Prevalence of cancers associated with the use of oral tobacco (OT) is rising very rapidly and prevention ofuse is the best option to tackle this scenario. This cross-sectional study estimated the proportion of OT use andpredictors associated with its initiation and determined the knowledge, attitude and practices of OT users. Atotal of 231 young adult patients (15-30 years age) were interviewed by medical students in family practice clinicsin Karachi, Pakistan. OT use was considered as usage of any of the following: betel quid (paan) with tobacco,betel nuts with tobacco (gutkha), and snuff (naswar). Overall, 49.8% (95% CI=43.3-56.2) subjects had used OTat least in one form. Multivariable analysis demonstrated independent association of OT users with secondaryeducation level (adjusted OR=3.6; 95% CI=1.6-8.1) and use of OT by a family member (OR=2.3; 95% CI=1.3-4.0). Among OT users, 37.4% started after being inspired by friends/peer pressure, 60% using for more than5 years, 53.2 % users reported getting physical/mental comfort from the use of OT while 31.6% tried to quitthis habit but failed. We suggest socially and culturally acceptable educational and behavioral interventions forcontrol of OT usage and hence to prevent its associated cancers.