A new NIHR-funded study reveals that commercial online advertising about cessation support could engage large numbers of women earlier in their pregnancies, and at a lower cost.
The study, led by the University of Cambridge, in collaboration with UEA and the University of Nottingham, is the first to investigate online uptake of cessation support among pregnant smokers.
Reducing smoking prevalence in pregnancy is a key public health priority in the UK, where it is a leading preventable cause of adverse prenatal outcomes including miscarriage, stillbirth and prematurity. It is also linked with a wide range of infant health problems. Around 11 per cent of UK women smoke throughout pregnancy and rates rise considerably with increasing social deprivation, which exacerbates health inequalities.
But most pregnant smokers want to quit. Effective ‘distance’ interventions, such as text-message support, may be particularly helpful for this group because of their low cost, convenience, anonymity and wide reach potential, with mobile phone ownership high across the socio-economic spectrum.
Researchers explored the uptake of a smoking cessation intervention called MiQuit and looked at what the best strategies would be to maximise its reach and uptake.
MiQuit is a low-cost, NHS-supported, tailored text-messaging intervention specifically developed for pregnant smokers. It was designed by Dr Felix Naughton from UEA’s School of Health Sciences. It is fully-automated and user-initiated, so women can start using it without the need for any health professional involvement. There is early evidence of its effectiveness for helping pregnant smokers quit and a definitive trial is now underway.
Dr Joanne Emery, also from UEA’s School of Health Sciences, said, “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.”
The research team advertised links to a website providing MiQuit information on Google and Facebook. Ads were also placed on the National Childbirth Trust and NHS Choices websites free of charge.
They recorded the number of times adverts were shown and clicked on, the number of MiQuit initiations, the characteristics of those initiating MiQuit, and whether support was discontinued prematurely.
For the commercial adverts, the cost per initiation was calculated and, using quit rates obtained from an earlier study, the cost per additional quitter was estimated.
Key findings:
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An overall uptake rate of 3.4 per cent was seen among individuals who clicked on any of the four adverts. As it is probable that not all advert clickers were pregnant smokers, the true uptake rate among this group is likely to be higher.
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Commercial adverts on Google and Facebook cost, on average, £24.73 per MiQuit initiation and an estimated £736 per confirmed quitter. This compares favourably 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 in this study, though these had fairly low visibility.
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User engagement and interaction with MiQuit appeared high. Over half of online initiators texted a quit date to the system and approximately two-thirds continued with MiQuit until the end of the 12-week programme.
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While the Facebook advert generated initiations throughout pregnancy, around 50 per cent of those who initiated MiQuit via Google were within their first five weeks’ gestation. Adverts attached to online search engines may therefore be a useful way to reach women when they are first pregnant and looking for support or information about smoking during pregnancy. Currently, the earliest cessation interventions tend to target pregnant smokers at their antenatal booking appointment, at around 8-12 weeks’ gestation.
The study also indicated that uptake rates could be increased substantially by making it easier for women to initiate support after clicking on an advert to the MiQuit website.
‘Uptake of Tailored Text Message Smoking Cessation Support in Pregnancy (MiQuit) When Advertised on the Internet: Observational Study’ was published in the Journal of Medical Internet Research (JMIR) on April 19, 2018. The study can be accessed here.