Statement of Clinical Relevance
- •High rates of smokeless tobacco, especially chewing tobacco and snuff use, were reported among several pediatric and adult populations in the Pan-American region with a positive association to the development of oral leukoplakia and head and neck cancer.
To determine the prevalence of smokeless tobacco (SLT) use and its association with oral potentially malignant disorders (OPMDs) and head and neck cancer (HNC) in the Pan-American Health Organization (PAHO) region.
A literature search was conducted across nine databases and other sources. The eligibility criteria were pediatric (0-18 years old) and adult (19 years and older) populations consuming any type of SLT. Meta-analysis was performed to determine the prevalence of SLT and association between its use and OPMDs/HNC in the PAHO region; the GRADE tool was used to verify the certainty of evidence.
Fifty-nine studies from six PAHO countries were included, of which 51 were also subjected to quantitative analysis. The pooled SLT prevalence of use was 15% (95%CI:11.93–18.69) overall; 17% (95%CI:13.25–22.65) in adults and 11% (95%CI:8.54–14.78) in the pediatric population. The highest reported SLT prevalence of use was 33.4% (95%CI:27.17–39.93) in Venezuela. Head and neck cancer was positively associated with SLT use (OR= 1.98, 95%CI:1.54–2.55), with a moderate certainty of evidence. Among OPMDs, only leukoplakia reported a positive association with SLT use (OR= 8.38; 95%CI:1.05–67.25). However, the quality of the evidence was very low.
A high consumption of SLT use, chewing tobacco and snuff, is reported among the adult population residing in the PAHO region with a positive association to development of oral leukoplakia and HNC.
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Accepted: February 28, 2023
Received in revised form: February 26, 2023
Received: December 5, 2022
Publication stageIn Press Journal Pre-Proof
© 2023 Published by Elsevier Inc.