广州地区肺癌高危人群筛查依从性及筛查结果分析

目的调查广州地区肺癌高危人群筛查依从性现状及影响因素,并分析肺癌筛查结果。方法选取2020年1月至2021年12月广州地区常住居民为研究对象,通过问卷收集其社会人口学资料及肺癌危险因素资料,筛查出肺癌高危人群,肺癌高危者由专业放射科医生进行低剂量螺旋CT(LDCT)扫描并根据诊断标准完成诊断。采用描述性分析方法对高危人群筛查依从性及筛查结果进行分析,并采用单、多因素分析方法对肺癌高危人群筛查依从性影响因素进行分析。结果17980名研究对象中肺癌高危评估率为19.96%(3589/17980),LDCT筛查依从率为34.99%(1256/3589)。3589例肺癌高危人员的肺癌确诊率为2.17%(78/3589),其中男性占61.54%(48/78),女性占38.46%(30/78),40~50岁占17.95%(14/78)、51~60岁占33.33%(26/78)、61~74岁占48.72%(38/78)。Logistic回归分析显示,女性(OR=2.130)、年龄越大(OR=1.408)、BMI≥24.0 kg/m2(OR=2.349、2.375)、中专及以上受教育程度(OR=2.008、3.251)、饮酒(OR=1.498)、吸烟(OR=2.239)、被动吸烟(OR=2.428)、有肺癌家族史(OR=2.081)、有慢性呼吸系统疾病史(OR=2.006)及不经常体育锻炼(OR=2.130)的肺癌高危者具有更高的筛查依从性。结论广州地区肺癌高危人群筛查依从性普遍较低,年龄、受教育程度、家族病史等均与筛查依从性有关,肺癌高危筛查有助于早期诊断肺癌及相关疾病,改善国民生活质量。     

海口市社区人群嚼食槟榔现状及致病风险认知调查

目的了解海口市社区人群嚼食槟榔行为、致病风险认知,为采取针对性措施提供依据。方法2013年10月—2014年3月,采用多级分层方便抽样,对海口市社区人群进行问卷调查。结果 960名被抽调居民共完成有效问卷924份,有161人嚼食槟榔,嚼食率为17.4%(161/924),其中男性占27.6%(146/529),高于女性的3.8%(15/395),差异有统计学意义(P0.05)。嚼食槟榔人群中,伴吸烟习惯者占54.0%(87/161),伴饮酒习惯者占34.2%(55/161),嚼食槟榔、吸烟、饮酒习惯三者皆有占33.5%(54/161)。仅15.0%的受访者认为槟榔子本身含有致癌物。非条件Logistic回归分析显示,男性(OR=7.734,95%CI:4.361~13.715)、饮酒(OR=1.831,95%CI:1.118~3.001)是海口市社区人群嚼食槟榔的危险因素,家人没有从事与槟榔有关职业(OR=0.520,95%CI:0.332~0.813)、未婚(OR=0.366,95%CI:0.151~0.887)、已婚(OR=0.439,95%CI:0.234~0.826)是海口市社区人群嚼食槟榔的保护因素。结论海口市社区有庞大的嚼食槟榔人群,应通过在当地积极开展嚼食槟榔危害的宣传,减少嚼食槟榔行为。     

北京市小学4～6年级在校流动儿童尝试吸烟行为及影响因素研究

目的初步了解北京市小学4~6年级在校流动儿童尝试吸烟行为的现状;分析影响尝试吸烟行为形成的多方面因素,确定尝试吸烟行为形成的高危人群;为进一步完善针对北京市小学在校流动儿童控烟的健康教育机制提供依据与指导,对相关高危人群提供有效的健康教育服务支持。方法在大量文献查阅的基础上编制自填式问卷;通过分层整群抽样方法在北京市共6所招收流动儿童为主的小学抽取四、五、六年级户籍为流动人口的小学生共516名,由项目组工作人员现场指导学生进行自填式问卷调查。结果共回收514份有效调查问卷,其中59.92%的流动儿童来自公立小学、40.08%来自打工子弟小学,平均年龄为(11.48±1.125)岁,其中男生占53.31%,女生占46.69%。问卷调查结果显示流动儿童尝试吸烟率为6.61%,平均吸第一口的年龄为8.41岁,被动吸烟情况普遍;统计分析结果显示流动儿童尝试吸烟行为受年龄、性别、家人吸烟情况和学校类型影响显著。结论北京市小学在校流动儿童尝试吸烟行为受年龄、性别、家人吸烟情况和学校类型影响显著,私立打工子弟学校的学生应作为控烟工作重点人群,相应组织开展有针对性的健康教育宣传工作。     

成都市30~79岁居民被动吸烟现状及影响因素分析

目的 了解成都市30~79岁居民被动吸烟现状及影响因素,为制定减少被动吸烟危害的相关措施提供依据。方法 研究数据来自西南区域自然人群队列成都地区基线调查,2018年在成都市招募30~79岁居民进行问卷调查,获得居民的一般人口学特征和被动吸烟行为特征。采用Logistic回归分析被动吸烟和被动吸烟时长的影响因素。结果 共纳入分析21 097人,平均年龄(50.8±12.3)岁。成都市30~79岁居民的被动吸烟率为52.2%(11 009/21 097),平均每周被动吸烟时长为6 h。不同性别、年龄、居住地、文化程度、以及有无吸烟史的成都市居民被动吸烟率、每周被动吸烟时长分布差异均有统计学意义(均P<0.01)。Logistic回归分析表明女性(OR=1.104)、高中及以上文化程度(OR=1.241)、有吸烟史者(OR=1.510)是被动吸烟的危险因素,年龄较高(45~64岁:OR=0.854;65~79岁:OR=0.443)是被动吸烟的保护因素;年龄45~64岁(OR=1.116)、有吸烟史者(OR=1.623)每周被动吸烟时长更长,高中及以上文化程度者(OR=0.903)每周被动吸烟时长更短。结论 成都市被动吸烟问题较严重,控烟工作需同时关注降低高危人群的暴露率与暴露时长。     

湖北省15岁以上常住居民吸烟状况及相关因素

目的了解湖北省居民吸烟现状及其相关因素,为制定控烟措施提供科学依据。方法采用多阶段分层整群随机抽样方法,选取湖北省20个县(市、区)年龄在15岁及以上常住居民,采用统一的问卷,由经过统一培训合格的调查员对每一调查对象进行面对面的询问调查。采用非条件logistic回归分析方法分析吸烟影响因素。结果共调查28 563人,吸烟率为26.96%;男性吸烟率(51.72%)高于女性(4.05%);农村吸烟率(28.54%)高于城市(24.74%);吸烟率随着年龄的增长呈上升趋势,35岁以上人群吸烟率均处于较高水平,55~64岁组吸烟率达到最高,为31.38%。调查人群平均开始吸烟年龄为21.7岁(中位数20.0岁),74.80%的人群开始吸烟年龄集中在15~24岁;吸烟者平均每天吸烟(18.6±10.2)支,以每日吸烟20~29支最多,占49.65%。男性(OR值=20.95,95%CI:18.92~23.19)、农村地区(OR值=1.12,95%CI:1.03~1.22)、饮酒(OR=2.64,95%CI:2.46~2.84)居民更可能吸烟;以15~24岁、没上过学、未婚、在业为对照,年龄、文化程度、婚姻状况、就业状况也是吸烟的影响因素。结论湖北省15岁以上人群吸烟率仍处于相对较高的水平,控烟工作仍需加强;应对不同目标人群,采取有针对性的控烟措施。     

2006年商南县城区部分居民吸烟状况调查

[目的]真实了解商南县城区不同人群的吸烟状况,制定切实可行的控烟健康教育对策、措施.[方法]2006年4～5月,在商南县城区抽取5个行业的1 144名居民进行吸烟状况调查.[结果]调查1 144人,吸烟率为23.51%,其中男性为39.21%,女性为0.43%(P＜0.01);干部为28.85%,企业职工为27.85%,农民为45.67%,医务人员为9.87%,中学教师为12.71%(P＜0.01);18～29岁为11.05%,30～39岁为18.24%,40～49岁为24.50%,50岁以上为48.26%(P＜0.01);文化程度大专及以上为19.93%,中专、高中为22.37%,初中及以下为37.57%(P＜0.01).269名吸烟者开始吸烟年龄为(27.70±4.97)岁,每天吸烟10～20支的占48.33%;每月吸烟支出101～200元者占73.23%;33.83%曾戒过烟,82.53%愿意戒烟.[结论]商南县城区居民吸烟率较低,男性、40岁以上、农民、初中以下文化的人群吸烟率较高.     

遵义市中青年男性脑卒中患者吸烟行为特点及相关因素分析

目的 分析遵义地区中青年男性脑卒中患者吸烟行为特点及相关因素,为制定干预措施提供依据。方法 对2018年遵义市某医院就诊中青年男性吸烟脑卒中患者进行问卷调查,内容包括一般情况(文化程度、年龄、职业、婚姻状况、居住地)、吸烟情况(吸烟量、吸烟年限等)及尼古丁依赖程度量表,采用单、多因素分析方法对吸烟量影响因素进行分析。结果 共纳入120例中青年男性吸烟脑卒中患者参与本研究,年龄以40~59岁为主,占60.00%;职业以体力劳动为主,占58.33%;婚姻状况以已婚为主,占70.00%;尼古丁依赖程度以高度依赖为主,占45.00%;家庭收入情况以中等收入为主,占54.17%。人群平均吸烟量为(24.17 ± 4.01)支/d,其中轻度15例,中度32例,重度73例,分别占12.5%、26.7%、60.8%。多因素logistic回归模型分析结果显示,年龄越大(OR=6.044)、职业为体力劳动者(OR=3.935)、离异(OR=4.007)、尼古丁依赖程度越高(OR=6.913)的中青年男性脑卒中患者吸烟量越大,文化程度越高(OR=0.420)的中青年男性脑卒中患者吸烟量越小。结论 遵义地区中青年男性脑卒中患者吸烟量较大,年龄越大、体力劳动、离异、尼古丁依赖程度高是中青年男性脑卒中患者吸烟量的危险因素,相关部门可针对此人群特点制定相应的干预措施,以降低该人群脑卒中患病风险。     

潍坊市居民高血压患病及影响因素分析

目的了解山东省潍坊市城乡居民高血压患病情况及影响因素,为制定相应的对策及高血压防治工作提供依据。方法采用分层抽样方法,用问卷调查方式,对潍坊市3 546户、11 425名15岁~居民进行调查。结果潍坊市15岁~居民高血压患病率为8.40%,30岁~者患病率为12.45%;不同年龄、职业、体质指数的人群高血压患病率差异有统计学意义(P0.05);吸烟与不吸烟人群的高血压患病率差异有统计学意义(P0.05)。结论潍坊市居民高血压患病率低于全国水平,应加强对肥胖者、老年人、生活压力大及吸烟人群的健康教育,降低高血压患病风险。     

山西省长治市居民吸烟危害认知调查

目的了解长治市居民对吸烟危害程度的认识。方法采用分段分层随机抽样方法,抽取4个居民区部分居民进行面对面询问式的问卷调查。结果共调查居民304人,男性201名,占66.12%,女性103名,占33.88%;认为主动吸烟有害的占94.41%,被动吸烟有害的占95.72%;认为主动吸烟有害程度为重度的占58.22%,被动吸烟有害程度为重度的占66.77%。对吸烟有害的认知女性高于男性,36-50岁组低于35岁以下、51岁以上组,卫生、教育、行政机关工作人员高于厂矿企业工作人员,离退休人员、家庭主妇认为吸烟有害率达100%;认为吸烟比不吸烟更容易患气管炎的占67.11%,易患肺癌的占72.36%,易患高血压的占19.41%。结论调查人群对吸烟有害的认知程度存在差异,对吸烟引起的疾病知晓程度不同,应该把吸烟有害健康认知程度低的人群和居民知晓程度低的疾病作为健康教育的重点。     

福州市慢性阻塞性肺疾病的检出率及相关因素

目的掌握福州市慢性阻塞性肺疾病(COPD)的患病情况和影响因素,为基层开展COPD健康教育提供基础数据。方法以整群随机抽样方法抽取福州市台江区3个街道6个居委会2 400户居民户,每户用KISH表法随机抽取40岁及以上居民1名,对随机抽取2 156人进行面对面问卷调查、体检和肺功能检查,对FEV1/FVC<70%人群进行心电图和胸片检查。结果福州市40岁及以上人群COPD总检出率为6.33%,男性检出率明显高于女性(P<0.01)。随着年龄增长、受教育程度越低、有父亲或母亲家族史、经常接触粉尘或有害气体、经常接触油烟其检出率上升(P<0.01/0.05);而工作中采取防护器具、在室外做饭人群COPD检出率低(P<0.01)。多因素分析,男性、年龄≥50岁、有父或母家族史、吸烟和被动吸烟、经常接触油烟与COPD发生呈正相关;受教育程度与COPD发生呈负相关。结论福州市COPD检出率低于全国平均水平,年龄、吸烟等人口学特征及油烟接触是COPD发病的重要相关因素。     

Betel nut chewing is associated with increased risk of cardiovascular disease and all-cause mortality in Taiwanese men

BACKGROUND: Betel nut chewing is related to several kinds of cancer, metabolic syndrome, and type 2 diabetes. Whether it is associated with a greater risk of cardiovascular disease (CVD) and all-cause mortality, however, remains unclear. OBJECTIVE: We aimed to investigate the association between betel nut chewing and CVD and all-cause mortality. DESIGN: A baseline cohort of 56,116 male participants > or = 20 y old were recruited from 4 nationwide health screening centers in Taiwan in 1998 and 1999. Cox proportional hazards regression analyses were used to estimate the relative risks (RRs) of CVD and all-cause mortality for betel nut chewers during an 8-y follow-up period. RESULTS: There were 1549 deaths during the follow-up period, 309 of which were due to CVD. After adjustment for age, body mass index, diabetes, hypertension, lipids, smoking, alcohol consumption, physical activity, income, and education level, the RRs (95% CI) of CVD and all-cause mortality among the former betel nut chewers were 1.56 (1.02, 2.38) and 1.40 (1.17, 1.68), respectively, and those among current chewers were 2.02 (1.31, 3.13) and 1.40 (1.16, 1.70), respectively, compared with persons who had never chewed betel quid. Current and former betel nut chewers had a higher risk of CVD mortality (RR: 2.10; P < 0.05) than did current and former smokers. Greater frequency of betel nut chewing was associated with greater CVD and all-cause mortality. CONCLUSIONS: Betel nut chewing was independently associated with a greater risk of CVD and all-cause mortality in Taiwanese men. Regular screening for betel nut chewing history may help prevent excess deaths in the future. An anti-betel nut chewing program is urgently warranted for current chewers.     

Betel Nut Chewing Increases the Risk of Metabolic Syndrome and Its Components in a Large Taiwanese Population Follow-Up Study Category: Original Investigation

Betel nut chewing is a popular habit in Taiwan, and it is associated with adverse metabolic effects. The aim of this study was to investigate correlations between betel nut chewing with metabolic syndrome (MetS) and its components in a longitudinal study using data from the Taiwan Biobank. A total of 121,423 participants were included in the baseline study, and 27,002 received follow-up examinations after a median of 4 years. The association between betel nut chewing and MetS was analyzed using multiple logistic regression after controlling for confounders. The baseline prevalence of MetS was 22.5%. Multivariable analysis showed that a history of chewing betel nut was significantly associated with baseline MetS (odds ratio (OR) = 1.629; 95% confidence interval (CI) = 1.535 to 1.730, p < 0.001) and five components of MetS in all participants. A long history of chewing betel nut (per 1 year; OR = 1.008; 95% CI = 1.004 to 1.013, p < 0.001) was associated with baseline MetS, abdominal obesity, hypertriglyceridemia and low high-density lipoprotein (HDL) cholesterol. In addition, high cumulative dose (per 1 year × frequency × daily score; OR = 1.001; 95% CI = 1.001–1.002; p < 0.001) was significantly associated with baseline MetS. At the end of the follow-up, a history of chewing betel nut (OR = 1.352; 95% CI = 1.134 to 1.612, p = 0.001) was significantly associated with MetS and its components including abdominal obesity, hypertriglyceridemia and low HDL-cholesterol in the participants without baseline MetS. In addition, a longer history of betel nut chewing was associated with MetS (per 1 year; OR = 1.021; 95% CI = 1.008 to 1.035, p = 0.002), abdominal obesity and hypertriglyceridemia at follow-up. However, cumulative dose (p = 0.882) was not significantly associated with follow-up MetS. Chewing betel nut and a long history of betel nut chewing were associated with baseline MetS and its components. In the participants without MetS at baseline, chewing betel nut and a long history of chewing betel nut were associated with the development of MetS after 4 years of follow-up. However, a cumulative dose of betel nut chewing was not associated with follow-up MetS. Betel nut chewing cessation programs are important to reduce the incidence of MetS in Taiwan.     

Betel Nut Chewing Decreased Calcaneus Ultrasound T-Score in a Large Taiwanese Population Follow-Up Study

Chewing betel nut is common in Taiwan. Although previous studies have shown that chewing betel nuts is associated with adverse health effects, findings about the impact on bone density have been inconsistent. Therefore, the aim of this study was to investigate the correlation between betel nut chewing and calcaneus ultrasound T-score in a longitudinal study of 118,856 participants from the Taiwan Biobank. Of these participants, 27,002 were followed up with for a median of 4 years. The T-score of the calcaneus was measured in the non-dominant foot using ultrasound. Multivariable analysis showed that a history of chewing betel nut (coefficient β = −0.232; p < 0.001) was significantly associated with low baseline T-score in all participants (n = 118,856). In addition, a long duration of betel nut chewing (per 1 year; coefficient β = −0.003; p = 0.022) was significantly associated with a low baseline T-score in the participants with a history of chewing betel nut (n = 7210). Further, a long duration of betel nut chewing (per 1 year; coefficient β = −0.004; p = 0.039) was significantly associated with a low ΔT-score in the participants with a history of chewing betel nut (n = 1778) after 4 years of follow-up. In conclusion, our results showed that betel nut chewing was associated with a decrease in calcaneus ultrasound T-score, and thus, it is important to stop chewing betel nut to help prevent an increased risk of osteoporosis in the Taiwanese population.     

嚼槟榔与口腔癌关系的病例对照研究

目的 分析口腔癌发病的危险因素,并进一步探讨嚼槟榔与口腔癌的关系。 方法 采用以医院为基础的1:1病例对照研究方法,对2014年在湘潭市某综合医院确诊的口腔癌病例及同期该院其他科室就诊的非口腔疾病、非肿瘤病人共100对进行问卷调查。采用条件logistic回归对资料进行分析,计算OR值及95%CI,并分析嚼槟榔与吸烟、饮酒的交互作用。 结果 单因素条件logistic回归分析结果:吸烟(OR=3.441,95%CI:1.671～7.001,P=0.001)、饮酒(OR=3.010,95%CI:1.497～6.063,P=0.002)、嚼槟榔(OR=3.340,95%CI:1.423～7.844,P=0.006)是口腔癌的危险因素;而多因素条件logistic回归分析结果:吸烟(OR=2.700,95%CI:1.289～5.656,P=0.008)、饮酒(OR=2.257,95%CI:1.071～4.756,P=0.032)是口腔癌的危险因素,但未发现嚼槟榔(OR=2.070,95%CI:0.790～4.758,P=0.139)能独立升高口腔癌的发病风险。交互作用分析结果:嚼槟榔与吸烟(OR_相乘交互=0.696,95%CI:0.140～1.465,P=0.658)、饮酒(OR_相乘交互=1.416,95%CI:0.318～6.300,P=0.648)间不存在相乘交互作用。相加交互作用:嚼槟榔与吸烟之间不存在相加交互作用,相对超危险度比(RERI)的95%CI(-1.573～2.225),归因比(AP)的95%CI(-0.364～0.514)包括0,且交互作用指数(S)的95%CI (0.589～2.087)包括1。但嚼槟榔与饮酒之间存在相加交互作用,嚼槟榔且饮酒患口腔癌的危险性是不嚼槟榔不饮酒的5.034倍,RERI为2.263、AP为0.449、S为2.275。 结论 嚼槟榔、吸烟、饮酒都是口腔癌的主要危险因素。嚼槟榔与饮酒存在相加交互作用,可增加饮酒患口腔癌的发病风险。     

食用槟榔对口腔黏膜健康影响的现况研究

目的研究咀嚼槟榔对口腔黏膜健康异常状况的影响情况和影响因素。方法在湖南省湘潭市和常德市通过多阶段随机抽样的方法对调查对象开展咀嚼槟榔对口腔黏膜健康影响的问卷调查和口腔检查,采用SPSS13.0软件对数据进行统计分析。结果调查对象中咀嚼槟榔524人,口腔黏膜健康异常检出率为12.4%;不咀嚼槟榔521人,口腔黏膜健康异常检出率为2.5%,两组差异有统计学意义(P0.05)。口腔黏膜典型纤维化、粘膜充血、张口受限与咀嚼槟榔有统计学联系,口腔黏膜溃疡、出血、白斑、白色角化、扁平苔藓、白斑病及舌活动受限与咀嚼槟榔无统计学联系;性别、年龄、是否嚼槟榔、嚼槟榔年限和量、吸烟、饮酒为口腔黏膜健康状况的影响因素,地域分布、嗜好辣椒、刷牙习惯、嚼口香糖习惯与口腔黏膜健康状况的影响差异无统计学意义;χ2趋势检验结果显示随着咀嚼槟榔片数的增加口腔黏膜健康异常检出率有增加的趋势。多因素的非条件Logistic回归分析结果显示嚼槟榔年限(年)、嚼槟榔片数(片/d)为口腔黏膜健康的影响因素(OR=1.498和1.510)。结论长时间大量咀嚼槟榔可能损伤口腔黏膜健康。     

A Positive Relationship between Betel Nut Chewing and Significant Liver Fibrosis in NAFLD Subjects,but Not in Non-NAFLD Ones

Background: Betel nut chewing is associated with oral cancer, cardiovascular disease, liver cirrhosis, and hepatocellular carcinoma (HCC). The aim of this study was to explore the association of betel nut chewing with liver fibrosis in subjects with and without nonalcoholic fatty liver disease (NAFLD). Method: A total of 5967 subjects were enrolled. NAFLD was diagnosed with ultrasonography. Betel nut chewing was classified into non-chewing, ex-chewing, and current chewing, and cumulative dosages were calculated. The aspartate aminotransferase (AST)/platelet ratio index and NAFLD fibrosis scores (NFS) were calculated for evaluation of liver fibrosis. Results: NAFLD increased the associated risk of liver fibrosis in those with (odds ratio (OR): 5.51, 95% confidence interval (CI): 3.09–9.80) and without betel nut chewing (OR: 2.33, 95% CI: 1.64–3.29). In subjects without NAFLD, betel nut chewing was not associated with liver fibrosis (OR: 1.12, 95% CI: 0.44–2.86). In subjects with NAFLD, cumulative betel nut chewing and ex- and current chewing were positively associated with NFS and significant liver fibrosis. Conclusions: In subjects with NAFLD, betel nut chewing, even ex-chewing, was associated with a higher risk of liver fibrosis, where higher cumulative levels were found to increase the risk of significant liver fibrosis. However, the associated risk of liver fibrosis due to betel nut chewing was insignificant in subjects without NAFLD.     

Population Burden of Betel Quid Abuse and Its Relation to Oral Premalignant Disorders in South,Southeast, and East Asia: An Asian Betel-Quid Consortium Study

Objectives. We investigated the population burden of betel quid abuse and its related impact on oral premalignant disorders (OPDs) in South, Southeast, and East Asia.Methods. The Asian Betel-Quid Consortium conducted a multistage sampling of 8922 representative participants from Taiwan, Mainland China, Malaysia, Indonesia, Nepal, and Sri Lanka. Participants received an interviewer-administered survey and were examined for oral mucosal disorders.Results. The prevalence of betel quid abuse was 0.8% to 46.3% across 6 Asian populations. The abuse frequency was over 40.5% for current chewers, with the highest proportion in Nepalese and Southeast Asian chewers (76.9%−99.6%). Tobacco-added betel quid conferred higher abuse rates (74.4%−99.6%) among Malaysian, Indonesian, and Sri Lankan men than did tobacco-free betel quid (21.8%−89.1%). Gender, lower education level, younger age at chewing initiation, and clustering of familial betel quid use significantly contributed to higher abuse rates. Indonesian betel quid abusers showed the highest prevalence of OPDs and had a greater risk of OPDs than did nonabusers.Conclusions. Betel quid abuse is high in regions of Asia where it is customarily practiced, and such abuse correlates highly with OPDs. By recognizing abuse-associated factors, health policies and preventive frameworks can be effectively constructed to combat these oral preneoplasms.The chewing of betel quid, a combination of areca nut, betel leaf, slaked lime, and region-dependent flavoring ingredients, is a uniquely Asian, culturally derived lifestyle habit. Bred from ancient tradition, its use is socially accepted in all groups, including women and young children, although other substance use such as tobacco smoking is deemed objectionable.1,2 Chemical composition studies have showed that areca nut includes psychoactive alkaloids, of which arecoline contributes the most quantity.3 By raising epinephrine and norepinephrine plus modulation of cholinergic and monoamine transmission, areca nut exerts neurobiological effects on the sympathetic and parasympathetic nervous systems.3–5 In human studies, tolerance and withdrawal symptoms have been clearly detected in regular betel quid chewers.6–8 Such a pharmacological profile is comparable with nicotine, a well-known substance that leads to abuse and dependence. In recent decades, successful marketing of commercially manufactured betel quid has dramatically increased its accessibility and widespread use throughout Asia.9 An increased availability indicates that betel quid may be abused throughout different cultures, but the extent is unknown.Studies on the natural history of oral cancer suggest that several oral premalignant disorders (OPDs), including oral lichen planus (OLP), oral submucous fibrosis (OSF), oral leukoplakia (OL) and oral erythroplasia, precede the development of this neoplasm.10 In Asia, the prevalence of oral precancerous conditions and lesions was estimated to be 1.7% to 11.7% in western India,11 4.4% to 12.7% in southern Taiwan,12,13 0.1% to 4.7% in the Hunan province of Mainland China,14 1.4% in Malaysia,15 and 6.7% in the central Sri Lanka.16 Although there is evidence to support that chronic consumption of betel quid products, with or without added tobacco, is a central etiological agent for OPD and neoplasms of the oral cavity, pharynx, esophagus and larynx,10,17–23 no data are available concerning the oral precancerous consequences among betel quid abusers.To study the health effects of betel quid consumption in Asian populations and mobilize outreach activities in disease prevention, in 2008, the Center of Excellence for Environmental Medicine at Kaohsiung Medical University in Kaohsiung, Taiwan, in consultation with the World Health Organization (WHO) Collaborating Centre for Oral Cancer in the United Kingdom, launched an international collaborative project that constitutes the Asian Betel-quid Consortium (ABC) study. Six large research centers from East Asia (Kaohsiung Medical University, Taiwan, and Central South University, Changsha, Mainland China), Southeast Asia (Airlangga University, Surabaya, Indonesia and University of Malaya, Kuala Lumpur, Malaysia), and South Asia (University of Peradeniya, Peradeniya, Sri Lanka and Kathmandu University, Kavrepalanchwok, Nepal) participated in this investigation. Because of varying practices and particular marketing of betel quid products in those countries (detailed explanations shown in Table A, available as a supplement to the online version of this article at http://www/ajph.org), present study actions are promisingly warranted. The purposes of this report are twofold: (1) to present the current population burden of betel quid abuse and the factors associated with this behavior in the investigated Asian communities, and (2) to evaluate the impact of betel quid abuse on oral premalignant disorders.     

某部队官兵嚼食槟榔健康教育干预

目的了解南海某岛礁驻防官兵嚼食槟榔现状,明确其主要原因,验证教育宣讲的干预效果,探索有效控制槟榔嚼食的具体措施。方法采用自行编制的岛礁部队官兵嚼食槟榔调查问卷,对随机抽取的南海某岛礁部队147名经槟榔危害健康教育宣讲官兵进行调查对比。结果受调查官兵槟榔嚼食率为58.5%,其中41.62%为偶尔嚼食,40.14%嚼食时间≥1年。经健康教育后1月,随访发现未嚼食槟榔者有91人(61.9%),嚼食槟榔数量减少者有44人(29.93%)。认为健康教育宣讲对本人和周围人群戒食槟榔有作用占89.11%。结论健康教育是岛礁部队官兵戒食槟榔的强有力手段之一。结合调查问卷,建议采取多样化措施,减少槟榔嚼食对官兵的影响,提高官兵身体素质和战斗力。     

Betel nut chewing: the prevalence and the intergenerational effect of parental behavior on adolescent students.

PURPOSE: To explore the betel nut chewing prevalence among students, analyze the probability and the odds ratio of ex-chewers and current chewers, as well as the correlation between parental behavior characteristics and those of adolescents chewing betel nut. METHODS: A cross-sectional survey was designed and 10,288 Taiwanese students answered the questionnaires in 2002. A structured questionnaire included information about betel nut chewing behavior among the adolescent students, sociodemographic data, and the betel nut chewing practice among parents or classmates. Samples were randomly chosen from each cluster of different types of schools in various areas. Three different grade levels of the first, second, and third grade (ages 16-18 years) were selected. Frequency distribution was used to analyze the prevalence among adolescent students, and Chi-square tests were used to compare the differences of betel nut chewing behavior among genders and the effect of parental behavior and socioeconomic factors. Logistic regression was used to analyze the odds ratio of the prevalence of adolescent students' betel nut chewing in the different types of schools and by gender. RESULTS: When the parents' marriage was not successful, or was of a lower social status, a higher incidence of adolescent betel nut chewing was observed. It was easy to experience betel nut chewing in adolescence if either parent chewed betel nut. The prevalence of betel nut chewing among male students was higher than female students and among vocational school students than general school students. The odds ratio of agricultural school students to general school students was highest of all the ex-chewers and current chewers from different types of schools. CONCLUSIONS: Betel nut chewing behavior is related to the effect of parental behavior on adolescent students. Apparently, it is indicated that there is a significant intergenerational effect of the parent's behavior on their children's behavior.     

Sociocultural Factors that Affect Chewing Behaviors among Betel Nut Chewers and Ex-Chewers on Guam

Areca nut (betel nut) is chewed by an estimated 10% of the world''s population which is equivalent to about 600 million people. It is classified as a Group 1 carcinogen by the World Health Organization (WHO) and has been linked to various types of oral cancer. Chewing areca predominates in South and South East Asia, East Africa, and the Western Pacific and has important social and cultural implications. The purpose of the pilot study was twofold: (1) to examine sociocultural factors that affect why people on Guam chew betel nut, their chewing behaviors, perceptions of risks, probability of changing behaviors, and methods that could be used to reduce use or quit; and (2) to pilot two surveys (one for chewers and one for ex-chewers) to be used in a larger study in the future. A mixed methods design was employed that included surveys pertaining to their status (chewer or ex-chewer) and in-depth interviews. A total of 30 adults participated in this pilot study: adult betel nut chewers (n = 15) and ex-chewers (n = 15). Chewing betel nut is a learned behavior, embedded within the culture, and is viewed as an important cultural identifier. Socially, chewing is viewed as positive. Chewers stated that they were not as aware of health issues; however, ex-chewers stated health reasons for quitting.