Background:
Global burden of smokeless tobacco use among adults and adolescents has not been updated after NCI report 2013.

Methods:
Most recent prevalence of smokeless tobacco use among adults was collected from standard surveillance system. Number of SLT users were calculated by corresponding age group population from UN statistics. Most recent prevalence of smokeless tobacco use among adolescent (13-15 years) was collected from Global Youth Tobacco Survey and numbers were calculated in the same way for adolescents also.

Results:
One in 10 adults use smokeless tobacco in one or another form. Prevalence of SLT use is higher among males (10.8%) as compared to females (5.7%).Prevalence of smokeless tobacco use among in SEAR is higher than smoking. In 129 (72% of the Parties) countries 357 million adult SLT users live. Nearly 93% of adult SLT burden is borne by Low resource countries (Low Middle Income Countries (LMIC) and Low Income Countries (LIC). Over 80% burden is in South East Asia Region (SEAR).
In 103 countries 12.2 million adolescent (13-15 years) use SLT. Of these 82.5% live in LIC and LMICs. Nearly 60% of adolescent users live in SEAR, 13% in African Region and 12% in Eastern Mediterranean region (EMR).Prevalence of current smoking was higher than current SLT use in all regions except SEAR where prevalence of SLT use was higher than smoking. Prevalence of SLT use varied from 1.2% in Western Pacific region to 8.2% in SEAR among adolescent aged 13-15 years.

Conclusions:
The epicenter of smokeless tobacco use burden among adult and adolescent is low resource countries (LMIC and LIC) and especially countries in SEAR. Policy interventions in such countries should include SLT.