title: Online advertising as a public health and recruitment tool: comparison of different media campaigns to increase demand for smoking cessation interventions.
abstract: BACKGROUND
  To improve the overall impact (reach x efficacy) of cessation treatments and to reduce the population prevalence of smoking, innovative strategies are needed that increase consumer demand for and use of cessation treatments. Given that 12 million people search for smoking cessation information each year, online advertising may represent a cost-efficient approach to reach and recruit online smokers to treatment. Online ads can be implemented in many forms, and surveys consistently show that consumers are receptive. Few studies have examined the potential of online advertising to recruit smokers to cessation treatments.
  
  
  OBJECTIVE
  The aims of the study were to (1) demonstrate the feasibility of online advertising as a strategy to increase consumer demand for cessation treatments, (2) illustrate the tools that can be used to track and evaluate the impact of online advertising on treatment utilization, and (3) highlight some of the methodological challenges and future directions for researchers.
  
  
  METHODS
  An observational design was used to examine the impact of online advertising compared to traditional recruitment approaches (billboards, television and radio ads, outdoor advertising, direct mail, and physician detailing) on several dependent variables: (1) number of individuals who enrolled in Web- or telephone-based cessation treatment, (2) the demographic, smoking, and treatment utilization characteristics of smokers recruited to treatment, and (3) the cost to enroll smokers. Several creative approaches to online ads (banner ads, paid search) were tested on national and local websites and search engines. The comparison group was comprised of individuals who registered for Web-based cessation treatment in response to traditional advertising during the same time period.
  
  
  RESULTS
  A total of 130,214 individuals responded to advertising during the study period: 23,923 (18.4%) responded to traditional recruitment approaches and 106,291 (81.6%) to online ads. Of those who clicked on an online ad, 9655 (9.1%) registered for cessation treatment: 6.8% (n = 7268) for Web only, 1.1% (n = 1119) for phone only, and 1.2% (n = 1268) for Web and phone. Compared to traditional recruitment approaches, online ads recruited a higher percentage of males, young adults, racial/ethnic minorities, those with a high school education or less, and dependent smokers. Cost-effectiveness analyses compare favorably to traditional recruitment strategies, with costs as low as US $5-$8 per enrolled smoker.
  
  
  CONCLUSIONS
  Developing and evaluating new ways to increase consumer demand for evidence-based cessation services is critical to cost-efficiently reduce population smoking prevalence. Results suggest that online advertising is a promising approach to recruit smokers to Web- and telephone-based cessation interventions. The enrollment rate of 9.1% exceeds most studies of traditional recruitment approaches. The powerful targeting capabilities of online advertising present new opportunities to reach subgroups of smokers who may not respond to other forms of advertising. Online advertising also provides unique evaluation opportunities and challenges to determine rigorously its impact and value.
authors.affiliation: The Schroeder Institute for Tobacco Research and Policy Studies, American Legacy Foundation, NW, Washington, DC 20036, USA. agraham@americanlegacy.org
authors.forename: Amanda L
authors.initials: AL
authors.lastname: Graham
authors.forename: Pat
authors.initials: P
authors.lastname: Milner
authors.forename: Jessie E
authors.initials: JE
authors.lastname: Saul
authors.forename: Lillian
authors.initials: L
authors.lastname: Pfaff
mesh_terms: D000293:Adolescent; D000329:Advertising; D003362:Cost-Benefit Analysis; D034742:Electronic Mail / Q000706:statistics & numerical data; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D040541:Marketing / Q000379:methods*; D009515:New Jersey; D009862:Online Systems; D018579:Patient Selection; D011634:Public Health; D016540:Smoking Cessation / Q000379:methods*; D013813:Therapy, Computer-Assisted / Q000191:economics / Q000379:methods*; D055815:Young Adult