WASHINGTON, USA – A study co-authored by US Food and Drug Administration scientists was released showing the agency’s youth e-cigarette prevention campaign, “The Real Cost,” successfully reduced e-cigarette use among youth. The campaign, which launched in 2018 under the leadership of president Trump, was found to have prevented an estimated 444,252 American youth (age 11 to 17 at study recruitment) from starting to use e-cigarettes between 2023 and 2024.
The new studyExternal Link Disclaimer, published in the peer-reviewed scientific journal American Journal of Preventive Medicine, found evidence that the campaign contributed to the nearly 70 percent decline in e-cigarette use among American youth that has occurred since 2019. According to the National Youth Tobacco Survey, the number of US middle and high school students who currently use e-cigarettes has declined from 5.38 million in 2019 to 1.63 million in 2024, the lowest level in a decade.
“As part of our work to Make America Healthy Again, we must ensure that children have a healthy start in life,” said acting FDA Commissioner Sara Brenner, M.D., M.P.H. “This includes taking evidence-based actions to prevent youth tobacco product use.”
Data from the evaluation, which followed a nationally representative sample of US youth over time, showed that viewing ads from “The Real Cost” lowered chances that youth who had never used an e-cigarette would later initiate use. The survey collected information on how frequently youth were exposed to “The Real Cost” campaign and which youth went on to try e-cigarettes, among other variables.
“Adolescence is a critical period for prevention efforts because most adults who use tobacco products begin using them in their teenage years,” said Brian King, Ph.D., M.P.H., director of the FDA’s Center for Tobacco Products. “Youth tobacco prevention campaigns not only work, but they are also a cost-effective approach to protecting young people from a lifetime of nicotine addiction.”
These data build on prior scientific studies showing that exposure to “The Real Cost” campaign is a cost-saving strategy by reducing the lifetime risks of tobacco-related disease and death, including from chronic disease. A previous studyExternal Link Disclaimer that evaluated “The Real Cost” Youth Cigarette Prevention Campaign found that the effort prevented up to 587,000 American youth from initiating smoking over a three-year period, half of whom might have gone on to become established adult cigarette users. The cigarette prevention campaign also was found to save $180 for every dollar spent on the effort in its first two years, totaling more than $53 billion in reduced smoking-related costs like early loss of life, costly medical care, lost wages, lower productivity and increased disability.
There is no safe tobacco product. Those who do not currently use tobacco products, especially youth, should not start. Additionally, there are medications that have been approved by the FDA to be safe and effective for adults who want to quit smoking. Adults who smoke should also know that different types of tobacco products exist on a spectrum of health risk, with smoked products such as cigarettes being the most harmful. Adults who fully switch from cigarettes to a lower-risk alternative tobacco product can generally reduce their health risks and exposure to toxic and cancer-causing chemicals.
“The Real Cost” Youth E-cigarette Prevention Campaign uses a variety of marketing tactics and creative advertising to reach youth. Advertising and prevention materials are delivered across communication channels relevant to teens, including digital and streaming platforms, social media and gaming platforms. These education efforts are one component of the agency’s strategy to reduce and prevent youth use of tobacco products.
The agency’s activities also include compliance and enforcement actions across the supply chain – in coordination with federal partners using their unique authorities – to ensure that those that make, distribute or sell illegal tobacco products are held accountable to the law. All of the FDA’s Center for Tobacco Products’ efforts are 100 percent funded by tobacco user fees, which are fees paid by manufacturers and importers of certain classes of tobacco products.
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