A young man walks up to a convenience store counter and asks for a pack of cigarettes. He throws some money on the counter, but the cashier says, “That’s not enough.” So the young man pulls out a pair of pliers, wrenches out one of his teeth and hands it over.

The disturbing scene is part of the U.S. Food and Drug Administration’s first youth tobacco prevention campaign, known as The Real Cost. At the end of the tooth-pulling television ad, a voiceover asks: “What’s a pack of smokes cost? Your teeth.” To develop the campaign, which specifically tries to reach adolescents who are open to smoking or have already tried cigarettes, FDA researchers spent a year combing through the scientific literature, reaching out to experts, talking with young people and focus testing prevention concepts.

Eventually, two concepts rose to the top: the cosmetic health consequences of tobacco use and the idea that dependence on tobacco takes away a person’s control. According to Kathy Crosby, director of the Office of Health Communication and Education within the FDA’s Center for Tobacco Products, the anti-tobacco message had to be creatively wrapped to break through to kids who may be jaded and cynical. While the images of a young man pulling out his own teeth or a young woman paying for cigarettes with a piece of her smooth complexion may seem ghoulish to some, Crosby said that “what’s graphic in the eyes of adults is different with teens.

To continue reading this story from the August 2014 issue of The Nation’s Health, visit the newspaper online.