嚼食槟榔地区槟榔使用现状研究

摘要:目的　为嚼食槟榔地区流行病学研究提供数据。方法　查阅近年来国内、外相关文献,对我国、东南亚及南亚、西方等嚼食槟榔地区槟榔使用现状及问题进行综述。结果　我国及东南亚及南亚地区,槟榔嚼食率较高,而戒断率较低,西方地区槟榔嚼食率相对较低,长期嚼食槟榔对口腔健康会产生影响。结论　嚼食槟榔地区不断蔓延,公众对于槟榔知晓率偏低,有关部门应采取相对措施,控制槟榔咀嚼率。     

我国嚼食槟榔地区居民槟榔使用问题及对策探讨的研究现况

对我国嚼食槟榔流行地区居民的槟榔使用现状、与嚼食槟榔相关健康问题以及对策探讨的研究现况进行综述.     

The synergistic effect of cigarette taxes on the consumption of cigarettes, alcohol and betel nuts

Background  

Consumption of cigarettes and alcoholic beverages creates serious health consequences for individuals and overwhelming financial burdens for governments around the world. In Asia, a third stimulant – betel nuts – increases this burden exponentially. For example, individuals who simultaneously smoke, chew betel nuts and drink alcohol are approximately 123 times more likely to develop oral, pharyngeal and laryngeal cancer than are those who do not.     

The synergistic effect of cigarette taxes on the consumption of cigarettes,alcohol and betel nuts

Background

Factor structure of the 12-item General Health Questionnaire (GHQ-12) was studied by a survey of subjects who had experienced the 2004 Niigata-Chuetsu earthquake (6.8 on the Richter scale) in Japan.

Methods

Psychological distress was measured at two years after the earthquake by using GHQ-12 in 2,107 subjects (99.0% response rate) who suffered the earthquake. GHQ-12 was scored by binary, chronic and Likert scoring method. Confirmatory factor analysis was used to reveal the factor structure of GHQ-12. Categorical regression analysis was performed to evaluate the relationships between various background factors and GHQ-12 scores.

Results

Confirmatory factor analysis revealed that the model consisting of the two factors and using chronic method gave the best goodness-of-fit among the various models for factor structure. Recovery in the scale for the factor 'social dysfunction' was remarkably impaired compared with that of the factor 'dysphoria'. Categorical regression analysis revealed that various factors, including advanced age, were associated with psychological distress. Advanced age affected the impaired recovery of factor 'social dysfunction' score as well as total GHQ score.

Conclusion

The two-factor structure of GHQ-12 was conserved between the survey at five month and that at two years after the earthquake. Impaired recovery in the ability to cope with daily problems in the subjects who had experienced the earthquake was remarkable even at two years after the earthquake.     

Betel quid use and mortality in Bangladesh: a cohort study

Objective

To evaluate the potential effects of betel quid chewing on mortality. (A quid consists of betel nut, wrapped in betel leaves; tobacco is added to the quid by some users).

Methods

Prospective data were available on 20 033 individuals aged 18–75 years, living in Araihazar, Bangladesh. Demographic and exposure data were collected at baseline using a standardized questionnaire. Cause of death was defined by verbal autopsy questionnaires administered to next of kin. We estimated hazard ratios (HR) and their 95% confidence intervals (CI) for associations between betel use and mortality from all causes and from specific causes, using Cox proportional hazards models. We adjusted for age, sex, body mass index, educational attainment and tobacco smoking history.

Findings

There were 1072 deaths during an average of 10 years of follow-up. Participants who had ever used betel were significantly more likely to die from all causes (HR: 1.26; 95% CI: 1.09–1.44) and cancer (HR: 1.55; 95% CI: 1.09–2.22); but not cardiovascular disease (HR: 1.16; 95% CI: 0.93–1.43). These findings were robust to adjustment for potential confounders. There was a dose–response relationship between mortality from all causes and both the duration and the intensity of betel use. The population attributable fraction for betel use was 14.1% for deaths from all causes and 24.2% for cancer.

Conclusion

Betel quid use was associated with mortality from all causes and from cancer in this cohort.     

Risk of betel quid chewing on the development of liver cirrhosis: a community-based case-control study

PURPOSE: The role of betel quid on the development of liver cirrhosis is unclear; we thus designed a community-based case-control study to evaluate the association between betel quid chewing and liver cirrhosis. METHODS: A total of 42 cases of liver cirrhosis and 165 matched controls were included for analysis. Questionnaires were administered to obtain histories of betel quid chewing, alcohol consumption, smoking, and family history of liver disease. Hepatitis B surface antigen and anti-hepatitis C antibody were also determined by immunoassay. RESULTS: Individuals with more betel quid chewing (more than 55 quid-years vs. less than 55 quid-years and never-chewers, matched odds ratio [OR(m)] = 2.2; 95% confidence interval [CI]: 1.0-5.0) had higher risks for liver cirrhosis. The combined effects on liver cirrhosis by betel quid chewing and the number of other risk factors, including hepatitis B virus (HBV) infection, smoking, and alcohol drinking, were also observed. When individuals with less betel quid chewing (less than 55 quid-years and never-chewers) and with no other risk factors used as a reference, betel quid chewers expressing greater betel quid chewing (more than 55 quid-years) and more risk factors of HBV infection, cigarette smoking, and habitual alcohol drinking expressed a greater risk of liver cirrhosis (OR(m) = 70.8; 95% CI: 4.0-1260.1). CONCLUSIONS: Our results suggest that betel quid chewing may play an important role in the development of hepatic cirrhosis. Larger study and cohort studies would be necessary to provide further evidence regarding this finding.     

Biological monitoring of environment exposure to safrole and the Taiwanese betel quid chewing

A rapid and sensitive biological monitoring (BM) method for assessing exposure to the environmental carcinogen safrole has been developed. The method is an isocratic high-performance liquid chromatographic (HPLC) analysis of urinary dihydroxychavicol (DHAB) and eugenol, the urinary metabolites of safrole. Good linearity, precision, and accuracy were demonstrated. A recovery of 98.8 ± 5.4% (SD, n = 3) was found for DHAB and 84.1 ± 3.4% (n = 3) for eugenol. The quantitation limits of the method were 8 ng for DHAB and 10 ng for eugenol. The validity of the method was demonstrated by a linear dose-response relationship observed in rats given oral doses of safrole at 30, 75, and 150 mg/kg body weight. The method was also used to monitor the environmental exposure to the Taiwanese betel quid (TBQ) chewing, because TBQ used in Taiwan not only contains areca (betel) nut, slaked lime, and catechu but also Piper betle inflorescence or its leaves. Both of the latter have a high content of safrole. The feasibility of the method to monitor TBQ chewing was demonstrated by an analysis of 153 spot human urine samples. The results showed that the p value of the nonparametric group comparison was < 0.001 for DHAB and 0.832 for eugenol. The TBQ chewers also exhibited a significantly higher rate of urinary DHAB (but not eugenol) than the nonchewers with an odd ratio of 3.47 (95% CI, 1.61–7.51). However, when only the eugenol-positive subjects were taken into analysis, the ratio rose to 24.38 (95% CI, 3.00–197.90). Received: 12 November 2001/Accepted: 25 April 2002     

Carcinogenicity examination of betel quid. II. Effect of vitamin A deficiency on rats fed semipurified diet containing betel nut and calcium hydroxide

The effect of vitamin A deficiency on the carcinogenicity of betel quid was studied, using long-term feeding of vitamin-A-deficient and -sufficient diets with and without betel nut and calcium hydroxide in ACI rats. A high incidence of focal epithelial hyperplasia was observed in the upper digestive tract (tongue, buccal oral mucosa, esophagus, and forestomach) of rats in the group given the vitamin-A-deficient diet mixed with betel nut and calcium hydroxide. The vitamin-A-deficient group also showed a high incidence of squamous papilloma in the tongue, buccal mucosa, and forestomach. The incidence of hyperplastic lesions of the tongue and buccal oral mucosa was significantly higher in this group than in the group receiving the vitamin-A-sufficient diet with betel nut and calcium hydroxide. These results suggest that the vitamin-A-deficient condition enhanced the growth of epithelial hyperplasia that was due to the administration of the betel quid ingredients. However, vitamin A did not protect against the development of altered liver cell foci, which were frequently seen with a small number of hepatocellular neoplasms in all groups given the diets containing betel nut and calcium hydroxide (both vitamin-A-deficient and -sufficient groups).     

Carcinogenicity examination of betel quid. II. Effect of vitamin a deficiency on rats fed semipurified diet containing betel nut and calcium hydroxide

The effect of vitamin A deficiency on the carcinogenicity of betel quid was studied, using long‐term feeding of vitamin‐A‐deficient and ‐sufficient diets with and without betel nut and calcium hydroxide in ACI rats. A high incidence of focal epithelial hyperplasia was observed in the upper digestive tract (tongue, buccal oral mucosa, esophagus, and forestomach) of rats in the group given the vitamin‐A‐deficient diet mixed with betel nut and calcium hydroxide. The vitamin‐A‐deficient group also showed a high incidence of squamous papilloma in the tongue, buccal mucosa, and forestomach. The incidence of hyperplastic lesions of the tongue and buccal oral mucosa was significantly higher in this group than in the group receiving the vitamin‐A‐sufficient diet with betel nut and calcium hydroxide. These results suggest that the vitamin‐A‐deficient condition enhanced the growth of epithelial hyperplasia that was due to the administration of the betel quid ingredients. However, vitamin A did not protect against the development of altered liver cell foci, which were frequently seen with a small number of hepatocellular neoplasms in all groups given the diets containing betel nut and calcium hydroxide (both vitamin‐A‐deficient and ‐sufficient groups).     

The effects of preventative interventions targeting the use of stimulants

Numerous prevention programs aimed at reducing the use of stimulants (tobacco, alcohol, drugs) have been developed and examined during the past few decades. Most research has been conducted into school-based prevention programs. School-based prevention programs have been found to reduce the use of drugs to a certain extent, provided they use interactive methods where the focus is not on didactic presentations but on peer discussions, role-playing, and interaction between students. Promising interventions, but which have as yet been insufficiently researched for broad-scale dissemination, include family-based programs (courses for parents of adolescents), mass media campaigns and community interventions in which a combined package of interventions is organised within a specific region or town.     

Tobacco, betel quid, alcohol, and illicit drug use among 13- to 35-year-olds in I-Lan, rural Taiwan: prevalence and risk factors.

OBJECTIVES: This study determined the prevalence of and risk factors for substance use among rural Taiwanese. METHODS: We used a survey of a representative sample of 6318 participants aged 13 to 35 years in I-Lan, Taiwan, in 1996 through 1997. RESULTS: Perceived use of illicit drugs by peers, tobacco smoking, betel quid chewing, and male gender were the strongest predictors of illicit drug use. The prevalence of illicit drug use ranged from 0.3% among those who did not use any other substance to 7.1% among those using tobacco, betel quid, and alcohol. CONCLUSIONS: Preventive measures should address substance use in general rather than aiming at single substances.     

Firm behavior in a market with addiction: the case of cigarettes.

This paper investigates firm behavior when demand is linked over time. Among other things, the theoretical section shows that if firms are forward-looking, anticipated future events can affect current consumption of an 'addictive' good even when consumers are completely myopic. The empirical part of the paper reports a simulation of the 1983 federal cigarette excise tax increase. Both myopic and rational models of consumer demand give roughly the same predictions for per capita consumption, but neither model does very well predicting actual consumption. The problem appears to lie in the prediction of price, suggesting that supply considerations are important.     

The effect of drinking coffee and smoking cigarettes on the risk of cirrhosis associated with alcohol consumption

In order to assess the interaction between alcohol intake, tobacco smoking and coffee con sumption in determining the risk of liver cirrhosis we carried out a hospital-based case-control study involving 115 patients at their first diagnosis of cirrhosis and 167 control patients consecutively enrolled in the General Hospitals of the Province of L'Aquila (Central Italy). The mean life-time daily alcohol intake (as g ethanol consumed daily) was measured by direct patient interviews, whose reproducibility was >0.80 and similar for cases and controls, as checked by interviewing the relatives of a sample of 50 cases and 73 controls. During the same patient's interview we also measured the mean consumption of coffee (daily number of cups of filtered coffee) and tobacco (life-time daily number of cigarettes smoked). A dose-effect relationship on the risk of cirrhosis was present both for alcohol intake — for which the risk was significantly increased above 100 g of daily intake — and for cigarette consumption. The latter did not however improve the goodness-of-fit of a logistic regression model including alcohol intake as covariate. By contrast, coffee consumption had a protective effect on the risk of cirrhosis and significantly improved the goodness-of-fit of such a model. Abstaining from coffee consumption determined both a significantly increased risk of cirrhosis, even for daily alcohol intake below 100 g, and a multiplicative effect with alcohol intake on this risk. In patients drinking 101 g ethanol daily the relative risk increased from 5.5 (95% confidence interval: 1.4–22.0) for coffee consumers to 10.8 (95% confidence interval: 1.3–58.1) for coffee abstainers. We conclude that: (1) tobacco smoking is likely to be a faint risk factor for cirrhosis, and studies on wider patients series should be performed for confirmation; (2) coffee drinking is associated with a reduced risk of cirrhosis. Whether coffee contains some hitherto unknown protective substances, or is just a marker of other life-style or dietary protective factors, deserves further clarification. Provincial Group for the Study of Chronic Liver Disease: A. Attili (Cattedra di Fisiopatologia Digestiva, Università di L'Aquila), S. Santini, F. Bruccoleri & E. Zepponi (Laboratorio Analisi Cliniche, Ospedale Civile Tagliacozzo), G. Tullio & G. Tonietti (Cattedra di Clinica Medica, Università di L'Aquila), V. Festuccia, G. Giandomenico & G. Natali (Cattedra di Patologia Medica, Università di L'Aquila), M. Pozone, A. Giusti & F. Caione (Divisione di Geriatria, Ospedale Civile L'Aquila), M. Mariani, A. Grimaldi & A. Iannessi (Divisione di Malattie Infettive, Ospedale Civile L'Aquila), F. Marchionni, G. Del Bove Orlandi & G. Rabitti (Divisione di Medicina Generate, Ospedale Civile Avezzano), G. Sgrò & S. Cercone (Divisione di Medicina Generate, Ospedale Civile Sulmona), E. Bernardini & P. Capobianchi (Divisione di Medicina Generate, Ospedale Civile Tagliacozzo), M. Giovannone, M. Cincis & P. Caracciolo (Divisione di Medicina Generate, Ospedale Civile Castel di Sangro), L. Colitti & A. Biocca (Divisione di Medicina Generate, Ospedale Civile Pescina), C. Ercole, C. Miccoli & C. Rapone (Scuola di Specializzazione in Patologia Clinica, Università di L'Aquila), S. Necozione & G. Pantaleo (Centro Interdipartimentale di Epidemiologia, Università di L'Aquila)     

The combined effect of smoking tobacco and drinking alcohol on cause-specific mortality: a 30 year cohort study

Background  

Smoking and consuming alcohol are both related to increased mortality risk. Their combined effects on cause-specific mortality were investigated in a prospective cohort study.     

The impact of diet and betel nut use on skin lesions associated with drinking-water arsenic in Pabna, Bangladesh

An established exposure-response relationship exists between water arsenic levels and skin lesions. Results of previous studies with limited historical exposure data, and laboratory animal studies suggest that diet may modify arsenic metabolism and toxicity. In this study, we evaluated the effect of diet on the risk of arsenic-related skin lesions in Pabna, Bangladesh. Six hundred cases and 600 controls loosely matched on age and sex were enrolled at Dhaka Community Hospital, Bangladesh, in 2001-2002. Diet, demographic data, and water samples were collected. Water samples were analyzed for arsenic using inductively coupled plasma mass spectroscopy. Betel nut use was associated with a greater risk of skin lesions in a multivariate model [odds ratio (OR) = 1.67; 95% confidence interval (CI), 1.18-2.36]. Modest decreases in risk of skin lesions were associated with fruit intake 1-3 times/month (OR = 0.68; 95%CI, 0.51-0.89) and canned goods at least 1 time/month (OR = 0.41; 95% CI, 0.20-0.86). Bean intake at least 1 time/day (OR = 1.89; 95% CI, 1.11-3.22) was associated with increased odds of skin lesions. Betel nut use appears to be associated with increased risk of developing skin lesions in Bangladesh. Increased intake of fruit and canned goods may be associated with reduced risk of lesions. Increased intake of beans may be associated with an increased risk of skin lesions. The results of this study do not provide clear support for a protective effect of vegetable and overall protein consumption against the development of skin lesions, but a modest benefit cannot be excluded.     

Price and consumption of cigarettes: a case for intervention?

It is suggested that cigarette consumption can and should be reduced by tax increases. As this contradicts a recent communication, the differences of analysis and the underlying models are discussed. Straightforward curve-fitting to serial social or economic data can be very misleading. If there is random drift, it is better to analyse consecutive changes of the parameters rather than their actual values.