BACKGROUND: Smokeless tobacco (SLT) use poses significant public health challenges globally, particularly in low- and middle-income countries (LMICs), where it is deeply rooted in cultural practices. SLT is consumed in various forms, including chewing tobacco, snuff, betel quid, gutkha, and khaini, and is associated with a wide range of morbidities such as oral cancers, cardiovascular diseases, diabetes, and adverse pregnancy outcomes. Despite its widespread use, SLT has received less attention than combustible tobacco in global tobacco control efforts, underscoring the need for a deeper understanding of research trends and themes in SLT-associated health outcomes.
METHODS: A bibliometric analysis of 2467 articles from Scopus, published up to 2024, utilized the Population-Exposure-Outcomes framework. The search strategy included terms related to SLT (e.g., "smokeless tobacco," "gutkha") and morbidities (e.g., "oral cancer," "cardiovascular diseases," "diabetes"). It examined publication trends, geographic distribution, research themes, key authors, and collaborative networks. Advanced tools like keyword co-occurrence and thematic mapping revealed emerging trends and focal areas.
RESULTS: From the analysis, 42% of publications originated in South Asia, with India contributing 34% of the global output. Oral cancers were the most studied morbidity, appearing in 38% of articles, followed by cardiovascular diseases (22%) and diabetes (16%). Publications on metabolic disorders and pregnancy complications have shown a 25% annual growth rate over the last five years, reflecting emerging research priorities. Collaboration network analysis revealed that only 18% of studies involved international co-authorship, with limited engagement between high- and low-prevalence regions. Thematic maps highlighted underexplored areas such as reproductive health and SLT-related respiratory diseases.
CONCLUSIONS: This bibliometric analysis highlights global research trends on SLT and its morbidities, guiding researchers and policymakers in prioritizing interventions and addressing research gaps, especially in high-prevalence regions. Future efforts should promote international collaboration and explore under-researched morbidities to reduce SLT's health impact.