Background and challenges to implementation:
Nationally representative prevalence studies have consistently reported higher rates of tobacco use in the South-Eastern parts of Nigeria but little is known about the pattern and perceptions and predictors of smokeless tobacco use in these parts of the country. The aim of this study was to determine the pattern and predictors of smokeless tobacco use, their health related knowledge and social attitudes towards its use among residents of Ukpo community of Dunukofia LGA of Anambra State, Nigeria.

Intervention or response:
Across-sectional descriptive study was carried out among 490 residents of Ukpo using a two-stage sampling method. Data was collected using anonymous pre-tested interviewer administered questionnaires adapted from GATS. Odd ratio and 95% confidence intervals were computed and P values of < 0.05 were considered statistically significant.

Results and lessons learnt:
The results showed that respondents were mostly male 300(61.2%), aged between 20 and 70 years, mean of 42.2 ± 15.4 years. Almost half of the respondents, 210 (42.9%) were ever-users of smokeless tobacco with majority of them 188 (89.5%) remaining as current users. Dry snuff 155 (73.8%) was the most common form of smokeless tobacco used. The primary reasons for use were: to relieve stress 115(61.2%); to increase levels of alertness 106(56.4%); for personal pleasure 105(55.9%) and social acceptance 98 (52.1%). Age (p< 0.0001), male gender (p< 0.0001), being single (p< 0.0001) and lower educational attainment (p< 0.0001) were associated with smokeless tobacco use. Only about half of the respondents were aware that smokeless tobacco is dangerous to human health and many 254(51%) people believed that that it is safer than cigarettes, a way of promoting friendship (65%) and should be used within their community (73%).

Conclusions and key recommendations:
Efforts targeted at raising community awareness of the health effects of smokeless tobacco use are needed in rural communities. Programs should be directed at young males with lower levels of education.