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  1. The Real Cost Campaign

The Real Cost Cigarette Prevention Campaign

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FDA’s first tobacco prevention campaign, “The Real Cost,” was launched in 2014. In its first two years, research showed “The Real Cost” prevented up to 587,000 youth ages 11 to 19 from initiating smoking between February 2014 and November 2016, half of whom might have gone on to become established adult smokers. 

Our Goal: Educate youth ages 12 to 17 who are at-risk for smoking cigarettes in the United States about its harmful effects.

Campaign Research

How Research Guides Our Campaign  

The Real Cost campaign conducts research with teens on an ongoing basis. Our research provides key insights about how potential campaign advertising (ads) resonate with members of our intended audiences. Campaign research consists of both testing ads before they are aired (also called formative research) and assessing the impact of the ads after they are released (also called evaluation research).

Through formative research, we continually refine our understanding of the campaign’s intended audience, stay up to date on the most effective ways to reach them, and identify and test prevention ads. Formative research includes:

  • Conducting focus groups and surveys to gather audience insights and understand which ads members of our intended audience find understandable, believable, and motivating
  • Reviewing data from large national surveys, sales data, social media comments and trends and other sources to better understand teens, their media behaviors, and their tobacco attitudes.  We use this information to develop and refine ads and strategies for our campaigns.

Evaluation research allows us to see how exposure to the campaign ads might change someone’s perceptions about tobacco.  Evaluation research includes:

  • Conducting surveys with teens to understand who has seen our ads and the impact that the ads have on knowledge, attitudes, and beliefs about tobacco. Some of these surveys are conducted multiple times over several months with the same group of participants
  • Evaluating our media strategy by conducting surveys at one point in time to assess how many teens have seen our ads and are aware of The Real Cost brand

In addition to sharing our research findings through webinars and other public forums, our formative and evaluation research is often published in peer-review journals. To read publications about CTP campaigns, see Awards and Recognition.

By preventing these kids from becoming established smokers, "The Real Cost" campaign will save more than $53 billion for youth, their families and society at large by reducing smoking-related costs like early loss of life, costly medical care, lost wages, lower productivity, and increased disability.

Our Approach

“The Real Cost” cigarette prevention campaign uses digital marketing tactics and creative advertising to educate the audience on the negative consequences of smoking. Some of these marketing tactics included: 

  • Digital and streaming video advertising  
  • Streaming audio advertising
  • Social media to engage the audience 
  • A variety of influencers to extend the campaign’s messaging

In January 2023, “The Real Cost” launched two new ads rooted in science-based facts about cigarette smoking. One ad, “Auctioneer,” focuses on the negative mental health effects of cigarette smoking and withdrawal, a new messaging area for the campaign.

The other ad “Said Every Smoker Ever” introduces youth to the fact that 3 out of 4 teens who smoke will continue to smoke into adulthood and focuses on the negative consequences of cigarette addiction.



Campaign Resources

Quitting Resources for Youth

FDA partners with the National Cancer Institute’s (NCI) Smokefree.gov initiative to provide youth with resources for quitting tobacco products. Resources and information on Teen.smokefree.gov are designed specifically for youth audiences by cessation experts. “The Real Cost” campaign connects youth to these resources on social media and various digital platforms (Spotify Pandora, Wattpad, etc.). Some of the quit tools and resources include: 

Free Tobacco Education Materials at FDA Tobacco Education Resource Library  

TERL teen posters






Learn more about print materials, web content, and social media posts available for free that help keep communities, including LGBTQI+ smokers and Spanish language speakers informed about tobacco-related issues.

Awards and Recognition

  • Anthem Awards
    • 2022: Bronze award in the Awareness Category
  • Effie Awards
    • 2020: Bronze Effie in the Youth Marketing category  
    • 2017: Bronze Effie in the Youth Marketing category 
    • 2015: Gold Effie in the Disease Awareness and Education category
  • Festival of Media Awards 
    • 2020: Grand Prix for Campaign of the Year 
    • 2020: Best Branded Content led by Digital Channels 
    • 2020: Best Communications Strategy 
    • 2020: Creative Use of Media  
  • The One Show Award 
    • 2020: Merit award at The One Show in the Branded Entertainment Games category 
      • Power or Purpose Award 
    • 2020: Power of Purpose for Brand Purpose 
  • Verizon Media Award
    • 2019: Brandblazer for Premium Integrations 
  • AdWeek 
    • 2019: Media Plan of the Year Award for Best Use of Branded Content/Entertainment 
  • Clio Health Award 
    • 2019: Silver Clio award for Branded Entertainment and Content  
    • 2017: Bronze Clio award for Visual Effects 
  • Spikes Asia
    • 2017: Silver Spike for Film Craft 
  • Shorty Award  
    • 2016: Creative work on Tumblr
  • Publications
    1. Duke JC, Alexander TN, 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. doi:10.1371/journal.pone.0144827.
    2. Zhao X, Alexander T, Hoffman L, et al. Youth receptivity to FDA’s The Real Cost tobacco prevention campaign: Evidence from message pretesting. J Health Commun. 2016;21(11):1153–1160. doi:10.1080/10810730.2016.1233307.
    3. Farrelly MC, Duke JC, Nonnemaker J, et al. Association between The Real Cost media campaign and smoking initiation among youths—United States, 2014–2016. MMWR Morb Mortal Wkly Rep. 2017 Jan 20;66(2):47–50. doi:10.15585/mmwr.mm6602a2.
    4. Crosby K, Santiago S, Talbert EC, Roditis ML, Resch G. Bringing "The Real Cost" to life through breakthrough, evidence-based advertising. Am J Prev Med. 2019;56(2S1):S16–S23. doi:10.1016/j.amepre.2018.08.024.
    5. Roditis, M. L., Jones, C., Dineva, A. P., & Alexander, T. N. (2019). Lessons on addiction messages from “The Real Cost” campaign. American Journal of Preventive Medicine56(2), S24-S30.
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