title: Levels and trends of smokeless tobacco use among youth in countries of the World Health Organization South-East Asia Region.
abstract: BACKGROUND
  At least two rounds of the Global Youth Tobacco Survey (GYTS) have been completed in most of the countries in the World Health Organization South-East Asia region. Comparing findings from these two rounds provides trend data on smokeless tobacco (SLT) use for the first time.
  
  
  METHODS
  This study uses GYTS data from Bangladesh, Bhutan, India, Indonesia, Maldives, Myanmar, Nepal, Sri Lanka, Thailand, and Timor-Leste during 2006-2013. GYTS is a nationally representative survey of 13-15-year-old students using a consistent and standard protocol. Current SLT use is defined as using any kind of SLT products, such as chewing betel quid or nonbetel quid or snuffing any other products orally or through the nasal route, during the 30 days preceding the survey. Prevalence and 95% confidence intervals were computed using SAS/SUDAAN software.
  
  
  RESULTS
  According to most recent GYTS data available in each country, the prevalence of current use of SLT among youth varied from 5.7% in Thailand to 23.2% in Bhutan; among boys, from 7.1% in Bangladesh to 27.2% in Bhutan; and among girls, from 3.7% in Bangladesh to 19.8% in Bhutan. Prevalence of SLT was reported significantly higher among boys than girls in Bhutan (boys 27.2%; girls 19.8%), India (boys 11.1%; girls 6.0%), Maldives (boys 9.2%; girls 2.9%), Myanmar (boys 15.2%; girls 4.0%), and Sri Lanka (boys 13.0%; girls 4.1%). Prevalence of current SLT use increased in Bhutan from 9.4% in 2009 to 23.2% in 2013, and in Nepal from 6.1% in 2007 to 16.2% in 2011.
  
  
  CONCLUSIONS
  The findings call for countries to implement corrective measures through strengthened policy and enforcement.
authors.affiliation: World Health Organization, Regional Office for South-East Asia New Delhi, India.
authors.forename: D N
authors.initials: DN
authors.lastname: Sinha
authors.forename: K M
authors.initials: KM
authors.lastname: Palipudi
authors.forename: C K
authors.initials: CK
authors.lastname: Jones
authors.forename: B B
authors.initials: BB
authors.lastname: Khadka
authors.forename: P D
authors.initials: PD
authors.lastname: Silva
authors.forename: M
authors.initials: M
authors.lastname: Mumthaz
authors.forename: N N N
authors.initials: NN
authors.lastname: Shein
authors.forename: T
authors.initials: T
authors.lastname: Gyeltshen
authors.forename: K
authors.initials: K
authors.lastname: Nahar
authors.forename: S
authors.initials: S
authors.lastname: Asma
authors.forename: N N
authors.initials: NN
authors.lastname: Kyaing
mesh_terms: D000293:Adolescent; D001210:Asia, Southeastern; D001459:Bangladesh; D005260:Female; D006801:Humans; D007194:India; D008297:Male; D002052:Myanmar; D009390:Nepal; D012907:Smoking / Q000453:epidemiology*; D013188:Sri Lanka; D013785:Thailand; D014029:Tobacco Use Disorder / Q000453:epidemiology*; D014030:Tobacco, Smokeless / Q000009:adverse effects*; D014930:Women; D014944:World Health Organization