complexity of the major statement, such               which provide more context than lists of
                                              Hearing, Aging, and Direct-to-Consumer                  as maintaining active voice, reducing                 unrelated words or sentences, as often
                                              Television Advertisements                               instances where words need                            found in laboratory experiments. Thus,
                                                                                                      clarification from other later words in               it is an open question whether hearing
                                              OMB Control Number 0910—NEW                             the broadcast, and using shorter                      loss will impede the comprehension of
                                                 Section 1701(a)(4) of the Public                     sentences. Third, television ad spots are             DTC ads or whether the ability to make
                                              Health Service Act (42 U.S.C.                           typically bought in increments of 15                  use of context will counteract these
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                                              300u(a)(4)) authorizes the FDA to                       seconds, leading to a preponderance of                decrements across the lifespan.
                                              conduct research relating to health                     30- and 60-second ads, and some 75-
                                                                                                                                                            II. General Research Questions
                                              information. Section 1003(d)(2)(C) of the               second ads when risk information is
                                              Federal Food, Drug, and Cosmetic Act                    especially dense. In order to fit the                   1. How do hearing and cognitive
                                              (the FD&C Act) (21 U.S.C. 393(b)(2)(c))                 required information into this time                   declines in older adults affect
                                              authorizes FDA to conduct research                      frame, the audio presentation speed may               comprehension of DTC television ads,
                                              relating to drugs and other FDA                         be adjusted to be faster or slower.                   and the major statement in particular?


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                                              79910                           Federal Register / Vol. 80, No. 246 / Wednesday, December 23, 2015 / Notices

                                                2. How do the frequency, speed, and                                       3. How do hearing and cognitive                                     III. Design
                                              complexity of the major statement                                         declines interact with the frequency,                                   To test these research questions, we
                                              influence the comprehension of the                                        speed, and complexity of the major                                    will examine four groups of adults and
                                              major statement and DTC ads as a                                          statement to affect the comprehension of                              manipulate three variables as shown in
                                              whole?                                                                    DTC ads?                                                              table 1.
                                                                                                                                                    TABLE 1
                                                                                                                                                                                               Voiceover frequency

                                                                                                                                                                                           Male                       Female
                                                                                                                                                                                     (low frequency)             (high frequency)
                                                                                  Age                                                              Speed                                                                                 Total
                                                                                                                                                                                  Organization of major      Organization of major
                                                                                                                                                                                       statement                  statement

                                                                                                                                                                                   Simple     Complex         Simple      Complex

                                              Young Adults (18–25) ...................................................             Low Speed          .......................            33            33            33             33      132
                                                                                                                                   High Speed         .......................            33            33            33             33      132
                                              Middle-Aged (40–50) ....................................................             Low Speed          .......................            33            33            33             33      132
                                                                                                                                   High Speed         .......................            33            33            33             33      132
                                              Young-Older (60–75) ....................................................             Low Speed          .......................            33            33            33             33      132
                                                                                                                                   High Speed         .......................            33            33            33             33      132
                                              Old-Older (OO; 75+) .....................................................            Low Speed          .......................            33            33            33             33      132
                                                                                                                                   High Speed         .......................            33            33            33             33      132

                                                   Total .......................................................................   ...........................................          264            264          264         264       1,056



                                                 Pretesting will take place before the                                  information, verbatim memory,                                            (Response 2) We will not rely solely
                                              main study to evaluate the hearing                                        comprehension, gist memory, and                                       on self-reported hearing loss. We have
                                              assessment procedures and                                                 confidence in memory and                                              arranged for trained audiologists to
                                              questionnaire measures used in the                                        comprehension judgments. The draft                                    conduct in-person audiological
                                              main study. We will recruit adults who                                    questionnaire is available upon request.                              assessments with validated approaches
                                              fall into one of four age brackets shown                                     To examine differences between                                     as well.
                                              in table 1. We will exclude individuals                                   experimental conditions, we will                                         (Comment 3) As the Agency plans to
                                              who work in healthcare or marketing                                       conduct inferential statistical tests such                            test multiple variables and age groups,
                                              settings because their knowledge and                                      as analysis of variance (ANOVA).                                      it is important to test these variables
                                              experiences may not reflect those of the                                     In accordance with 5 CFR 1320.8(d),                                independently; testing only in
                                              average consumer. A priori power                                          FDA published a 60-day notice for                                     combination with other variables or
                                              analyses revealed that we need 640                                        public comment in the Federal Register                                aggregating across age groups or
                                              participants for the pretest to obtain 80                                 of June 25, 2015 (80 FR 36545). Two                                   variables may mask true drivers.
                                              percent power to detect a small effect                                    comments were received. We will                                       Individual cells with a sample size of 33
                                              size, and 1,056 participants for the main                                 address the issues raised in each                                     are too small to compare to other
                                              study to obtain 90 percent power to                                       comment subsequently, beginning with                                  individual cells. A minimum of 50 is
                                              detect a small effect size. Data collection                               those of AbbVie.                                                      necessary to understand individual
                                              will take place in person.                                                   (Comment 1) The Agency should                                      variables within and across age groups.
                                                 For the pretest and main study,                                        place research results in the context that                               (Response 3) We are aware of no
                                              within each age group, participants will                                  older adults are diverse and increasingly                             statistical or research standard that
                                              be randomly assigned to one of eight                                      involved in new technologies.                                         specifies that groups must contain 50
                                              experimental conditions in a 2 (speed)                                       (Response 1) We agree that older                                   individuals. We conducted power
                                              × 2 (frequency) × 2 (complexity) design,                                  adults are not homogenous. Regarding                                  analyses to determine that 33
                                              as depicted in table 1. The study will                                    our focus on television ads, the fact that                            individuals per cell is adequate and
                                              include audiometric measurement of                                        older people are increasingly able to                                 statistically defensible for our study
                                              individual hearing ability to help                                        look at advertisements online does not                                goals.
                                              determine if hearing declines account                                     eliminate the fact that many continue to                                 (Comment 4) The Introduction and
                                              for any age group differences in reported                                 be exposed to television advertising and                              Debriefing state that the study ‘‘involves
                                              comprehension or retention of ad                                          that advertising is not always presented                              information about a drug that is not yet
                                              information. During the scheduled                                         with closed-captioning. We will ensure                                available for sale.’’ However, survey
                                              appointment time, participants will                                       that we frame our research results in the                             questions 8, 10, 18, and 30 refer to
                                              receive a complete audiometric test                                       proper context.                                                       respondents having access to the drug
                                              performed by audiologists from the                                           (Comment 2) A bias may exist in                                    with verbiage such as ‘‘even if you have
                                              University of North Carolina Hearing                                      asking survey participants to self-                                   never taken the drug,’’ ‘‘ask the doctor
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                                              and Communication Center, watch a                                         declare ‘‘a hearing loss’’ as hearing loss                            to prescribe Drug X,’’ and ‘‘have you
                                              fictitious DTC television ad twice, and                                   can be viewed as a negative                                           seen any advertising for Drug X before
                                              answer questions in a survey.                                             consequence/indicator of aging. Thus,                                 today.’’ Yet none of these could happen
                                              Participation is estimated to take                                        those in older age groups may                                         if Drug X is not yet available for sale.
                                              approximately 45 minutes.                                                 underestimate their true hearing loss as                                 (Response 4) We acknowledge that we
                                                 Questionnaire measures are designed                                    well as the need for some type of                                     are posing hypothetical possibilities in
                                              to assess, for both risk and benefit                                      hearing aid or assistance.                                            some questions that respondents should


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                                                                             Federal Register / Vol. 80, No. 246 / Wednesday, December 23, 2015 / Notices                                                         79911

                                              not have previously experienced. We                                  need for 20 individuals per cell, or 640                    (Response 8) We are aware of no
                                              have changed the introduction to                                     total participants.                                       statistical or research standard that
                                              reference ‘‘advertising for a new                                       (Comment 7) The age groups selected                    specifies that groups must contain 50
                                              product’’ rather than ‘‘information about                            are logical, but why are people aged 51–                  individuals. We conducted power
                                              a drug that is not yet available for sale.’’                         59 excluded and why are 18–25 year                        analyses to determine that 33
                                              However, using language such as ‘‘even                               olds selected as the control? ‘‘Although                  individuals per cell is adequate and
                                              if you have never taken the drug’’ will                              18–25 year olds as a control group might                  statistically defensible for our study
                                              assure respondents that their answers                                be common in studies of age changes in                    goals.
                                              are welcome even if they do not have                                 memory and hearing, this age group
                                                                                                                                                                               (Comment 9) Because the Summary
                                              direct experience with the drug. The                                 does not seem as relevant for
                                                                                                                                                                             Brief of the project does not adequately
                                              question about asking the doctor to                                  pharmaceutical advertisements about
                                                                                                                                                                             provide details regarding the individual
                                              prescribe the drug measures behavioral                               cholesterol lowering drugs.’’ Also, the
                                                                                                                                                                             ads to be tested, we seek clarification on
                                              intentions, not actual behavior related to                           age group of 60–75 should be capped at
                                                                                                                                                                             whether multiple ads will be tested and
                                              the drug. The question asking whether                                74 to make sure the groups are mutually
                                                                                                                                                                             the variability of ad content. With
                                              they have seen an ad for the drug will                               exclusive.
                                                                                                                      (Response 7) We agree that there is a                  greater variability of the ads tested,
                                              allow us to capture false reporting                                                                                            there is potential for a new source of
                                              tendencies.                                                          likely slow progression of age-related
                                                                                                                   hearing loss across the lifespan and if                   bias to be introduced into the study.
                                                 (Comment 5) Question 13 refers to
                                              ‘‘claims’’. We suspect ‘‘claim’’ is not as                           our focus was on this progression, we                       (Response 9) We agree that extraneous
                                              readily understood by consumers as is                                would want to include 50–59 year olds.                    variability should be kept to a
                                              the more general term ‘‘information’’                                The approach we are taking will ensure                    minimum. For this study, the same base
                                              used in Question 17. Also, there are                                 that we can see contrasts between                         ad will be manipulated such that all else
                                              only minor differences in the wording of                             younger and older people. We also have                    remains constant except for the gender
                                              two recognition choices for Questions                                a middle-aged group to see whether any                    of the voiceover announcer, the
                                              13a vs. 13b; was this intended?                                      contrast between the youngest and                         complexity of the risk information, and
                                                                                                                   oldest groups appears to be relatively                    the speed at which it is stated. The
                                                 (Response 5) Thank you for your close
                                                                                                                   linear or is curvilinear. Including the                   visuals will be as similar as possible
                                              review of the questionnaire. The two ad
                                                                                                                   50–59 year age group would not add                        except for minimal differences in length
                                              versions (simple and complex) are
                                                                                                                   substantial information to this design,                   of time on screen to account for the
                                              designed to include the same
                                                                                                                   although we do acknowledge that we                        different lengths of the voiceover. The
                                              information but stated differently. Thus,
                                                                                                                   will not be able to address when decline                  same male and female voice actors will
                                              these two questions (then 13a and 13b;
                                                                                                                   occurs if it appears to drop dramatically                 record all variations of the ad.
                                              now 14a and 14b) should be similar in
                                                                                                                   from our middle-aged group to our
                                              nature and only two of the sub-items are                             young-older age group.                                    IV. External Reviewers
                                              stated differently (#2 and #4).                                         We are including participants
                                              Participants will see either question 14a                                                                                        In addition to public comment, Office
                                                                                                                   between 18–25 years as a baseline for
                                              or 14b depending on their experimental                                                                                         of Prescription Drug Promotion solicited
                                                                                                                   our measurement of hearing ability, as
                                              condition.                                                                                                                     peer-review comments from academic
                                                                                                                   that is an integral part of this research.
                                                 The next responses address issues                                                                                           researchers in fields relevant to the
                                                                                                                   The entire sample will be drawn from
                                              raised by Eli Lilly and Company.                                                                                               communication of DTC prescription
                                                                                                                   the general population, and although
                                                 (Comment 6) What are the objectives                                                                                         drug information. We received
                                                                                                                   there may be distinct differences in
                                              of the pretest? The proposed sample size                             potential interest in the advertised drug,                responses and incorporated the thoughts
                                              for the pretest (n = 640) appears                                    we feel the addition of this younger                      of the following individuals:
                                              excessive to test the procedural flow                                group is worth measurement. We have                       Dr. Susan Blalock, University of North
                                              and survey procedures.                                               included a question to assess whether                       Carolina at Chapel Hill, School of
                                                 (Response 6) The pretest will be used                             participants have been diagnosed with                       Pharmacy
                                              to assess whether the instrument as a                                high cholesterol and can use that as a                    Dr. Robert McKeever, University of South
                                              whole as well as individual sections                                 proxy for interest, regardless of age.                      Carolina, School of Journalism and Mass
                                              work equally well across respondent                                  Thank you for pointing out the need to                      Communications
                                              groups (e.g., age). In addition, the                                 cap the young-old age group at 74 rather
                                              pretest will include manipulation                                    than 75 to ensure the groups are                            To examine differences between
                                              checks as a main function of the task.                               mutually exclusive.                                       experimental conditions, we will
                                              The sample size for the pretest (640                                    (Comment 8) We advise caution in                       conduct inferential statistical tests such
                                              participants equally split across the four                           reporting results for individual cells                    as analysis of variance (ANOVA). With
                                              age groups) was determined based on an                               (e.g., 40–50 year old respondents who                     the sample size described in table 2, we
                                              assumption of a need for 80 percent                                  see an ad with a male voice, simple                       will have sufficient power to detect
                                              power with an alpha of 0.10 to detect a                              statement, low speed) due to the low                      small-to-medium sized effects in the
                                              small effect size. With eight                                        sample size (n = 33). We recommend                        main study.
                                              experimental conditions across four age                              excluding results for a sample that has                     FDA estimates the burden of this
                                              groups, the calculation resulted in a                                fewer than 50 respondents.                                collection of information as follows:

                                                                                                        TABLE 2—ESTIMATED ANNUAL REPORTING BURDEN 1
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                                                                                                                                                    Number of re-
                                                                                                                                 Number of                             Total annual     Average burden per
                                                                              Activity                                                               sponses per                                              Total hours
                                                                                                                                respondents                             responses            response
                                                                                                                                                      respondent

                                              Cognitive Interview screener .......................................                          96                    1               96       0.08 (5 minutes)              8
                                              Cognitive Interviews .....................................................                     9                    1                9         1 (60 minutes)              9
                                              Pretest screener ...........................................................               1,280                    1            1,280       0.08 (5 minutes)            102



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                                              79912                             Federal Register / Vol. 80, No. 246 / Wednesday, December 23, 2015 / Notices

                                                                                                TABLE 2—ESTIMATED ANNUAL REPORTING BURDEN 1—Continued
                                                                                                                                                          Number of re-
                                                                                                                                       Number of                             Total annual     Average burden per
                                                                                 Activity                                                                  sponses per                                                           Total hours
                                                                                                                                      respondents                             responses            response
                                                                                                                                                            respondent

                                              Pretest ..........................................................................                 640                    1              640       0.75 (45 minutes)                        480
                                              Main Study Screener ...................................................                          2,112                    1            2,112        0.08 (5 minutes)                        169
                                              Main Study ...................................................................                   1,056                    1            1,056       0.75 (45 minutes)                        792

                                                    Total ......................................................................               5,193                    1            5,193    ................................          1,560
                                                 1 There     are no capital costs or operating and maintenance costs associated with the collection of information.


                                              V. References                                                                   CFRSearch.cfm?fr=202.1)                              DEPARTMENT OF HEALTH AND
                                                                                                                         10. Wingfield A., L.W. Poon, L. Lombardi, D.              HUMAN SERVICES
                                                The following references are on
                                                                                                                              Lowe. ‘‘Speed of Processing in Normal
                                              display in the Division of Dockets
                                                                                                                              Aging: Effects of Speech Rate, Linguistic            Food and Drug Administration
                                              Management (HFA–305), Food and Drug
                                                                                                                              Structure, and Processing Time.’’ The
                                              Administration, 5630 Fishers Lane, Rm.
                                                                                                                              Journals of Gerontology. 40(5):579–85,
                                              1061, Rockville, MD 20852, and are                                                                                                   [Docket No. FDA–2012–N–0873]
                                                                                                                              1985.
                                              available for viewing by interested                                        11. Kramer A.F., S. Hahn, D. Gopher. ‘‘Task
                                              persons between 9 a.m. and 4 p.m.,                                                                                                   Agency Information Collection
                                                                                                                              Coordination and Aging: Explorations of
                                              Monday through Friday; they are also                                                                                                 Activities: Proposed Collection;
                                                                                                                              Executive Control Processes in the Task
                                              available electronically at http://                                                                                                  Comment Request; Bar Code Label
                                                                                                                              Switching Paradigm.’’ Acta
                                              www.regulations.gov. FDA has verified                                           Psychologica. 101:339–78, 1999.
                                                                                                                                                                                   Requirement for Human Drug and
                                              the Web site addresses, as of the date                                     12. Naveh-Benjamin M., J. Guez, A. Kilb, S.               Biological Products; Correction
                                              this document publishes in the Federal                                          Reedy. ‘‘The Associative Memory Deficit
                                              Register, but Web sites are subject to                                          of Older Adults: Further Support Using               AGENCY:     Food and Drug Administration,
                                              change over time.                                                               Face-Name Associations.’’ Psychology                 HHS.
                                              1. Zhong W., H. Maradit-Kremers, J.L. St.                                       and Aging. 19(3):541–6, 2004.
                                                   Sauver, et al., ‘‘Age and Sex Patterns of                                                                                       ACTION:    Notice; correction.
                                                                                                                         13. Sommers M.S., N. Tye-Murray, B. Spehar.
                                                   Drug Prescribing in a Defined American
                                                   Population.’’ Mayo Clinic Proceedings.                                     ‘‘Auditory-Visual Speech Perception and              SUMMARY:   The Food and Drug
                                                   88(7):697–707, 2013.                                                       Auditory-Visual Enhancement in
                                                                                                                                                                                   Administration (FDA) is correcting a
                                              2. Depp C.A., D.A. Schkade, W.K. Thompson,                                      Normal-Hearing Younger and Older
                                                                                                                                                                                   notice entitled ‘‘Agency Information
                                                   D.V. Jeste. ‘‘Age, Affective Experience,                                   Adults.’’ Ear and Hearing. 26(3):263–75,
                                                   and Television Use.’’ American Journal                                     2005.
                                                                                                                                                                                   Collection Activities: Proposed
                                                   of Preventative Medicine. 39:173–8,                                   14. Watson J.M., K.B. McDermott, D.A.                     Collection; Comment Request; Bar Code
                                                   2010.                                                                      Balota. ‘‘Attempting to Avoid False                  Label Requirement for Human Drug and
                                              3. Agrawal Y., E.A. Platz, J.K. Niparko.                                        Memories in the Deese/Roediger-                      Biological Products’’ that appeared in
                                                   ‘‘Prevalence of Hearing Loss and                                                                                                the Federal Register of December 15,
                                                   Differences by Demographic                                                 McDermott Paradigm: Assessing the
                                                   Characteristics Among US Adults.’’                                         Combined Influence of Practice and                   2015 (80 FR 77637). The document
                                                   Archives of Internal Medicine.                                             Warnings in Young and Old Adults.’’                  solicited comments on the bar code
                                                   168(14):1522–30, 2008.                                                     Memory and Cognition. 32(1):135–41,                  label requirements for human drug and
                                              4. Cruickshanks K.J., T.L. Wiley, T.S. Tweed,                                   2004.                                                biological products. The document was
                                                   et al., ‘‘Prevalence of Hearing Loss in                               15. Gates G.A., M.P. Feeney, D. Mills. ‘‘Cross-           published with an incorrect docket
                                                   Older Adults in Beaver Dam,                                                Sectional Age-Changes of Hearing in the              number. This document corrects that
                                                   Wisconsin.’’ American Journal of                                           Elderly.’’ Ear and Hearing. 29(6):865–74,
                                                   Epidemiology. 148(9):879–86, 1998.                                                                                              error.
                                                                                                                              2008.
                                              5. Lin FR, R. Thorpe, S. Gordon-Salant, L.
                                                   Ferrucci. ‘‘Hearing Loss Prevalence and                               16. Morrell C.H., S. Gordon-Salant, J.D.                  FOR FURTHER INFORMATION CONTACT:    Lisa
                                                   Risk Factors Among Older Adults in the                                     Pearson, L.J. Brant, J.L. Fozard. ‘‘Age-             Granger, Office of Policy and Planning,
                                                   United States.’’ The Journals of                                           and Gender-Specific Reference Ranges                 Food and Drug Administration, 10903
                                                   Gerontology Series A: Biological                                           for Hearing Level and Longitudinal                   New Hampshire Ave., Bldg. 32, rm.
                                                   Sciences and Medical Sciences.                                             Changes in Hearing Level.’’ Journal of               3330, Silver Spring, MD 20993–0002,
                                                   66A(5):582–90, 2011.                                                       the Acoustical Society of America.                   301–796–9115.
                                              6. Garstecki DC, S.F. Erler. ‘‘Hearing Loss,                                    100(4)Pt. 1:1949–67, 1996.
                                                   Control, and Demographic Factors                                      17. Cutler A., D. Dahan, W. van Donselaar.                SUPPLEMENTARY INFORMATION:    In the
                                                   Influencing Hearing Aid Use Among                                          ‘‘Prosody in the Comprehension of                    Federal Register of Tuesday, December
                                                   Older Adults.’’ Journal of Speech,
                                                   Language, and Hearing Research.
                                                                                                                              Spoken Language: A Literature Review.’’              15, 2015, in FR Doc. 2015–31402, the
                                                   41:527–37, 1998.                                                           Language and Speech. 40(2):141–201,                  following correction is made:
                                              7. Gates G.A., J.C. Cooper. ‘‘Incidence of                                      1997.                                                  1. On page 77637, in the second
                                                   Hearing Decline in the Elderly.’’ Acta                                  Dated: December 15, 2015.                               column, the docket number is corrected
                                                   Oto-laryngol. 111:240–8, 1991.
                                                                                                                         Leslie Kux,                                               to read FDA–2012–N–0873.
tkelley on DSK3SPTVN1PROD with NOTICES




                                              8. Humes L.E. ‘‘Speech Understanding in the
                                                   Elderly.’’ Journal of the American                                    Associate Commissioner for Policy.                          Dated: December 15, 2015.
                                                   Academy of Audiology. 7:161–7, 1996.                                  [FR Doc. 2015–32251 Filed 12–22–15; 8:45 am]              Leslie Kux,
                                              9. U.S. Food and Drug Administration. Code
                                                                                                                         BILLING CODE 4164–01–P                                    Associate Commissioner for Policy.
                                                   of Federal Regulations. Prescription drug
                                                   advertisements, 21 CFR Sect. 202.1.                                                                                             [FR Doc. 2015–32252 Filed 12–22–15; 8:45 am]
                                                   2013. (http://www.accessdata.fda.gov/                                                                                           BILLING CODE 4164–01–P
                                                   scripts/cdrh/cfdocs/cfCFR/



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Document Created: 2018-03-02 09:20:16
Document Modified: 2018-03-02 09:20:16
CategoryRegulatory Information
CollectionFederal Register
sudoc ClassAE 2.7:
GS 4.107:
AE 2.106:
PublisherOffice of the Federal Register, National Archives and Records Administration
SectionNotices
ActionNotice.
DatesSubmit either electronic or written comments on the collection of information by January 22, 2016.
ContactFDA PRA Staff, Office of Operations, Food and Drug Administration, 8455 Colesville Rd., COLE-14526, Silver Spring, MD 20993-0002, [email protected]
FR Citation80 FR 79909 

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