Smokeless and combustible tobacco use among 148,944 South Asian adults: a cross-sectional study of South Asia Biobank

IntroductionTobacco use, in both smoking and smokeless forms, is highly prevalent among South Asian adults. The aims of the study were twofold: (1) describe patterns of SLT and combustible tobacco product use in four South Asian countries stratified by country and sex, and (2) assess the relationships between SLT and smoking intensity, smoking quit attempts, and smoking cessation among South Asian men.MethodsData were obtained from South Asia Biobank Study, collected between 2018 and 2022 from 148,944 men and women aged 18 years and above, living in Bangladesh, India, Pakistan, or Sri Lanka. Mixed effects multivariable logistic and linear regression were used to quantify the associations of SLT use with quit attempt, cessation, and intensity.ResultsAmong the four South Asian countries, Bangladesh has the highest rates of current smoking (39.9% for male, 0.4% for female) and current SLT use (24.7% for male and 23.4% for female). Among male adults, ever SLT use was associated with a higher odds of smoking cessation in Bangladesh (OR, 2.88; 95% CI, 2.65, 3.13), India (OR, 2.02; 95% CI, 1.63, 2.50), and Sri Lanka (OR, 1.36; 95% CI, 1.14, 1.62). Ever SLT use and current SLT use was associated with lower smoking intensity in all countries.ConclusionsIn this large population-based study of South Asian adults, rates of smoking and SLT use vary widely by country and gender. Men who use SLT products are more likely to abstain from smoking compared with those who do not. center dot Tobacco use remains a leading risk factor of chronic disease in South Asia. Smokeless tobacco use is particularly popular in this region, even among adult women. Evidence on smokeless tobacco use and smoking cessation are inconclusive and may be dependent on specific cultural and historical factors.center dot Contemporaneous data on smokeless and combustible tobacco use patterns in South Asia are limited. Little is known whether SLT use is associated with smoking cessation in South Asia where the vast majority of the world's SLT users reside.center dot This study provided information on patterns of SLT use and smoking in four South Asia countries using a large population-based sample of 148,944 adults collected between 2018 and 2022. We observed that SLT use was associated with higher smoking cessation and lower smoking intensity among men. Strengthening SLT product regulation may have important population health implications with the changing tobacco use landscape in South Asia.