US businesses engaged in direct-to-consumer marketing of perinatal stem cell interventions following the Food and Drug Administration's enforcement discretion era

BACKGROUND AIMS

The goal of this study was to analyze online marketing representations made by 300 US businesses selling allogeneic perinatal stem cell products. The study was conducted after a period of enforcement discretion by the US Food and Drug Administration (FDA).

METHODS

Data mining and content analysis were used to identify, analyze and categorize marketing claims made on the websites of 300 businesses selling perinatal stem cell interventions.

RESULTS

The study identified types of perinatal interventions companies advertised, geographic locations of clinics selling such products, types of companies operating in this space, diseases and injuries such businesses claim to treat, prices companies charge for such interventions, brand names of advertised perinatal cell products and identities of suppliers.

CONCLUSIONS

A substantial number of US businesses market unapproved perinatal stem cell products for various indications. This widespread commercial activity occurred following the conclusion of a period of enforcement discretion by the FDA and suggests the need for more robust and comprehensive regulatory responses to businesses selling unapproved perinatal stem cell products.

Effect of Truvada lawsuit advertising on preexposure prophylaxis attitudes and decisions among sexual and gender minority youth and young adults at risk for HIV

OBJECTIVE

In 2019, US advocates reported misleading language regarding the safety of TDF/FTC (Truvada) used by lawsuit advertisements against Gilead Sciences. We sought to ascertain the reach and effects of the advertisements on preexposure prophylaxis (PrEP) opinions and decisions in a cohort of youth and young adults at-risk for HIV.

DESIGN

An online survey was administered to participants enrolled in Keeping it LITE, a prospective US cohort study of ethnically diverse, sexually active, cisgender and transgender persons ages 13-37.

METHODS

Quantitative data were analyzed using descriptive and inferential analysis in SAS, and qualitative data via thematic analysis.

RESULTS

Survey response rate was 51.3% (n = 1485). Mean age at baseline was 24. Previous PrEP use was reported by 43% of respondents and 32.7% reported PrEP use in the past 6 months. Almost half (48.7%) were aware of the lawsuit. Most of these participants (81.3%) reported the advertisements did not impact their PrEP use, but 13.2% decided to not to begin a Truvada-based PrEP regimen and 5.5% decided to stop taking Truvada due to the advertisements claims. Predictors of changing PrEP behavior were lower education and no previous PrEP use. The qualitative analysis revealed the advertisements increased skepticism about safety and benefit of Truvada PrEP and led to greater distrust of the pharmaceutical industry.

CONCLUSION

The advertisements reached a large, diverse US audience. Disturbingly, 18.7% of PrEP candidates who were aware of the lawsuit attributed not initiating or cessation of a Truvada-based PrEP regimen to exposure to the Truvada lawsuit advertisements.

Designing Effective Digital Advertisements to Prevent Online Consumption of Child Sexual Exploitation Material

The necessity of developing effective and innovative primary prevention strategies is a pressing objective in stemming the harm caused by the production and consumption of child sexual exploitation material (CSEM). Digital media interventions - including search engine advertisements - hold promise as prevention tools to deflect potential users away from CSEM and redirect them to therapeutic services. This study aimed to establish an evidence base for effective advertising in this context by creating mock-up helpline advertisements and testing them in focus groups and interviews with staff and clients of New Zealand's major treatment service providers for harmful sexual behavior. Prior to testing these advertisements in situ (on online platforms), this paper reports on a foundational creative and qualitative investigation of effective advertisements - what imagery, text, and design features are most likely to succeed in diverting people away from seeking CSEM and encouraging them to reach out to a helpline? The findings of this study offer deeper understanding of the mindset, emotions, and barriers to reaching out that are experienced by onset CSEM users, as well as suitability of certain imagery and text for advertising in this context, and thereby contribute to strengthening primary prevention efforts in combatting CSEM consumption.

Comparing Web-Based Platforms for Promoting HIV Self-Testing and Pre-Exposure Prophylaxis Uptake in High-Risk Men Who Have Sex With Men: Protocol for a Longitudinal Cohort Study

BACKGROUND

The majority of those living with HIV in the United States are men who have sex with men (MSM), and young, minority MSM account for more new HIV infections than any other group. HIV transmission can be reduced through detection and early treatment initiation or by starting pre-exposure prophylaxis (PrEP), but rates of testing are lower than recommended among MSM, and PrEP uptake has been slow. Although promoting HIV testing and PrEP uptake by placing advertisements on web-based platforms - such as social media websites and dating apps - is a promising approach for promoting HIV testing and PrEP, the relative effectiveness of HIV prevention advertising on common web-based platforms is underexamined.

OBJECTIVE

This study aims to evaluate the relative effectiveness of advertisements placed on 3 types of web-based platforms (social media websites, dating apps, and informational websites) for promoting HIV self-testing and PrEP uptake.

METHODS

Advertisements will be placed on social media websites (Facebook, Instagram, and Twitter), dating apps (Grindr, Jack'd, and Hornet), and informational search websites (Google, Yahoo, and Bing) to recruit approximately 400 young (18-30 years old), minority (Black or Latino) MSM at elevated risk of HIV exposure. Recruitment will occur in 3 waves, with each wave running advertisements on 1 website from each type of platform. The number of participants per platform is not prespecified, and recruitment in each wave will occur until approximately 133 HIV self-tests are ordered. Participants will complete a baseline survey assessing risk behavior, substance use, psychological readiness to test, and attitudes and then receive an electronic code to order a free home-based HIV self-test kit. Two follow-ups are planned to assess HIV self-test results and PrEP uptake.

RESULTS

Recruitment was completed in July 2020.

CONCLUSIONS

Findings may improve our understanding of how the platform users' receptivity to test for HIV differs across web-based platforms and thus may assist in facilitating web-based HIV prevention campaigns.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04155502; https://clinicaltrials.gov/ct2/show/NCT04155502.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/20417.

A New Information-Theoretic Method for Advertisement Conversion Rate Prediction for Large-Scale Sparse Data Based on Deep Learning

With the development of online advertising technology, the accurate targeted advertising based on user preferences is obviously more suitable both for the market and users. The amount of conversion can be properly increased by predicting the user’s purchasing intention based on the advertising Conversion Rate (CVR). According to the high-dimensional and sparse characteristics of the historical behavior sequences, this paper proposes a LSLM_LSTM model, which is for the advertising CVR prediction based on large-scale sparse data. This model aims at minimizing the loss, utilizing the Adaptive Moment Estimation (Adam) optimization algorithm to mine the nonlinear patterns hidden in the data automatically. Through the experimental comparison with a variety of typical CVR prediction models, it is found that the proposed LSLM_LSTM model can utilize the time series characteristics of user behavior sequences more effectively, as well as mine the potential relationship hidden in the features, which brings higher accuracy and trains faster compared to those with consideration of only low or high order features.

Inducing Behavioral Change in Seekers of Pro-Anorexia Content Using Internet Advertisements: Randomized Controlled Trial

BACKGROUND

The influence of pro-anorexia (pro-ana) websites is debated, with studies indicating both negative and positive effects, as well as significant variation in the effects of different websites for those suffering from eating disorders (EDs) and the general population. Online advertising, known to induce behavioral change both online and in the physical world, has not been used so far to modify the search behavior of people seeking pro-ana content.

OBJECTIVE

The objective of this randomized controlled trial (RCT) was to examine if online advertisements (ads) can change online search behaviors of users who are looking for online pro-ana content.

METHODS

Using the Bing Ads system, we conducted an RCT to randomly expose the searchers for pro-ana content to 10 different ads referring people to one of the three websites: the National Eating Disorders Association, the National Institutes of Mental Health, and MyProAna. MyProAna is a pro-ana website that was found in a previous study to be associated with less pathological online behaviors than other pro-ana websites. We followed participants exposed and unexposed to the ads to explore their past and future online searches. The ads were shown 25,554 times and clicked on 217 times.

RESULTS

Exposure to the ads was associated with a decrease in searches for pro-ana and self-harm content. Reductions were greatest among those referred to MyProAna (reduction of 34.0% [73/215] and 37.2% [80/215] for pro-ana and self-harm, respectively) compared with users who were referred elsewhere (reduction of 15.47% [410/2650] and 3.21% [85/2650], respectively), and with users who were not shown the ads, who increased their behaviors (increase of 57.12% [6462/11,314] and 4.07% [461/11,314], respectively). In addition, those referred to MyProAna increased their search for treatment, as did control users, who did so to a lesser extent. However, users referred elsewhere decreased their searches for this content.

CONCLUSIONS

We found that referring users interested in ED-related content to specific pro-ana communities might lessen their maladaptive online search behavior. This suggests that those who are preoccupied with EDs can be redirected to less pathological online searches through appropriate pathways.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03439553; https://clinicaltrials.gov/show/NCT03439553 (Archived by WebCite at http://www.webcitation.org/6xNYnxYlw).

Judgments at Gaze Value: Gaze Cuing in Banner Advertisements, Its Effect on Attention Allocation and Product Judgments

Banner advertising is a popular means of promoting products and brands online. Although banner advertisements are often designed to be particularly attention grabbing, they frequently go unnoticed. Applying an eye-tracking procedure, the present research aimed to (a) determine whether presenting human faces (static or animated) in banner advertisements is an adequate tool for capturing consumers' attention and thus overcoming the frequently observed phenomenon of banner blindness, (b) to examine whether the gaze of a featured face possesses the ability to direct consumers' attention toward specific elements (i.e., the product) in an advertisement, and (c) to establish whether the gaze direction of an advertised face influences consumers subsequent evaluation of the advertised product. We recorded participants' eye gaze while they viewed a fictional online shopping page displaying banner advertisements that featured either no human face or a human face that was either static or animated and involved different gaze directions (toward or away from the advertised product). Moreover, we asked participants to subsequently evaluate a set of products, one of which was the product previously featured in the banner advertisement. Results showed that, when advertisements included a human face, participants' attention was more attracted by and they looked longer at animated compared with static banner advertisements. Moreover, when a face gazed toward the product region, participants' likelihood of looking at the advertised product increased regardless of whether the face was animated or not. Most important, gaze direction influenced subsequent product evaluations; that is, consumers indicated a higher intention to buy a product when it was previously presented in a banner advertisement that featured a face that gazed toward the product. The results suggest that while animation in banner advertising constitutes a salient feature that captures consumers' visual attention, gaze cuing can be an effective tool for driving viewers' attention toward specific elements in the advertisement and even shaping consumers' intentions to purchase the advertised product.

Web-Based Antismoking Advertising to Promote Smoking Cessation: A Randomized Controlled Trial

Background

Although hundreds of millions of dollars are spent each year on public health advertising, the advertisement content, design, and placement are usually developed by intuition rather than research.

Objective

The objective of our study was to develop a methodology for testing Web-based advertisements to promote smoking cessation.

Methods

We developed 10 advertisements that varied by their content (those that empower viewers to quit, help viewers to quit, or discuss the effects of smoking). We then conducted a series of Web-based randomized controlled trials that explored the effects of exposing users of Microsoft’s Bing search engine to antismoking advertisements that differed by content, placement, or other characteristics. Finally, we followed users to explore whether they conducted subsequent searches for smoking cessation products or services.

Results

The advertisements were shown 710,106 times and clicked on 1167 times. In general, empowering advertisements had the greatest impact (hazard ratio [HR] 2.6, standard error [SE] 0.09 relative to nonempowering advertisements), but we observed significant variations by gender. For instance, we found that men exposed to smoking cessation advertisements were less likely than women to subsequently conduct smoking cessation searches (HR 0.2, SE 0.07), but that this likelihood increased 3.5 times in men exposed to advertisements containing empowering content. Women were more influenced by advertisements that emphasized the health effects of smoking. We also found that appearing at the top right of the page (HR 2.1, SE 0.07) or at the bottom rather than the top of a list (HR 1.1, SE 0.02) can improve smoking cessation advertisements’ effectiveness in prompting future searches related to smoking cessation.

Conclusions

Advertising should be targeted to different demographic groups in ways that are not always intuitive. Our study provides a method for testing the effectiveness of Web-based antismoking advertisements and demonstrates the importance of advertisements that are tailored according to specific demographics.

A Qualitative and Quantitative Comparative Analysis of Commercial and Independent Online Information for Hip Surgery: A Bias in Online Information Targeting Patients?

BACKGROUND

Direct to consumer (DTC) advertising, targeting the public over the physician, is an increasingly pervasive presence in medical clinics. It is trending toward a format of online interaction rather than that of traditional print and television advertising.

METHODS

We analyze patient-focused Web pages from the top 5 companies supplying prostheses for total hip arthroplasties, comparing them to the top 10 independent medical websites. Quantitative comparison is performed using the Journal of American Medical Association benchmark and DISCERN criteria, and for comparative readability, we use the Flesch-Kincaid grade level, the Flesch reading ease, and the Gunning fog index. Content is analyzed for information on type of surgery and surgical approach.

RESULTS

There is a statistically significant difference between the independent and DTC websites in both the mean DISCERN score (independent 74.6, standard deviation [SD] = 4.77; DTC 32.2, SD = 10.28; P = .0022) and the mean Journal of American Medical Association score (Independent 3.45, SD = 0.49; DTC 1.9, SD = 0.74; P = .004). The difference between the readability scores is not statistically significantly. The commercial content is found to be heavily biased in favor of the direct anterior approach and minimally invasive surgical techniques.

CONCLUSION

We demonstrate that the quality of information on commercial websites is inferior to that of the independent sites. The advocacy of surgical approaches by industry to the patient group is a concern. This study underlines the importance of future regulation of commercial patient education Web pages.

Evaluating and Optimizing Online Advertising: Forget the Click, but There Are Good Proxies

Online systems promise to improve advertisement targeting via the massive and detailed data available. However, there often is too few data on exactly the outcome of interest, such as purchases, for accurate campaign evaluation and optimization (due to low conversion rates, cold start periods, lack of instrumentation of offline purchases, and long purchase cycles). This paper presents a detailed treatment of proxy modeling, which is based on the identification of a suitable alternative (proxy) target variable when data on the true objective is in short supply (or even completely nonexistent). The paper has a two-fold contribution. First, the potential of proxy modeling is demonstrated clearly, based on a massive-scale experiment across 58 real online advertising campaigns. Second, we assess the value of different specific proxies for evaluating and optimizing online display advertising, showing striking results. The results include bad news and good news. The most commonly cited and used proxy is a click on an ad. The bad news is that across a large number of campaigns, clicks are not good proxies for evaluation or for optimization: clickers do not resemble buyers. The good news is that an alternative sort of proxy performs remarkably well: observed visits to the brand's website. Specifically, predictive models built based on brand site visits-which are much more common than purchases-do a remarkably good job of predicting which browsers will make a purchase. The practical bottom line: evaluating and optimizing campaigns using clicks seems wrongheaded; however, there is an easy and attractive alternative-use a well-chosen site-visit proxy instead.

Advert saliency distracts children's visual attention during task-oriented internet use

The general research question of the present study was to assess the impact of visually salient online adverts on children's task-oriented internet use. In order to answer this question, an experimental study was constructed in which 9- and 12-year-old Swedish children were asked to solve a number of tasks while interacting with a mockup website. In each trial, web adverts in several saliency conditions were presented. By both measuring children's task accuracy, as well as the visual processing involved in solving these tasks, this study allows us to infer how two types of visual saliency affect children's attentional behavior, and whether such behavioral effects also impacts their task performance. Analyses show that low-level visual features and task relevance in online adverts have different effects on performance measures and process measures respectively. Whereas task performance is stable with regard to several advert saliency conditions, a marked effect is seen on children's gaze behavior. On the other hand, task performance is shown to be more sensitive to individual differences such as age, gender and level of gaze control. The results provide evidence about cognitive and behavioral distraction effects in children's task-oriented internet use caused by visual saliency in online adverts. The experiment suggests that children to some extent are able to compensate for behavioral effects caused by distracting visual stimuli when solving prospective memory tasks. Suggestions are given for further research into the interdiciplinary area between media research and cognitive science.