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U.S. Department of Health and Human Services

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The Real Cost: Research and Evaluation



“The Real Cost” campaign is grounded in scientific research and uses evidence-based practices proven to reduce youth tobacco use.

FDA’s youth tobacco prevention campaign, “The Real Cost,” is based on a robust body of evidence that supports the use of mass media campaigns to prevent and reduce youth tobacco use, including evidence from state and national youth tobacco prevention campaigns as well as youth-focused health campaigns on topics other than tobacco. Campaign efforts are informed by recognized best practices for mass media campaigns and lessons learned from previous efforts to educate the public about tobacco.


Formative Research

FDA conducted extensive research to develop effective strategies and messaging to reach our at-risk youth target audience, including youth aged 12-17 who are either open to smoking or already experimenting with cigarettes.  These strategies included:

  • An extensive literature review and target audience analysis to identify and develop promising messages;
  • Consultation with experts in tobacco public health education, marketing,  and campaign development;
  • Focus groups with members of the target audience to assess their perceptions of draft advertising concepts; and 
  • Testing of near-final TV advertisements with members of the target audience to measure perceived effectiveness, levels of engagement, and message comprehension.
    • Research results indicated the near-final TV advertisements provided understandable and engaging messages about the harms of tobacco use without potential unintended adverse or counterproductive message effects.
    • All ads had promising results providing confidence they will lead to increased negative feelings about tobacco use, increased intention to not initiate, and increased intention to quit using tobacco products.

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The Real Cost: Research and Evaluation
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Evaluation results will be used to assess changes in key tobacco-related knowledge, attitudes, beliefs and behaviors over time to measure the effectiveness of the campaign. Ultimately, results will be used to determine if exposure to the campaign is associated with a decrease in cigarette smoking among youth aged 12-17.

Campaign Evaluation

FDA’s campaign goal is to reduce the number of youth aged 12-17 who smoke.

To assess our success achieving this goal, “The Real Cost” campaign will be evaluated through a multi-year, in person, nationwide study. The study design is longitudinal, meaning the evaluators will attempt to follow the same youth over time to measure changes in tobacco-related attitudes and behaviors before and after the campaign launch.