FDA’s award-winning public education campaign, “The Real Cost,” continues to prevent youth from tobacco initiation and use. “The Real Cost” launched in 2014 with cigarette prevention messaging using a robust paid media strategy to effectively reach teens and change their tobacco-related knowledge, attitudes, beliefs, and behaviors. The campaign expanded to include smokeless tobacco messaging in 2016, and FDA began prioritizing e-cigarette messaging in 2017 due to high usage rates among youth.    

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On this page:

• E-Cigarette Prevention Campaign 
• Cigarette Smoking Prevention Campaign
• Smokeless Tobacco Prevention Campaign
• Campaign Resources
• Awards and Recognition

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"The Real Cost” Youth E-Cigarette Prevention Campaign

Though only a small percentage of U.S. youth used e-cigarettes in 2011, 28 percent of high school students and 11 percent of middle school students used e-cigarettes by 2019. In 2020, these numbers declined and there were 1.8 million fewer youth using e-cigarettes. While this is progress, youth use of e-cigarettes remains a public health issue with 3.6 million youth still using e-cigarettes, and disposable e-cigarette use surged in 2020.  Under “The Real Cost” campaign, FDA began prioritizing e-cigarette prevention messaging in 2017, and since then the campaign has been educating youth about the risks of using e-cigarettes. 

To address the “cost-free” mentality found in a majority of middle and high schoolers, campaign messages focus on educating youth that using e-cigarettes puts them at risk for addiction and other health consequences. Advertising and other prevention materials are delivered across a variety of channels, including: 

• Television ads
• Online video ads
• “The Real Cost” campaign’s youth-targeted website
• Social media
• High schools nationwide (e.g., posters for school bathrooms)

FDA also continues to provide resources to educators, parents, and community leaders to prevent youth use and help kids who are already addicted to e-cigarettes quit.

Looking for resources to teach youth about the harms of e-cigarette use?

FDA and Scholastic created educational resources for middle and high schools that are available in English and Spanish. Materials include a student magazine, videos, lesson plans, activity sheets, a guide for parents to talk to kids about e-cigarettes, and infographics. These materials are accessible online for free and are adaptable for remote instruction or independent student work.

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Cigarette Smoking Prevention Campaign

FDA’s first tobacco prevention campaign, “The Real Cost,” was launched in 2014 to educate the more than 10 million¹ youth ages 12-17 who were at-risk for smoking cigarettes in the United States about its harmful effects.

In its first two years, research shows the campaign has done just that: “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.

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.  

FDA continues to educate youth about the dangers of cigarette smoking through the “The Real Cost” campaign.  

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“The Real Cost” Smokeless Tobacco Prevention Campaign 

In April 2016, FDA expanded “The Real Cost” campaign brand to include new advertising targeting hard-to-reach rural male youth ages 12-17 at risk for smokeless tobacco use. The campaign was built on extensive formative research and delivered facts about the dangers of smokeless tobacco use in relevant and attention-grabbing ways. The campaign’s central message, “smokeless doesn’t mean harmless,” motivated teens to reconsider what they think they know about smokeless tobacco use.  

The campaign used a variety of tactics, including: 

• Local television and radio 
• Outdoor signs 
• Precise targeting on digital and social media platforms 

FDA has completed the campaign’s paid media implementation and outcome evaluation. The campaign was successful in reaching almost 90% of the intended target audience and shifting attitudes and beliefs related to addiction and negative health consequences. 

FDA will continue to provide youth messaging on smokeless tobacco through stakeholder outreach.

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Campaign Resources

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Download or order free youth e-cigarette prevention posters and infographics