The prevalence of smokeless tobacco use in the West Asian countries: A systematic review and meta-analysis

Smokeless tobacco use represents a significant public health concern globally, yet comprehensive prevalence data across West Asian populations remain limited. This systematic review and meta-analysis estimated the pooled prevalence of smokeless tobacco use in West Asian countries across age groups and geographic regions. A systematic literature search was conducted across databases from inception to May 2025. Studies reporting prevalence data on smokeless tobacco use in West Asian countries were included. Heterogeneity was assessed using I2 statistics, with subgroup analyses by age and country. Publication bias was evaluated using funnel plots. Meta-analysis was performed using CMA version 3.0 with statistical significance level less than 0.05. Out of 745 fount studies, 22 studies across 11 West Asian countries were included in the meta-­analysis. The overall pooled prevalence of smokeless tobacco use was 16% (95% CI: 12%, 21%) with significant heterogeneity (I2=99.90%, p < 0.001). Age-specific analysis revealed a prevalence of 15% (95% CI: 12%, 18%) among adolescents and 18% (95% CI: 6%, 29%) among adults. Country-specific prevalence varied substantially, ranging from 6% in Iraq to 34% in Lebanon. Saudi Arabia demonstrated the most extreme variation (1%-86%), largely attributed to one outlier study. Funnel plot analysis suggested potential publication bias, though sensitivity analyses confirmed the robustness of pooled estimates. Smokeless tobacco use affects approximately one in six individuals across West Asian populations, with considerable geographic and methodological variation. The substantial heterogeneity observed emphasizes the need for country-­specific tobacco control strategies and standardized surveillance methods.