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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.  More than 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 launched 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 two years.


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
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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 fewer than 100
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 Does

“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, dangerous chemicals, and health effects like tooth loss and skin damage.

“The Real Cost” messages include:

  • Loss of Control Due to Addiction:  Reframes addiction to cigarettes as a loss of control to disrupt the beliefs of independence-seeking youth who currently think they will not get addicted or feel they can quit at any time.
  • Dangerous Chemicals: Depicts the dangers of the toxic mix of chemicals in cigarette smoke to motivate youth to find out more about what’s in each cigarette and reconsider the harms of smoking. 
  • Health Consequences:  Dramatizes the negative health consequences of smoking in a meaningful way to demonstrate that every cigarette comes with a “cost” that is more than just financial.


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 Is Being Implemented

Advertising focuses 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.5 

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.


How It Will Be Evaluated

FDA is conducting a multi-year outcome evaluation to assess its effectiveness and identify areas for further refinement. The study design is longitudinal, meaning the study will attempt to follow the same youth over time. Evaluation results will be used to assess changes in key tobacco-related knowledge, attitudes, beliefs and behaviors among the target audience 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 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