Barriers and Facilitators of Tobacco Cessation Interventions at the Population and Healthcare System Levels: A Systematic Literature Review

Background: Tobacco use is responsible for eight million preventable deaths annually, making it a major modifiable risk factor for chronic conditions such as cardiovascular diseases, respiratory illnesses, and over 20 types of cancers. Objective: This study aimed to systematically review the barriers and facilitators of tobacco cessation interventions at both the population and healthcare system levels in the U.S. Understanding these determinants is critical for narrowing health disparities, optimizing resource allocation, and ultimately, enhancing tobacco cessation success rates across all demographic groups. Methods: A comprehensive literature search was conducted across the PubMed, Embase, and Web of Science databases, guided by the population, intervention, comparison, and outcome framework and quality assessment guided by PRISMA guidelines. Data extraction focused on study characteristics, intervention types, barriers, facilitators, and cessation outcomes at both the population and health system levels. The random effects forest plots were graphed to estimate pooled effect sizes for both medical and non-medical interventions. Results: A total of 35 studies met the inclusion criteria from an initial pool of 1555 identified records. Socioeconomic disadvantages, digital inequities, and low motivation constitute primary barriers at the individual level, while systemic factors such as healthcare access limitations, inadequate provider engagement, and lack of financial support further hinder cessation efforts. Financial incentives, culturally tailored interventions, and digital engagement strategies significantly improve tobacco cessation outcomes. Public health implications: as identified by the study, tailored interventions, the expansion of health coverage policies to include intervention, digital solutions, and healthcare resource workforce training will help improve tobacco cessation intervention outcomes.