Background:
Smokeless tobacco has gained more importance following its increased use in the post-smoking ban era. This has more significance in SEA region as it is the hub of smokeless tobacco manufacturing and use. However its assessment among adults from national surveys like global adult tobacco survey (GATS) is limited. This study compiles the NCD risk factor surveillance data as well as GATS data to have a complete picture of SLT use among adults in SEA region.

Methods:
Both the GATS and the NCD risk factor surveillance data during last decade were compiled and SLT uses among adults were compared. NCD RF surveillance data from Bhutan, Maldives, Myanmar, Nepal, Sri Lanka, and Timor Leste, as well as GATS data from Bangladesh, India and Thailand were analyzed.

Results:
The prevalence of SLT use among adults varied from nil in DPR Korea (2008) to 43.2% in Myanmar (2014). Only Maldives and Thailand had shown prevalence of SLT use less than 5% and other countries had higher prevalence (>15%). India and Bangladesh had prevalence of 24.3% and 27.2% respectively. Decreasing trend in SLT use in India, Thailand, Nepal etc. were observed. Myanmar had shown increase in use of SLTs. Except Timor Leste in all other nine countries men chewed more SLTs than their women counterparts.

Conclusions:
There is wide variation in SLT use in SEA region. Countries showing higher prevalence and increasing trend of SLT use should be prioritized for tobacco control. Complementing tobacco use surveillance tools should always be compared or triangulated for a comprehensive picture of tobacco use burden. Higher use of SLTs among women in Timor Leste needs further exploration.