Intercountry prevalences and practices of betel-quid use in south, southeast and eastern Asia regions and associated oral preneoplastic disorders: an international collaborative study by Asian betel-quid consortium of south and east Asia.

Center of Excellence for Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
International Journal of Cancer (Impact Factor: 6.2). 12/2010; 129(7):1741-51. DOI: 10.1002/ijc.25809
Source: PubMed

ABSTRACT Health risks stemming from betel-quid (BQ) chewing are frequently overlooked by people. Updated epidemiological data on the increased BQ use among Asian populations using comparable data collection methods have not been widely available. To investigate the prevalence, patterns of practice and associated types of oral preneoplastic disorders, an intercountry Asian Betel-quid Consortium study (the ABC study) was conducted for Taiwan, Mainland China, Malaysia, Indonesia, Nepal and Sri Lanka. A random sample of 8,922 subjects was recruited, and the data were analyzed using survey-data modules adjusted for the complex survey design. Chewing rates among men (10.7-43.6%) were significantly higher than women (1.8-34.9%) in Taiwan, Mainland China, Nepal and Sri Lanka, while women's rates (29.5-46.8%) were higher than that for men (9.8-12.0%) in Malaysia and Indonesia. An emerging, higher proportion of new-users were identified for Hunan in Mainland China (11.1-24.7%), where Hunan chewers have the unique practice of using the dried husk of areca fruit rather than the solid nut universally used by others. Men in the Eastern and South Asian study communities were deemed likely to combine chewing with smoking and drinking (5.6-13.6%). Indonesian women who chewed BQ exhibited the highest prevalence of oral lichen planus, oral submucous fibrosis and oral leukoplakia (9.1-17.3%). Lower schooling, alcohol drinking and tobacco smoking were identified as being associated with BQ chewing. In conclusion, the ABC study reveals the significant cultural and demographic differences contributing to practice patterns of BQ usage and the great health risks that such practices pose in the Asian region.

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    ABSTRACT: Background and AimsBetel-quid (BQ) contains biologically psychoactive ingredients; however, data are limited concerning the symptoms and syndrome of BQ dependence among chewers. The aims of this study were to evaluate the ingredients-associated BQ dependence syndrome and country-specific chewing features and behavior for BQ dependence among chewers from six Asian communities.DesignAn inter-country Asian Betel-quid Consortium study.SettingSix Asian general communities in Taiwan, Mainland China, Indonesia, Malaysia, Sri Lanka and Nepal.ParticipantsSix multistage random-samples of BQ chewers in the Asian Betel-quid Consortium study (n=2078).MeasurementsAll chewers were evaluated for BQ dependence using the DSM-IV and ICD-10 criteria.FindingsThe 12-month BQ dependence rate was 12.5-92.6% and 47.9-99.3% (P=0.023) among tobacco-free and tobacco-added BQ chewers across the six Asian communities, with a higher dependence rate in chewers who used tobacco-free BQ with lime added than without (23.3-95.6% vs. 4.0%, P<=0.001). Taiwanese and Hunanese BQ chewers both notably endorsed the dependency domain of ‘time spent chewing’. ‘Tolerance’ and ‘withdrawal’ were the major dependence domains associated with the Nepalese and Indonesian chewers with high BQ dependence rates. Malaysian and Sri Lankan chewers formed a BQ dependence cluster closely linked to ‘craving’. In Sri Lanka, the quantity consumed explained 90.5% (P<0.001) of the excess dependence risk for tobacco-added use, and could be a mediator between tobacco-derived psychoactive effect and BQ dependence development.ConclusionsDSM-IV criteria for dependence apply to a significant proportion of betel quid users in Asian communities, more so if they use it with tobacco or lime.
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May 20, 2014