ArticlePloS one2021
Disparities in smokeless tobacco use in Bangladesh, India, and Pakistan: Findings from the Global Adult Tobacco Survey, 2014-2017.
Article in PloS one, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 27 papers, 2 of them syntheses that pooled it.
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Who cites it
27 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Interventions for smokeless tobacco use cessation.The Cochrane database of systematic reviews · 2025Pooled it
- Risk factors, lab parameters, angiographic characteristics and outcomes of coronary artery disease in young South Asian patients: a systematic review.The Journal of international medical research · 2023Pooled it
- The vaping paradox in hypertension; A South Asian perspective.Journal of human hypertension · 2026Article
- Mixed Methods Process Evaluation of Behavioral Support and Nicotine Replacement Therapy for Smokeless Tobacco Cessation in Bangladesh, India, and Pakistan.Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco · 2026Article
- A secondary multivariate decomposition analysis of factors influencing smokeless tobacco cessation across two Global Adult Tobacco Survey waves in India and Bangladesh.Tobacco prevention & cessation · 2026Article
- Nicotine pouches, oral cancer and tobacco harm reduction: current evidence and research priorities.Frontiers in oral health · 2026Review
- Article
- Rural Pakistan's smokeless tobacco epidemic: a need for tailored interventions.BMC oral health · 2025Article
- Article
- The Burden and Factors Associated With Smokeless Tobacco Use Among Adults in Nikki, Benin.Tobacco use insights · 2025Article
- Smokeless Tobacco Usage and Oral Cancer Risk: A Hospital-Based Case-Control Study From Bangladesh.Tobacco use insights · 2025Article
- Burden of lip and oral cavity cancer among young people across South, East, and Southeast Asia: trends from 1990 to 2021 and predictions to 2030.Frontiers in oncology · 2025Article
- The association between smoking and smokeless tobacco use with dental caries among Pakistani patients.BMC oral health · 2024Article
- Non-compliant packaging and illicit smokeless tobacco in Bangladesh, India and Pakistan: findings of a pack analysis.Tobacco control · 2024Article
- Standard smokeless tobacco packaging: potential impact on perceived attractiveness, warning label visibility and harm perceptions among adults in Bangladesh.Tobacco control · 2024Article
- Exploring the Risk Factors for Oral Cancer in Pakistan: A Systematic Literature Review.Dentistry journal · 2024Review
- A qualitative study to explain the determinants of naswār consumption from the point of view of its consumers.Journal of education and health promotion · 2024Article
- Smokeless and combustible tobacco use among 148,944 South Asian adults: a cross-sectional study of South Asia Biobank.BMC public health · 2023Article
- The mortality of oral cancer attributable to tobacco in China, the US, and India.Journal of cancer research and clinical oncology · 2023Article
- How does Indian news media report smokeless tobacco control? A content analysis of the gutka ban enforcement.PLOS global public health · 2023Article
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Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundSmokeless tobacco (SLT) use is associated with multiple adverse health effects. It is prominent in Bangladesh, India, and Pakistan, but disparities in use within and across these countries are not well documented or understood. This study assessed the prevalence, patterns, and correlates of SLT use in these three countries.
methodData came from the Global Adult Tobacco Survey, a household survey of adults aged ≥15 years. Data were collected in 2014 (Pakistan), 2017 (Bangladesh), and India (2016-2017). Current SLT use (nasal or oral use) was defined as reported SLT use daily or less than daily at the time of the survey. Prevalence of both overall and specific SLT types were assessed. Multivariate logistic regression was used to assess correlates of SLT use.
resultsOverall, SLT use among adults ≥15 years of age was 20.6% in Bangladesh, 21.4% in India, and 7.7% in Pakistan, corresponding to 22.0 million SLT users in Bangladesh, 199.4 million in India, and 9.6 million in Pakistan. Among current tobacco users overall, the percentage of those who used SLT was 58.4% (CI: 56.0-60.7) in Bangladesh, 74.7% (CI: 73.4-76.0) in India, and 40.3% (CI: 36.2-44.5) in Pakistan. The most commonly used oral SLT product was Zarda (14.5%) in Bangladesh, Khaini (11.2%) in India, and Naswar (5.1%) in Pakistan. Females had greater odds of SLT use than males in Bangladesh, but lower odds of SLT use than males in India and Pakistan. In all three countries, the odds of SLT use was higher among those 25 years and older, lower education, lower wealth index, and greater exposure to SLT marketing.
conclusionAn estimated 231 million adults aged 15 years or older currently use SLT in Bangladesh, India, and Pakistan, comprising 40.3%-74.7% of overall tobacco product use in these countries. Moreover, marked variations in SLT use exist by population groups. Furthermore, exposure to pro-SLT marketing was found to be associated with higher SLT use compared to non-exposed. It is important that tobacco control strategies address all forms of tobacco product use, including SLT.
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