Anti-smoking commercials burn out over time

In the new study the team was able to look at the first two years of the campaign for the first time by monitoring the nation's internet search behavior. They used the contents of these search queries to infer whether Americans were searching for smoking-related diseases, whether they were thinking about quitting smoking, and when they were thinking about these topics.

The "Tips" campaign was produced by the Centers for Disease Control and Prevention (CDC) and has received more than $200 million in federal funding. Launched in 2012, "Tips" has run about a dozen commercials featuring a smoker who had suffered some costly and frequently shocking injury or debilitation as a result of tobacco use.

Some of the more graphic commercials highlighted people who had limbs amputated or required laryngectomies. Others showed people who suffered from asthma, stroke, or heart problems.

Does it work?

Yet, very little is known about the effectiveness of the "Tips" campaign. "'Tips' is the nation's most costly tobacco control initiative," Ayers said. "We need to know if it's working and have this knowledge in a timely fashion to make changes going forward." Collaborating with Benjamin Althouse at the Santa Fe Institute in New Mexico and Sherry Emery leader of the Health Media Collaboratory at the University of Illinois at Chicago, the team delved into internet search data provided by Google. Using data corresponding to the precise timing of the campaign, they sought to find whether internet users' searched more frequently for the risks being highlighted by "Tips" as a marker for engagement with the campaign.

For example, did searches for "smoking and asthma" or "does smoking cause asthma" and all queries for smoking and the risk increase during the campaign. Additionally, they looked to see whether internet users searched more frequently for topics related to quitting smoking, as a marker for campaign effectiveness.

During the first round of commercials in 2012, internet searches went up for more grisly risks like amputation or throat cancer resulting in a tracheotomy. But searches stayed flat for less visually shocking and better-known conditions such as asthma, heart attack and stroke. Internet queries for smoking cessation also rose by about 16 percent. In the first half of 2013, "Tips" ran the same series of commercials as before, but this time they seemed less effective. The previous spike in searches related to the most gruesome and novel smoking consequences was cut in half, and on the whole there was no increase in smoking cessation related searches.

Gruesome gravitas

"Content that motivated people's interest during 2012 only seemed to motivate them about half as much when presented with the same content again in 2013," Ayers said. "The timing of these advertisements did not correspond to any increase in smoking cessation related internet searches. In the second half of 2013, the CDC aired a new set of anti-smoking commercials focusing on diseases such as diabetes, chronic obstructive pulmonary disease and other lung diseases. In the wake of this new crop of advertising, Ayers and his team saw no increase in internet searches related to either the diseases or cessation.

"In 2013 'Tips' stopped being effective," Ayers said, "but we can improve the campaign to make it even more effective than when it began. Reflecting on the campaign as a whole, he added that visually shocking commercials tended to prompt more internet searches, but that shock becomes less effective over time.

"Our analysis shows we can't keep hammering on the same subject," Ayers said. "For campaigns like 'Tips' to remain effective they need to be generating new content on new themes. If the same themes stopped resonating in 2013, can we really be expecting the current 2015 campaign to be working?"

Better campaigns

The good news? By analyzing internet search data in real time, anti-smoking advocates could tailor future campaigns to better respond to the public's reaction.

Ayers noted that the campaign's early successes indicate that the concept has potential, but that the CDC would be better served by harnessing big data sources like internet search behavior to stay on top of the campaign's effectiveness. They could then modify the campaign's messages to take advantage of commercials that appear to be working and stop spending resources on ineffective ones.