• Kathleen Crosby, Suzanne Santiago, Emily C Talbert, Maria L Roditis, and Gary Resch.
• Office of Health Communication and Education, Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, Maryland.
• Am J Prev Med. 2019 Feb 1; 56 (2 Suppl 1): S16-S23.

AbstractBuilding on the success "The Real Cost" campaign has already achieved requires the constant development of new audience insights, novel ideas, and unconventional ways of bringing the campaign to life. This article provides a high-level overview of the campaign's approach to developing and testing breakthrough advertising that has proven effective in preventing smoking initiation among a skeptical, hard-to-reach, at-risk youth audience. This approach is informed by evidence-based communication best practices for youth behavior change campaigns; insights from published literature and subject matter experts with decades of experience in youth health marketing and tobacco prevention; and findings from formative research studies conducted as part of the campaign development process. The paper also explores two campaign advertisements to showcase the research-based creative development process in action. This article is a collaboration between federal government officials, campaign managers, ad agency creatives, and researchers, and thus provides a unique, multidisciplinary examination into the research and creative processes that go into creating a national health communication effort. SUPPLEMENT INFORMATION: This article is part of a supplement entitled Fifth Anniversary Retrospective of "The Real Cost," the Food and Drug Administration's Historic Youth Smoking Prevention Media Campaign, which is sponsored by the U.S. Food and Drug Administration.Published by Elsevier Inc.

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