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Anti-Vaping Ads Among Youth: Do They Work?

Key Points:

  • “The Real Cost” e-cigarette prevention campaign from the U.S. Food and Drug Administration (FDA) has demonstrated effectiveness.

  • Anti-vaping messages tailored for younger individuals offer prevention potential for both vaping and cigarette smoking.

An illustration of a teenager seeing an ad on a phone.

To combat electronic cigarette and vaping advertisements that may entice youth to try these products, various anti-vaping ad campaigns have been launched. Zeptive examines some of the research studying the impact of these campaigns, with a focus on the U.S. Food and Drug Administration’s (FDA) "The Real Cost" messaging, in particular.

“The Real Cost” Campaign Results

"The Real Cost," a high-profile campaign launched by the FDA in 2014 to educate teens about the harmful effects of cigarette smoking, expanded its messaging in 2018 to include the health consequences of e-cigarettes. The campaign relies upon various marketing and creative advertising tactics to reach youth audiences across teen-relevant communication channels – like social media, online video ads, television ads, Marvel Comics and even Rick and Morty content.

Are Anti-Vaping Ads Effective?

So, do vaping prevention advertisements from this national campaign reduce susceptibility to vaping? A three-group randomized clinical trial of 1,514 adolescents aged 13 to 17 years who were either open to vaping or were e-cigarette users at the time of study enrollment provides some answers. The intervention consisted of a:

  • Control group (504 adolescents), who viewed three investigator-created videos about vaping at three weekly visits.

  • Real Cost/health harms group (504 adolescents), who viewed three video advertisements about the health harms of vaping at three weekly visits. These videos focused on the harmful chemicals emitted by vaping devices and the potential for lung damage caused by vape.

  • Real Cost/addiction group (506 adolescents), who viewed three video advertisements about addiction consequences of vaping at three weekly visits. These videos focused on the highly addictive nature of vapes and the consequences of nicotine addiction, such as loss of autonomy.

"The Real Cost" Ad Campaign Study Findings

Two teenagers looking at their phones.
  • Adolescents who viewed "The Real Cost" health harms and addiction videos had lower susceptibility to vaping than those in the control group.

  • Similar effectiveness for health harms versus addiction-themed ads.

  • "The Real Cost" vaping prevention video ads also reduced susceptibility to cigarette smoking.

Other research backs up effectiveness. In one study, "The Real Cost" ads, compared to control videos, scored higher on message and effects perceptions. Message perceptions assess the persuasive potential of an advertisement, while effects perceptions assess the potential to change behavior.

Maximizing the Anti-Vaping Message

Aside from "The Real Cost" campaign’s success, other state, local and non-governmental agencies strive to produce successful vaping prevention advertisements. One online study, in particular, sought to identify and test a large set of vaping prevention ads by asking 1,501 teens to rate seven random vaping prevention ads from a pool of over 200 to help determine what makes an effective youth-focused anti-vaping advertisement.

Researchers learned the most impact occurs when advertisements:

  • Include the negative consequences and harms of vaping, such as nicotine addiction, chemicals used, specific health effects on the brain and lungs and comparisons to cigarette smoking.

  • Use graphic images and warning symbols.

  • Avoid hashtags and internet memes.

  • Avoid statistics.

  • Refrain from referring to environmental impact.

  • Forego reference to flavors, as this was associated with increasing vaping appeal. The 2022 National Youth Tobacco Survey backs up this concern, with nearly 85% reporting the preference and use of flavored e-cigarettes.

The Bottom Line

Continuing to develop anti-vaping advertisements geared to adolescents is an effective tool for helping curb youth vaping. By Linda Antinoro Reviewed by Cindy Bistany, DHSc References

1. Noar SM, Gottfredson NC, Kieu T, et al. Impact of Vaping Prevention Advertisements on US Adolescents: A Randomized Clinical Trial. JAMA Netw Open. 2022; 5(10):e2236370

2. Noar SM, Rohde JA, Prentice-Dunn H, Kresovich A, Hall MG, Brewer NT. Evaluating the actual and perceived effectiveness of E-cigarette prevention advertisements among adolescents. Addict Behav. 2020 Oct; 109:106473.

3. Boynton MH, Sanzo N, Brothers W, et al. Perceived effectiveness of objective elements of vaping preventionmessages among adolescents. Tob Control. 2022; tobaccocontrol-2021-057151. doi:10.1136/tobaccocontrol-2021057151

4. Cooper M, Park-Lee E, Ren C, Cornelius M, Jamal A, Cullen KA. Notes from the Field: E-cigarette Use Among Middle and High School Students — United States, 2022. MMWR Morb Mortal Wkly Rep 2022;71:1283–1285

5. U.S. Food and Drug Administration (2022, November 10). Results from the Annual National Youth Tobacco Survey. U.S. Food and Drug Administration.

6. U.S Food and Drug Administration (2022, April 5). The Real Cost Campaign.

7. U.S Food and Drug Administration (2022, April 5). The Real Cost E-Cigarette Prevention Campaign.


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