Multilevel Socioecological Factors in Smokeless Tobacco Consumption Across South Asia: A Systematic Scoping Review Protocol

Smokeless tobacco (SLT) use remains a significant public health concern, impacting more than 356 million users worldwide. The burden is disproportionately concentrated in South Asia, where approximately 80% of all SLT users reside. To date, the global focus on tobacco control has been cigarette consumption with very little progress on the prevention and control of smokeless tobacco. The primary objective of this scoping review is to systematically identify, explore and map the existing literature on factors that are associated with smokeless tobacco use among adults in six South Asian countries: Bangladesh, Bhutan, India, Maldives, Nepal, and Sri Lanka. Given the region’s vast diversity, it is essential to examine the cultural, social and community level factors, particularly as they vary between countries, within countries, and across marginalized populations. To ensure a comprehensive understanding of smokeless tobacco use in this region, this review will employ a socio-ecological model developed by McLeroy et al (1988). To date no review has systematically reviewed literature on the socioecological factors that shape adult SLT use in the South Asia region. By mapping existing evidence, the review will provide a more holistic understanding of the drivers of smokeless tobacco use and inform the development of targeted, context-specific interventions.