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They experience higher levels of violence than adults, which undermines their basic human rights and threatens their development.[40] According to Cristosal, high rates of early and forced pregnancies among adolescents, widespread sexual violence, and alarming levels of problematic alcohol consumption are related to a broader context of violence.[41] Disciplinary practices within families frequently involve both physical and psychological abuse.[42] Such problems, together with pervasive gang violence, contribute to elevated school dropout rates, participation in criminal groups, and migration among children and youth.[43] For years, the homicide rate among children in El Salvador has been one of the highest globally, reflecting an alarming level of violence and severe violations of the fundamental rights to life and physical security.[44] Homicide has consistently been the leading cause of death among Salvadoran children and young people aged 10 to 19.[45] The Institute of Legal Medicine (Instituto de Medicina Legal, IML) documented some 6,300 homicides of children and adolescents (ages 0 to 19) from 2005 to 2013.[46] Of these, the majority89 percentwere among teenagers aged 15 to 19, and 87 percent were male.[47] In El Salvador, 2,714 children from ages 0 to 17 were murdered, from January 2014 to March 2022, the government reported, before declaring information on homicides classified for seven years.[48] Discrepancies in figures reported by various government agencies complicate the assessment of the true scale of child homicides.[49] A study conducted in 2023 by the Pan American Journal of Public Health (PAJPH), highlights the high homicide rates among those aged 10-19 in El Salvador for the decade from 2010 to 2019.[50] Disappearancesmeaning, in El Salvador and elsewhere in the region, the seizing of people, by any perpetrator, against their will, with their fate and whereabouts unknownhave notably affected children in El Salvador.[51] In addition to kidnappings to increase territorial control, gangs appear to use disappearances to kill, lowering official homicide counts, particularly during negotiations with governments.[52] Sexual violence is pervasive in El Salvador, disproportionately affecting women and girls

Many European countries should intensify the implementation of tobacco control policies that are effective to reach the youngsters, in particular increases in the price of tobacco products, enforced legislation on sales to minors, plain packaging, and bans on advertising. Dr