CONSUMER PERCEPTION OF SUPPLEMENTS: AN ANNOTATED BIBLIOGRAPHY

Consumer Perception of Supplements: An Annotated Bibliography

Leigh Ehrhardt
University of Mississippi

CONSUMER PERCEPTION OF SUPPLEMENTS: AN ANNOTATED BIBLIOGRAPHY

Dietary supplement use has become a big trend over the years. The general public has
access to hundreds of different supplements. They are available over the counter at most general
stores. The U.S. Food Drug Administration (FDA) regulates dietary supplements under the
Dietary Supplement Heath and Education Act (DSHEA). While the FDA regulates the labeling
of supplements, the companies that produce the supplements are not required to gain approval of
their product from the FDA before distributing. Consumers may not be aware that FDA does not
regulate the safety and effectiveness of these supplements that are being sold. The idea of a
possible lack of knowledge of the current regulations is of concern and may need to be
addressed. The issues that may be of alarm include serious health risks and inadequate consumer
safety awareness. To be able to gain a better understanding on the publics perception of the use
of supplements and their process of regulation, it is necessary to examine professional academic
journals that focus on researching the current knowledge level that a variety of consumers have
regarding supplements. In this annotated bibliography, academic sources are presented by the use
of citations, summaries and evaluations.
The academic journals that are included in this annotated bibliography are dated from
2004 to 2013. The articles that I chose not to include in this annotated bibliography are those that
were not focused strictly on dietary supplement use/knowledge in the United States. I chose to
omit these sources because my research is mainly based on assessing consumers knowledge on
current United States laws and regulations. I also omitted sources that were over ten years old
because the information is outdated. While many of the sources were not published within this
year, much of the research focuses on different aspects of the usage of dietary supplements that
have not been studied before.

CONSUMER PERCEPTION OF SUPPLEMENTS: AN ANNOTATED BIBLIOGRAPHY

Ashar, B., Rice, T., & Sisson, S. (2007). Physicians' understanding of the regulation of dietary
supplements. Archives of internal medicine, 167(9), 966-969.
In the article, Physicians Understanding of the Regulation of Dietary Supplements,
Asher, Rice and Sisson (2007) argue that physicians have a poor understanding on the
regulation laws of dietary supplement. To explore and evaluate physicians level of
understanding on the regulation laws, the researchers developed and administrated an online
didactic program that included a pretest and posttest. The questions asked were multiple-choice
and all reviewed by experts pertaining to dietary supplements. The purpose of this study was to
inform the current knowledge that most physicians have regarding the regulation of dietary
supplements. The intended audience for this article is for doctors and health law regulation
experts who want to explore the knowledge level of dietary supplement regulation within the
health field.
I chose this article because it is the first study that I have found that focuses strictly on
physicians and their knowledge level on dietary supplement regulations. The beginning of the
article discusses the current law, the Dietary Supplement Health and Education Act that allows
dietary supplements to be sold to the public without the FDAs approval. During the study, 335
out of 1541 physicians completed the entire didactic module and answered the pre/post
questions. The solution that the researchers proposed to increase knowledge among physicals
could be helpful to address their argument. They propose that FDA needs to expand its outreach
programs to health care professionals as a way to provide education on dietary supplements. The
limitation to this study is that the participants who completed the questions may have short
retention of the information. I believe further research needs to be done to verify the retention
span of knowing the regulatory laws.

CONSUMER PERCEPTION OF SUPPLEMENTS: AN ANNOTATED BIBLIOGRAPHY

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.
In the article, Dietitians Use and Recommend Dietary Supplements: Report of a
Survey, Dickinson, Bonci, Boyon and Franco (2012) assert the importance of knowing how
many health care professionals use and recommend dietary supplements to their clients. To
support their position they conduct an online survey to examine the attitudes and usage of
supplements by 300 dietitians. To be qualified to participate in the study only those who
described their primary job as a Registered Dietitian and sees clients weekly in their work
environment were permitted. The purpose of this article is to highlight the amount of dietitians
that take dietary supplements in order to raise awareness on how many clients are being
recommended to take a supplement. As a result, the researchers main audience is of those in the
medical field who are nutritional professionals who advise patients diets.
The main reason why I chose this article is because it is the only study that I found that
specifically surveyed Dietitians on their idea and knowledge of supplement usage. Since I am a
dietetic student, it is vital for me to know the thoughts and ideas of professionals in my future
field. Also, since they are nutritional and diet experts it is helpful to know their thoughts on
supplement use. The questions that were asked to the dietitians consisted of, Are you a regular
user of dietary supplements and have you ever recommended dietary supplements (p. 16). It is
noteworthy to highlight that 96% out of the 300 dietitians have said they used a supplement and
97% said they have recommended a supplement to their clients (p. 26-17). Another reason why
this article is helpful is because it addresses the concept that only 23% of the dietitians believed
that their clients have a good understanding on the appropriate intake of supplements. The
limitation to this study is that it was an online survey and data was not collected by interview.

CONSUMER PERCEPTION OF SUPPLEMENTS: AN ANNOTATED BIBLIOGRAPHY

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
In the journal article, Influence of the Dietary Supplement Health and Education Act on
Consumer Beliefs about the Safety and Effectiveness of Dietary Supplements, Dodge, Litt, and
Kaufman (2011) assert that most consumers lack knowledge and understanding of the Dietary
Supplement Health and Education Act (DSHEA) that currently defines and regulates dietary
supplements. To support this claim the researchers used questionnaires in two different studies as
a way to examine participants views on the safety and effectiveness of a dietary supplement.
The purpose of the study is to learn about how consumers assess the safety and effectiveness of a
dietary supplement by reading its product description. The intended audience is scholarly
professionals who want to learn more about consumers views and perceptions on regulations of
supplements.
I chose this article because it focuses on assessing participants knowledge on the Dietary
Supplement Health and Education Act. The two studies that are completed focused on two main
objectives. The first studys objectives are that participants will be more likely to rate a product
being safer and more effective if the product states that it is approved by FDA. The other
objective in study 1 is to find if the effectiveness ratings are not significantly different between
those that were told FDA has approved the product vs. those that were told FDA did not approve.
The objective for study 2 is to see if providing information on DSHEA and FDA would affect
the beliefs of participants on dietary supplements. The results that I found useful in my research
is that most of the participants were not aware of the current regulation by DSHEA and that
safety/effectives views depended on what type of supplement was described. The limitation to

CONSUMER PERCEPTION OF SUPPLEMENTS: AN ANNOTATED BIBLIOGRAPHY

this study is that the products that were viewed by participants were not real, which means that
they are not a current dietary supplement that a consumer may be exposed to.
Dodge, T., & Kaufman, A. (2007). What makes consumers think dietary supplements are safe
and effective? The role of disclaimers and FDA approval. Health Psychology, 26(4), 513517
Dodge and Kaufman (2007) asserts in their article, What Makes Consumers Think
Dietary Supplements Are Safe and Effective? The Role of Disclaimers and FDA Approval, that
educating individuals about the FDAs role in regulating dietary supplements is important. To
support their argument, the researchers provide data on 262 undergraduate students who take part
in a questionnaire that assesses how knowledgeable they are on the FDAs role in regulating
dietary supplements. The researchers purpose was to see if participants were more or less likely
to use a dietary supplement product that was either stated to be approved or not to be by the
FDA. The researchers intended audience is of scholars in the field of medicine and psychology,
but also for business/law regulation professionals who may want to know about the consumers
perception of commercial dietary products sold.
The article is very important for my research because it is one of the first studies that
questions the knowledge of consumers about the FDAs role in regulating dietary supplements. I
included this article despite there being an updated study from 2011. I think this article is
relevant because it is mentioned in many dietary supplement studies. The results show that
individuals are not very knowledgeable on the regulations. For example, McDonald, and
Nicholson (2006) state, on average, the participants answered only about 50% of the knowledge
items correctly, suggesting that individuals are not very knowledgeable about the FDAs role in
regulating dietary supplements (p. 516). The questions that were asked regarding dietary

CONSUMER PERCEPTION OF SUPPLEMENTS: AN ANNOTATED BIBLIOGRAPHY

supplement knowledge are provided at the end of the journal article, which I can use in my
research because they are still valid questions. Being one of the first articles to address these
questions leaves limitations. There needs to be more research on the timing and sources of
knowledge. For example, the question whether consumers educate or research prior to using
supplements may need to be addressed.
McDonald, D., & Nicholson, N. R. (2006). Dietary supplement information and intention to
continue and recommend supplements. International Journal of Nursing Studies, 43(1),
51-57.
In their article, Dietary Supplement Information and Intention to Continue and
Recommend Supplements, published in the International Journal of Nursing Studies,
McDonald, and Nicholson (2006) argues the need to know more about the attitudes of consumers
who use dietary supplements. To support their position, they provide statistics on individuals
beliefs of supplement safety, continuing and recommending dietary supplements after reading a
pamphlet based on the United States Federal Drug Administration (FDA) Tips for the Savvy
Supplement User. The purpose of the article is to inform individuals to evaluate the safety of
dietary supplements before continual use. The researchers are writing to an audience who is in a
professional health field who would benefit from hearing about the beliefs and attitudes of
consumers regarding dietary supplement use.
I chose to include the article in this annotated bibliography for several reasons. Firstly,
because they use a pamphlet based on the FDAs tips for supplement use to assess the current
beliefs of consumers. It is important for my research to answer the question if the public is
familiar with FDAs protocol on regulating dietary supplements. The statistical answers based on
the questions asked to the participants are of good quality and can be used to answer my question

CONSUMER PERCEPTION OF SUPPLEMENTS: AN ANNOTATED BIBLIOGRAPHY

on the perception of safety use of supplements by the consumer. There are weaknesses and
limitations to the study. The study included many participants who have been using a supplement
prior to completing the survey questions. Thus, their attitude is less likely to change after reading
the FDA pamphlet. A follow up study that only includes participants who have never taken a
supplement may be important.
Miller, C. K., & Russell, T. (2004). Knowledge of dietary supplement label information among
female supplement users. Patient Education & Counseling, 52(3), 291-296.
Miller and Russell (2004) argues in their article, Knowledge of Dietary Supplement
Label Information Among Female Supplement Users, that consumers need to be more educated
on supplement claims, testing/product safety and how to better evaluate supplement products
prior to use. To support their claim, the researchers focus on identifying womens attitudes and
beliefs by the use of questionnaires and interviews. The purpose of this study is to highlight the
current knowledge and usage of supplements by women. The intended audience for this article is
health promotion researchers, physicians, nurses and other health care providers.
I chose this article because it is one of the first studies to examine and determine
womens knowledge on dietary supplement labeling. The study only focuses on women of childbearing age and this is significant because women at this age are more likely to take a dietary
supplement. The areas that were divided in the study includes: knowledge about ingredients, use
and dosing instructions on supplement labels, knowledge about the percent daily value, and
knowledge about product quality (p. 293-294). While the study concludes that the majority of the
participants (70%) answered questions correctly on adequate knowledge of dietary sources of
nutrients, few participants understood FDAs role in regulation of supplements (p. 291-295).
Thus, the study further highlights the perception of FDA regulation by consumers. The limitation

CONSUMER PERCEPTION OF SUPPLEMENTS: AN ANNOTATED BIBLIOGRAPHY

in this study is that the majority of women included were upper income and well educated. Thus,
the data gathered cannot be applied to every female supplement user.
Tarn, D. M., Paterniti, D. A., Good, J. S., Coulter, I. D., Galliher, J. M., Kravitz, R. L., &
Wenger, N. S. (2013). Physicianpatient communication about dietary supplements.
Patient Education & Counseling, 91(3), 287-294
Tarn, Paterniti, Good, Coulter, Galliher, Kravitz and Wenger (2013) argue in their article,
Physician-patient Communication about Dietary Supplements, that dietary supplement
discussions need to be addressed more frequently during physician-patient visits. To support
their claim they analyzed 1477 auto-recorded office visits and patient/provider surveys. The
purpose of the study is to inform physicians that communication with their clients on dietary
supplements is lacking and needs to be addressed as a way to further educate supplement use.
The intended audience for this journal article is physicians because the article strictly focuses on
that medical group.
The reason why I chose this article is because it focuses on communication between
physicians and their clients. This is the first study that addresses communication on dietary
supplements by physicians and their clients. I found this article important because physicians are
more likely to be discussing supplement use with the public. The results of the study that I found
interesting is that out of 1478 patients, 357 (24.2%) had visits that had discussions on
supplement use with their physicians (p. 289). I also found it helpful to know the topics that were
addressed on dietary supplements during visits. The topics that were mentioned were the reason
for taking a dietary supplement, how to take it, potential risks, effectiveness and cost (p. 290).
The other statistics that I found useful is that in the study fewer than 25% of the five major topics
were addressed and less than 20% of the effectiveness/potential risks were discussed (p. 292).

CONSUMER PERCEPTION OF SUPPLEMENTS: AN ANNOTATED BIBLIOGRAPHY

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There are limitations to this study. The major limitation is that the statistics on the discussion of
supplement use may be understated because some of the visits might have been non-disclosure or
a lack of supplement use.
Timbo, B. B., Ross, M. P., McCarthy, P. V., & Lin, C. J. (2006). Dietary supplements in a
national survey: Prevalence of use and reports of adverse events. Journal of the American
Dietetic Association, 106(12), 1966-1974
Timbo, Ross, McCarthy, and Lin (2006) explains in their article, Dietary Supplements in
a National Survey: Prevalence of Use and Reports of Adverse Events, the need for medical
professionals to become more proactive in learning about their patients supplement use because
adverse reactions can take place. To support their position they offer self-reported data from
individuals who completed a telephone survey (2002 Health and Diet survey) that is sponsored
by the US Food and Drug Administration. The survey is to find out consumer awareness,
attitudes, and practices related to health and diet issues. The purpose of the study is to focus on
population-based data that tracks information on dietary supplement use and the adverse health
issues. The intended audience is medical health professionals, such as dietitians, doctors, nurses,
and etc., who seek to gain more understanding of the popular trend of patients self-medicating
using dietary supplements.
Although the article is from 2006, it is the only source that I have found that explores
adverse health issues that are reported directly from consumers who are using dietary
supplements. Also, the study focuses on possible supplement use with prescribed medication that
may point to drug/food interactions that have not been researched heavily. The study had a total
of 2,743 telephone interviews and 2,101 (73%) of those individuals had used a supplement
during the past 12 months (p=1968). That high of a ratio is very important in my research

CONSUMER PERCEPTION OF SUPPLEMENTS: AN ANNOTATED BIBLIOGRAPHY

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because it shows that more than half of participants used some type of dietary supplement.
Another reason why I chose this article is because 4% of the supplement users reported having at
least one adverse effect and highlights a concern of safety for the public. There are limitations to
this study because the data was gathered by participants self-reporting their history and adverse
effects of supplement use. As a result there is a degree of measurement error because the
researchers were not able to directly look at their medical records or the product packages (p.
1967). There was also no room for a control group to measure possible adverse effects in a
clinical setting because the time and resources were not available.