Research, Monitoing and Surveillance of Smokeless tobacco use Dhirendra Narain Sinha

SLT use: Global prevalence of SLT users by gender Based on available prevalence of SLT use among adults in 140 countries, Nearly one in 10 males and one in 20 females used SLT in some form. Source: Sinha et al. 2018 Nicotine & Tobacco Research,,

Prevalence of smoking and SLT use among adults by WHO region

Prevalence of smoking and SLT use among adolescents by WHO region

356 million SLT users worldwide Males 65.8% (234 million) Females 34.2% (122 million)

Proportion of smokeless tobacco users by income group of countries and gender Source:. Sinha et al. Nicotine & Tobacco Research, 2018

Number of SLT Users by WHO Region South-East Asia Region (SEAR), African Region (AFR), American Region (AMR), Eastern Mediterranean Region (EMR), European Region (EUR) and Western Pacific Region (WPR) Source: Sinha et al. 2018 Nicotine & Tobacco Research,,

SLT Use by Place of Residence and Income of the Family in LIC and LMICs SLT use is 1.2–8 times higher in rural areas as compared to urban in countries of SEAR and AFR ; SLT use was 1.5–17 times higher among poorest section as compared to the richest section in countries of SEAR and AFR .

Percentage distribution type of tobacco use and gender among adults aged 15 years and above in select member countries of the South East Asia Region Source: Sinha et al. Indian Journal of Public Health, Volume 55, Issue 3, July-September, 2011; 169-176

Prevalence of SLT use by type among adults

Trends of SLT use among adults in selected LICs and LMICs In India SLT use was on increase between 1990-2009 but has significantly decreased between 2010 and 2016 SLT use has significantly increased between 2008 and 2016 in Myanmar** SLT use remained the same between 2004 and 2014 in Sri Lanka In Bangladesh SLT use remains the same over last 10 years (conflicting reports)

Trend of smokeless tobacco among adolescents in countries of South-East Asia Regions Source: WHO, SEARO

Percentage of Parties having SLT use Prevalence data

Number and percentage of Parties having data on prevalence, health and economic indicators of smokeless tobacco (SLT) use Source: Dhirendra N. Sinha et al. Indian J Med Res 148, July 2018; 110-115

Percentage of Parties having tax incidence data and Health Cost Study

Comparison of retail price and tax incidence between smokeless tobacco (SLT) and cigarettes by country income groups. Note: Retail Price (PPP$) shows the retail price in international purchasing power parity dollars for a 20 cigarettes pack of the most sold brand and 20 g pouch of the most sold SLT brand in each country. HIC, high-income countries; UMIC, upper middle-income countries; LMIC, lower middle-income countries; LIC, low-income countries. Source: Rijo M. John et al. Indian J Med Res 148, July 2018; 46-55

Summary in 140 countries, Nearly one in 10 males and one in 20 females use SLT 356 million SLT users worldwide, 23rd males Nearly 82% SLT users live in SEAR Over 90%users live in LICs and LMICs Nearly 3/4th parties have SLT use one time data both among adults and adolescents, however two point data is lacking in LIC and LMICs All cause mortality and cause specific mortality is available for 5% of the parties and data on SLT economics is availavle for <20% Parties

Conclusion SLT use is global epidemic wide variation by region. Poorest of Poors are sufferers Data collection on SLT related issues have increased in the recent past however there is a big gap in information on SLT related issues. Standard methods and protocols are available, countries should use those and collect periodic comparable data