Exploring Attention to Digital Ads: How Audiences Attend to and Respond to “The Real Cost” Youth E-Cigarette Prevention Campaign Ads

INTRODUCTION: This study examined visual attention to and recognition of "The Real Cost" Youth e-cigarette Prevention Campaign ads in simulated, naturalistic digital media environments. METHODS: In 2024, a convenience sample of 2,040 individuals aged 18-24 years in the U.S. was exposed to a campaign ad in 1 of 4 simulated digital media environments (YouTube skippable and nonskippable, Instagram Reels and Stories). Participants' cameras captured facial coding measurements (e.g., attention), and a survey captured brand and ad recognition. Analyses included descriptive statistics and statistical testing (z-scores for categorical outcomes, independent t-tests for continuous outcomes) to compare outcomes for ad placements. RESULTS: Nonskippable YouTube ads captured the most attention, with participants focusing for 8.6-9.7 seconds, and 46%-54% paying attention to at least half the ad and the last 2 seconds. Instagram Stories held attention for 5-7 seconds; 25%-32% of viewers watched half the ad and the last 2 seconds. Instagram Reels and YouTube skippable ads received the least attention. Brand recognition was similar across YouTube nonskippable ads (37%-49%), Instagram Stories (45%-46%), and Instagram Reels (39%-41%), whereas fewer YouTube skippable viewers (23%-32%) recognized the brand. Ad recognition was highest for YouTube nonskippable ads (52%-73%), followed by Instagram Reels (36%-61%), Instagram Stories (32%-41%), and YouTube skippable ads (22%-48%). CONCLUSIONS: Results show that some media platforms and placements can capture more of a viewer's attention than others. Results show that attention, brand awareness, and ad awareness can increase on several digital media platforms and ad placements.