Table 1.

Tobacco industry and health advocacy activity during implementation of Law 9028 (2012–2015)

Issue	Law 902819	Regulations22	Tobacco industry (and front groups) interference	Health advocate responses	Results
Smoke-free environments	100% smoke-free, except in hotels	100% smoke-free, except in hotels and in work places `to allow smoking in outdoor spaces located 5 m from the “productive unit'”	▶ Lobbied Health Ministry, complaining about smokers' rights to smoke in open areas (April–June 2012)25	▶ Did not pursue legal action due to legal costs and high compliance with law.27	▶ Health Ministry allowed exception due to smoker complaints (June 2012)25,29
	▶ Electronic cigarettes not defined	▶ Electronic cigarettes prohibited in smoke-free environments	▶ CACORE and CCH complained in the media that each had lost 25% of their revenues31	▶ Questioned the Health Ministry and complained in the media about exception for smoking in open areas28	▶ Despite exception, enforcement has been strong and compliance has been high
					▶ 80% of a group of employers reported that they did not have economic loses (October 2012)31
Tobacco Advertising, Promotion and Sponsorship (TAPS)	▶ 100% prohibited, except places and events that only permit adult access and through direct communication with vendors and consumers	▶ 100% prohibited, except places and events that only permit adult access and through direct communication with vendors and consumers	▶ Lobbied the Health Ministry, MEIC, and the office of the presidency, complaining that TAPs violate intellectual property rights, the right of free enterprise, freedom of expression and consumer rights to information.30	▶ Lobbied Health Ministry to clarify and expand regulations to include banning TAPs through CSR and at the POS (May 2012)23,24	▶ Enforcement has been strong and compliance has been high, except TAPS at the POS
	▶ TAPS not defined at the POS	▶ CSR campaigns prohibited	▶ Issued pamphlets to merchants, endorsed by CACORE that argued the regulation permitted TAPS at the POS44,45	▶ Presented Health Ministry with letters about TAPS at the POS and compliance with Article 13 (September 2013)41	▶ Health Minister Corrales issued a directive permitting TAPS at the POS to respect the consumer's right to information42
		▶ Electronic digital advertising prohibited		▶ Filed complaints with Health Ministry about tobacco companies promoting to merchants that the regulation permitted TAPS at the POS44,45
		▶ TAPS 100% prohibited at the POS
Tobacco Taxes	▶ 20 colones (US$0.04) per cigarette package	▶ Same	▶ Complained and exaggerated in the media that the tobacco tax increase was directly related to the upsurge in smuggled cigarettes49	▶ Tobacco taxes helped expand tobacco control programmes, support implementation, and increase global participation in international tobacco control efforts28,36,37	▶ Finance Ministry and fiscal control police reported that Law 9028 had little to no impact on smuggled cigarettes48
	▶ 100% of funds allocated to CCSS (60%), Health Ministry (20%), IAFA (10%), and ICODER (10%)
Cigarette Package Health Warning Labels (HWLs)	▶ Front: 50% pictorial.	▶ Same	▶ Lobbied MEIC, complaining the HWLs were a technical barrier to trade and that it was necessary to consult trade agreements (eg, WTO) before adopting HWL regulations25	▶ Presented Health Ministry with legal advice that the WTO Preamble recognises government rights to take necessary measures to protect public health and that more than 50 countries have established 50% pictorial HWLs following FCTC Article 11 (April 2013)52,58*	▶ Regulations implemented in September 2014 instead of June 201360
	▶ Back: 50% pictorial		▶ Lobbied Health Ministry for a 2-month extension to implement new designs37		▶ Health Ministry allowed a 2-month grace period for new pictorial HWLs to be implemented61

^*As of September 2014, more than 60 countries have established 50% pictorial HWLs.

CACORE, Costa Rican Chamber of Restaurants; CCH, Costa Rican Chamber of Hotels; CCSS, Costa Rican Social Security Fund; CSR, Corporate Social Responsibility; FCTC, Framework Convention on Tobacco Control; IAFA, Institute of Alcoholism and Drug Dependence; ICODER, Costa Rican Institute of Sport and Recreation; MEIC, Ministry of Economy, Industry, and Commerce; POS, Point of Sale; WTO, World Trade Organization.