Tobacco Products

The Real Cost Campaign

Nearly 350,000 Kids Prevented from Smoking

Tobacco Use is a Public Health Problem

Every day in the U.S., nearly 2,300 youth under age 18 smoke their first cigarette, and more than 750 male youth use smokeless tobacco for the first time.1 In fact, tobacco use is almost always started and established during adolescence2 because the developing brain is especially vulnerable to nicotine addiction3.

After decades of steadily declining rates, youth tobacco use has largely plateaued since 2011 due to sharp increases in e-cigarette and hookah tobacco use among teens in recent years. Nationwide, more than 2 million teens currently use e-cigarettes.4 Further, youth who use tobacco today do so despite the efforts that led so many of their peers to remain tobacco-free in the past, making them an even harder group to reach and highlighting a critical need for stronger, more targeted youth tobacco prevention efforts.

“The Real Cost” CampaignFDA's award-winning youth tobacco prevention campaign, "The Real Cost," seeks to educate at-risk teens about the harmful effects of tobacco use. The goal is to prevent youth who are open to tobacco from trying it and to reduce the number of youth who move from experimenting with tobacco to regular use.

2014: Launch of “The Real Cost” Campaign

"The Real Cost" campaign launched nationally in February 2014 across multiple media platforms including TV, radio, print, web, social media, and out-of-home sites, like billboards. Initial campaign advertising focused on reaching the nearly 10 million youth ages 12-17 in the United States who are either open to smoking or are already experimenting with cigarettes.5

2016: Expansion to Prevent Smokeless Tobacco Use by Rural Male Youth

In April 2016, “The Real Cost” expanded its campaign brand umbrella to include new advertising targeting rural male youth ages 12-17 who are at risk of smokeless tobacco use in 35 targeted local markets around the U.S. The selected rural markets reflect areas with higher concentrations of the target audience.

2017: Expansion to Prevent of Youth E-Cigarette Use

In August 2017, FDA announced it would pursue a new, strategic public health education effort designed to prevent youth from using e-cigarettes and other electronic nicotine delivery systems (ENDS). In support of this goal, the agency expanded “The Real Cost” public education campaign in October 2017 to educate teens about the dangers of nicotine on the developing brain. The new campaign materials include digital images and online video and radio ads. Additionally, FDA is planning to launch a full-scale media campaign to prevent youth e-cigarette use in 2018.

Campaign Development

FDA conducts research with at-risk youth across the country to develop campaign advertising that resonates with teens. Near-final TV ads are tested with thousands of target audience members for perceived effectiveness, message comprehension, and potential unintended consequences prior to being placed in market. Since campaign launch, “The Real Cost” has refreshed its creative regularly to keep youth engaged.

View more “The Real Cost” ads
on our YouTube Channel.

Achieving Behavior Change

FDA hired an independent research firm to assess the impact of “The Real Cost” on tobacco-related attitudes, beliefs and behaviors among youth who are open to smoking or already experimenting with cigarettes, and the results are impressive. Results from the first study indicate that exposure to “The Real Cost” from 2014-2016 was associated with a 30 percent decrease in the risk for smoking initiation, preventing an estimated 350,000 U.S. youth ages 11-18 from smoking. These results demonstrate the effectiveness of a national campaign that focused on the harmful effects of smoking and delivered salient messages that resonated with youth. Separate outcome evaluation studies specific to campaign messaging and knowledge, attitudes and beliefs around smokeless tobacco and e-cigarette use are underway.


The results from the first evaluation study are published in CDC’s Morbidity and Mortality Weekly Report (MMWR).

How “The Real Cost” successfully changed youth's risk perceptions and beliefs about smoking is described in the American Journal of Health Promotion.disclaimer icon

The 2015 findings on the target audience’s awareness of “The Real Cost” campaign are published in PLOS ONE.

Evidence of youth receptivity to the ads during message pretesting was published in the Journal of Health Communication.


Gold Effie Award"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. Substance Abuse and Mental Health Services Administration (SAMHSA). 2016 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; 2017. Accessed October 12, 2017.
2. U.S. Department of Health and Human Services (USDHHS). The Health Consequences of Smoking - 50 Years of Progress. A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2014.
3. U.S. Department of Health and Human Services (USDHHS). A Report of the Surgeon General: Preventing Tobacco Use among Youth and Young Adults. We Can Make the Next Generation Tobacco-Free (Consumer Booklet). Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2012.
4. 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
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. Accessed February 24, 2017


Page Last Updated: 03/30/2018
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