Studies Show FDA Educational Efforts Help Prevent Youth From Starting E-Cigarette Use, Illegal E-Cigarette Sales

June 24, 2026

Today, the U.S. Food and Drug Administration (FDA) announced the publication of a special issue of the American Journal of Preventive Medicine (AJPM) with research demonstrating that “The Real Cost” campaigns have achieved significant, measurable public health results—including preventing more than $42 million in sales of illegal e-cigarette products that would have been used by youth.

A peer-reviewed study in the special issue found that “The Real Cost” youth e-cigarette prevention campaign prevented an estimated 444,252 American youth from starting to use e-cigarettes between 2023 and 2024. Based on that finding, FDA estimates the campaign also blocked more than $42 million in sales of unauthorized e-cigarettes that would have been used by youth during that same period.

“Given the careful research that went into the campaign’s development, it’s no surprise that ‘The Real Cost’ has been so effective at its core goal of preventing youth from starting to use tobacco products,” said Bret Koplow, Ph.D., J.D., acting director of FDA’s Center for Tobacco Products (CTP). “I’m heartened to see the scientific investment in developing these efforts transformed into real-world success in keeping kids from picking up a cigarette or e-cigarette.”

The special issue, titled “A Decade of Innovations and Insights from FDA's ‘The Real Cost’ Campaigns and Youth Prevention Efforts,” includes 12 published peer-reviewed papers authored by FDA scientists and external researchers and a new commentary by Dr. Koplow. The papers share the science, strategy, and measurable public health impact of the award-winning “The Real Cost” youth tobacco prevention campaigns.

Since launching in 2014 to help prevent youth cigarette use, and expanding in 2018 to address rising e-cigarette use among youth, “The Real Cost” has continuously evolved alongside changes in teen tobacco use patterns and media consumption, including a shift from broadcast television to digital and social media platforms.

An audience segmentation analysis published in the issue found that 75 percent of surveyed youth reported seeing at least one e-cigarette prevention ad during the study period. Awareness was notably high among groups at elevated risk of tobacco use, suggesting the campaign's media strategy successfully reaches the teens who need it most to avoid tobacco use and nicotine addiction.

Another paper demonstrates how the “The Real Cost” is connecting teens who are already affected by nicotine addiction to cessation help. From 2021 to 2022, campaign links drove over 253,000 visits to the National Cancer Institute's SmokefreeTeen cessation website. Visitors arriving to the website via the campaign were far more likely to complete a Vaping Reality Check quiz and build personalized e-cigarette quit plans than other visitors, with over 11,000 quit plan completions driven by “The Real Cost” alone.

Additionally, a meta-analysis of a decade's worth of ad testing found that FDA's tobacco prevention ads consistently and significantly shifted youth attitudes and beliefs about tobacco use. E-cigarette ads showed the largest effects in youth belief shifts. Researchers conclude this likely occurred because when the campaign launched, many teens were not yet aware of the harms of e-cigarette use.

Since 90 percent of adults who smoke started before age 18, preventing youth initiation is the most effective long-term strategy for reducing overall smoking rates and adverse health outcomes. While preventing youth tobacco use remains a top priority of the public education program, opportunities also exist to improve the health of adults who smoke and who struggle to quit. As noted by Dr. Koplow in his commentary, the creativity and scientific rigor of the campaign have proved that evidence-based public education “can fundamentally change how people think about tobacco products.”

FDA is exploring expanding these efforts into the new and important territory of educating those who can influence adults who smoke—whether by encouraging cessation or by raising awareness of ways to reduce the harms of tobacco use. CTP is committed to accurate, responsible tobacco harm-reduction communication that works to improve the health of adults who smoke without compromising youth prevention gains. The research presented in this special issue provides a strong scientific foundation for that expanded mission, demonstrating that evidence-based education can achieve measurable impact.

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