Navigating Challenges in Tobacco Control: A Systematic Review of Barriers to Implementing Article 5.3 of the WHO Framework Convention on Tobacco Control (FCTC).

Background: Tobacco control efforts face substantial obstacles from industry interference and regulatory weaknesses. This review synthesizes qualitative evidence on barriers to implementing effective tobacco control measures, offering actionable recommendations for policymakers and practitioners. Objective: To identify barriers to implementing tobacco control measures, specifically Article 5.3 of the WHO FCTC, and propose solutions to overcome them. Methods: A systematic search was conducted across PubMed, EBSCO, and the Cochrane Library, using keywords like "tobacco," "industry," and "interference." The search, limited to English-language studies published until July 15, 2024, included qualitative studies addressing barriers to implementing Article 5.3. Eligible studies focused on government policies, institutional actions, economic measures, and public awareness. The protocol was registered in PROSPERO (CRD42024565548). Study quality was assessed using the CASP checklist, and confidence in findings was evaluated with GRADE-CERQual. Findings: Twelve qualitative studies were included, covering regions such as Bangladesh, Ethiopia, India, Uganda, and the UK Overseas Territories. Key barriers identified were conflicts of interest involving government officials, lobbying by the tobacco industry, resource constraints, weak regulatory frameworks, and limited awareness of Article 5.3. Economic considerations often overshadowed public health priorities, further enabling industry influence. Conclusion: Addressing these barriers requires strengthened regulations, improved coordination, and enhanced support for tobacco control initiatives. Efforts should prioritize reducing conflicts of interest, increasing awareness of Article 5.3, and balancing public health and economic interests. Public health dentists and policymakers must collaborate to ensure effective tobacco control measures are implemented and sustained.