Background Tobacco uptake in adolescents is associated with a range of predictors. We examined the predictors of cigarette smoking, smokeless tobacco (ST) consumption and use of both ST and cigarettes among adolescents in four South Asian countries. Methods We analysed the Global Youth Tobacco Surveys (GYTS) data for Bangladesh (2013), India (2009), Pakistan (2013), and Sri-Lanka (2015), using multinomial regression to examine associations between several predictors and tobacco use. Results Data from 23,681 adolescents were analyzed. Overall, 82.8% of the study population were between 13 and 15 years and 52.7% were girls, 2% were cigarette smokers, 6.5% were ST users and 1.1% used both ST and cigarettes, in the past 30-days. Exposure to smoking in public places was associated with past 30-days smoking (RRR 5.59, 95%CI 4.28-7.28), ST use (RRR 2.07, 95%CI 1.84-2.32) and use of both ST and cigarettes (RRR 11.42, 95%CI 7.44-17.54). Exposure to tobacco use in electronic media and being offered free tobacco products were associated with all forms of tobacco use. Shopkeepers’ refusal to sell cigarettes protected adolescents from smoking (RRR 0.47, 95%CI 0.36-0.63) and ST use (RRR 0.65, 95%CI 0.45-0.95). However, exposure to anti-tobacco mass media messages was not protective for any form of tobacco use. Adolescents taught at school about harmful effects of tobacco were less likely to use ST; no evidence of this association was observed for smoking. Conclusion The associations between tobacco use and pro-tobacco factors were strong but the associations with anti-tobacco factors lacked strength and consistency in this study population.

Introduction Tobacco use among women, especially during pregnancy is a public health concern. There is a need to understand the diverse nature of their tobacco consumption across the globe. Methods We used Demographic and Health Surveys (DHS) data collected between 2010 and 2016 from 42 low- and middle-income countries (LMICs) to estimate the prevalence of smoking, smokeless tobacco, and dual use among pregnant and non-pregnant women of reproductive age (15–49 y). We compared tobacco use between both groups adjusted for age, type of residence, education and combined wealth index, and a subgroup analysis for the South-East Asia Region (SEAR) as the tobacco use in SEAR among women is far more diverse than in other regions primarily due to the popularity of smokeless tobacco use in this region. Results Based on the data of 1 310 716 women in 42 LMICs, the prevalence of smoking was 0.69%(95%CI: 0.51–0.90) among pregnant women and 1.09%(95%CI: 0.81–1.42) among non-pregnant women. The prevalence of smokeless tobacco use was 0.56%(95%CI: 0.33–0.84) among pregnant women and 0.78%(95%CI: 0.35–1.37) among non-pregnant women. The relative risk ratios(RRR) for smoking (0.85; 95%CI: 0.67–1.09) and smokeless tobacco use (0.81; 95%CI:0.67–1.00) were not-significantly lower among pregnant women than non-pregnant women and education and wealth index had an inverse relationship with both forms of tobacco. In SEAR, among pregnant women, the prevalence of smoking and smokeless tobacco use was 1.81% and 0.45%, respectively. However, pregnant women were 7%(RRR 1.07; 95%CI:1.02–1.12) more likely to use smokeless tobacco than non-pregnant women. Conclusion Despite the added risk of foetal harm during pregnancy, there is no evidence that the tobacco consumption between pregnant and non-pregnant women differ in 42 LMICs. A significantly higher use of smokeless tobacco among pregnant women in SEAR is of particular concern and warrants further investigation. Implications Tobacco use among women in low- and middle-income countries (LMICs) is lower than high-income countries (HICs), but this may be because LMICs are earlier in the epidemiological transition of tobacco use. If ignored as a public health issue and the tobacco industry continues to market its products to women, the level of tobacco use may rise as it did in HICs. Also, despite low prevalence rates and with no evidence that these differ among pregnant and non-pregnant women, is concerning as tobacco consumption in any form during pregnancy is associated with poor birth outcomes. This suggests a need for raising awareness about the harms of tobacco use among women in LMICs, especially during pregnancy. There is a need to develop preventive and cessation interventions to decrease tobacco use (smoking and smokeless) among women who are from low socio-economic status and less educated, as they bear the greatest burden of tobacco use.