BACKGROUND: The need to address the tobacco epidemic from an international approach had been acknowledged for some time, but it was not until 1996 that the World Health Organization initiated preparations for what would become the Framework Convention on Tobacco Control (FCTC). Adopted in May 2003 by the World Health Assembly, the FCTC gained 168 signatories and later entered into force in February 2005. As of January 2025, the FCTC had 183 Parties, covering more than 90% of the world’s population. The FCTC has often been lauded as a success story but its impact has not been systematically assessed.
METHODS: We conducted a systematic review of studies that examined the impact of the FCTC on policy implementation, tobacco use, and health. We searched three electronic databases, two grey literature databases, and two working paper repositories. At least three reviewers independently screened studies for inclusion, extracted characteristics, and assessed risk of bias.
RESULTS: Thirteen studies met our inclusion criteria. The number of years since FCTC ratification was generally associated with higher odds of having enacted advertising bans, smoking bans in pubs and indoor workplaces, mandated FCTC-compliant and graphic warning labels, but not with having higher taxes. On the whole, existing studies provided mixed and contradictory evidence that the FCTC affected cigarette use.
CONCLUSIONS: Most studies reviewed have important methodological limitations; all included studies were assessed at serious or critical risk of bias. Important limitations included the lack of sufficiently sharp discontinuity in policy, the possibility that other important changes occurred at the boundary, the lack of comparison group or differences in their characteristics, and the assumption that FCTC membership (or its timing) impacted all countries equally. On the whole, existing studies do not provide strong evidence that the FCTC affected policy implementation or tobacco use.