| Abstract: | 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. |
