Background and challenges to implementation:
Nearly 9 out of 10 U.S. adult daily smokers smoke their first cigarette by age 18, making youth prevention a critical interception point. U.S. FDA's The Real Cost campaign is a nationwide public education effort targeting the nearly 10 million at-risk youth ages 12-17 to prevent and reduce tobacco use. The campaign's challenge is to catch the attention of teens and get them to engage with tobacco-prevention messaging--something they have limited interest in. To succeed, the campaign requires innovative advertising that speaks to teen passion points. Because teens don't think they'll become addicted and ignore the long-term health consequences of smoking, the campaign speaks to consequences they care about in the here-and-now, such as stunted lungs and cosmetic health effects.

Intervention or response:
In response to this challenge, U.S. FDA developed, “Little Lungs,” a digital campaign based on audience insights that teens like snarky humor. A series of 15-30 second ads were developed to tell the story of the main character “Little Lungs,” who smoked as a teen, never grew to normal size, and now can't keep up in the activities he loves. This leads to his “tragicomic” demise. The video series launched on digital platforms (https://www.youtube.com/watch?v=nEjrjTsVLY4). Paid digital ads drove traffic, relevant hashtags were used to insert the campaign into teens interest areas.

Results and lessons learnt:
“Little Lungs” was viewed over 17 million times on YouTube, 8 million times on Facebook and Instagram, and the content received over 8.2 million social engagements with a 17% social engagement rate.

Conclusions and key recommendations:
Teens are already deeply submerged in the digital world-inserting “Little Lungs” in that space presented an opportunity to deliver an impactful message that aligned with passion points to spark initial interest and then seamlessly tie in a tobacco prevention message.