Background and challenges to implementation:
The evidence for mass media to raise awareness about the harm of smoking and benefits of quitting remains strong. However, pressures on budgets means TV is not always seen as an affordable option, while the emergence of digital media presents an attractive option to funders as a way of saving costs while maintaining responses. Digital and social media has provided us with learnings about the role of “push” (broadcast) and “pull” (direct responses) within campaigns and the balance of positive and negative messages.

Intervention or response:
Fresh (a subnational tobacco control programme) has ran three hard hitting health campaigns on regional TV while using digital media including advertising and boosted Facebook posts as a supporting channel to prompt discussion and to generate responses to a campaign website. Content online has included real people's stories, including emotionally engaging videos of former smokers with COPD or cancer.

Results and lessons learnt:
Our experience has found that as well as generating thousands of responses:
Social media is a new platform to share hard hitting real people's stories which convey the shock, emotion and life-limiting reality of smoking. The public are keen to engage on a discourse around how smoking has devastated families. People tag friends, share posts and tell their own stories about loved ones affected. This challenges assumptions by some that social media needs to be constantly positive to compete with commercial brands for attention and doubtless provides opportunities on other tobacco control topics.

Conclusions and key recommendations:
Digital media plays an important role in driving direct responses to campaign websites that offer support, and in generating discussion. However, it is still TV that drives the conversation and response rates online; digital display performs best if it features campaign visuals, while TV advertising is often discussed in Facebook responses. We continue to make the case to fund TV advertising.