Protecting Children and Families from Tobacco: Leadership Training. Nicaragua

Transcripción

1 Click here for the Table of Contents! Protecting Children and Families from Tobacco: Leadership Training Nicaragua VI Congreso Latinoamericano de Pediatría vember 14, 2012 La Asociación Latinoamericana de Pediatría-ALAPE

2 Table of Contents Click on the links below to access the reports included in this document. WHO Country Profile WHO NCD WHO Region of the Americas Atlantico Bluefields GYTS 2003 Factsheet (Ages 13 15) Atlantico Puerto Cabezas GYTS 2003 Factsheet (Ages 13 15) Centro GYTS 2003 Factsheet (Ages 13 15) Centro Managua GYTS 2003 Factsheet (Ages 13 15) Pacifico GYTS 2003 Factsheet (Ages 13 15) Informe sobre Control del Tabaco 2011 Additional Resources

3 WHO Report on the Global Tobacco Epidemic, 2011 Country profile Nicaragua te: Where no data were available, " " shows in the table. Where data were not required, " " shows in the table. WHO Framework Convention on Tobacco Control (WHO FCTC) status Date of signature 7 June 2004 Date of ratification (or legal equivalent) 9 April 2008 Socioeconomic context Population (thousands) 5822 Income group Middle income Prevalence of tobacco use Tobacco use data as provided by the country from the latest survey result available to WHO as at 1 vember 2010 Any smoked tobacco Cigarettes Adult prevalence, smoking (%)* Current Daily Current Daily Male Female Total Adult prevalence, smokeless tobacco use (%)*... Male... Female... Total... * Ages 15-49, Encuesta Nicaragüense de Demografia y Salud, 2001 " " Data not reported/not available. WHO age-standardized estimated prevalence of smoking among those aged 15 years or more: Year 2009 Adult prevalence, smoking (%) Any smoked tobacco Cigarettes Current Daily Current Daily Male Female Total " " Estimate not available.

4 Country Profile: Nicaragua Tobacco control measures and programmes as at 31 December 2010 Smoke-free environments 2010 Public places with smoke-free legislation: Health-care facilities * Educational facilities except universities * Universities * Government facilities * Indoor offices * Restaurants Pubs and bars Public transport * All other public places NA Compliance score... National law requires fines for smoking * Fines levied on the establishment Fines levied on the smoker Dedicated funds for enforcement * Citizen complaints and investigations * * Policy adopted but not implemented by 31 December A score of 0 10, where 0 is low compliance. Subnational laws on smoke-free environments Subnational jurisdictions do not have the authority to adopt and implement smoke-free laws. 2

5 Country Profile: Nicaragua Treatment of tobacco dependence Is there a toll-free telephone quit line/help line with a live person available to discuss cessation with callers in your country? 2010 Nicotine replacement therapy (e.g., patch, gum, lozenge, spray or inhaler) Bupropion (e.g., Zyban, Wellbutrin) Varenicline Is this product legally sold in the country? Where and how can this product be legally purchased in your country? Does the national/federal health insurance or the national health service cover the cost of this product? Is any NRT on the country's essential drugs list? Is this product legally sold in your country? Where and how can this product be legally purchased in your country? Does the national/federal health insurance or the national health service cover the cost of this product? Is this product legally sold in your country? In a pharmacy with a prescription Is smoking cessation support available in the following places in your country? Does the national/federal health insurance or the national health service cover the cost of this support? Where and how can this product be legally purchased in your country? Does the national/federal health insurance or the national health service cover the cost of this product? Health clinics or other primary care facilities in most Hospitals in most Office of a health professional in most In the community Other Health clinics or other primary care facilities Hospitals Office of a health professional In the community Other 3

6 Country Profile: Nicaragua Health warnings on tobacco packages 4 Cigarettes 2010 Smokeless tobacco Does the law mandate that health warnings appear on tobacco packages? What percentage of the principal display areas of the package is legally mandated to be 50* 50* covered by health warnings? FRONT AND REAR COMBINED What percentage of the principal display areas of the FRONT of the package is legally 50* 50* mandated to be covered by health warnings? What percentage of the principal display areas of the REAR of the package is legally 50* 50* mandated to be covered by health warnings? Does the law mandate that the warning be placed at the top of the principle display areas of the package? Does the law mandate font style, font size and colour for package warnings? * * Are the health warnings rotating on packages? * * Are the health warnings on packages written in the principal language(s) of the country? * * Does the law require that health warnings on packages are not obscured in any way, * * including by required markings such as tax stamps? Do the health warnings on packages include a photograph or graphic? * * Do health warnings appear on each package and any outside packaging and labelling used * * in the retail sale? Does the law on health warnings apply to products whether manufactured domestically, imported, AND for duty-free sale? Does the law state that warnings on packages do not remove or diminish the liability of the tobacco industry? Do health warnings on packages describe the harmful effects of tobacco use on health? a a Does the law mandate specific health warnings on cigarette packages? * * How many specific health warnings are approved by the law? 6* 6* Does the law require or establish fines for violations regarding health warnings on * * packages? Are there any laws requiring that cigarette packaging and labelling do not use misleading * * terms which imply the product is less harmful than other similar products, such as low tar, light, ultra-light, or mild? Are there any laws requiring that cigarette packaging and labelling do not use figurative or other signs, including colours or numbers, as substitutes for prohibited misleading terms and descriptors? Are there any laws requiring that cigarette packaging and labelling do not use descriptors depicting flavours? Does the law ban the display of quantitative information on emission yields (such as tar, nicotine and carbon monoxide) on cigarette packaging, including when used as part of a brand name or trademark? Does the law mandate the display of qualitative information on relevant constituents and emissions of tobacco products on cigarette packaging? Does the law mandate that this information is displayed on one or more of the principal display areas (front, rear) of the package? Does the law prevent the display of expiry dates on cigarette packaging? Is it mandatory for the quit line number to appear on packaging or labelling? Does the law mandate plain packaging (ie. prohibit the use of logos, colours, brand images or promotional information on packaging other than brand names and product names displayed in a standard colour and font style)? * Policy adopted but not implemented by 31 December a Regulations pending.

7 Country Profile: Nicaragua Bans on tobacco advertising, promotion and sponsorship 2010 Direct bans National TV and radio * International TV and radio * Local magazines and newspapers International magazines and newspapers Billboards and outdoor advertising * Point of sale Internet Other direct bans Compliance score of direct bans Indirect bans Free distribution * Promotional discounts n-tobacco goods and services identified with tobacco brand names Brand name of non-tobacco products used for tobacco product Appearance of tobacco brands in TV and/or films (product placement) Appearance of tobacco products in TV and/or films Sponsored events Other indirect bans Compliance score of indirect bans Are there subnational laws or regulations banning some or all types of tobacco advertising, promotion and sponsorship mentioned in the above questions? * Policy adopted but not implemented by 31 December A score of 0 10, where 0 is low compliance. 5

8 Country Profile: Nicaragua Tobacco taxation policy as at 31 July 2010 Price of lowest-cost brand of cigarettes (Casino) A Tax inclusive retail sales price (TIRSP) for a pack of 20 cigarettes NIO NIO Price of Marlboro or similar brand of cigarettes (Marlboro) A Tax inclusive retail sales price (TIRSP) for a pack of 20 cigarettes NIO NIO Taxes on the most popular brand of cigarettes (Belmont) Price of most sold brand, pack of 20 cigarettes In currency reported by country In US$ at official exchange rate WHO's comparable estimate for 2008 NIO USD 1.06 WHO's comparable estimate for 2010 NIO USD 1.30 Taxes on this brand (% of retail price) ᄌ Total taxes Specific excise 0 16 Ad valorem excise 7 0 Value added tax (VAT) Import duty Other taxes ᄌ Individual categories of tax may not add to total due to rounding. National tobacco control programme 2010 Specific national government objectives in tobacco control National agency or technical unit for tobacco control Number of full-time equivalent staff 1 Government expenditure on tobacco control: In currency reported by country... Year of expenditure... In US$ at official exchange rate US$... ***** 6

9 Sociodemographic indicators NCDs IN NICARAGUA Men Women Total population (thousands): 5,869.9 Average annual deaths (thousands): 27.5 Life expectancy at birth (years): Total: 74.1 Male: 71.1 Female: 77.2 Adult literacy rate (%): 93.6 Gross National Income US$ per capita: 1,000.0 % of population covered by any type health insurance:... Burden of disease PREMATURE DEATHS (2007) RISK FACTORS Prevalence (%) of: Total Males Females 37.0 % Cancer 17.3 % Diabetes Mellitus 6,031 premature deaths (<70 yrs) 5.0 % Chronic Respiratory Disease 40.7 % Cardiovascular Disease Premature deaths from NCDs (<70 yrs) account for 21.9 % of all deaths Current adult tobacco smokers Adolescent tobacco smokers Fruit and vegetable intake in adults a Fruit and vegetable intake in adolescents a Binge drinking among adults Low physical activity in adults b Low physical activity in adolescents c Overweight among adults (BMI ) Obesity among adults (BMI 30) Overweight among adolescents (BMI>+1SD) Obesity among adolescents (BMI>+2SD) Children <5 overweight Adults with diabetes mellitus Adults with raised BP and/or taking medication tes: a: % who eat 5 servings of fruit and vegetables per day; b: physically active for <600 met minutes; c: physically active less than 60 min per day in 5-7 of the last 7 days; BP: Blood pressure. Country capacity POLICIES & ACTION PLANS SURVEILLANCE Is there an integrated NCD policy? Is there a budget? Is there an operational multisectoral mechanism to coordinate the NCD policies? Is there an integrated NCD action plan? If the answer is yes, does it have: Budget? Measurable outcomes? Monitoring and evaluation component? Communications component? N/A Is there dedicated staff? Does the information system include specific data on? Specific cause of mortality Hospital based morbidity Risk factors surveys Are there disease specific registries? Is there a unique personal identifier? Use of data for policy making and planning? Are there plans for specific diseases? Established mechanisms for data dissemination? te: N/A: t applicable. 41

10 Country capacity PREVENTIVE HEALTH SERVICES AT THE PRIMARY LEVEL OF CARE CVD RISK ASSESSMENT BMI Blood pressure Blood glucose Blood lipids Individual risk management with a validated CV risk score DM AND CVD MANAGEMENT Blood pressure monitoring Blood glucose monitoring Blood lipids monitoring HbA1C Diabetic foot examination Available? All patients Free? Limited resources Electrocardiogram t specified CERVICAL CANCER Cervical cytology or PAP Available? All patients Free? tes: HPV: Human Papillomavirus; DM: Diabetes mellitus; CVD: Cardiovascular disease; CV: Cardiovascular. Limited resources HPV DNA testing t applicable Visual inspection techniques (VIA) VIA & cryotherapy in a single visit BREAST CANCER Clinical examination Mammography COLORECTAL CANCER Fecal occult blood test Digital exam SPECIALIZED CARE CANCER DIAGNOSIS AND TREATMENT Colposcopy Diagnostic mammography Chemotherapy Radiotherapy CVD MANAGEMENT Cardiac bypass Available? All patients response Free? Limited resources Angioplasty t applicable DIABETES MANAGEMENT Eye exams Photocoagulation for retinopahty Dialysis OTHER Home care for patients with terminal or advanced disease Available? All patients response Free? Limited resources t applicable NON COMMUNICABLE DISEASES MEDICINES Insulin Aspirin Metformin Glibenclamide Thiazide diuretics Available? All patients Free? Limited resources Calcium channels blockers Beta blockers Statins Tamoxifen Available? All patients Free? Limited resources ACE inhibitors Oral morphine t applicable 42 Sources:»» Sociodemographic indicators and risk factors: Pan American Health Organization. n communicable disease project, health information and analysis project and sustainable development and environment area: n communicable diseases in the Americas: Basic indicators 2011, Washington DC, USA, 2011.»» Premature mortality: PAHO/WHO Mortality Information System (updated on May 2011).»» Country capacity: 2012 Country Capacity Survey in preparation for the CARMEN meeting, completed by Wendy Idiaquez Mendoza, General Director of quality of care, Ministry of Health, Nicaragua.

11 NICARAGUA REGION OF THE AMERICAS Population (millions) All adults, ages Female adults All youth, ages Female youth Source: United Nations Population Division, World Population Prospects (2000 revision) Real GDP per capita (PPP), US Dollars Source: World Health Report 2002 SMOKING PREVALENCE Adult (Young), 1988 Males 51 Females 16 Youth (11-22 Year Olds), 2001 Male 49.6 Females 23.9 Overall 35.5 Health Professionals Males Females Overall Adult: Current smoking in northern Nicaragua among rural agricultural and urban industrial workers with an average age of 33 years for men and 25 years for women, measured by the Nicaragua-Sweden Cooperative Program on Occupational Health Research; Quintero, C., Andersson, K., McConnel, R. and Hogstedt, C. (1989). Valores de referencia para funcion pulmonar en trabajadores nicaraguenses. Orebro: Universidad Nacional Autonoma de Nicaragua. Youth: Current daily smoking; Ministerio de Salud. Urban schools in Leon City. Information provided by WHO PAHO Regional Office (April 29, 2003). Health professional: data available TOBACCO ECONOMY Annual per capita Consumption, Three Year Moving Average Level of cigarette consumption data available Annual Cigarette Consumption Per capita Consumption Total Consumption Year (cigarette sticks) (millions of cigarette sticks) Annual Tobacco Trade and Agriculture Statistics Unit of Measurement Cigarette imports sticks in millions Cigarette exports sticks in millions 64 2 Tobacco leaf imports metric tons Tobacco leaf exports (% of total exports) metric tons (%) 575 (1.08%) 423 (0.35%) 494 (0.43%) 457 (0.49%) 1149 (0.88%) Cigarette production sticks in millions Tobacco leaf production metric tons Land devoted to tobacco growing (% of agricultural land) hectares (%) 1032 (0.02%) 1645 (0.03%) 840 (0.01%) 1325 (0.02%) 934 (0.01%) Employment in tobacco manufacturing people Retail Price of 20 Cigarettes with Tax Type US $ Local MPPC $ Source: TJI, 2001 Cigarette Taxes and Duties Excise tax (domestic) 40% of ex-factory price Sales tax 15% Import duty 39% Imports from CACM countries are duty free Source: TMA Market Share by Cigarette Manufacturer, 2001 BAT 85% Smuggling 10% Source: Dr. Julio César Bendaña (MIFIC), PAHO PM 5% 290

12 SMOKING-RELATED DISEASE IMPACT Mortality from Cancer, Respiratory and Circulatory Disease, 2000 Numbers of deaths/ World age-standardized mortality rate per 100,000 population Male Female Disease Number Rate Number Rate Ages Trachea, lung, and bronchus cancer Lip, oral cavity, and pharynx cancer Respiratory disease Source: World Health Organization. (2003). WHO Mortality Database. Geneva: WHO. Male Female Disease Number Rate Number Rate Ages Ischemic heart disease Stroke Other diseases of the circulatory system All causes INFRASTRUCTURE FOR TOBACCO CONTROL National Tobacco Control Provisions Tobacco Bans t and Restrictions Banned Restricted Regulated Unknown Advertising in certain media Advertising to certain audiences Advertising in certain locations Advertisement content or design Sponsorship or promotion for certain audiences Sponsorship advertising of events Brand stretching Sales to minors Sales by minors Place of sales Vending machines Free products Single cigarette sales Misleading information on packaging Smoking in government buildings (incl. worksites) Smoking in private worksites Smoking in educational facilities Smoking in health care facilities Smoking on buses Smoking on trains Smoking in taxis Smoking on ferries Smoking on domestic air flights Smoking on international air flights Smoking in restaurants Smoking in nightclubs and bars Smoking in other public places Tobacco Requirements t and Regulations Required Regulated Regulated Unknown Advertising health warnings/ messages Age verification for sales Manufacturing licensure Package health warning/ message Label design on packaging Ingredient/constituent information on package label Amount of tar Amount of nicotine Amount of other ingredients/ constituents Product constituents as confidential information Product constituents as public information Constituent disclosure by brand Constituent disclosure in the aggregate Other Provisions Unknown National tobacco control committee Tobacco control education/ promotion Anti-smuggling provisions Litigation enabling provisions Refer to Appendix B for more information about national tobacco control provisions. 291

13 Nicaragua - Atlantico Bluefields (Ages 13-15) Global Youth Tobacco Survey (GYTS) FACT SHEET The Nicaragua - Atlantico Bluefields GYTS includes data on prevalence of cigarette and other tobacco use as well as information on five determinants of tobacco use: access/availability and price, exposure to secondhand smoke (SHS), cessation, media and advertising, and school curriculum. These determinants are components Nicaragua - Atlantico Bluefields could include in a comprehensive tobacco control program. The Nicaragua - Atlantico Bluefields GYTS was a schoolbased survey of students in years 1, 2 and 3 conducted in A two-stage cluster sample design was used to produce representative data for Nicaragua - Atlantico Bluefields. At the first stage, schools were selected with probability proportional to enrollment size. At the second stage, classes were randomly selected and all students in selected classes were eligible to participate. The school response rate was 100.0%, the class response rate was 100.0%, the student response rate was 93.0%, and the overall response rate was 93.0%. A total of 370 students aged participated in the Nicaragua - Atlantico Bluefields GYTS. Prevalence 46.0% of students had ever smoked cigarettes (Boy = 58.9%, Girl = 37.4%) 20.2% currently use any tobacco product (Boy = 23.2%, Girl = 18.0%) 16.7% currently smoke cigarettes (Boy = 16.5%, Girl = 16.4%) 6.7% currently use other tobacco products (Boy = 11.0%, Girl = 3.9%) 24.4% of never smokers are likely to initiate smoking next year Knowledge and Attitudes 26.3% think boys and 11.2% think girls who smoke have more friends 13.0% think boys and 8.8% think girls who smoke look more attractive Access and Availability - Current Smokers 28.3% usually smoke at home 31.9% buy cigarettes in a store Exposure to Secondhand Smoke (SHS) 38.0% live in homes where others smoke in their presence 49.3% are around others who smoke in places outside their home 85.2% think smoking should be banned from public places 62.8% think smoke from others is harmful to them 33.8% have one or more parents who smoke 11.0% have most or all friends who smoke Cessation - Current Smokers 76.9% tried to stop smoking during the past year 66.2% have ever received help to stop smoking Media and Advertising 78.6% saw anti-smoking media messages, in the past 30 days 72.2% saw pro-cigarette ads on billboards, in the past 30 days 64.4% saw pro-cigarette ads in newspapers or magazines, in the past 30 days 8.1% have an object with a cigarette brand logo 9.4% were offered free cigarettes by a tobacco company representative School 62.9% had been taught in class, during the past year, about the dangers of smoking 31.3% had discussed in class, during the past year, reasons why people their age smoke 54.5% had been taught in class, during the past year, the effects of tobacco use Highlights 20.2% of students currently use any form of tobacco; 16.7% currently smoke cigarettes; 6.7% currently use some other form of tobacco. SHS exposure is high almost 2 in 5 students live in homes where others smoke, and half the students are exposed to smoke around others outside of the home; one-third of the students have at least one parent who smokes. Over 3 in 5 students think smoke from others is harmful to them. More than 8 in 10 students think smoking in public places should be banned. 8.1% of students have an object with a cigarette brand logo on it. Over three-quarters of the students saw anti-smoking media messages in the past 30 days; more than 7 in 10 students saw pro-cigarette ads on billboards and close to twothirds saw pro-tobacco ads in newspapers or magazines in the past 30 days. For additional information, please contact: Marcos Membreño Idiáquez Phone: (505)

14 Nicaragua - Atlantico Puerto Cabezas (Ages 13-15) Global Youth Tobacco Survey (GYTS) FACT SHEET The Nicaragua - Atlantico Puerto Cabezas GYTS includes data on prevalence of cigarette and other tobacco use as well as information on five determinants of tobacco use: access/availability and price, exposure to secondhand smoke (SHS), cessation, media and advertising, and school curriculum. These determinants are components Nicaragua - Atlantico Puerto Cabezas could include in a comprehensive tobacco control program. The Nicaragua - Atlantico Puerto Cabezas GYTS was a schoolbased survey of students in years 1, 2 and 3 conducted in A two-stage cluster sample design was used to produce representative data for Nicaragua - Atlantico Puerto Cabezas. At the first stage, schools were selected with probability proportional to enrollment size. At the second stage, classes were randomly selected and all students in selected classes were eligible to participate. The school response rate was 100.0%, the class response rate was 100.0%, the student response rate was 80.6%, and the overall response rate was 80.6%. A total of 355 students aged participated in the Nicaragua - Atlantico Puerto Cabezas GYTS. Prevalence 49.3% of students had ever smoked cigarettes (Boy = 56.6%, Girl = 44.0%) 23.9% currently use any tobacco product (Boy = 29.2%, Girl = 20.0%) 20.0% currently smoke cigarettes (Boy = 25.4%, Girl = 15.7%) 9.3% currently use other tobacco products (Boy = 9.3%, Girl = 8.9%) 26.4% of never smokers are likely to initiate smoking next year Knowledge and Attitudes 27.3% think boys and 17.8% think girls who smoke have more friends 22.6% think boys and 13.4% think girls who smoke look more attractive Access and Availability - Current Smokers 14.0% usually smoke at home 36.8% buy cigarettes in a store Exposure to Secondhand Smoke (SHS) 48.8% live in homes where others smoke in their presence 61.5% are around others who smoke in places outside their home 79.5% think smoking should be banned from public places 49.6% think smoke from others is harmful to them 34.2% have one or more parents who smoke 14.7% have most or all friends who smoke Cessation - Current Smokers 83.8% have ever received help to stop smoking Media and Advertising 75.6% saw anti-smoking media messages, in the past 30 days 73.5% saw pro-cigarette ads on billboards, in the past 30 days 66.5% saw pro-cigarette ads in newspapers or magazines, in the past 30 days 14.2% have an object with a cigarette brand logo 15.5% were offered free cigarettes by a tobacco company representative School 65.1% had been taught in class, during the past year, about the dangers of smoking 35.2% had discussed in class, during the past year, reasons why people their age smoke 51.5% had been taught in class, during the past year, the effects of tobacco use Highlights 23.9% of students currently use any form of tobacco; 20.0% currently smoke cigarettes; 9.3% currently use some other form of tobacco. SHS exposure is high half the students live in homes where others smoke, and 6 in 10 students are exposed to smoke around others outside of the home; one-third of the students have at least one parent who smokes. Half the students think smoke from others is harmful to them. Seven in 10 students think smoking in public places should be banned. One in 7 students has an object with a cigarette brand logo on it. Three-quarters of the students saw anti-smoking media messages in the past 30 days; more than 7 in 10 students saw pro-cigarette ads on billboards and two-thirds saw pro-tobacco ads in newspapers or magazines in the past 30 days. For additional information, please contact: Marcos Membreño Idiáquez Phone: (505)

15 Nicaragua - Centro (Ages 13-15) Global Youth Tobacco Survey (GYTS) FACT SHEET The Nicaragua - Centro GYTS includes data on prevalence of cigarette and other tobacco use as well as information on five determinants of tobacco use: access/availability and price, exposure to secondhand smoke (SHS), cessation, media and advertising, and school curriculum. These determinants are components Nicaragua - Centro could include in a comprehensive tobacco control program. The Nicaragua - Centro GYTS was a school-based survey of students in years 1, 2 and 3 conducted in Prevalence 32.9% of students had ever smoked cigarettes (Boy = 46.1%, Girl = 22.6%) 19.1% currently use any tobacco product (Boy = 26.1%, Girl = 13.3%) 14.2% currently smoke cigarettes (Boy = 21.1%, Girl = 9.4%) 7.6% currently use other tobacco products (Boy = 9.8%, Girl = 5.5%) 18.5% of never smokers are likely to initiate smoking next year Knowledge and Attitudes 27.7% think boys and 13.9% think girls who smoke have more friends 12.3% think boys and 12.0% think girls who smoke look more attractive Access and Availability - Current Smokers 12.6% usually smoke at home 31.4% buy cigarettes in a store 76.5% who bought cigarettes in a store were NOT refused purchase because of their age Exposure to Secondhand Smoke (SHS) 38.1% live in homes where others smoke in their presence 48.3% are around others who smoke in places outside their home 86.9% think smoking should be banned from public places 66.8% think smoke from others is harmful to them 29.6% have one or more parents who smoke 13.9% have most or all friends who smoke A two-stage cluster sample design was used to produce representative data for Nicaragua - Centro. At the first stage, schools were selected with probability proportional to enrollment size. At the second stage, classes were randomly selected and all students in selected classes were eligible to participate. The school response rate was 100.0%, the class response rate was 100.0%, the student response rate was 88.5%, and the overall response rate was 88.5%. A total of 1,005 students aged participated in the Nicaragua - Centro GYTS. Highlights 19.1% of students currently use any form of tobacco; 14.2% currently smoke cigarettes; 7.6% currently use some other form of tobacco. SHS exposure is high nearly 2 in 5 students live in homes where others smoke, and almost half the students are exposed to smoke around others outside of the home; 3 in 10 students have at least one parent who smokes. Two-thirds of the students think smoke from others is harmful to them. Over 8 in 10 students think smoking in public places should be banned. Cessation - Current Smokers 87.6% want to stop smoking 77.6% tried to stop smoking during the past year 76.2% have ever received help to stop smoking Media and Advertising 78.9% saw anti-smoking media messages, in the past 30 days 71.9% saw pro-cigarette ads on billboards, in the past 30 days 66.2% saw pro-cigarette ads in newspapers or magazines, in the past 30 days 9.2% have an object with a cigarette brand logo 11.9% were offered free cigarettes by a tobacco company representative School 74.0% had been taught in class, during the past year, about the dangers of smoking 34.6% had discussed in class, during the past year, reasons why people their age smoke 65.5% had been taught in class, during the past year, the effects of tobacco use Close to 9 in 10 current smokers want to stop smoking. One in 11 students has an object with a cigarette brand logo on it. More than three-quarters of the students saw anti-smoking media messages in the past 30 days; 7 in 10 students saw procigarette ads on billboards and two-thirds saw pro-tobacco ads in newspapers or magazines in the past 30 days. For additional information, please contact: Marcos Membreño Idiáquez Phone: (505)

16 Nicaragua - Centro Managua (Ages 13-15) Global Youth Tobacco Survey (GYTS) FACT SHEET The Nicaragua - Centro Managua GYTS includes data on prevalence of cigarette and other tobacco use as well as information on five determinants of tobacco use: access/availability and price, exposure to secondhand smoke (SHS), cessation, media and advertising, and school curriculum. These determinants are components Nicaragua - Centro Managua could include in a comprehensive tobacco control program. The Nicaragua - Centro Managua GYTS was a school-based survey of students in years 1, 2 and 3 conducted in Prevalence 51.2% of students had ever smoked cigarettes (Boy = 55.9%, Girl = 47.4%) 25.1% currently use any tobacco product (Boy = 30.4%, Girl = 20.5%) 21.2% currently smoke cigarettes (Boy = 25.6%, Girl = 17.4%) 9.6% currently use other tobacco products (Boy = 12.8%, Girl = 6.7%) 21.3% of never smokers are likely to initiate smoking next year Knowledge and Attitudes 25.0% think boys and 14.7% think girls who smoke have more friends 10.5% think boys and 7.5% think girls who smoke look more attractive Access and Availability - Current Smokers 19.0% usually smoke at home 29.9% buy cigarettes in a store 77.8% who bought cigarettes in a store were NOT refused purchase because of their age Exposure to Secondhand Smoke (SHS) 43.7% live in homes where others smoke in their presence 54.1% are around others who smoke in places outside their home 83.9% think smoking should be banned from public places 71.7% think smoke from others is harmful to them 37.1% have one or more parents who smoke 16.9% have most or all friends who smoke Cessation - Current Smokers 60.4% want to stop smoking 69.4% tried to stop smoking during the past year 73.3% have ever received help to stop smoking Media and Advertising 80.8% saw anti-smoking media messages, in the past 30 days 83.2% saw pro-cigarette ads on billboards, in the past 30 days 74.2% saw pro-cigarette ads in newspapers or magazines, in the past 30 days 12.5% have an object with a cigarette brand logo 14.1% were offered free cigarettes by a tobacco company representative School 66.1% had been taught in class, during the past year, about the dangers of smoking 31.9% had discussed in class, during the past year, reasons why people their age smoke 61.5% had been taught in class, during the past year, the effects of tobacco use A two-stage cluster sample design was used to produce representative data for Nicaragua - Centro Managua. At the first stage, schools were selected with probability proportional to enrollment size. At the second stage, classes were randomly selected and all students in selected classes were eligible to participate. The school response rate was 100.0%, the class response rate was 100.0%, the student response rate was 86.4%, and the overall response rate was 86.4%. A total of 881 students aged participated in the Nicaragua - Centro Managua GYTS. Highlights One-quarter of the students currently use any form of tobacco; 21.2% currently smoke cigarettes; 9.6% currently use some other form of tobacco. SHS exposure is high over 2 in 5 students live in homes where others smoke, and more than half the students are exposed to smoke around others outside of the home; close to 4 in 10 students have at least one parent who smokes. Seven in 10 students think smoke from others is harmful to them. Over 8 in 10 students think smoking in public places should be banned. Six in 10 current smokers want to stop smoking. One in 8 students has an object with a cigarette brand logo on it. Eight in 10 students saw antismoking media messages in the past 30 days; more than threequarters of the students saw pro-cigarette ads on billboards and in newspapers or magazines in the past 30 days. For additional information, please contact: Marcos Membreño Idiáquez Phone: (505)

17 Nicaragua - Pacifico (Ages 13-15) Global Youth Tobacco Survey (GYTS) FACT SHEET The Nicaragua - Pacifico GYTS includes data on prevalence of cigarette and other tobacco use as well as information on five determinants of tobacco use: access/availability and price, exposure to secondhand smoke (SHS), cessation, media and advertising, and school curriculum. These determinants are components Nicaragua - Pacifico could include in a comprehensive tobacco control program. The Nicaragua - Pacifico GYTS was a school-based survey of students in years 1, 2 and 3 conducted in Prevalence 41.3% of students had ever smoked cigarettes (Boy = 51.9%, Girl = 31.4%) 21.5% currently use any tobacco product (Boy = 25.9%, Girl = 16.4%) 17.6% currently smoke cigarettes (Boy = 23.1%, Girl = 12.1%) 7.8% currently use other tobacco products (Boy = 9.0%, Girl = 6.3%) 21.4% of never smokers are likely to initiate smoking next year Knowledge and Attitudes 25.2% think boys and 16.5% think girls who smoke have more friends 13.6% think boys and 11.4% think girls who smoke look more attractive Access and Availability - Current Smokers 17.1% usually smoke at home 21.1% buy cigarettes in a store Exposure to Secondhand Smoke (SHS) 41.3% live in homes where others smoke in their presence 48.9% are around others who smoke in places outside their home 85.6% think smoking should be banned from public places 68.6% think smoke from others is harmful to them 33.9% have one or more parents who smoke 17.8% have most or all friends who smoke Cessation - Current Smokers 73.5% want to stop smoking 63.2% tried to stop smoking during the past year 77.4% have ever received help to stop smoking A two-stage cluster sample design was used to produce representative data for Nicaragua - Pacifico. At the first stage, schools were selected with probability proportional to enrollment size. At the second stage, classes were randomly selected and all students in selected classes were eligible to participate. The school response rate was 95.0%, the class response rate was 100.0%, the student response rate was 89.8%, and the overall response rate was 85.3%. A total of 816 students aged participated in the Nicaragua - Pacifico GYTS. Highlights 21.5% of students currently use any form of tobacco; 17.6% currently smoke cigarettes; 7.8% currently use some other form of tobacco. SHS exposure is high over 2 in 5 students live in homes where others smoke, and almost half the students are exposed to smoke around others outside of the home; one-third of the students have at least one parent who smokes. Seven in 10 students think smoke from others is harmful to them. More than 8 in 10 students think smoking in public places should be banned. Nearly three-quarters of the current smokers want to stop smoking. Media and Advertising 76.3% saw anti-smoking media messages, in the past 30 days 75.6% saw pro-cigarette ads on billboards, in the past 30 days 69.6% saw pro-cigarette ads in newspapers or magazines, in the past 30 days 13.4% have an object with a cigarette brand logo 13.1% were offered free cigarettes by a tobacco company representative School 72.6% had been taught in class, during the past year, about the dangers of smoking 30.6% had discussed in class, during the past year, reasons why people their age smoke 64.5% had been taught in class, during the past year, the effects of tobacco use Over 1in 7 students has an object with a cigarette brand logo on it. More than three-quarters of the students saw anti-smoking media messages in the past 30 days; over 7 in 10 students saw pro-cigarette ads on billboards and in newspapers or magazines in the past 30 days. For additional information, please contact: Marcos Membreño Idiáquez Phone: (505)

18 Nicaragua Informe sobre Control del Tabaco 2011 Prevalencia actual del consumo de tabaco 30,4% 20,5% Adultos Hombres Mujeres Adolescentes NOTAS: Prevalencia actual para adultos: se notificaron datos. Prevalencia actual para jóvenes: porcentaje de la población entre 13 y 15 años que consumió al menos una vez, algún producto de tabaco con o sin humo en los 30 días anteriores a la encuesta. Los datos corresponden al ámbito sub-nacional para el año FUENTE: Basado en los datos del Informe OMS sobre la Epidemia Mundial de Tabaquismo, 2011: Advertencia sobre los peligros del tabaco.

19 Progreso en la implementación del CMCT OMS en la Región de las Américas Adoptado por unanimidad por la 56ª Asamblea Mundial de la Salud del 21 de mayo del 2003, el Convenio Marco de la OMS para el Control del Tabaco (CMCT OMS) fue el primer paso en la lucha mundial contra la epidemia de tabaquismo. El Convenio entró en vigor el 27 de febrero del De los 193 Estados Miembros de la OMS, 174 son Estados Partes en el Convenio (julio 2011) convirtiéndose en uno de los pactos de más rápida aceptación en la historia de las Naciones Unidas. Nicaragua firmó el tratado el 7 de junio del 2004 y lo ratificó el 9 de abril del Como Parte en el Convenio, Nicaragua está legalmente obligada por las disposiciones del tratado. Los siguientes gráficos muestran la situación de Nicaragua en varias áreas claves del tratado y cómo se compara con el resto de los países de la Región de las Américas. El símbolo (3) indica en cual categoría está Nicaragua dentro de cada artículo, con las categorías de color verde representando las políticas más completas. Situación nacional Artículo 6: Medidas relacionadas con los precios e impuestos para reducir la demanda de tabaco Criterio: Porcentaje del precio del paquete que corresponde a impuestos >75% del precio al por menor de un paquete de 20 cigarrillos corresponde a los impuestos al tabaco 51 75% del precio al por menor de un paquete de 20 cigarrillos corresponde a los impuestos al tabaco % del precio al por menor de un paquete de 20 cigarrillos corresponde a los impuestos al tabaco 25% del precio al por menor de un paquete de 20 cigarrillos corresponde a los impuestos al tabaco se notificaron datos Artículo 8: Protección contra la exposición al humo de tabaco Criterio: Número de tipos de espacios públicos que son totalmente libres de humo de tabaco Todos los lugares públicos y de trabajo cerrados son totalmente libres de humo de tabaco (o al menos 90% de la población está cubierta por legislación subnacional) Igual que la categoría anterior pero esta pendiente la reglamentación y/o la implementación 3 De seis a siete tipos de lugares públicos y de trabajo cerrados totalmente libres de humo de tabaco De tres a cinco tipos de lugares públicos y de trabajo cerrados totalmente libres de humo de tabaco Hasta dos tipos de lugares públicos y de trabajo cerrados totalmente libres de humo de tabaco se notificaron datos Artículo 11: Empaquetado y etiquetado de los productos de tabaco Criterio: Tamaño y contenido de advertencias sanitarias en productos de tabaco Advertencia sanitaria grande (que cubre un 50% promedio del frente y dorso del paquete) con todas las características apropiadas 1 3 Igual, pero está pendiente la reglamentación y/o implementación Advertencia sanitaria de tamaño medio (con un promedio del frente y dorso entre 30% y 49%) con todas las características o advertencias sanitarias grandes (promedio de 50% frente y dorso) pero falta una o más características apropiadas 1 Advertencia sanitaria de tamaño medio (promedio de frente y dorso entre 30% y 49%) pero falta una o más características apropiadas o advertencia sanitaria grande (promedio de al menos 50% de frente y dorso) pero faltan cuatro o más características apropiadas 1 Ley aprobada, pero la reglamentación e implementación pendientes. Con la información contenida en la ley no se puede clasificar al país Ningúna advertencia sanitaria o advertencia sanitaria pequeña (promedio en el frente y dorso del paquete de menos de 30%) se notificaron datos Artículo 13: Publicidad, promoción y patrocinio del tabaco Criterio: Número de prohibiciones según medio de publicidad directa e indirecta 2 Prohibición de toda forma de publicidad directa e indirecta 3 Igual, pero está pendiente la reglamentación y/o implementación Prohibición en televisión, radio, y medios impresos nacionales, así como algunas pero no todas las otras formas de publicidad directa y/o indirecta 3 Igual, pero está pendiente la reglamentación y/o implementación Solo prohibición en televisión, radio y en medios impresos nacionales 3 Ausencia de prohibiciones, o prohibiciones que no cubren televisión, radio y medios impresos nacionales se notificaron datos Artículo 14: Medidas de reducción de la demanda relativas a la dependencia y al abandono del tabaco Criterio: Disponibilidad en el país de tratamientos de la dependencia del tabaco y cobertura de gastos Hay disponibilidad de línea telefónica de cesación y de servicios de cesación (SC) 3 con terapias de sustitución nicotínica (TSN) con cobertura total de costos Hay disponibilidad de TSN y/o de algunos SC 3, al menos uno de ellos tiene cobertura de costos 3 Hay disponibilidad de TSN y/o de algunos SC 3, pero ninguno de ellos tiene cobertura de costos Ninguno se notificaron datos 1 Consulte la tabla en la página 5 para ver la lista de características apropiadas. 2 Consulte la tabla en la página 6 para ver la lista de las formas de publicidad directa e indirecta. 3 Apoyo para cesación disponible en cualquiera de los siguientes lugares: centros de salud u otros servicios de atención primaria, hospitales, oficinas de profesionales de la salud, o en la comunidad. Nicaragua Página 2 Situación regional Distribución de países según progreso en la implementación del CMCT Número total de países en la Región de las Américas: 35 Los números en las gráficas indican el número de países en cada categoría. Para información sobre el estado especifico de cada país, visite

20 Precios e impuestos Artículo 6: Medidas relacionadas con los precios e impuestos para reducir la demanda de tabaco En virtud del Artículo 6 del CMCT OMS, las Partes reconocen que las medidas relacionadas con los precios e impuestos son un medio eficaz e importante para que diversos sectores de la población, en particular los jóvenes, reduzcan su consumo de tabaco. Cada Parte deberá aplicar políticas fiscales y de precios a los productos de tabaco, incluyendo la prohibición o restricción, según proceda, de la venta libre de impuestos de productos de tabaco a fin de contribuir a los objetivos de salud tendientes a la reducción de su consumo. Las Partes también deberán informar sobre las tasas impositivas y las tendencias de consumo periódicamente a la Conferencia de las Partes. En Nicaragua el precio de la marca de cigarrillos más vendida es de PPP$ 3,55 y los impuestos comprenden el 29% del precio de venta final. El precio en PPP$ en Nicaragua es más bajo bajo que el promedio de la región (PPP% 3,93) y la porción de dicho precio que corresponde a impuestos es más baja que el promedio en la región (45%). Precios e impuestos al tabaco en Nicaragua, 2010 Precio de una cajetilla de 20 cigarrillos de la marca más vendida En Córdobas de oro NIO 27,95 En dólares internacionales, 2010 PPP$ 3,55 Porcentaje del precio que corresponde a impuestos Impuestos de tipo específico 16% Impuestos de tipo ad valorem 0% Derechos de importación 0% Total de impuestos 1 29% 1 El impuesto total incluye algunos impuestos que no entran en las categorías de impuestos de tipo específico, impuestos de tipo ad valorem o de derechos de importación. Sabías que...? Aumentar los precios del tabaco mediante un incremento significativo de los impuestos constituye la medida individual más eficaz para disminuir el consumo de tabaco y para alentar a sus consumidores a abandonarlo. Los aumentos de los impuestos son muy importantes para disuadir del consumo de tabaco a los jóvenes y a las personas de bajos ingresos. También benefician directamente a los gobiernos porque les permite aumentar sus ingresos fiscales, y éstos a su vez pueden utilizarse en el control del tabaco y en otros programas sanitarios y sociales. todos los impuestos al tabaco son igualmente efectivos. Los impuestos especiales o al consumo tienen un mayor efecto ya que se aplican de manera exclusiva al tabaco (o en conjunto con un número reducido de productos como alcohol y combustible) y por tanto tienen la capacidad de encarecer el tabaco en relación a otros productos. Ello, a diferencia de los impuestos al valor agregado (IVA) que se aplican a un gran número de productos por igual. Existen diferentes tipos de impuestos especiales: los fijados en un monto fijo (específicos) y los fijados en un porcentaje (ad valorem). La elección entre ambos tipos es un tema de discusión. Sin embargo, existe información que sugiere que los impuestos específicos tienden a aumentar el precio al consumidor más que los ad valorem así como que combinarlos es una buena opción: El precio promedio en los países que usan una combinación de específico y ad valorem es de PPP$ 4,42 (en los que se apoyan más en específicos) y de PPP$ 3,40 (en los que se apoyan más en ad valorem). Entre los que usan un tipo o el otro, el precio promedio es de PPP$ 4,51 entre los que sólo usan específicos y PPP$ 2,38 entre los que sólo usan ad valorem. En la región de las Américas de los 33 países que notificaron datos 14 países aplican impuesto sólo del tipo específico, 13 países aplican sólo del tipo ad valorem y únicamente 4 países tienen sistemas combinados (2 países aplican impuestos que no entran en las categorías de tipo específico o ad valorem). $12,00 Precio de un paquete de cigarrillos de la marca más vendida y proporción de él que corresponde a impuestos, 2010 Precio (dólares internacionales, 2010) $10,00 $8,00 $6,00 $4,00 $2,00 $0,00 porción de impuesto Jamaica Barbados Canadá Estados Unidos de América República Bolivariana de Venezuela República Dominicana Panamá Granada Belice Santa Lucía Uruguay Chile San Vicente y las Granadinas México Nicaragua Guyana El Salvador Bahamas Trinidad y Tabago Antigua y Barbuda Honduras San Cristóbal y Nevis Suriname Guatemala Perú Dominica Argentina Costa Rica Estado Plurinacional de Bolivia Brasil Ecuador Colombia Paraguay Fuentes: Basado en los datos del Informe OMS sobre la Epidemia Mundial del Tabaco, 2011: Advertencia sobre los peligros del tabaco. Los datos están actualizados a julio del 2010; cualquier incremento de impuestos o precios posterior a esta fecha no está reflejado. Nicaragua Página 3

21 Ambientes libres de humo de tabaco Artículo 8: Protección contra la exposición al humo de tabaco El Artículo 8 del CMCT OMS y sus Directrices requieren que las Partes protejan a todas las personas contra la exposición al humo de tabaco. En el marco de este artículo, las Partes reconocen que la ciencia ha demostrado inequívocamente que la exposición al humo de tabaco ajeno causa muerte, enfermedad y discapacidad. Cada Parte se compromete a adoptar medidas legislativas que protejan de la exposición al humo de tabaco en los lugares de trabajo interiores, lugares públicos cerrados, transporte público y otros lugares públicos. En Nicaragua la población está protegida por ley de la exposición al humo de tabaco ajeno en todos los lugares de trabajo interiores y lugares públicos cerrados excepto restaurantes y bares. En la región de las Américas, ya hay trece países que han aprobado leyes protegiendo a toda la población sin excepciones de la exposición al humo de tabaco ajeno, aunque no todos han implementado o regulado la legislación. En estos países todos los lugares mencionados en la tabla siguiente son totalmente libres de humo de tabaco. Sabías que...? Varios organismos competentes han determinado que el humo de tabaco ajeno contiene carcinógenos para los cuales no existe ningún nivel seguro de exposición. La única manera de proteger efectivamente a las personas es proporcionar ambientes 100% libres de humo de tabaco. Otros enfoques, como la ventilación, la filtración del aire y el uso de áreas designadas para fumadores no protegen a las personas contra la exposición al humo de tabaco. El apoyo a los lugares públicos libres de humo de tabaco es abrumador. Los mismos benefician tanto a los no fumadores como a los fumadores al reducir la exposición al humo de tabaco ajeno entre no fumadores y reducir el consumo de cigarrillos entre los fumadores. Además disminuyen la aceptabilidad social de fumar, desestimulando la iniciación en los jóvenes. Las leyes de ambientes libres de humo de tabaco, producen no solo beneficios para la salud a largo plazo, como por ejemplo la disminución de la incidencia de cáncer de pulmón en no fumadores, sino también en el corto plazo, con disminución de las admisiones hospitalarias por infarto agudo de miocardio. Legislación de ambientes libres de humo de tabaco en Nicaragua, 2011 Afiche de una campaña de ambientes libre de humo de tabaco en Uruguay. Espacios públicos y lugares de trabajo libres de humo* Centros sanitarios Centros docentes ( universidades) Universidades Edificios gubernamentales Oficinas cerradas Restaurantes Bares Transporte público * Un ambiente totalmente libre de humo de tabaco es aquel donde no se permite fumar en ningún momento, en ninguna área de su interior y bajo ninguna circunstancia. Para que una categoría alcance esta denominación, todos los establecimientos comprendidos en la misma deben cumplir estos requisitos. Fuentes: Basado en los datos del Informe OMS sobre la Epidemia Mundial del Tabaco, 2011: Advertencia sobre los peligros del tabaco. En aquellos países dónde se aprobó legislación en fecha posterior al cierre del informe los datos fueran actualizados a julio del 2011 por el Equipo de Control de Tabaco de la OPS. Nicaragua Página 4

22 Advertencias sanitarias Artículo 11: Empaquetado y etiquetado de los productos de tabaco El Artículo 11 del CMCT OMS y sus Directrices requieren que cada Parte adopte medidas que incluyan la presentación de una serie rotativa de advertencias sanitarias y otros mensajes apropiados en los paquetes de productos de tabaco, que cubran idealmente el 50% o más de las superficies principales expuestas y que preferentemente incluyan imágenes o pictogramas, entre otras. Las Partes también se asegurarán de que en el empaquetado y etiquetado no se promocione un producto de tabaco de manera falsa, equívoca, engañosa o que pueda directa o indirectamente crear una impresión errónea sobre sus características, efectos para la salud, riesgos o emisiones. En Nicaragua la ley sobre advertencias sanitarias cumple con los mandatos del CMCT y sus directrices y exige que ocupen el 50% o más de las superficies principales e incluyan imágenes. (Ley aprobada y reglamentación e implementación pendientes) Sabías que...? Las advertencias sanitarias grandes, enérgicas y con imágenes salvan vidas. Son más efectivas que una advertencia pequeña o sólo de texto. Cuando se muestran los daños causados por el tabaco las advertencias resultan particularmente efectivas para comunicar riesgo y motivar cambios de comportamiento como dejar de fumar. Las imágenes permiten trasmitir el mensaje sanitario a poblaciones no alfabetizadas. Las advertencias gráficas también pueden tener un efecto disuasorio para los jóvenes, al reducir el atractivo general de los paquetes de tabaco. Ejemplo de una advertencia sanitaria gráfica de Uruguay que cubre el 80% de las principales superficies expuestas. Advertencias sanitarias en productos de tabaco en Nicaragua, 2011 Características de las advertencias sanitarias Prohibido usar términos engañosos como suave o bajo contenido de alquitrán etc. Cigarrillos La ley manda advertencias específicas % de las caras principales (promedio del frente y dorso) cubierto por la advertencia % de la cara delantera cubierto por la advertencia % de la cara de atrás cubierto por la advertencia 50% 50% 50% Número de advertencias aprobadas por la ley 6 Las advertencias aparecen en cada paquete y fuera del paquete* Las advertencias describen los efectos nocivos del tabaco para la salud* Exige la ley que las advertencias tengan una fuente de un estilo, tamaño y color determinados?* La serie de advertencias es rotativa* Las advertencias están escritas en el idioma principal del país* Las advertencias incluyen alguna imagen * Estos indicadores incluyen las características usadas para evaluar el estado de las regulaciones de cada país que se muestra en la página 2. Fuentes: Basado en los datos del Informe OMS sobre la Epidemia Mundial del Tabaco, 2011: Advertencia sobre los peligros del tabaco. En aquellos países dónde se aprobó legislación en fecha posterior al cierre del informe los datos fueran actualizados a julio del 2011 por el Equipo de Control de Tabaco de la OPS. Nicaragua Página 5

23 Prohibición de la publicidad, promoción, y patrocinio del tabaco Artículo 13: Publicidad, promoción y patrocinio del tabaco En virtud del Artículo 13 del CMCT OMS y sus Directrices, las Partes reconocen que una prohibición total de la publicidad, la promoción y el patrocinio reduciría el consumo de productos del tabaco. El CMCT OMS requiere que se proceda a dicha prohibición dentro de los cinco años de la entrada en vigencia del tratado. La Parte que no esté en condiciones de proceder a una prohibición total debido a su constitución o sus principios constitucionales, aplicará las siguientes restricciones: prohibirá la publicidad falsa o engañosa, exigirá que las advertencias sanitarias acompañen toda la publicidad, restringirá el uso de incentivos que fomenten la compra de productos del tabaco, y prohibirá o restringirá la publicidad, promoción y patrocinio en la mayor cantidad de medios posibles, entre otras. Asimismo, deberían exigir a la industria del tabaco que revele sus gastos en publicidad, promoción y patrocinio. Nicaragua no tiene una ley integral que prohíba toda forma de publicidad, promoción y patrocinio. Sólo está prohibida la publicidad en radio, TV, vallas publicitarias y anuncios al aire libre y la distribución gratuita por correo. En la Región, Colombia, El Salvador y Panamá son los únicos países que tienen prohibiciones completas de todas formas de publicidad, promoción y patrocino de los productos de tabaco. En El Salvador la ley aún no ha sido reglamentada e implementada, Sabías que...? La mayoría de los fumadores prueban su primer cigarrillo mucho antes de alcanzar la edad adulta. Es por ello que la industria del tabaco crea anuncios coloridos y creativos diseñados para llegar a los jóvenes, patrocina eventos deportivos y financia la aparición de productos de tabaco en las películas. La exhibición de los productos de tabaco en los puntos de venta promociona su consumo, estimulando las compras por impulso y generando la impresión de que el producto es tan socialmente aceptable como cualquier otro que se presenta en estos sitios. Para ser efectiva una prohibición de la publicidad, promoción y patrocinio debe ser integral. Cuando solo se prohíben en ciertos medios, la industria del tabaco traslada su gasto en publicidad hacia los medios permitidos. Las prohibiciones por horarios o grupo de edad trasmiten el mensaje de que fumar es un comportamiento de adultos, haciéndolo por lo tanto más atractivo para los jóvenes. Una prohibición amplia de toda la publicidad, promoción y patrocinio podría reducir el consumo global de tabaco alrededor de un 7%. Prohibiciones de publicidad, promoción y patrocinio del tabaco en Nicaragua, 2011 Prohibiciones directas La televisión y la radio nacional** La televisión y la radio internacional Revistas y periódicos nacionales** Revistas y periódicos internacionales Vallas publicitarias y anuncios al aire libre** Puntos de venta** El Internet/La Red Prohibiciones indirectas Distribución gratuita por correo u otro medios** Descuentos promocionales** Productos no tabáquicos que llevan nombres de marcas de tabaco** mbres comerciales de productos no tabáquicos empleados en productos de tabaco** Aparición de productos de tabaco por televisión y/o en películas cinematográficas ** Eventos patrocinados por la industria del tabaco** Promoción enviada por via postal en los Estados Unidos ** Formas de publicidad directa e indirecta usadas para evaluar el estado de las regulaciones de cada país se muestran en la página 2. Nicaragua Página 6