The US FDA is expanding its award-winning “The Real Cost” campaign to educate rural, white male teenagers about the negative health consequences associated with smokeless tobacco use.

For the first time, messages on the dangers of smokeless tobacco use — including nicotine addiction, gum disease, tooth loss, and multiple kinds of cancer — are being highlighted through the placement of advertisements in 35 U.S. markets specifically selected to reach the campaign’s target audience.

“Not only is the target audience using smokeless tobacco at a high rate, but many do not fully understand the negative health consequences of their actions,” said Mitch Zeller, JD, director of the FDA’s Center for Tobacco Products. “In communities where smokeless tobacco use is part of the culture, reaching at-risk teens with compelling messaging is critical to help change their understanding of the risks and harms associated with smokeless tobacco use.”

Smokeless tobacco includes different types of products, such as dip, chew, snus and types of tobacco that dissolve when placed in the mouth. According to the Substance Abuse and Mental Health Services Administration, each day in the US nearly 1,000 males under the age of 18 use smokeless tobacco for the first time — almost as many male teenagers who smoke their first cigarette — making early intervention critical and highlighting a need for targeted youth smokeless tobacco prevention.

Smokeless tobacco use is culturally ingrained in many rural communities. For many, it has become a rite of passage, with these teenagers seeing smokeless tobacco used by role models, such as fathers, grandfathers, older brothers and community leaders. In fact, its use is more than twice as likely in rural areas compared to metropolitan areas in the US.

However, some rural youth are impacted more significantly than others — with white, male youth being more likely to use smokeless tobacco than other youth. According to the most recent data from the FDA’s Population Assessment of Tobacco and Health (PATH) study, 31.84% of rural, white males 12-17 years of age are either experimenting with, or at-risk for, using smokeless tobacco – this amounts to approximately 629,000 male youth nationwide.

The central message in “The Real Cost” Smokeless Tobacco Prevention Campaign is “smokeless doesn’t mean harmless,” which aims to motivate these teenagers to reconsider what they think they know about smokeless tobacco use. The FDA’s strategic approach is based on key insights from multi-state focus groups consisting of rural, white males, ages 12-17, as well as by extensive secondary research. Campaign messaging focuses on topics that the FDA’s research found to resonate with at-risk youth, such as cosmetic and health consequences, loss of control due to addiction, and the danger of chemicals found in smokeless tobacco products.

“The Real Cost” Smokeless Tobacco Prevention Campaign’s messages are being amplified across the US using a variety of methods, including traditional paid media (eg television, radio, print, public signs and billboards), as well as digital advertising and social media. These efforts will be evaluated by measuring the advertisements’ effectiveness in reaching rural, white male teenagers and changing their thinking, attitudes, beliefs and behavioral intentions to use smokeless tobacco.

The new campaign will also collaborate with select Minor League Baseball teams to help combat the link between baseball and smokeless tobacco use among the campaign’s target audience. This summer, stadiums across the country will promote tobacco-free lifestyles by displaying campaign advertising and providing opportunities for fans to meet and interact with players who support the campaign’s public health messages.