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The Real Cost Campaign

The Real Cost Campaign

Given the devastating consequences of cigarette addiction, FDA launched its first tobacco prevention campaign, “The Real Cost” in 2014, to educate at-risk teens on the harmful effects of cigarette smoking. In 2018, the campaign expanded to educate teens on the dangers of e-cigarette use and had previously expanded to educate rural boys on the harms of smokeless tobacco in 2016.

“The Real Cost” Youth E-Cigarette Prevention Campaign

Girl vaping in school bathroom mirror

The e-cigarette prevention campaign delivers ads focused on de-bunking myths, and includes images such as this one, from a digital ad entitled, “An epidemic is spreading.”

Work in public health? Order or download new FDA resources to educate youth about e-cigarettes.

Educator working with high school students? Check out materials FDA and Scholastic developed just for you.

A nicotine-free vape is not a worry-free vape.

E-cigarettes surpassed combustible cigarettes as the most commonly used tobacco product among U.S. middle and high school students in 2014.1 In 2018, more than 3.6 million middle and high school students reported they currently use e-cigarettes,2 with many parents, teachers, and school administrators raising alarm about pervasive vaping in schools. Additional research shows that about 80 percent of youth do not see great risk of harm from regular use of e-cigarettes,3 particularly alarming considering that harm perceptions can influence tobacco use behaviors.

To address this “cost-free” mentality, FDA expanded its award-winning “The Real Cost” campaign to educate the nearly 10.7 million youth aged 12-17 who have ever used e-cigarettes or are open to trying them about the potential risks of e-cigarette use.4 Campaign messages focus on educating youth that using e-cigarettes, just like cigarettes, puts them at risk for addiction and other health consequences.

Advertising and other prevention materials are delivered where teens spend most of their time—online and in school—including:

  • Online video ads
  • Additional content on “The Real Cost” campaign’s youth-targeted website
  • Digital and social media content
  • Materials for use in high schools nationwide (e.g., posters for school bathrooms)


“The Real Cost” Smokeless Tobacco Prevention Campaign

Each day in the United States, more than 950 male youth under 18 years of age use smokeless tobacco for the first time.4 Many of these boys are not aware of the negative health consequences of using smokeless tobacco products, or “dipping.” “The Real Cost” smokeless tobacco prevention campaign seeks to educate rural, male teenagers about risks of dipping – including loss of control, gum disease, tooth loss, and multiple kinds of cancer.

boy in front of a computer

The campaign’s central message is “smokeless doesn’t mean harmless,” which aims to motivate teens to reconsider what they think they know about smokeless tobacco use. The campaign will have a national digital presence and out-of-home advertisements will appear in select markets across 20 states specifically selected to reach the campaign’s at-risk target audience.

“The Real Cost” Smoking Prevention Campaign: A Cost-Effective Approach

CTP - Real Cost - Fall Spotlight on Science

FDA’s first smoking prevention campaign, “The Real Cost,” seeks to educate the more than 10 million5 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 costs 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. 

For each teen prevented from becoming an established smoker there will be $181,000 in cost savings.
*Download the full cost-effectiveness infographic

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 less 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.

Awards and Recognition

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. Centers for Disease Control and Prevention (CDC). Tobacco product use among middle and high school students – United States, 2011-2015. Morbidity and Mortality Weekly Report. 2016; 65(14):361-367.
2. Cullen KA, Ambrose BK, Gentzke AS, Apelberg BJ, Jamal A, King BA. Notes from the Field: Use of Electronic Cigarettes and Any Tobacco Product Among Middle and High School Students — United States, 2011–2018. MMWR Morb Mortal Wkly Rep 2018;67:1276–1277. (Original Data Source: NYTS 2018)
3. Johnston, L. D., Miech, R. A., O’Malley, P. M., Bachman, J. G., Schulenberg, J. E., & Patrick, M. E. (2018). Monitoring the Future national survey results on drug use: 1975-2017: Overview, key findings on adolescent drug use. Ann Arbor: Institute for Social Research, The University of Michigan.
4. Substance Abuse and Mental Health Services Administration (SAMHSA). 2017 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; 2018. https://www.samhsa.gov/data/sites/default/files/cbhsq-reports/NSDUHDeta…. Accessed October 12, 2018.
5. 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. http://www.cdc.gov/tobacco/data_statistics/surveys/nyts/. Accessed February 24, 2017