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Online ads might boost smoking cessation uptake in pregnancy

Paid ads for quit-smoking support might be more effective than advice in clinical setting

Louise Prime

Friday, 20 April 2018

Commercial online advertisements to encourage pregnant women to take up support in quitting smoking might be more effective than advice given in a clinical setting – at least in terms of reaching the target women – according to UK research. Authors of the study,* published in the Journal of Medical Internet Research, said it had shown the value of using online adverts to reach pregnant women even before their first booking appointment with the NHS.

A National Institute for Health Research (NIHR)-funded research team from the Universities of Cambridge, East Anglia and Nottingham said about 11% of pregnant women in the UK smoke throughout pregnancy, and they cited previous research showing that most pregnant smokers want to quit. They noted that the rate of mobile phone ownership is high in all socioeconomic groups, and that effective ‘distance’ interventions, such as text-message support, might be particularly helpful for this group because of their low cost, convenience and anonymity.

They investigated how best to encourage both reach and uptake among pregnant women of the NHS-supported MiQuit smoking cessation intervention, which was designed at the UEA and sends tailored text messages to women who have signed up to the automated service.

They arranged free-of-charge advertising for MiQuit on both the National Childbirth Trust and NHS Choices websites; and they also advertised links on Facebook and Google to a website providing MiQuit information. They recorded how many times the adverts were shown and clicked on; the characteristics of people who initiated MiQuit; and whether or not support was discontinued early. They then calculated the cost per initiation and the estimated cost per quitter (based on previous quit rate research), for the commercial advertisements.

The researchers found that:

  • Overall uptake of MiQuit among those who clicked on any of the four adverts was 3.4%; they said as it is likely that not all ‘clickers’ were pregnant, true uptake in this group is probably higher. MiQuit was initiated by 5.2% of those clicking via Google and 2.2% of those clicking via Facebook.
  • Commercial adverts on Google and Facebook cost a mean of £24.73 per MiQuit initiation and an estimated £736 per confirmed quitter, compared with other interventions deemed very cost-effective for pregnant smokers, such as offering financial incentives (£1,127 per quitter) or identifying pregnant smokers using exhaled carbon monoxide and referring all to specialist NHS cessation support unless they object (£952 per quitter). Free-of-charge adverts on health websites yielded relatively few initiations, though these had fairly low visibility.
  • More than half of online initiators with MiQuit texted a quit date to the system, and about two-thirds continued until the end of the 12-week programme.

They also reported that the Facebook advert generated initiations throughout pregnancy; but about 50% of those who started MiQuit having come from Google were at less than five weeks’ gestation – which, they said, means that adverts attached to online search engines could be a useful way of reaching women in early pregnancy when they are looking for support or information. They pointed out that currently, the earliest cessation interventions tend to target pregnant smokers at their antenatal booking appointment, at around 8-12 weeks’ gestation.

Lead author Dr Joanne Emery commented: “This study shows that online advertising appears to be a valuable means of promoting health interventions to hard-to-reach groups.

“We found that a significant minority of pregnant smokers were willing to initiate an automated text messaging intervention when offered this online. Given the high reach of the internet this could translate into substantial numbers of pregnant smokers supported to quit.”


* Emery J, Coleman T, Sutton S, et al. Uptake of tailored text message smoking cessation support in pregnancy (MiQuit) when advertised on the internet. J Med Internet Res, published online on 19 April 2018.

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