title: The importance of continued engagement during the implementation phase of tobacco control policies in a middle-income country: the case of Costa Rica.
abstract: To analyse the process of implementing and enforcing smoke-free environments, tobacco advertising, tobacco taxes and health warning labels from Costa Rica's 2012 tobacco control law.
  
  
  
  Review of tobacco control legislation, newspaper articles and interviewing key informants.
  
  
  
  Despite overcoming decades of tobacco industry dominance to win enactment of a strong tobacco control law in March 2012 consistent with WHO's Framework Convention on Tobacco Control, the tobacco industry and their allies lobbied executive branch authorities for exemptions in smoke-free environments to create public confusion, and continued to report in the media that increasing cigarette taxes led to a rise in illicit trade. In response, tobacco control advocates, with technical support from international health groups, helped strengthen tobacco advertising regulations by prohibiting advertising at the point-of-sale (POS) and banning corporate social responsibility campaigns. The Health Ministry used increased tobacco taxes earmarked for tobacco control to help effectively promote and enforce the law, resulting in high compliance for smoke-free environments, advertising restrictions and health warning label (HWL) regulations. Despite this success, government trade concerns allowed, as of December 2015, POS tobacco advertising, and delayed the release of HWL regulations for 15 months.
  
  
  
  The implementation phase continues to be a site of intensive tobacco industry political activity in low and middle-income countries. International support and earmarked tobacco taxes provide important technical and financial assistance to implement tobacco control policies, but more legal expertise is needed to overcome government trade concerns and avoid unnecessary delays in implementation.
authors: Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, California, USA.|Department of Politics, University of California Santa Cruz, Santa Cruz, California, USA.
authors: Eric
authors: E
authors: Crosbie
authors: International Advocacy Center, Campaign for Tobacco Free Kids, Washington DC, USA.
authors: Patricia
authors: P
authors: Sosa
authors: Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, California, USA.
authors: Stanton A
authors: SA
authors: Glantz
mesh_terms: D000329:Advertising / Q000331:legislation & jurisprudence; D003132:Commerce / Q000191:economics; D003364:Costa Rica; D006291:Health Policy; D006801:Humans; D008119:Lobbying; D011356:Product Labeling / Q000331:legislation & jurisprudence; D061845:Smoke-Free Policy / Q000331:legislation & jurisprudence; D000074606:Smoking Prevention / Q000331:legislation & jurisprudence*; D012941:Social Responsibility; D013660:Taxes / Q000331:legislation & jurisprudence*; D019460:Tobacco Industry / Q000331:legislation & jurisprudence*; D062789:Tobacco Products / Q000191:economics / Q000331:legislation & jurisprudence*
keywords: Advertising and Promotion; Global health; Low/Middle income country; Packaging and Labelling; Public policy