The Real Cost E-Cigarette Prevention Campaign
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Background
A critical part of FDA’s public health mission is educating youth about the dangers of e-cigarette use. According to the 2025 National Youth Tobacco Survey (NYTS), about 1.44 million youth across the nation reported current use of e-cigarettes. Since 2018, FDA has prioritized its public education efforts to further reduce e-cigarette use among youth.
Our Goal: Educate youth ages 12 to 17 who are at-risk for using e-cigarettes in the United States about the dangers of e-cigarette use. The campaign addresses the “cost-free” mentality in middle and high schoolers with messages that educate youth that using e-cigarettes puts them at risk for addiction and other health consequences.
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 our intended audiences. Campaign research consists of formative research and evaluation testing and surveys.
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 potential prevention ads.
Formative research includes:
- 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 attitudes and beliefs on tobacco.
- Directly conducting research with the campaign's intended audience to gather insights on their beliefs about tobacco products.
- Testing draft ads through focus groups and surveys to understand which ads our intended audience finds the most understandable, believable, and motivating.
Evaluation research allows us to see how exposure to the campaign ads might change someone’s perceptions and behaviors toward tobacco use, like whether they start using e-cigarettes or not.
Evaluation research includes:
- Conducting surveys with teens, some multiple times over several months with the same group of participants, to understand who has seen our ads and the impact that the ads have on knowledge, attitudes, and beliefs about e-cigarettes.
- 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.
The latest outcome evaluation data showed between 2023 and 2024, “The Real Cost” Youth E-Cigarette Prevention Campaign prevented an estimated 444,252 American youth (age 11 to 17 at study recruitment) from starting to use e-cigarettes. The study publishing these findings found that viewing campaign ads lowered the chances that youth who had never used an e-cigarette would initiate use, contributing to the dramatic declines in e-cigarette use among American youth that have led to the lowest levels of e-cigarette use in a decade.
These findings add to the evidence base demonstrating that “The Real Cost” youth tobacco prevention campaigns are a cost-effective strategy to:
- Reduce tobacco use among youth
- Prevent death and disease related to tobacco use, including chronic disease
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.
How We Reach Teens
“The Real Cost” e-cigarette prevention campaign uses a variety of marketing tactics and creative advertising to reach its teen audience. Advertising and prevention materials are delivered across teen-relevant communication channels, including:
- Television ads
- Digital and streaming video advertising on platforms like Hulu and YouTube
- Social media to engage the audience on platforms like Snapchat and Instagram
- Streaming audio advertising on platforms like Spotify and Pandora
- Gaming-focused advertising on platforms like Twitch and Xbox
- Media partnerships with youth-focused content, such as Marvel Comics, Fandom, and Overtime
- “The Real Cost” campaign’s youth-focused website
Quitting Resources for Teens
FDA partners with the National Cancer Institute’s (NCI) SmokeFree teen initiative to provide youth with resources for quitting e-cigarettes. “The Real Cost” campaign connects youth to these resources on social media and various digital platforms (Spotify, Pandora, YouTube, etc.). Some of the quit tools and resources include:
- Quit Builder tool to help teens make a personalized quit plan
- Quizzes and Surveys to help teens understand vaping addiction
- Information about nicotine withdrawal and addiction and other quitting resources
Awards and Recognition
- Clio Entertainment Awards
- 2023: Bronze award in the Diversity in Storytelling category and the Television Branded Content Medium for “My Vaping Mistake”
- Effie Awards
- 2025: Bronze Effie for the Youth Marketing category
- 2025: Silver Effie for the Disease Awareness & Education category
- 2024: Bronze Effie in the Sustained Success - Non-Profit category
- 2022: Bronze Effie in the Disease Awareness and Education category
- 2021: Bronze Effie in the Disease Awareness and Education category
- ARF David Ogilvy Awards