81_FR_86197 81 FR 85968 - Agency Information Collection Activities; Submission for Office of Management and Budget Review; Comment Request; Superimposed Text in Direct-to-Consumer Promotion of Prescription Drugs

81 FR 85968 - Agency Information Collection Activities; Submission for Office of Management and Budget Review; Comment Request; Superimposed Text in Direct-to-Consumer Promotion of Prescription Drugs

DEPARTMENT OF HEALTH AND HUMAN SERVICES
Food and Drug Administration

Federal Register Volume 81, Issue 229 (November 29, 2016)

Page Range85968-85972
FR Document2016-28733

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 81 Issue 229 (Tuesday, November 29, 2016)
[Federal Register Volume 81, Number 229 (Tuesday, November 29, 2016)]
[Notices]
[Pages 85968-85972]
From the Federal Register Online  [www.thefederalregister.org]
[FR Doc No: 2016-28733]


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

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Food and Drug Administration

[Docket No. FDA-2016-N-0735]


Agency Information Collection Activities; Submission for Office 
of Management and Budget Review; Comment Request; Superimposed Text in 
Direct-to-Consumer Promotion of Prescription Drugs

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: Fax written comments on the collection of information by 
December 29, 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 [email protected]. All 
comments should be identified with the OMB control number 0910-NEW nd 
title Superimposed Text in Direct-to-Consumer Promotion of Prescription 
Drugs. Also include the FDA docket

[[Page 85969]]

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, [email protected].

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

Superimposed Text in Direct-to-Consumer Promotion of Prescription 
Drugs--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(d)(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.
    The proposed study seeks to extend previous research on the effects 
of superimposed text (supers) in advertising to today's modern direct-
to-consumer (DTC) pharmaceutical promotion. Although earlier research 
on the effects of supers in other consumer settings suggests that 
altering text size can influence consumer comprehension of information, 
it is unclear if these findings extend to DTC promotion of prescription 
drugs and are applicable over 20 years later when viewing promotional 
materials using today's modern technologies (e.g., tablets). Moreover, 
other factors such as text/background contrast may also influence both 
the understanding of the superimposed information (Ref. 1) and the 
effects of text size. The proposed research seeks to update these 
earlier findings and also to answer new questions concerning 
presentation of supers.
    Part of FDA's public health mission is to ensure the safe use of 
prescription drugs; therefore it is important that the information 
provided in DTC promotion is clear and understandable for consumer 
audiences, avoids use of deceptive or misleading claims, and achieves 
``fair balance'' in presentation of benefits and risks. For example, 
varying presentation formats including type size, bulleting, amount of 
white space, and use of ``chunking'' or headlines can all influence 
consumer perceptions of information (Ref. 2). A systematic review of 
presentation formats in prescription drug labeling found that these 
``clear communication'' characteristics positively influenced 
consumer's comprehension of information and prescription drug behaviors 
(i.e., adherence) (Ref. 3). In one randomized controlled study, young 
and older adults were presented with 12 otherwise identical over-the-
counter drugs bottled with varied container labels along various 
dimensions, one of which was text size (7 vs 10 point). While younger 
participants performed equally well with both font sizes, elderly 
populations had significantly reduced recall and comprehension when 
exposed to the smaller text size (Ref. 4). Another study found that 
both young and older populations preferred the larger text size, and 
that patients read labels with larger font more rapidly and accurately 
than labels with smaller font (Ref. 5). Although these studies were 
specific to prescription drug container labels, it is plausible that 
the effects of font sizes would be applicable to drug promotion.
    Some early research in the late 1980s and 1990s examined the size 
of text information in advertising topics outside of prescription drugs 
(Refs. 6, 7, and 8). These studies all generally found that text size 
was associated with comprehension, such that larger text sizes 
increased understanding of the material (and, conversely, smaller text 
sizes interfered with comprehension). For example, Foxman and 
colleagues (Ref. 6) found that whereas ``small'' text size (<\1/2\ inch 
size) was associated with accurate comprehension for 59% of 
respondents, ``large'' text size (>\1/2\ inch size) was associated with 
comprehension for 79% of respondents. Studies by other researchers 
(Refs. 7 and 8) found similar patterns such that increasing the text 
size of supers generally corresponded with increased comprehension.
    We know of no studies that have examined other commonly variable 
factors, such as text/background contrast, that may interact with text 
size to influence comprehension. Early research on text readability 
determined that the contrast between text and background has a 
consistent but small effect. Specifically, while the contrast of color 
has a small effect (Ref. 9), the contrast in brightness, or luminance, 
makes the largest difference (Ref. 10). These studies showed that black 
text on a white background results in the highest readability (Ref. 
11), but that other effects of color contrasts are unclear (Ref .1). 
Some studies have demonstrated that contrast interacts with text size, 
such that contrast becomes a more important discriminator as the text 
size decreases (Ref. 12).
    The earlier research on supers is limited in their applicability to 
today's DTC promotion in several ways. None of these studies 
specifically focused on prescription drug promotion, but rather 
explored the effects of superimposed text in a variety of social and 
consumer advertising contexts. Another limitation is that these earlier 
studies were conducted with populations (i.e., undergraduate students) 
that are not representative of today's prescription drug users. It is 
not clear if the effects of supers would translate to older adult 
populations, who represent the greatest proportion of prescription drug 
users (Ref. 13). Perhaps most importantly, it is unknown if the effects 
of supers would be found today, considering the prevalent use of modern 
technologies, including large (40+ inches) TV screens and personal 
tablets. Our proposed study seeks to address these unanswered questions 
regarding the use of supers in prescription drug promotion.

General Research Questions

    1. Does the size of the superimposed text, the contrast behind the 
superimposed text, and/or the device type influence the noticeability, 
recall, and perceived importance of the super information?
    2. Does the size of the superimposed text, the contrast behind the 
superimposed text, and/or the device type influence the recall of and 
attitudes toward the promoted drug?
    3. Are there any interaction effects among any combination of 
independent variables?

Design

    To test these research questions, we will conduct one randomized 
controlled study. We will examine reactions to supers in a fictitious 
DTC prescription drug promotional video on two types of viewing devices 
with a general population sample. The study design will be a 3 x 2 x 2 
factorial design, where participants are randomly assigned to one of 12 
experimental study arms differentiated by:
     Super text size (small, medium, large);
     Device type (television, tablet);
     Super text contrast (high, low).

[[Page 85970]]



                                                      Table 1--Design and Cell Sizes for Main Study
--------------------------------------------------------------------------------------------------------------------------------------------------------
               Device type                                      TV                                            Tablet
-----------------------------------------------------------------------------------------------------------------------------------------      Total
               Super size                      Small          Medium           Large           Small          Medium           Large
--------------------------------------------------------------------------------------------------------------------------------------------------------
Contrast:
    High................................             106             106             106             106             106             106             636
    Low.................................             106             106             106             106             106             106             636
                                         ---------------------------------------------------------------------------------------------------------------
        Total...........................             212             212             212             212             212             212           1,272
--------------------------------------------------------------------------------------------------------------------------------------------------------
Note: The sample will be split evenly across three cities (Los Angeles, CA; Cincinnati, OH; and Tampa, FL), with 424 participants per city.

    For both the pretest and main study, we will work with two market 
research firms to recruit adult participants and conduct in-person data 
collection in three U.S. cities: Los Angeles, CA, Cincinnati, OH, and 
Tampa, FL. In addition to our aim for regional variation, we selected 
these three cities with the aim of recruiting a sample that is diverse 
on gender, race/ethnicity, education, and age characteristics.
    Participants from the general population will be invited to a 
market research facility to watch one video for a fictional 
prescription drug that treats asthma. In-person administration of study 
procedures will enable us to control the television and tablet watching 
experience in terms of size, distance, and other variables. 
Participants will watch the video twice and then answer questions 
addressing recall of risks and benefits, perceptions of risks and 
benefits, and questions regarding the salience of information in text. 
The questionnaire is available upon request. Participation is estimated 
to take approximately 20 minutes.
    To examine differences between experimental conditions, we will 
conduct inferential statistical tests such as analysis of variance 
(ANOVA).
    Pretesting will take place before the main study to select super 
sizes for the main study and to evaluate the procedures and measures 
that will be used. We will exclude individuals who work in healthcare 
or marketing settings because their knowledge and experiences may not 
reflect those of the average consumer. We conducted a priori power 
analyses to determine sample sizes for the pretest and the main study.
    In the Federal Register of March 9, 2016 (81 FR 12503), FDA 
published a 60-day notice requesting public comment on the proposed 
collection of information. FDA received 10 comments total. Six comments 
were outside the scope of the proposed research (``Ban DTC''), leaving 
four substantive comments.
1. Abbvie
    a. Comment: Mobile users can change font size and viewing size--we 
should incorporate this into our study.
    Response: Although the font size for certain text (such as 
newspaper articles) or closed captioning text size can be changed on a 
tablet, supers within a developed video cannot be manipulated. 
Participants will be allowed to hold the tablet as they normally would, 
but it is important to establish experimental control over many user 
settings to avoid threats to internal validity. Thus, font and viewing 
size will be standardized for this study.
    b. Comment: Recommend looking at use of TV and mobile devices 
concurrently, as some people use them this way.
    Response: This is a good suggestion for future research, but is out 
of scope for the current study.
2. Lilly
    a. Comment: Generally supportive; research objectives and study 
approach are reasonable.
    Response: Thank you.
    b. Comment: Recommend showing supers in black box at bottom of the 
screen and not superimposing them over moving, contrasting color field 
to mimic common practices in television commercial advertising.
    Response: Our high contrast condition indeed presents the supers in 
white font on a black background at the bottom of the screen. Our low 
contrast condition shows lettering over the moving scenes because not 
all advertisements show their supers in a black banner.
    c. Comment: Lilly requests clarity about how the size of text and 
level of contrast were developed when the agency reports the results of 
the study.
    Response: We used cognitive interviews and will use the pretest to 
make these determinations. We will be sure to include this information 
when we report the results of the study.
    d. Comment: Recommend qualitative pre-test instead of quantitative 
pretest.
    Response: We fulfilled this suggested purpose with a set of nine 
cognitive interviews that were conducted in April.
    e. Comment: Request clarity about quota sampling and other 
techniques we may plan to use to ensure a diverse sample. Also suggest 
groups of at least 50 in each cell for analysis purposes.
    Response: As this study is not intended to be nationally 
representative, we will not employ strict quota sampling procedures. 
However, we will work closely with our recruitment firms to monitor 
recruitment and ensure that our sample is diverse with regard to 
factors including race, education, age and gender. Further, selection 
of our three U.S. cities for data collection (Los Angeles, Cincinnati 
and Tampa) was purposive to help achieve diversity on these factors.
    To answer the second part of the comment, we are aware of no 
statistical or research standard that specifies that groups must 
contain 50 individuals. However, we conducted power analyses and 
determined that in order to have enough power for the proposed 
statistical tests, we will exceed this number per experimental cell.
    f. Comment: Recommends replacing the pre-test question about the 
importance of the text information (Question 5) with a question such as 
``how noticeable or legible was the text information?''
    Response: We agree that the noticeability and legibility of the 
text information is important, and we have other questions that address 
this. We are specifically interested in the perceived importance of the 
text information as a moderator variable.
    g. Comment: Recommends removing semantic differential questions 
(Question 9) and essentially any questions that ask about perceptions 
because it is a pretest.
    Response: Our pretest study is not designed to test the main study 
questionnaire. Rather, the main purposes of the pretest are to (1) test 
consumer perceptions of superimposed-text size with the aim of choosing 
perceptibly different levels of size (small, medium, large) for use in 
the main study; and (2) test our planned

[[Page 85971]]

procedures for implementation of the intervention (TV and tablet) and 
in-person data collection. However, to make the most use of our 
resources, we also plan to test the properties of certain main study 
survey items (e.g., means, ranges, etc.) to ensure the utility of the 
items for use in the main study.
    h. Comment: Calls out an inconsistency in terms of how many times 
participants will view the ad.
    Response: Thank you for noting that discrepancy. Participants will 
view the ad once. We have corrected all materials to reflect this 
change. Lilly recommends showing it twice. We agree that if the goal is 
to learn about user experience (preferences and such, or trying to 
improve the presentation) then two or more viewings makes sense. 
However, our goal is to test differences in cognitive processing based 
on the varied size/contrast presentations of the supers. Thus, we do 
not want to artificially enhance the scrutiny participants pay to the 
ad above and beyond the experimental situation. For example, small 
supers may interfere with cognitive processing as hypothesized, but 
this interference may be overcome upon a second viewing. In a real 
world viewing situation, consumers rarely see an ad two times in a row.
    i. Comment: Question 12: Attributes are very similar and will be 
duplicative.
    Response: The three survey items for question 12 (attitudes towards 
the ad) are conceptually similar and will be used as a multi-item 
scale. Conventionally, three items is the minimum recommended to assess 
inter-item reliability.
    j. Comment: Question 12 and 14: Suggest bolding or underlining 
``drug'' or ``ad'' in these questions to differentiate them for 
participants.
    Response: We agree and have added language to the survey items to 
better make this distinction. For items specific to attitudes towards 
the drug we now begin the item with ``Overall, DRUG X is . . .'' 
whereas items about the ad begin with ``Overall, the ad was . . .''
    k. Comment: Would be interesting to include an open-ended question 
about whether any additional information could have or should have been 
provided in the ad, such as accessibility to the drug, information 
about the disease, etc.
    Response: These are great ideas and would provide additional 
information about various communication issues relevant to DTC 
television promotion. However, we regret that we must make difficult 
choices about what to include and not include in this study and these 
issues fall outside the scope of the current research questions.
3. Merck
    a. Comment: FDA's execution may not yield useful data. For example, 
we are examining TV and tablet use, but people may be viewing promotion 
on mobile devices.
    Response: We agree that the ways in which people view their media 
are multiplying and that we have not captured all of them. However, 
rather than simply study superimposed text on a television screen, we 
opted to add an examination of viewing on a tablet, which is an 
increasingly popular option for viewing shows. We regret that we do not 
have the opportunity to explore viewing on all possible new 
technologies, but we believe that the current study will offer insights 
above and beyond the television screen.
    b. Comment: Prior to the implementation of results from individual 
studies on the content, format, and presentation of information in DTC 
advertisements on television, FDA should conduct research on the 
combination of all of the individual factors.
    Response: This comment is outside the scope of the present project. 
It is not directed at the improvement of the study and does not appear 
to require the abandonment of the current study.
4. GlaxoSmithKline (GSK)
    a. Comment: Allowing participants to view the TV at the distance 
they usually view it and to interact with the tablet the way they 
ordinarily do would better reflect a real-world experience.
    Response: We agree that these details are important to consider 
when conducting valid research. We must make a decision between the 
trade-off of experimental control and real-world generalizability. We 
have attempted to do this by setting up the television and chair in the 
room at the average distance that people tend to sit from their 
televisions in their living room and instructing participants to wear 
glasses or contact lenses if needed. Television viewing is a more fixed 
experience than more modern technologies. We also agree that allowing 
individuals to hold the tablet or place it on a table as they normally 
would is appropriate for both experimental control and ecological 
generalizability.
    b. Comment: Including a medium contrast instead of just a high and 
low contrast may be informative.
    Response: We appreciate this comment because we considered it when 
designing the study. We decided to use only high and low contrast in 
the study because our main variable of interest in this particular 
study is the size of the text. Thus, we are expending resources to 
attempt to determine multiple sizes of text to test in order to get a 
fuller appreciation of the role of text size in DTC promotion. We have 
found in past studies that identifying a medium level is difficult 
(e.g., OMB Control No. 0910-0695) and chose in this study to focus on 
size rather than contrast. That said, we do feel that contrast is 
valuable enough to add as a variable of interest, so we are planning to 
devote two conditions to it.
    c. Comment: It would be useful if the questionnaire is posted along 
with the notice on regulations.gov.
    Response: We are happy to provide the questionnaire to anyone who 
requests it.
    d. Comment: Suggests an FDA-Industry working group might be helpful 
in the furtherance of this research.
    Response: This is an intriguing idea and may have merit after we 
obtain empirical data that is specifically applicable to DTC promotion. 
Without this data, it is unclear what this working group would 
contribute. We will consider this idea in further detail upon 
interpretation of results.
    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 response  (in hours)     Total hours
                                                respondents     respondent       responses
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                       Pretesting
--------------------------------------------------------------------------------------------------------------------------------------------------------
Number to complete the screener (assumes 50%             338               1             338  0.08 (5 minutes)..........................              27
 eligible).

[[Page 85972]]

 
Number of completes.........................             240               1             240  0.42 (25 minutes).........................             101
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                       Main Study
--------------------------------------------------------------------------------------------------------------------------------------------------------
Number to complete the screener (assumes 50%           1,785               1           1,785  0.08 (5 minutes)..........................             143
 eligibility).
Number of completes.........................           1,272               1           1,272  0.42 (25 minutes).........................             534
                                             -----------------------------------------------------------------------------------------------------------
    Total hours.............................  ..............  ..............  ..............  ..........................................             805
--------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ There are no capital costs or operating and maintenance costs associated with this collection of information.

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. Hall R.H. and P. Hanna ``The Impact of Web page Text-background 
Colour Combinations on Readability, Retention, Aesthetics, and 
Behavioural Intention.'' Behavior & Information Technology. vol. 23 
pp. 183-95, 2004.
2. Baur C and C. Prue ``The CDC Clear Communication Index is a Tool 
to Prepare and Review Health Information.'' Health Promotion 
Practice. vol.15 pp. 629-37, 2014.
3. Shrank W, J. Avorn, C. Rolon, and P.Shekelle ``Effect of Content 
and Format of Prescription Drug Labels on Readability, 
Understanding, and Medication Use: A Systematic Review.'' Annals of 
Pharmacotherapy. vol. 41 pp. 783-801, 2007.
4. Wogalter, M.S. and W.J. Vigilante. ``Effects of Label Format on 
Knowledge Acquisition and Perceived Readability by Younger and Older 
Adults.'' Ergonomics. vol. 46 pp. 327-344, 2003.
5. Smither, J.A.A. and C.C. Braun ``Readability of Prescription Drug 
Labels by Older and Younger Adults.'' Journal of Clinical Psychology 
in Medical Settings. vol. 1 pp. 149-59, 1994.
6. Foxman, E.R., D.D. Muehling and P.A. Moore. ``Disclaimer 
Footnotes in Ads: Discrepancies Between Purpose and Performance.'' 
Journal of Public Policy and Marketing. vol. 7 pp. 127-37, 1988.
7. Murray N.M., L.A. Manrai and A.K. Manrai. ``Public Policy 
Relating to Consumer Comprehension of Television Commercials: A 
Review and Some Empirical Results.'' Journal of Consumer Policy. 
vol. 16 pp. 145-170, 1993.
8. Manrai, L.A., A.K. Manrai and N. Murray. ``Comprehension of Info-
aid Supers in Television Advertising for Social Ideas: Implications 
for Public Policy''. Journal of Business Research. vol. 30 pp. 75-
84, 1994.
9. Hill A. and L. Scharff. ``Readability of Computer Displays as a 
Function of Colour, Saturation, and Background Texture.'' In D. 
Harns (Ed.) Engineering Psychology and Cognitive Ergonomics (vol. 4) 
Ashgate, Aldershot, United Kingdom.
10. Shieh K-K. and C-C. Lin. ``Effects of Screen Type, Ambient 
Illumination, and Color Combination on VDT Visual Performance and 
Subjective Preference.'' International Journal of Industrial 
Ergonomics. vol. 26 pp. 527-36, 2000.
11. Tinker M.A. and D.G. Paterson. ``Studies of Typographical 
Factors Influencing Speed of Reading. VII. Variations in Color of 
Print and Background.'' Journal of Applied Psychology. vol. 15 pp. 
471-9, 1931.
12. Legge G.E., G.S. Rubin and A. Luebner ``Psychophysics of 
reading. V. The Role of Contrast in Normal Vision.'' Vision Research 
vol. 27 pp. 1165-77, 1987.
13. Kaufman D.W., J.P. Kelly, L. Rosenberg, T.E. Anderson and A.A. 
Mitchell. ``Recent Patterns of Medication Use in the Ambulatory 
Adult Population of the United States: The Slone Survey.'' Journal 
of the American Medical Association vol. 287 pp. 337-344, 2002.

    Dated: November 22, 2016.
Leslie Kux,
Associate Commissioner for Policy.
[FR Doc. 2016-28733 Filed 11-28-16; 8:45 am]
 BILLING CODE 4164-01-P



                                                    85968                      Federal Register / Vol. 81, No. 229 / Tuesday, November 29, 2016 / Notices

                                                    made publicly available, you can                        e.g., they may use a single water bottle              identify the guidance you are
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                                                    Management, 5630 Fishers Lane, Rm.
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                                                       Flexible gastrointestinal endoscopes                 DeviceRegulationandGuidance/                          ADDRESSES: To ensure that comments on
                                                    and accessories (including valves and                   GuidanceDocuments/default.htm.                        the information collection are received,
                                                    other devices used for irrigation) are                  Guidance documents are also available                 OMB recommends that written
                                                    class II devices regulated under 21 CFR                 at http://www.regulations.gov. Persons                comments be faxed to the Office of
                                                    876.1500, Endoscope and accessories.                    unable to download an electronic copy                 Information and Regulatory Affairs,
asabaliauskas on DSK3SPTVN1PROD with NOTICES




                                                    During a colonoscopy or                                 of ‘‘Mitigating the Risk of Cross-                    OMB, Attn: FDA Desk Officer, FAX:
                                                    esophagogastroduodenoscopy (EGD),                       Contamination from Valves and                         202–395–7285, or emailed to oira_
                                                    clinicians often use an irrigation system               Accessories Used for Irrigation Through               submission@omb.eop.gov. All
                                                    comprised of a water bottle, tubing,                    Flexible Gastrointestinal Endoscopes’’                comments should be identified with the
                                                    valves, etc., to supply irrigation for the              may send an email request to CDRH-                    OMB control number 0910–NEW nd
                                                    procedure. Clinicians typically do not                  Guidance@fda.hhs.gov to receive an                    title Superimposed Text in Direct-to-
                                                    clean and sterilize all components of the               electronic copy of the document. Please               Consumer Promotion of Prescription
                                                    irrigation system after each procedure;                 use the document number 1400054 to                    Drugs. Also include the FDA docket


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                                                                               Federal Register / Vol. 81, No. 229 / Tuesday, November 29, 2016 / Notices                                           85969

                                                    number found in brackets in the                         perceptions of information (Ref. 2). A                other effects of color contrasts are
                                                    heading of this document.                               systematic review of presentation                     unclear (Ref .1). Some studies have
                                                    FOR FURTHER INFORMATION CONTACT:    FDA                 formats in prescription drug labeling                 demonstrated that contrast interacts
                                                    PRA Staff, Office of Operations, Food                   found that these ‘‘clear communication’’              with text size, such that contrast
                                                    and Drug Administration, 8455                           characteristics positively influenced                 becomes a more important discriminator
                                                    Colesville Rd., COLE–14526, Silver                      consumer’s comprehension of                           as the text size decreases (Ref. 12).
                                                    Spring, MD 20993–0002, PRAStaff@                        information and prescription drug                        The earlier research on supers is
                                                    fda.hhs.gov.                                            behaviors (i.e., adherence) (Ref. 3). In              limited in their applicability to today’s
                                                                                                            one randomized controlled study, young                DTC promotion in several ways. None of
                                                    SUPPLEMENTARY INFORMATION: In
                                                                                                            and older adults were presented with 12               these studies specifically focused on
                                                    compliance with 44 U.S.C. 3507, FDA
                                                    has submitted the following proposed                    otherwise identical over-the-counter                  prescription drug promotion, but rather
                                                    collection of information to OMB for                    drugs bottled with varied container                   explored the effects of superimposed
                                                    review and clearance.                                   labels along various dimensions, one of               text in a variety of social and consumer
                                                                                                            which was text size (7 vs 10 point).                  advertising contexts. Another limitation
                                                    Superimposed Text in Direct-to-                         While younger participants performed                  is that these earlier studies were
                                                    Consumer Promotion of Prescription                      equally well with both font sizes,                    conducted with populations (i.e.,
                                                    Drugs—OMB Control Number 0910—                          elderly populations had significantly                 undergraduate students) that are not
                                                    NEW                                                     reduced recall and comprehension                      representative of today’s prescription
                                                       Section 1701(a)(4) of the Public                     when exposed to the smaller text size                 drug users. It is not clear if the effects
                                                    Health Service Act (42 U.S.C.                           (Ref. 4). Another study found that both               of supers would translate to older adult
                                                    300u(a)(4)) authorizes the FDA to                       young and older populations preferred                 populations, who represent the greatest
                                                    conduct research relating to health                     the larger text size, and that patients               proportion of prescription drug users
                                                    information. Section 1003(d)(2)(C) of the               read labels with larger font more rapidly             (Ref. 13). Perhaps most importantly, it is
                                                    Federal Food, Drug, and Cosmetic Act                    and accurately than labels with smaller               unknown if the effects of supers would
                                                    (the FD&C Act) (21 U.S.C. 393(d)(2)(c))                 font (Ref. 5). Although these studies                 be found today, considering the
                                                    authorizes FDA to conduct research                      were specific to prescription drug                    prevalent use of modern technologies,
                                                    relating to drugs and other FDA                         container labels, it is plausible that the            including large (40+ inches) TV screens
                                                    regulated products in carrying out the                  effects of font sizes would be applicable             and personal tablets. Our proposed
                                                    provisions of the FD&C Act.                             to drug promotion.                                    study seeks to address these
                                                       The proposed study seeks to extend                      Some early research in the late 1980s              unanswered questions regarding the use
                                                    previous research on the effects of                     and 1990s examined the size of text                   of supers in prescription drug
                                                    superimposed text (supers) in                           information in advertising topics                     promotion.
                                                    advertising to today’s modern direct-to-                outside of prescription drugs (Refs. 6, 7,
                                                    consumer (DTC) pharmaceutical                           and 8). These studies all generally found             General Research Questions
                                                    promotion. Although earlier research on                 that text size was associated with                      1. Does the size of the superimposed
                                                    the effects of supers in other consumer                 comprehension, such that larger text                  text, the contrast behind the
                                                    settings suggests that altering text size               sizes increased understanding of the                  superimposed text, and/or the device
                                                    can influence consumer comprehension                    material (and, conversely, smaller text               type influence the noticeability, recall,
                                                    of information, it is unclear if these                  sizes interfered with comprehension).                 and perceived importance of the super
                                                    findings extend to DTC promotion of                     For example, Foxman and colleagues                    information?
                                                    prescription drugs and are applicable                   (Ref. 6) found that whereas ‘‘small’’ text              2. Does the size of the superimposed
                                                    over 20 years later when viewing                        size (<1⁄2 inch size) was associated with             text, the contrast behind the
                                                    promotional materials using today’s                     accurate comprehension for 59% of                     superimposed text, and/or the device
                                                    modern technologies (e.g., tablets).                    respondents, ‘‘large’’ text size (>1⁄2 inch           type influence the recall of and attitudes
                                                    Moreover, other factors such as text/                   size) was associated with                             toward the promoted drug?
                                                    background contrast may also influence                  comprehension for 79% of respondents.
                                                                                                                                                                    3. Are there any interaction effects
                                                    both the understanding of the                           Studies by other researchers (Refs. 7 and
                                                                                                                                                                  among any combination of independent
                                                    superimposed information (Ref. 1) and                   8) found similar patterns such that
                                                                                                                                                                  variables?
                                                    the effects of text size. The proposed                  increasing the text size of supers
                                                    research seeks to update these earlier                  generally corresponded with increased                 Design
                                                    findings and also to answer new                         comprehension.
                                                    questions concerning presentation of                       We know of no studies that have                      To test these research questions, we
                                                    supers.                                                 examined other commonly variable                      will conduct one randomized controlled
                                                       Part of FDA’s public health mission is               factors, such as text/background                      study. We will examine reactions to
                                                    to ensure the safe use of prescription                  contrast, that may interact with text size            supers in a fictitious DTC prescription
                                                    drugs; therefore it is important that the               to influence comprehension. Early                     drug promotional video on two types of
                                                    information provided in DTC promotion                   research on text readability determined               viewing devices with a general
                                                    is clear and understandable for                         that the contrast between text and                    population sample. The study design
                                                    consumer audiences, avoids use of                       background has a consistent but small                 will be a 3 x 2 x 2 factorial design,
                                                    deceptive or misleading claims, and                     effect. Specifically, while the contrast of           where participants are randomly
asabaliauskas on DSK3SPTVN1PROD with NOTICES




                                                    achieves ‘‘fair balance’’ in presentation               color has a small effect (Ref. 9), the                assigned to one of 12 experimental
                                                    of benefits and risks. For example,                     contrast in brightness, or luminance,                 study arms differentiated by:
                                                    varying presentation formats including                  makes the largest difference (Ref. 10).                 • Super text size (small, medium,
                                                    type size, bulleting, amount of white                   These studies showed that black text on               large);
                                                    space, and use of ‘‘chunking’’ or                       a white background results in the                       • Device type (television, tablet);
                                                    headlines can all influence consumer                    highest readability (Ref. 11), but that                 • Super text contrast (high, low).




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                                                    85970                          Federal Register / Vol. 81, No. 229 / Tuesday, November 29, 2016 / Notices

                                                                                                       TABLE 1—DESIGN AND CELL SIZES FOR MAIN STUDY
                                                            Device type                                         TV                                                       Tablet
                                                                                                                                                                                                         Total
                                                            Super size                       Small            Medium               Large                  Small          Medium            Large

                                                    Contrast:
                                                        High .......................                 106               106                   106                  106             106              106           636
                                                        Low .......................                  106               106                   106                  106             106              106           636

                                                               Total ...............                 212               212                   212                  212             212              212       1,272
                                                       Note: The sample will be split evenly across three cities (Los Angeles, CA; Cincinnati, OH; and Tampa, FL), with 424 participants per city.


                                                       For both the pretest and main study,                     1. Abbvie                                               interviews that were conducted in
                                                    we will work with two market research                         a. Comment: Mobile users can change                   April.
                                                    firms to recruit adult participants and                                                                                e. Comment: Request clarity about
                                                                                                                font size and viewing size—we should
                                                    conduct in-person data collection in                                                                                quota sampling and other techniques we
                                                                                                                incorporate this into our study.
                                                    three U.S. cities: Los Angeles, CA,                                                                                 may plan to use to ensure a diverse
                                                                                                                   Response: Although the font size for
                                                    Cincinnati, OH, and Tampa, FL. In                                                                                   sample. Also suggest groups of at least
                                                                                                                certain text (such as newspaper articles)
                                                    addition to our aim for regional                                                                                    50 in each cell for analysis purposes.
                                                                                                                or closed captioning text size can be                      Response: As this study is not
                                                    variation, we selected these three cities                   changed on a tablet, supers within a
                                                    with the aim of recruiting a sample that                                                                            intended to be nationally representative,
                                                                                                                developed video cannot be                               we will not employ strict quota
                                                    is diverse on gender, race/ethnicity,                       manipulated. Participants will be                       sampling procedures. However, we will
                                                    education, and age characteristics.                         allowed to hold the tablet as they                      work closely with our recruitment firms
                                                       Participants from the general                            normally would, but it is important to                  to monitor recruitment and ensure that
                                                    population will be invited to a market                      establish experimental control over                     our sample is diverse with regard to
                                                    research facility to watch one video for                    many user settings to avoid threats to                  factors including race, education, age
                                                    a fictional prescription drug that treats                   internal validity. Thus, font and viewing               and gender. Further, selection of our
                                                    asthma. In-person administration of                         size will be standardized for this study.               three U.S. cities for data collection (Los
                                                    study procedures will enable us to                             b. Comment: Recommend looking at                     Angeles, Cincinnati and Tampa) was
                                                    control the television and tablet                           use of TV and mobile devices                            purposive to help achieve diversity on
                                                    watching experience in terms of size,                       concurrently, as some people use them                   these factors.
                                                    distance, and other variables.                              this way.                                                  To answer the second part of the
                                                    Participants will watch the video twice                        Response: This is a good suggestion                  comment, we are aware of no statistical
                                                    and then answer questions addressing                        for future research, but is out of scope                or research standard that specifies that
                                                    recall of risks and benefits, perceptions                   for the current study.                                  groups must contain 50 individuals.
                                                    of risks and benefits, and questions                        2. Lilly                                                However, we conducted power analyses
                                                    regarding the salience of information in                                                                            and determined that in order to have
                                                                                                                  a. Comment: Generally supportive;                     enough power for the proposed
                                                    text. The questionnaire is available                        research objectives and study approach
                                                    upon request. Participation is estimated                                                                            statistical tests, we will exceed this
                                                                                                                are reasonable.                                         number per experimental cell.
                                                    to take approximately 20 minutes.                             Response: Thank you.                                     f. Comment: Recommends replacing
                                                       To examine differences between                             b. Comment: Recommend showing                         the pre-test question about the
                                                    experimental conditions, we will                            supers in black box at bottom of the                    importance of the text information
                                                    conduct inferential statistical tests such                  screen and not superimposing them                       (Question 5) with a question such as
                                                    as analysis of variance (ANOVA).                            over moving, contrasting color field to                 ‘‘how noticeable or legible was the text
                                                       Pretesting will take place before the                    mimic common practices in television                    information?’’
                                                    main study to select super sizes for the                    commercial advertising.                                    Response: We agree that the
                                                    main study and to evaluate the                                Response: Our high contrast condition                 noticeability and legibility of the text
                                                    procedures and measures that will be                        indeed presents the supers in white font                information is important, and we have
                                                                                                                on a black background at the bottom of                  other questions that address this. We are
                                                    used. We will exclude individuals who
                                                                                                                the screen. Our low contrast condition                  specifically interested in the perceived
                                                    work in healthcare or marketing settings
                                                                                                                shows lettering over the moving scenes                  importance of the text information as a
                                                    because their knowledge and
                                                                                                                because not all advertisements show                     moderator variable.
                                                    experiences may not reflect those of the
                                                                                                                their supers in a black banner.                            g. Comment: Recommends removing
                                                    average consumer. We conducted a
                                                                                                                  c. Comment: Lilly requests clarity                    semantic differential questions
                                                    priori power analyses to determine                          about how the size of text and level of                 (Question 9) and essentially any
                                                    sample sizes for the pretest and the                        contrast were developed when the                        questions that ask about perceptions
                                                    main study.                                                 agency reports the results of the study.                because it is a pretest.
                                                       In the Federal Register of March 9,                        Response: We used cognitive                              Response: Our pretest study is not
asabaliauskas on DSK3SPTVN1PROD with NOTICES




                                                    2016 (81 FR 12503), FDA published a                         interviews and will use the pretest to                  designed to test the main study
                                                    60-day notice requesting public                             make these determinations. We will be                   questionnaire. Rather, the main
                                                    comment on the proposed collection of                       sure to include this information when                   purposes of the pretest are to (1) test
                                                    information. FDA received 10 comments                       we report the results of the study.                     consumer perceptions of superimposed-
                                                    total. Six comments were outside the                          d. Comment: Recommend qualitative                     text size with the aim of choosing
                                                    scope of the proposed research (‘‘Ban                       pre-test instead of quantitative pretest.               perceptibly different levels of size
                                                    DTC’’), leaving four substantive                              Response: We fulfilled this suggested                 (small, medium, large) for use in the
                                                    comments.                                                   purpose with a set of nine cognitive                    main study; and (2) test our planned


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                                                                               Federal Register / Vol. 81, No. 229 / Tuesday, November 29, 2016 / Notices                                                  85971

                                                    procedures for implementation of the                    provided in the ad, such as accessibility             generalizability. We have attempted to
                                                    intervention (TV and tablet) and in-                    to the drug, information about the                    do this by setting up the television and
                                                    person data collection. However, to                     disease, etc.                                         chair in the room at the average distance
                                                    make the most use of our resources, we                     Response: These are great ideas and                that people tend to sit from their
                                                    also plan to test the properties of certain             would provide additional information                  televisions in their living room and
                                                    main study survey items (e.g., means,                   about various communication issues                    instructing participants to wear glasses
                                                    ranges, etc.) to ensure the utility of the              relevant to DTC television promotion.                 or contact lenses if needed. Television
                                                    items for use in the main study.                        However, we regret that we must make                  viewing is a more fixed experience than
                                                       h. Comment: Calls out an                             difficult choices about what to include               more modern technologies. We also
                                                    inconsistency in terms of how many                      and not include in this study and these               agree that allowing individuals to hold
                                                    times participants will view the ad.                    issues fall outside the scope of the                  the tablet or place it on a table as they
                                                       Response: Thank you for noting that                  current research questions.                           normally would is appropriate for both
                                                    discrepancy. Participants will view the                                                                       experimental control and ecological
                                                    ad once. We have corrected all materials                3. Merck
                                                                                                                                                                  generalizability.
                                                    to reflect this change. Lilly recommends                   a. Comment: FDA’s execution may not                   b. Comment: Including a medium
                                                    showing it twice. We agree that if the                  yield useful data. For example, we are                contrast instead of just a high and low
                                                    goal is to learn about user experience                  examining TV and tablet use, but people               contrast may be informative.
                                                    (preferences and such, or trying to                     may be viewing promotion on mobile
                                                    improve the presentation) then two or                   devices.                                                 Response: We appreciate this
                                                    more viewings makes sense. However,                        Response: We agree that the ways in                comment because we considered it
                                                    our goal is to test differences in                      which people view their media are                     when designing the study. We decided
                                                    cognitive processing based on the varied                multiplying and that we have not                      to use only high and low contrast in the
                                                    size/contrast presentations of the                      captured all of them. However, rather                 study because our main variable of
                                                    supers. Thus, we do not want to                         than simply study superimposed text on                interest in this particular study is the
                                                    artificially enhance the scrutiny                       a television screen, we opted to add an               size of the text. Thus, we are expending
                                                    participants pay to the ad above and                    examination of viewing on a tablet,                   resources to attempt to determine
                                                    beyond the experimental situation. For                  which is an increasingly popular option               multiple sizes of text to test in order to
                                                    example, small supers may interfere                     for viewing shows. We regret that we do               get a fuller appreciation of the role of
                                                    with cognitive processing as                            not have the opportunity to explore                   text size in DTC promotion. We have
                                                    hypothesized, but this interference may                 viewing on all possible new                           found in past studies that identifying a
                                                    be overcome upon a second viewing. In                   technologies, but we believe that the                 medium level is difficult (e.g., OMB
                                                    a real world viewing situation,                         current study will offer insights above               Control No. 0910–0695) and chose in
                                                    consumers rarely see an ad two times in                 and beyond the television screen.                     this study to focus on size rather than
                                                    a row.                                                     b. Comment: Prior to the                           contrast. That said, we do feel that
                                                       i. Comment: Question 12: Attributes                  implementation of results from                        contrast is valuable enough to add as a
                                                    are very similar and will be duplicative.               individual studies on the content,                    variable of interest, so we are planning
                                                       Response: The three survey items for                 format, and presentation of information               to devote two conditions to it.
                                                    question 12 (attitudes towards the ad)                  in DTC advertisements on television,                     c. Comment: It would be useful if the
                                                    are conceptually similar and will be                    FDA should conduct research on the                    questionnaire is posted along with the
                                                    used as a multi-item scale.                             combination of all of the individual                  notice on regulations.gov.
                                                    Conventionally, three items is the                      factors.                                                 Response: We are happy to provide
                                                    minimum recommended to assess inter-                       Response: This comment is outside                  the questionnaire to anyone who
                                                    item reliability.                                       the scope of the present project. It is not           requests it.
                                                       j. Comment: Question 12 and 14:                      directed at the improvement of the                       d. Comment: Suggests an FDA-
                                                    Suggest bolding or underlining ‘‘drug’’                 study and does not appear to require the              Industry working group might be
                                                    or ‘‘ad’’ in these questions to                         abandonment of the current study.                     helpful in the furtherance of this
                                                    differentiate them for participants.
                                                                                                            4. GlaxoSmithKline (GSK)                              research.
                                                       Response: We agree and have added
                                                    language to the survey items to better                     a. Comment: Allowing participants to                  Response: This is an intriguing idea
                                                    make this distinction. For items specific               view the TV at the distance they usually              and may have merit after we obtain
                                                    to attitudes towards the drug we now                    view it and to interact with the tablet               empirical data that is specifically
                                                    begin the item with ‘‘Overall, DRUG X                   the way they ordinarily do would better               applicable to DTC promotion. Without
                                                    is . . .’’ whereas items about the ad                   reflect a real-world experience.                      this data, it is unclear what this working
                                                    begin with ‘‘Overall, the ad was . . .’’                   Response: We agree that these details              group would contribute. We will
                                                       k. Comment: Would be interesting to                  are important to consider when                        consider this idea in further detail upon
                                                    include an open-ended question about                    conducting valid research. We must                    interpretation of results.
                                                    whether any additional information                      make a decision between the trade-off of                 FDA estimates the burden of this
                                                    could have or should have been                          experimental control and real-world                   collection of information as follows:

                                                                                                   TABLE 2—ESTIMATED ANNUAL REPORTING BURDEN 1
asabaliauskas on DSK3SPTVN1PROD with NOTICES




                                                                                                                                      Number of                               Average burden
                                                                                                                    Number of                            Total annual
                                                                            Activity                                                responses per                              per response            Total hours
                                                                                                                   respondents                            responses
                                                                                                                                      respondent                                 (in hours)

                                                                                                                                Pretesting

                                                    Number to complete the screener (assumes 50%                              338                    1             338     0.08 (5 minutes) ........             27
                                                      eligible).




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                                                    85972                            Federal Register / Vol. 81, No. 229 / Tuesday, November 29, 2016 / Notices

                                                                                                  TABLE 2—ESTIMATED ANNUAL REPORTING BURDEN 1—Continued
                                                                                                                                                             Number of                                                Average burden
                                                                                                                                  Number of                                            Total annual
                                                                                  Activity                                                                 responses per                                               per response                     Total hours
                                                                                                                                 respondents                                            responses
                                                                                                                                                             respondent                                                  (in hours)

                                                    Number of completes ...............................................                           240                            1                     240       0.42 (25 minutes) ......                        101

                                                                                                                                                    Main Study

                                                    Number to complete the screener (assumes 50%                                               1,785                             1                  1,785        0.08 (5 minutes) ........                       143
                                                      eligibility).
                                                    Number of completes ...............................................                        1,272                             1                  1,272        0.42 (25 minutes) ......                        534

                                                         Total hours ........................................................   ........................   ........................   ........................   ....................................            805
                                                       1 There   are no capital costs or operating and maintenance costs associated with this collection of information.


                                                    References                                                                ‘‘Comprehension of Info-aid Supers in                                   SUMMARY:    The Food and Drug
                                                                                                                              Television Advertising for Social Ideas:                                Administration is correcting a notice
                                                      The following references are on                                         Implications for Public Policy’’. Journal
                                                    display in the Division of Dockets                                                                                                                entitled ‘‘Novus International, Inc.;
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                                                    1061, Rockville, MD 20852, and are                                        Computer Displays as a Function of                                      Federal Register of November 8, 2016
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                                                    persons between 9 a.m. and 4 p.m.,                                        Texture.’’ In D. Harns (Ed.) Engineering                                announced that Novus International,
                                                                                                                              Psychology and Cognitive Ergonomics
                                                    Monday through Friday; they are also                                      (vol. 4) Ashgate, Aldershot, United                                     Inc., has filed a petition proposing that
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                                                    www.regulations.gov. FDA has verified                                10. Shieh K-K. and C-C. Lin. ‘‘Effects of                                    amended to provide for the safe use of
                                                    the Web site addresses, as of the date                                    Screen Type, Ambient Illumination, and                                  poly (2-vinylpyridine-co-styrene) as a
                                                    this document publishes in the Federal                                    Color Combination on VDT Visual                                         nutrient protectant for methionine
                                                    Register, but Web sites are subject to                                    Performance and Subjective Preference.’’
                                                                                                                                                                                                      hydroxy analog in animal food for beef
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                                                                                                                              Ergonomics. vol. 26 pp. 527–36, 2000.                                   cattle, dairy cattle, and replacement
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                                                         Web page Text-background Colour                                      of Typographical Factors Influencing                                    proposes that the food additive
                                                         Combinations on Readability, Retention,                              Speed of Reading. VII. Variations in                                    regulations be amended to provide for
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                                                         Behavior & Information Technology. vol.
                                                                                                                                                                                                      the safe use of ethyl cellulose as a
                                                                                                                              of Applied Psychology. vol. 15 pp. 471–
                                                         23 pp. 183–95, 2004.                                                 9, 1931.                                                                binder for methionine hydroxy analog to
                                                    2. Baur C and C. Prue ‘‘The CDC Clear                                12. Legge G.E., G.S. Rubin and A. Luebner                                    be incorporated into animal food. The
                                                         Communication Index is a Tool to                                     ‘‘Psychophysics of reading. V. The Role                                 document was published with the
                                                         Prepare and Review Health                                            of Contrast in Normal Vision.’’ Vision                                  incorrect docket number. This
                                                         Information.’’ Health Promotion Practice.                            Research vol. 27 pp. 1165–77, 1987.                                     document corrects that error.
                                                         vol.15 pp. 629–37, 2014.                                        13. Kaufman D.W., J.P. Kelly, L. Rosenberg,
                                                    3. Shrank W, J. Avorn, C. Rolon, and                                      T.E. Anderson and A.A. Mitchell.                                        FOR FURTHER INFORMATION CONTACT:  Lisa
                                                         P.Shekelle ‘‘Effect of Content and Format                            ‘‘Recent Patterns of Medication Use in                                  Granger, Food and Drug Administration,
                                                         of Prescription Drug Labels on                                       the Ambulatory Adult Population of the                                  10903 New Hampshire Ave., Bldg. 32,
                                                         Readability, Understanding, and                                      United States: The Slone Survey.’’
                                                         Medication Use: A Systematic Review.’’
                                                                                                                                                                                                      Rm. 3330, Silver Spring, MD 20993–
                                                                                                                              Journal of the American Medical
                                                         Annals of Pharmacotherapy. vol. 41 pp.                               Association vol. 287 pp. 337–344, 2002.                                 0002, 301–796–9115, lisa.granger@
                                                         783–801, 2007.                                                                                                                               fda.hhs.gov.
                                                                                                                           Dated: November 22, 2016.
                                                    4. Wogalter, M.S. and W.J. Vigilante. ‘‘Effects
                                                         of Label Format on Knowledge                                    Leslie Kux,                                                                  SUPPLEMENTARY INFORMATION:     In the
                                                         Acquisition and Perceived Readability                           Associate Commissioner for Policy.                                           Federal Register of Tuesday, November
                                                         by Younger and Older Adults.’’                                  [FR Doc. 2016–28733 Filed 11–28–16; 8:45 am]                                 8, 2016, in FR Doc. 2016–26922, on page
                                                         Ergonomics. vol. 46 pp. 327–344, 2003.                          BILLING CODE 4164–01–P                                                       78528, the following correction is made:
                                                    5. Smither, J.A.A. and C.C. Braun                                                                                                                 On page 78528, in the first column,
                                                         ‘‘Readability of Prescription Drug Labels
                                                         by Older and Younger Adults.’’ Journal
                                                                                                                                                                                                      ‘‘Docket No. FDA–2014–F–0452’’ is
                                                                                                                         DEPARTMENT OF HEALTH AND                                                     corrected to read ‘‘Docket No. FDA–
                                                         of Clinical Psychology in Medical
                                                         Settings. vol. 1 pp. 149–59, 1994.                              HUMAN SERVICES                                                               2016–F–3880’’.
                                                    6. Foxman, E.R., D.D. Muehling and P.A.                                                                                                             Dated: November 22, 2016.
                                                         Moore. ‘‘Disclaimer Footnotes in Ads:                           Food and Drug Administration
                                                         Discrepancies Between Purpose and                                                                                                            Leslie Kux,
asabaliauskas on DSK3SPTVN1PROD with NOTICES




                                                                                                                         [Docket No. FDA–2016–F–3880]
                                                         Performance.’’ Journal of Public Policy                                                                                                      Associate Commissioner for Policy.
                                                         and Marketing. vol. 7 pp. 127–37, 1988.                         Novus International, Inc.; Filing of                                         [FR Doc. 2016–28656 Filed 11–28–16; 8:45 am]
                                                    7. Murray N.M., L.A. Manrai and A.K.                                 Food Additive Petition (Animal Use);                                         BILLING CODE 4164–01–P
                                                         Manrai. ‘‘Public Policy Relating to                             Correction
                                                         Consumer Comprehension of Television
                                                         Commercials: A Review and Some                                  AGENCY:        Food and Drug Administration,
                                                         Empirical Results.’’ Journal of Consumer                        HHS
                                                         Policy. vol. 16 pp. 145–170, 1993.                              ACTION:       Notice; correction.
                                                    8. Manrai, L.A., A.K. Manrai and N. Murray.



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Document Created: 2016-11-29 00:33:16
Document Modified: 2016-11-29 00:33:16
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.
DatesFax written comments on the collection of information by December 29, 2016.
ContactFDA PRA Staff, Office of Operations, Food and Drug Administration, 8455 Colesville Rd., COLE-14526, Silver Spring, MD 20993-0002, [email protected]
FR Citation81 FR 85968 

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