The U.S. Food and Drug Administration’s (FDA) youth e-cigarette prevention campaign, known as The Real Cost, may have successfully reduced e-cigarette use among youth, according to a recent study published by MacMonegle et al in the American Journal of Preventive Medicine.
Background
The Real Cost campaign—which was launched in 2018—uses a variety of marketing tactics and creative advertising to reach U.S. 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 FDA’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 manufacturing, distributing, or selling illegal tobacco products are held accountable. All of the FDA’s Center for Tobacco Products’ efforts are 100% funded by tobacco user fees that are paid by manufacturers and importers of certain classes of tobacco products.
“[W]e must ensure that children have a healthy start in life,” noted Sara Brenner, MD, MPH, Acting Commissioner of the FDA. “This includes taking evidence-based actions to prevent youth tobacco product use,” she added.
Study Methods and Results
In this study, investigators evaluated a nationally representative sample of U.S. youths (aged 11–17 at recruitment). A survey collected information on how frequently they were exposed to The Real Cost campaign and which ones went on to use e-cigarettes, among other variables.
The investigators demonstrated that viewing advertisements from The Real Cost campaign lowered the likelihood that youths who had never used an e-cigarette would later initiate use. They found The Real Cost campaign prevented an estimated 444,252 U.S. youths from initiating e-cigarettes use between 2023 and 2024. Further, the campaign contributed to nearly a 70% decline in e-cigarette use among U.S. youth that has occurred since 2019.
According to the National Youth Tobacco Survey, the number of U.S. middle and high school students who currently use e-cigarettes declined from 5.38 million in 2019 to 1.63 million in 2024, the lowest level in a decade.
The findings built on prior studies showing that exposure to The Real Cost campaign is a cost-saving strategy by reducing the lifetime risks of tobacco-related disease and mortality. For instance, previous research indicated that the effort prevented up to 587,000 U.S. youths from initiating smoking over a 3-year period, 50% of whom might have gone on to become established adult cigarette users. The cigarette prevention campaign was also found to save $180 for every $1 dollar spent on the effort in its first 2 years, totaling more than $53 billion in reduced smoking-related costs such as premature mortality, costly medical care, lost wages, lower productivity, and increased disability.
Conclusions
“Adolescence is a critical period for prevention efforts because most adults who use tobacco products begin using them in their teenage years,” underscored Brian King, PhD, MPH, Director of the Center for Tobacco Products at the FDA. “Youth tobacco prevention campaigns not only work, but they are also a cost-effective approach to protecting young [individuals] from a lifetime of nicotine addiction,” he concluded.
Disclosure: For full disclosures of the study authors, visit ajpmonline.org.
