Tobacco Products

The Real Cost Campaign

Nearly 350,000 Kids Prevented from Smoking

Tobacco Use is a Public Health Problem

Every day in the U.S., nearly 2,500 youth under age 18 smoke their first cigarette, and more than 1,000 male youth use smokeless tobacco for the first time. In fact, tobacco use is almost always started and established during adolescence. After decades of steadily declining rates, youth tobacco use has largely plateaued since 2011. Youth who use tobacco today do so despite the efforts that led so many of their peers to remain tobacco-free in the past, making them an even harder group to reach and highlighting a critical need for stronger, more targeted youth tobacco prevention efforts.

“The Real Cost” CampaignFDA's award-winning youth tobacco prevention campaign, "The Real Cost," seeks to educate at-risk teens about the harmful effects of tobacco use. The goal is to prevent youth who are open to tobacco from trying it and to reduce the number of youth who move from experimenting with tobacco to regular use.

Launch of “The Real Cost” Campaign

"The Real Cost" campaign launched nationally in February 2014 across multiple media platforms including TV, radio, print, web, social media, and out-of-home sites, like billboards. Initial campaign advertising focused on reaching the nearly 10 million youth ages 12-17 in the United States who are either open to trying smoking or are already experimenting with cigarettes.

2016: Expansion to Smokeless Tobacco Use in Rural Male Youth

In April 2016, “The Real Cost” expanded its campaign brand umbrella to include new advertising targeting rural male youth ages 12-17 who are at risk of smokeless tobacco use in 35 targeted local markets around the U.S. The selected rural markets reflect areas with higher concentrations of the target audience.

2017: Expansion to Focus on the Prevention of Youth E-Cigarette Use

In August 2017, FDA announced it would pursue a strategic, new public health education campaign aimed at discouraging the use of e-cigarettes and other electronic nicotine delivery systems (ENDS) by kids. The agency plans to expand its “The Real Cost” public education campaign to include messaging to teens about the dangers of using these products this fall while developing a full-scale campaign to launch in 2018.

Campaign Development

FDA conducts research with at-risk youth across the country to develop campaign advertising that resonates with teens. Near-final TV ads are tested with thousands of target audience members for perceived effectiveness, message comprehension, and potential unintended consequences prior to being placed in market. Since campaign launch, “The Real Cost” has refreshed its creative regularly to keep youth engaged.

View more “The Real Cost” ads
on our YouTube Channel.

Achieving Behavior Change

FDA hired an independent research firm to assess the impact of “The Real Cost” on tobacco-related attitudes, beliefs and behaviors among youth who are open to smoking or already experimenting with cigarettes, and the results are impressive. Results disclaimer iconfrom the first study indicate that exposure to “The Real Cost” from 2014-2016 was associated with a 30% decrease in the risk for smoking initiation, preventing an estimated 350,000 U.S. youth ages 11-18 from smoking. These results demonstrate the effectiveness of a national campaign that focused on the harmful effects of smoking and delivered salient messages that resonated with youth. A separate outcome evaluation study specific to campaign messaging around smokeless tobacco use is underway.


The results from the first evaluation study are published in CDC’s Morbidity and Mortality Weekly Report (MMWR).

The 2015 findings on the target audience’s awareness of “The Real Cost” campaign are published in PLOS ONE.

Evidence of youth receptivity to the ads during message pretesting was published in the Journal of Health Communication.


Shorty Awards logo“The Real Cost” earned a 2016 Shorty Award for its creative work on Tumblr. Shortys are prestigious, highly-coveted awards for the best work in social media.

Gold Effie Award"The Real Cost" also earned a gold Effie in the Disease Awareness and Education category at the 2015 North American Effie Awards. The campaign was recognized for its insightful communications strategy, outstanding creative, and success in market.

For “The Real Cost” resources, such as fact sheets and sample social media content, visit our Campaign Resources page.


1. Duke J, Alexander T, Zhao X, et al. Youth’s awareness of and reactions to The Real Cost national tobacco public education campaign. PLoS ONE. 2015;10(12):e0144827.
2. Farrelly MC, Duke JC, Nonnemaker J, et al. Association Between The Real Cost Media Campaign and Smoking Initiation Among Youths — United States, 2014–2016. Morbidity and Mortality Weekly Report (MMWR) 2017;66:47–50. DOI:
3. Substance Abuse and Mental Health Services Administration (SAMHSA). Results from the 2014 National Survey on Drug Use and Health: Detailed Tables. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality; 2015.
4. U.S. Department of Health and Human Services (USDHHS). The Health Consequences of Smoking - 50 Years of Progress. A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2014.
5. Based on 2012 data from NYTS on openness to smoking among youth and 2012 youth population estimates from the U.S. Census Bureau.
6. U.S. Department of Health and Human Services (USDHHS). The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2014.


Page Last Updated: 08/08/2017
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