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U.S. Department of Health and Human Services

About FDA

The Real Cost: Overview

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What It Is

FDA’s first youth tobacco prevention campaign, “The Real Cost,” targets at-risk youth aged 12-17 who are open to smoking or already experimenting with cigarettes.  About 10 million youth in the United States currently fall into this category.1  The objective of the campaign is to educate these at-risk youth about the harmful effects of tobacco use with the goal of reducing initiation rates among youth who are open to smoking and reducing the number of youth already experimenting with cigarettes that progress to regular use.

“The Real Cost” campaign is launching nationally on February 11, 2014 across multiple media platforms including TV, radio, print, and online.  The campaign will continue to air in more than 200 markets across the country for at least one year.


Why It’s Important

Tobacco use is the leading preventable cause of disease, disability, and death in the United States, responsible for more than 480,000 deaths each year.2  But the consequences of tobacco use are not limited to adults. In fact, tobacco use is almost always initiated and established during adolescence.3  Every day in the United States, more than 3,200 youth under age 18 smoke their first cigarette —and more than 700 youth under age 18 become daily smokers—highlighting a critical need for stronger, targeted youth tobacco prevention efforts.4 

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The Real Cost: Campaign Overview
A thumbnail of the The Real Cost Overview PDF

Through “The Real Cost” campaign, FDA seeks to reduce the number of youth who experiment with tobacco use to ultimately reduce the number of future tobacco users and thereby diminish the harmful consequences tobacco use has on the health of our country.


Who It Targets

“The Real Cost” campaign targets at-risk youth aged 12-17, including youth who have never smoked a cigarette but are open to trying it and youth who have already smoked between 1 puff and 99
Living a chaotic life, Pete (aged 12–17) struggles with his social and economic situation both at home (living in suburban or rural areas with unmarried parents, who use tobacco at home) and at school (poor school environment and low academic achievement). His stress about his personal situation, coupled with poor coping skills and a pessimistic outlook on life, make Pete a troubled kid. Pete finds it hard to regulate his mood and is a sensation-seeking risk taker. Pete smokes occasionally (<100 cigarettes, lifetime) as do his friends. cigarettes in their lifetime and are at risk of becoming regular users. The target’s demographic, psychographic and key insights are embodied through the campaign’s at-risk persona, Pete (see box). Though the persona has been developed as a male, the target audience is evenly divided between male and female.


What It Will Do

“The Real Cost” campaign was developed using evidence-based best practices and multiple phases of research to identify promising messages. The campaign is specifically designed to affect at-risk youth who experiment with cigarettes but do not consider themselves smokers, do not believe they will become addicted smokers, and are not particularly interested in the topic of tobacco. Campaign messages are intended to make the target audience acutely aware of the risk from every cigarette by highlighting consequences that youth are concerned about, such as loss of control due to addiction and health effects like tooth loss and skin damage. Additionally, the campaign will include messages that specifically address the health consequences of menthol cigarettes as youth are more likely to report smoking menthol cigarettes.5

“The Real Cost” messages include:

  • Health Consequences:  A focus on consequences that are aligned with what concerns teens, e.g., cosmetic consequences like tooth loss and skin damage. The “cost” is the main theme, getting teens to think about the range of costs associated with smoking, beyond money.
  • Loss of Control Leading to Addiction:  A focus on how cigarettes can take away the control teens are just beginning to have in their lives. This theme portrays nicotine addiction as an unwanted presence in a young person’s life.


The campaign identity, “The Real Cost,” is a personal call to action to teens, encouraging them to be in the know and understand the real costs and risks of tobacco use, beyond just the financial costs. “The Real Cost” is designed to be candid, empowering and respectful. It speaks directly to teens in a straightforward, authentic and peer-to-peer manner.


How It Will Be Implemented

Advertising will focus on a multi-channel approach that surrounds teens with “The Real Cost” messages. The campaign includes traditional broadcast media such as television and radio ads, as well as advertising through a mix of other multimedia channels including the web, cinema, print publications and out-of-home advertising (e.g., bus shelters). The campaign seeks to maximize message impact by utilizing each channel’s strengths.

A critical factor in reducing youth tobacco use is to produce and maintain effective levels of campaign awareness within the target population. The Centers for Disease Control and Prevention (CDC) indicates that new tobacco prevention campaigns that reach 75% to 85% of the target audience within one year can expect to produce attitude and behavior change within 2 years if the time in market is adequately sustained.6 

FDA is positioned to sustain “The Real Cost” campaign at the reach, frequency and time in-market recommend by CDC to achieve behavior change and improve public health. The campaign will reach 90% of the target audience 15 times a quarter for a total reach and frequency of more than 9 million youth 60 times a year. 


How It Will Be Evaluated

The campaign’s effects will be measured through a multi-year outcome evaluation to assess its effectiveness and identify areas for further refinement over time. Baseline collection for the evaluation began in November 2013 and consists of in-person, nationally representative data collection in 75 media markets across the country. The study design is longitudinal, meaning the study will attempt to follow the same youth over a two year period. Evaluation results will be used to assess changes in key tobacco-related knowledge, attitudes, beliefs and behaviors over several years to measure the impact and 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.


How You Can Get Involved

Social Media Channels for Stakeholders www.fda.gov/therealcostwww.facebook.com/FDAwww.youtube.com/USFoodandDrugAdmin@FDATobaccoWe recommend that adults and stakeholder audiences use FDA's stakeholder resource page  for campaign information and resources such as posters, postcards and campaign flyers that can be shared through appropriate channels. For example, healthcare practitioners can make these materials available in waiting rooms and clinics frequented by teens. All materials are available for free download and many can be ordered through the campaign's clearinghouse.

FDA's goal is to keep “The Real Cost” campaign authentic through a peer-to-peer approach. Thus, “The Real Cost” campaign website (www.therealcost.gov) and social channels are intended for teens. Stakeholders should use FDA's social media channels to engage with us around the campaign—check out our list of suggested tweets. Organizations that work directly with youth can help extend the campaign by encouraging teens to share campaign messages with their peers. Stakeholders who do not work directly with youth can share our resources with youth-focused organizations. For more information, please contact CTPcommunications@fda.hhs.gov