Running Head: CONSUMER PERCEPTION OF DIETARY SUPPLEMENTS

Consumer Perception of Dietary Supplements

Leigh Ehrhardt
University of Mississippi

CONSUMER PERCEPTION OF DIETARY SUPPLEMENTS

Consumer Perception of Dietary Supplements

In the United States, the public has unlimited access to hundreds of dietary supplements.
The reason why supplements are easy to obtain is because they are sold as over the counter
products, which allows the entire public at any age to buy them. While being available to the
public without a prescription, dietary supplements are still regulated by the U.S. Food Drug
Administration (FDA) under the Dietary Supplement Health and Education Act (DSHEA). The
FDAs role in regulation is verifying that the products labels and claims are truthful. Since,
dietary supplements are not treated as drug products; the products created and sold by
manufactures do not require approval by the FDA before being distributed. Therefore under
DSHEA, the manufacturer is responsible for the safety and effectiveness of the supplement. The
only instance where the FDA has to approve a product is if a new dietary ingredient is added or
adverse reactions have been submitted to them by the public. The growing concern that is seen
with consumers buying dietary supplements is that they are not receiving accurate information
on how the supplement is regulated. Research has been conducted to test consumers knowledge
on supplements and one source suggests that even though DSHEA has been around for 15 years,
individuals still do not understand the regulation process (Dodge, Litt & Kaufman, 2011, p.231).
It is therefore important to research the factors and beliefs that play a role in the lack of
knowledge consumers have on current dietary regulations in the United States, to better
understand how to act upon this problem.
To what extent does the public accurately understand and know the current regulation
laws regarding dietary supplements? Many studies have tested consumers
perception/understanding of the regulations and the results found are very similar. The sources

CONSUMER PERCEPTION OF DIETARY SUPPLEMENTS

suggest that consumers do not fully understand the regulation process. Miller and Russell (2004)
argue that even though more than 70% correctly answered the knowledge base question on
nutrient sources, few participants understood FDAs role and demonstrated confusion about the
governments role in regulating the safety of dietary supplement (p. 297). To expand upon the
idea that there is a lack of knowledge from consumers, Dodge and Kaufman (2007) tested
participants by providing a questionnaire that focused strictly on true/false knowledge questions
on FDAs regulation regarding dietary supplements. The study concluded on average only 50%
of the questions were answered correctly and suggests that Miller and Russell (2007) could be
correct in their proposal that supplement users are confused on current regulations. A later study
by Dodge et al. (2011) was completed to validate the results from Dodge and Kaufman (2007)
study, which used a similar questionnaire to test the knowledge of current regulations and the
results, showed that participants once again answered fewer than 50% of the knowledge
questions correctly. By examining the studies, Miller and Russell (2007) make note that
consumers need to understand DSHEA as a way to, make informal health care choices, but only
when fully informed about the safety, efficacy, and quality of products consumed for health
promotion, which correlates with Dodge et al. (2011) who suggest that because the public does
not fully understand DSHEA, they might make decisions on using a dietary supplement, with
inaccurate or incomplete information (p.236).
While numerous data supports the idea that consumers in the United States are generally
knowledge deficient regarding dietary regulation, it is important to look at possible limitations
and flaws in the sources. For example, Russell and Miller (2004) only had female supplement
users that had been using dietary supplements prior to completing the study and thus the
characteristics of the supplement participants cannot be applied to all supplement users. The

CONSUMER PERCEPTION OF DIETARY SUPPLEMENTS

women were mostly Caucasian and well-educated, which further omits other supplement users.
Another issue that could skew data is that the participants were recruited from a local university
which does not provide an overview on a vast region of individuals in the United States. Similar
issues are seen in all the studies mentioned. In the Dodge and Kaufman (2007) study, 80% of the
participants were Caucasian and recruited from a university. Likewise, participants were 82%
Caucasian and recruited from psychology courses at a private university (Dodge, Litt, &
Kaufman 2011). To be able to obtain more accurate statistics on supplement users, more
research is needed.
To begin answering the question on why consumers are not up to date regarding
regulations, consumer beliefs/attitudes on dietary supplements is an important factor to consider.
For what purpose do consumers take supplements? The sources that focus on why consumers
choose to take supplements do not vary. In Miller and Russell (2004) study, the data shows that
the majority (60.8%) of participants take supplements to prevent an illness. Bailey, Gahche,
Miller, Thomas and Dwyer (2013) strictly researched the motivations behind consumers taking
supplements by examining the NHANES cross-sectional survey from 2007-2010. They found
that the majority of adults (45%) stated that they used supplements to improve overall health and
33% used them to maintain health (p.356). When asked if participants used a supplement to
improve overall health, 46% stated they have (Dodge, Litt, Kaufman, 2011). The idea that
consumers may be taking supplements to improve their own health is significant because it is a
key to begin fully understanding their real perception on supplements. That being said, the next
area to look at under beliefs/attitude is if the majority of consumers are using supplements to stay
healthy, how are they evaluating the safety and effectiveness of supplements prior to use?

CONSUMER PERCEPTION OF DIETARY SUPPLEMENTS

To test consumers beliefs and attitudes on safety of supplements, McDonald and

Nicholson (2006), provided participants with a pamphlet by FDA called Tips for the Savvy
Supplement user that discussed the regulation process of supplements. What was significant was
that 82.4% of participants intended to continue and recommend dietary supplements despite 20
of the 113 sample having the potential for adverse reaction with the supplement they are
currently taking. The concern based on these statistics is, are consumers more likely to change
their views on supplement safety after reading regulation tips? To challenge the current beliefs
and attitudes, Dodge and Kaufman (2007) presented participants with a product that tested safety
and effectiveness ratings based on several labeling manipulations on a supplement that was said
to improve lean muscle and burn fat. The researchers suggest that emphasizing to the participants
that, FDA has not approved a dietary supplement made them more skeptical of the products
safety but had no influence on effectiveness ratings (p.516). In contrast, when a structurefunction disclaimer was present, it influenced effectiveness but not safety. To test whether
attitudes and beliefs depended on the supplement type, Dodge et al. (2011) conducted a study
that used a supplement that was said to be used to help promote more resistance to a cold and
other respiratory illness. The major significance is safety and effectiveness in the FDA approval
group had no effect on beliefs. To reconnect with Dodge and Kaufman (2007) findings suggest
that consumers beliefs differ depending on the supplement that is used. Dodge et al. (2011) also
looked to see if consumers belief would change after being educated on regulation laws
pertaining to DSHEA. The results showed that the participants rated the product as less safe and
effective vs. those who did not complete the intervention prior to rating the supplement. More
research is needed to see if the results are consistent with these findings because if providing
educational courses to consumers is beneficial, it may be a possible solution.

CONSUMER PERCEPTION OF DIETARY SUPPLEMENTS

Another theme that is significant is that health care professionals may factor into the lack
of knowledge that consumers have on supplements. Many studies have been done to test whether
or not health care professionals are up to date with the current supplement regulations. It is
essential area to research because consumers are more likely to discuss supplement use with their
physician. The first area to look at is where consumers are obtaining information on
supplements. According to Miller and Russell (2004) data suggests that 72.5% of participants
went to health food stores to obtain information and only 39.2% went to their physicians.
Another study recorded sessions between physicians and their clients which suggest that fewer
than 25% of the visits included discussing the subject of dietary supplements (Tarn et al., 2013).
By examining these two studies suggests that consumers may not be relying on physicians
advice when starting a supplement. For emphasis, an online questionnaire that was only
completed by licensed dietitians questioned whether dietitians thought consumers had a good
understanding on supplements, the overall opinion is that only 23% of the dietitians stated that
they thought consumers had a good understanding (Dickinson, Bonci, Boyon, & Franco, 2012).
Since Dietitians are experts in the field of food and nutrition it is helpful to gain insight on what
they believe consumers know about dietary supplements.
Not only do consumers need to be aware of current regulation laws, but physicians need
to have knowledge on regulation laws of supplements. To test whether physicians are familiar
with current regulations, Asher, Rice, and Sisson (2007) developed an online didactic pre/post
that was completed by physicians. The average score for the pre-test was a 59% out of 100 and
the post-test results had an average score of a 91%. The researchers suggest that physicians are
not very knowledgeable of the current regulations prior to the educational module. They do argue
that providing an educational module to physicians is important because it may help improve

CONSUMER PERCEPTION OF DIETARY SUPPLEMENTS

knowledge and overall quality of physician-patient communication on supplement use (p. 966).
What is also significant is that 60% of the physicians did not have a good understanding on how
to proceed with reporting adverse reactions to the FDA. To reconnect it in terms with consumers,
48% of individuals who claimed having an adverse event went to their physician (Timbo, Ross,
McCarthy and Lin, 2013). Therefore additional research needs to be done to answer the question
if educating physicians on how to handle reporting adverse events can help make more
consumers aware of current dietary regulations and help notify FDA in a timely manner.
There are possible limitations to these studies. If consumers are relying on supplements to
improve their health, are they self-medicating without talking to their physician before use?
Results indicated that 77% of participants stated that they used a supplement by personal choice
rather than being recommended by a physician (Bailey, Gahche, Miller, Thomas, & Dwyer,
2013, p.360). The survey that was used in the study could be underestimating or overestimating
their findings since data was self-reported. Timbo, Ross, McCarthy and Lin data is self-reported
and the researchers were not able to look at actual product bottles which can skew results.
Likewise Tarn et al. (2013) study that looked at physician-patient visits and the frequency of
supplements being mentioned may also be under or over represented because of possible
confidentiality instances. Also, does providing tips on FDA regulation really change the beliefs
of current supplement users? Since participants were less likely to stop using their supplements
after reading about a pamphlet on FDA tips, will education courses really help consumers safely
assess supplements despite knowing regulations? More research needs to be completed to see if
educational courses will affect consumers beliefs in the long term. By examining the two
studies, Dodge and Kaufman (2007) and Dodge, Litt and Kaufman (2011) indicates that
consumers assess safety and effectiveness based on the supplement being used, but the methods

CONSUMER PERCEPTION OF DIETARY SUPPLEMENTS

that were used could cause conflicts because FDA does not approve supplements, thus some of
the questions that stated FDA approved is not based on real life product labeling that consumers
may be exposed to. Despite there being limitations to these studies, much of the data collected
reviewed together is very valuable because possible solutions are evident as a way to help
consumers gain a better understanding on the regulation of dietary supplements.
To be able to single out more possibilities for why consumers are not aware of the current
regulations of dietary supplements, additional research is needed. For example, by examining
more varieties of participants who use supplements can help gather more data on their
beliefs/attitudes. What may be important is to test individuals who have never used a supplement
before, to see if providing an educational module can help future consumers critically evaluate
supplements better prior to use. Since, self-medicating may be a more current issue with
consumers, not only is it the consumers responsibly to learn about the regulation process of
supplements, but also health professionals need to be able to discuss with their clients the
importance of safe supplement use and how to report an adverse event if one occurs. Therefore,
providing educational programs to the public is a possible solution that may need to be
implemented to address current statistics on lack of consumer knowledge.

CONSUMER PERCEPTION OF DIETARY SUPPLEMENTS

References
Ashar, B., Rice, T., & Sisson, S. (2007). Physicians' understanding of the regulation of dietary
supplements. Archives of internal medicine, 167(9), 966-969.
Bailey, R. L., Gahche, J. J., Miller, P. E., Thomas, P. R., & Dwyer, J. T. (2013). Why US Adults
Use Dietary Supplements. JAMA Internal Medicine, 173(5), 355-361.
Dickinson, A., Bonci, L., Boyon, N., & Franco, J. (2012). Dietitians use and recommend dietary
supplements: Report of a survey. Nutrition Journal, 11(1), 14-20.
Dodge, T., Litt, D., & Kaufman, A. (2011). Influence of the dietary supplement health and
education act on consumer beliefs about the safety and effectiveness of dietary
supplements. Journal of Health Communication, 16(3), 230-244
Dodge, T., & Kaufman, A. (2007). What makes consumers think dietary supplements are safe
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McDonald, D., & Nicholson, N. R. (2006). Dietary supplement information and intention to
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Miller, C. K., & Russell, T. (2004). Knowledge of dietary supplement label information among

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female supplement users. Patient Education & Counseling, 52(3), 291-296.

Tarn, D. M., Paterniti, D. A., Good, J. S., Coulter, I. D., Galliher, J. M., Kravitz, R. L., &
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