title: Trends of Smokeless Tobacco use among Adults (Aged 15-49 Years) in Bangladesh, India and Nepal.
abstract: BACKGROUND
  Smokeless tobacco (SLT) has long been realized as an important component of the fight for global tobacco control. It still remains a major problem in countries like India, Bangladesh and Nepal. The objective of this study was to estimate the trends of SLT use in three countries of the SEARO WHO office.
  
  
  METHODS
  We used data from national surveys in three countries (Bangladesh, India and Nepal) to estimate trends in prevalence of current SLT use. All available nationally representative data sources were used. Estimates were weighted, age standardized and given along with 95% confidence intervals. Significance of linear trend in prevalence over time was tested using the Cochrane-Armitage test for trend. A p value of less than 0.05 was considered statistically significant.
  
  
  RESULTS
  We identified three surveys for Bangladesh, three for India and four for Nepal that met the selection criteria (such as Demographic and Health Surveys, WHO-STEPwise approach to Surveillance and Global Adult Tobacco Surveys). A significantly increasing trend was noticed in the prevalence of current SLT use among Bangladeshi men (20.2% to 23%, p=0.03). In India, a similar significantly increasing trend was seen among men (27.1% to 33.4%, p<0.001) and women (10.1% to 15.7%, p<0.001). In Nepal, there was a no significant trend among both men (39.1% to 31.6%, p=0.11) and women (5.6% to 4.7%, p=0.49).
  
  
  CONCLUSIONS
  In the study countries SLT use has remained at alarmingly high levels. Usage trends do not show any signs of decline in spite of control efforts. Tobacco control measures should focus more on controlling SLT use.
authors.affiliation: Regional Adviser, Surveillance, (Tobacco Control), Tobacco Free Initiative Unit, Regional Office for South-East Asia, World Health Organization, New Delhi, India E-mail : sinhad@who.int.
authors.forename: Dhirendra N
authors.initials: DN
authors.lastname: Sinha
authors.forename: S A
authors.initials: SA
authors.lastname: Rizwan
authors.forename: Krishna K
authors.initials: KK
authors.lastname: Aryal
authors.forename: Khem B
authors.initials: KB
authors.lastname: Karki
authors.forename: Mostafa M
authors.initials: MM
authors.lastname: Zaman
authors.forename: Prakash C
authors.initials: PC
authors.lastname: Gupta
mesh_terms: D000293:Adolescent; D000328:Adult; D001459:Bangladesh / Q000453:epidemiology; D005260:Female; D006306:Health Surveys; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009390:Nepal / Q000453:epidemiology; D015995:Prevalence; D012737:Sex Factors; D064424:Tobacco Use / Q000453:epidemiology* / Q000639:trends*; D014030:Tobacco, Smokeless / Q000706:statistics & numerical data*; D055815:Young Adult