Using Google Search Ads to Promote Lethal Means Safety in Military Veterans

Background: Despite increasing use of Google Ads in public health campaigns, few studies have described their use in suicide prevention and/or examined application to lethal means safety (LMS), a priority for suicide prevention efforts in military veterans. Aims: The objective of this study was to evaluate the effectiveness of an LMS campaign for US veterans by analyzing engagement rates across different types of Google Ad search terms included in the campaign. Methods: We conducted a secondary data analysis of Google Ads from July 2022 and May 2023 in Keep It Secure, the Department of Veterans Affairs (VA) first national LMS campaign. Our primary outcome was click-through rate (CTR). Our predictor variable was category of Google search. Categories were identified from the user queries employing a team-based immersion/crystallization process, an inductive, iterative qualitative approach. We then used generalized mixed modeling to compare CTR across search categories. Results: Using Google Ads, the campaign resulted in a total of 1,849,077 impressions and 342,747 clicks to the campaign website, for an overall 18.5% CTR of 59,587 unique searches, and we categorized 47,387 into 10 categories (Firearm Storage, General VA Inquiries, Veteran Resources, Suicide Prevention, Mental Health, Crisis Line, Suicidal Ideation, Safety Class, Firearm Policy, and Homelessness). Campaign engagement varied significantly across categories (p < .001). Searches related to general VA inquiries (30.0% CTR) and veteran resources (23.0% CTR) demonstrated the highest engagement, whereas firearm storage (4.6% CTR) and suicidal ideation (1.3% CTR) were the lowest. Limitations: Since this study was a secondary analysis, causal inferences cannot be made. Conclusions: Google Ads resulted in high overall engagement in an LMS educational campaign. For LMS outreach to veterans who are not in acute crisis, a "side-door" approach targeting people searching for general VA information and veteran benefits and resources may be more effective than using firearm or suicide-related keywords.