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Background: Globally, twelve percent of all deaths among adults aged 30 years and over are attributable to tobacco use. A large proportion of the tobacco attributable disease and deaths in many countries are now due to use of Smokeless tobacco (ST) and this has gone unnoticed in most countries except in a few south Asian economies. However most of the tobacco control strategies have traditionally been directed at smoking forms of tobacco especially cigarettes. The regulation of ST is therefore increasingly posing a major public health challenge, especially in LMIs where high prevalence of ST coexists with limited expertise and resources for regulation.This paper aims to draw attention of relevant stakeholders to the growing epidemic of smokeless tobacco, its impact and issues related to regulation. Methods: A standard literature search was performed using multiple electronic databases to identify peer reviewed articles. The internet and organizational databases were also used to find other types of documents (e.g. books and reports). The reference lists of identified relevant documents were reviewed to find additional sources. Results: The use of smokeless tobacco is prevalent across all WHO regions, with high prevalence (≥ 10%) countries representing about 25% of the global adult population. The use of ST is associated with a wide range of harmful effects on health. Tobacco manufacturers are continuously introducing newer forms of smokeless tobacco products and expanding their user base. The diversity of ST products, information and research gap, industry tactics, promotion as harm reduction product, in addition to lack of resources, technical knowhow and proven regulatory policies have emerged as major challenges to regulate ST globally. Conclusion: The growing epidemic of ST requires sustained and effective public health action. Many countries have tried partial bans on import and sale of ST. Looking at the circumstances and challenges involved in regulating ST, authors call for a more coordinated approach and global and regional consultation to look at appropriate policies and strategies including a complete, comprehensive and transnational ban on ST products to counter this epidemic.

Smokeless Tobacco–Countering the Global Epidemic