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key takeaway, from the conclusion article, "'The Real Cost' Campaign: Efficacy by Design": "An evaluation from 2014 to 2016 found that “The Real Cost” cigarette prevention campaign prevented up to 587,000 youth from starting to smoke, and more recently, an evaluation found that the e-cigarette prevention campaign prevented nearly 450,000 youth aged 11–18 from starting e-cigarette use between 2023 and 2024."



key takeaway: "Tobacco use continued declining through 2025, when 7.2% of youth used tobacco. Only nicotine pouches increased, doubling from 0.8% in 2021 to 1.7% in 2025. Pouches were the second most used tobacco product, after e-cigarettes (5.2%). Most youth used flavored tobacco products. E-cigarette use intensity increased over time, with daily use growing from 9.4% in 2014 to 35.4% in 2025. Dual and poly use is common among e-cigarette and pouch users."

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