Tobacco Products

The Real Cost Campaign

The Real Cost

FDA’s first smoking prevention campaign, “The Real Cost,” seeks to educate the more than 10 million1 at-risk teens in the United States about the harmful effects of cigarette smoking. Launched in 2014, the campaign strives to prevent youth who are open to smoking from trying it and to reduce the number of youth who move from experimenting with cigarettes to regular use by messaging on loss of control due to addiction, health consequences, and dangerous chemicals found in cigarettes.

In its first two years, research shows the campaign has done just that: “The Real Cost” prevented an estimated 350,000 teens ages 11 to 18 from initiating smoking between 2014 and 2016, half of whom might have gone on to become established adult smokers. Preventing teens from initiating smoking, doesn’t just impact their personal health, but also the health of their families and smoking-related costs borne to society. Ultimately, by preventing these kids from becoming established smokers, the campaign has saved them, their families, and the country more than $31 billion by reducing smoking-related costsdisclaimer icon like early loss of life, costly medical care, lost wages, lower productivity, and increased disability.

The campaign obtained these impressive results through a carefully executed paid media strategy based on evidence-based best practices for tobacco prevention campaigns, and by ensuring its messaging was designed to reach and motivate an at-risk teen audience. For example, FDA conducts research with at-risk teens across the country to develop campaign advertising that resonates. Near-final TV ads are tested with thousands of target audience members for perceived effectiveness and message comprehension prior to being placed in market.

FDA also hired an independent firm, RTI International, to conduct a multi-year evaluation to measure indicators of success throughout the first two years of the campaign, including advertising awareness and changes in the target audience’s tobacco-related beliefs, intentions and behaviors. Results from this research are impressive: More than 90 percent of the target audience was aware of the first wave of ads disclaimer iconless than a year after launch, and the campaign changed teens’ perceptions and beliefs about tobacco, ultimately resulting in a 30 percent decrease in youth smoking initiation from 2014 to 2016.

These results not only reinforce the importance of our public education efforts in reducing the public health and financial burden of tobacco use, but also highlight the importance of investing in tobacco-related education campaigns. Investment in tobacco prevention can have huge returns: The campaign had a cost savings of $128 for every dollar of the nearly $250 million invested in the first two years of the campaign.

The campaign continues to air nationally across TV, radio, print, web, and social media.

Expanding "The Real Cost"

The campaign’s impressive success and overall cost effectiveness in achieving its goals has led to new evolutions in messaging that reach beyond cigarettes. In 2016, the campaign expanded to include messaging on smokeless tobacco use, and new advertising about the harms of youth e-cigarette use or “vaping” launched in 2017. Both of these efforts are being evaluated independently to measure their additional positive impacts on public health.

Smokeless Tobacco Prevention

Smoking can cause mouth cancer, tooth loss, brown teeth, jaw pain, white patches, gum disease.

“The Real Cost” expanded its campaign to include new advertising to educate rural, white male teenagers about the negative health consequences associated with smokeless tobacco use. Each day in the United States, more than 750 male youth under 18 years of age use smokeless tobacco for the first time.2

Messages on the dangers of smokeless tobacco use – including nicotine addiction, gum disease, tooth loss, and multiple kinds of cancer – are being highlighted through the placement of advertisements in 35 U.S. markets specifically selected to reach the campaign’s target audience.

The central message in “The Real Cost” Smokeless Tobacco Prevention Campaign is “smokeless doesn’t mean harmless,” which aims to motivate these teens to reconsider what they think they know about smokeless tobacco use.

Vaping Prevention

In support of FDA’s goal to pursue a strategic public health education effort aimed at preventing youth use of e-cigarettes and other electronic nicotine delivery systems, “The Real Cost” campaign expanded in 2017 to include teen-focused messages about the dangers of nicotine in e-cigarettes for the developing brain with digital images, online video, and online radio ads, with the goal of developing additional campaign messages about these topics in Fall 2018.


Effie Awards Icon"The Real Cost" has earned two Effie awards to date, including a 2015 gold Effie in the Disease Awareness and Education category and a 2017 bronze Effie in the Youth Marketing category. The Effies ‎are the advertising industry's most prestigious award, recognizing marketing ideas that work and have demonstrated effectiveness. “The Real Cost” campaign was recognized for its insightful communications strategy, outstanding creative, and success in market.

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

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

1. U.S. Census Bureau. Monthly Population Estimates by Age, Sex, Race, and Hispanic Origin for the United States: April 1, 2010 to July 1, 2015. Washington, D.C.: U.S. Census Bureau, Population Division; 2016. Centers for Disease Control and Prevention (CDC), Food and Drug Administration (FDA). Total At-risk Experimenters and Susceptible Non-trier Estimates: 2015 NYTS Dataset and Codebook. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. Updated October 1, 2015. Accessed February 24, 2017
2. Substance Abuse and Mental Health Services Administration (SAMHSA). 2016 National Survey on Drug Use and Health: Detailed Tables. Rockville, MD: U.S. Department of Health and Human Services, SAMHSA, Center for Behavioral Health Statistics and Quality; 2017. Accessed October 12, 2017.


Page Last Updated: 08/16/2018
Note: If you need help accessing information in different file formats, see Instructions for Downloading Viewers and Players.
Language Assistance Available: Español | 繁體中文 | Tiếng Việt | 한국어 | Tagalog | Русский | العربية | Kreyòl Ayisyen | Français | Polski | Português | Italiano | Deutsch | 日本語 | فارسی | English