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  1. The Real Cost Campaign

The Real Cost E-Cigarette Prevention Campaign

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The Real Cost 10 Years Power of Prevention

A critical part of FDA’s public health mission is educating youth about the dangers of e-cigarette use. According to the 2023 National Youth Tobacco Survey (NYTS), an estimated 2.13 million middle and high school students across the nation have reported using 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

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 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, lifestyles, and values.
  • 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 about tobacco.

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 tobacco.
  • 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 collected between August and December 2023 show that approximately 67 percent of youth were aware of at least one “The Real Cost” e-cigarette campaign advertisement and 37 percent of teens were aware of “The Real Cost” brand. In addition, results based on multiple years of data suggest that there are significant associations between exposure to “The Real Cost” ads and an increase in agreement with campaign-specific beliefs.     

For example, exposure was associated with increases in beliefs that e-cigarettes can expose the user’s lungs to toxic metals and cause lung damage; ingredients in e-cigarettes are dangerous; and e-cigarettes could increase anxious feelings, increase the likelihood of smoking cigarettes, and disappoint people who are important to youth.

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 

Campaign Resources

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, Wattpad, etc.). Some of the quit tools and resources include: 

Vaping Prevention and Education Resource Center 

Youth on bleachers vaping

FDA’s Vaping Prevention and Education Resource Center is an online hub with free science-based, standards-mapped lesson plans and materials teachers can use to help students understand the dangers associated with vaping and nicotine addiction. The resource center features numerous age-appropriate, cross-curricular resources for teachers to promote learning and begin having open conversations with youth about vaping.

In addition to content designed for teachers, there are also materials for parents and teens. All content on the resource center is free, easy to navigate, and optimized for each audience. These resources are also available in Spanish.

Visit the Vaping Resource Center

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.

Campaign Ads



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
    • 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 
    • 2021: Gold award for “The Facts about Vaping are Scary Enough” campaign ad

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