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The importance of continued engagement during the implementation phase of tobacco control policies in a middle-income country: the case of Costa Rica
  1. Eric Crosbie1,2,
  2. Patricia Sosa3,
  3. Stanton A Glantz1
  1. 1Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, California, USA
  2. 2Department of Politics, University of California Santa Cruz, Santa Cruz, California, USA
  3. 3International Advocacy Center, Campaign for Tobacco Free Kids, Washington DC, USA
  1. Correspondence to Professor Stanton A Glantz, Center for Tobacco Control Research and Education, Room 366 Library, 530 Parnassus, San Francisco, CA 94143-13990, USA; glantz{at}


Objective 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.

Method Review of tobacco control legislation, newspaper articles and interviewing key informants.

Results 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.

Conclusions 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.

  • Advertising and Promotion
  • Global health
  • Public policy
  • Low/Middle income country
  • Packaging and Labelling

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  • Contributors EC collected the raw data and prepared the first draft of the manuscript. PS helped revise the paper. SAG initiated and supervised the project and helped revise the paper.

  • Funding This work was supported by National Cancer Institute Grant CA-87472. The funding agency played no role in the conduct of the research or the preparation of this article.

  • Competing interests None declared.

  • Ethics approval This study was conducted with the approval of the UCSF Committee on Human Research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Most data are public documents and media reports. The interviews are available to qualified researchers on request to the authors.