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.     

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.     

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。     

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。     

A prospective community-population-registry based cohort study of the association between betel-quid chewing and cardiovascular disease in men in Taiwan (KCIS no. 19)

BACKGROUND: Betel-quid chewing, a recognized risk factor for oral cancer, was shown to be a contributory cause of metabolic syndrome in humans, which implies a greater likelihood of developing cardiovascular disease (CVD) among those with the betel habit. OBJECTIVE: This study investigated the effect of betel chewing on the risk of developing overt CVD. DESIGN: We used the prospective cohort data derived from a community-population-registry-based integrated screening program to quantify the effect of betel-quid chewing on the incidence of newly diagnosed CVD by classifying the study population into either exposed or nonexposed groups according to chewing status at baseline. We then followed the group free of CVD at recruitment for 2.72 y (SD=1.52 y) to learn of new cardiovascular events. Proportional hazards regression modeling was used to estimate the magnitude of the effect of betel-quid chewing on CVD. RESULTS: After control for age and education level, ever chewers had a 23% (95% CI: 11%, 37%) greater risk of developing CVD than did never chewers; ever chewers were still at greater risk of developing CVD by 24% (95% CI: 11%, 39%) after further adjustment for age, education, and other significant confounders. Significant dose-response relations were found for betel-quid chewing (P<0.05, trend test) after adjustment for other significant variables. CONCLUSION: The habit of chewing betel nut was shown to have independent dose effects to predict increases in the risk of CVD in men, with the use of a prospective community-population-registry-based cohort study.     

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.     

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.     

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。     

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.     

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.     

Prevalence and related risk factors of areca quid chewing among junior high students in eastern Taiwan

Areca quid chewing is a serious problem in eastern Taiwan. The prevalence and related risk factors of areca quid chewing among junior high students were studied. Group 1 consisted of 896 non-aboriginal students and group 2 of 565 aboriginal students. The students were asked to fill out a questionnaire anonymously. Among the non-aboriginal students, 2.2% were found as current areca quid chewers, 16.4% had tried but not become regular users, and 2.2% had used it regularly and quit, whereas 9.7% of aboriginal students were current chewers, and 32.7% had tried it but had not become regular users, and 7.4% had used it regularly and quit. The prevalence of areca chewing is significantly different between boys and girls in the non-aboriginal group. A logistic regression analysis indicated that a non-aboriginal student who is a male, grows areca at home, is a tobacco smoker, an alcohol drinker, and has family members and close friends as chewers is more likely to chew areca quid than others. Aboriginal students who are chewers are likely to grow areca at home, are tobacco smokers and alcohol drinkers, and have family members and close friends as chewers. Based on the findings of the study, the need for a health promotion program was identified. Areca quid is not only detrimental to people's health, but also to the environment in which people live.     

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 quid chewing and risk of adverse pregnancy outcomes among aborigines in Southern Taiwan

It is known that substance use is associated with increased risk of adverse pregnancy, outcomes. The aims of this study were to estimate the prevalence of alcohol, cigarette, betel quid and drug use during pregnancy and to assess the risk of adverse effects of betel quid chewing on pregnancy outcomes in aboriginal women in southern Taiwan. The study population included 62 women with adverse pregnancy outcomes and 124 age-matched women. Subjects were interviewed at their homes by trained interviewers using a structure questionnaire. Prevalences of various substance use in aborigines with adverse pregnancy outcomes were estimated as follows: alcohol, 43.6%; smoking, 14.5%; betel quid chewing, 43.6% and over-the-counter drug use, 8.1%; whereas in the comparison group it was alcohol, 38.7%; smoking, 8.1%; betel quid chewing, 28.2% and none used drugs. Univariate analysis revealed that adverse pregnancy outcomes were associated with maternal betel quid chewing, maternal illness during pregnancy, and the number of pregnancies (gravidity) experienced. After adjusting for maternal illness and number of previous pregnancies covariates, the prevalence of adverse pregnancy outcome was computed to be 2.8-fold higher among betel quid chewing women as compared to non-chewers (AOR=2.8, 95% CI=1.2-6.8). Among the aboriginal women, prenatal care is essential not only for routine care, but also to focus health education on the harmful effects of substance use, especially betel quid use during pregnancy.     

Confirmatory factor analysis and structural equation modeling of socio-cultural constructs among chamorro and non-chamorro micronesian betel nut chewers

Objectives: Betel nut chewing is embedded within the cultures of South Asia, and Southeast Asia, and the Western Pacific. The determinants of betel nut consumption are complex. Ongoing consumption of betel nut is affected by cultural, social, and drug-specific effects (i.e. dependence). This study’s first objective was to assess the psychometric properties (i.e. reliability and validity) of the socio-cultural constructs in a survey developed for betel nut chewers. The study’s second objective was to investigate the influence of socio-cultural variables on betel nut chewing behaviors among Chamorro and non-Chamorro Micronesians in Guam.

Design: The current study was a secondary analysis of a larger study (N?=?600; n?=?375 chewers and n?=?225 former chewers) that examined socio-cultural factors that influence why chewers chew betel nut, along with assessing chewing behaviors, perceptions of risks, probability of changing behaviors, and methods that could be used to reduce use or quit. The socio-cultural constructs of the survey were analyzed using confirmatory factor analysis and structural equation modeling.

Results: The socio-cultural factors were a sufficient fit with data and the instrument is reliable and valid, as indicated by various model fit indices (χ² (13)?=?18.49 with p?=?.14, TLI?=?.99, CFI?=?1.00, SRMR?=?.02, RMSEA?=?.03 with 90% CIs [.00,.07]). Cronbach’s alpha, the sign and magnitude of the factor loadings, the inter-factor correlations, and the large proportion of variance extracted for each factor, all indicate that the instrument is reliable and valid. Additionally, multivariate analyses showed that socio-cultural reasons were important contributing or chewing betel nut. Participants cited chewing because their friends and family members chewed, the behavior is embedded within their culture, and it would be considered rude and disrespectful to not chew.

Conclusion: Based on the findings, this study provides important implications pertaining to creating culturally appropriate cessation programs.     

Betel Nut Use among First and Second Generation Bangladeshi Women in London,UK

This study evaluated the effects of socio-economic variables and migration history on the prevalence of betel nut and smokeless tobacco use in both UK- and Bangladeshi born migrant women resident in London. No significant difference in betel nut use prevalence was found among women of different generations. However, in all groups betel nut users were significantly older and less educated than non-users. Among first generation women there was no effect of either length of time living in the UK or age at migration on use of betel nut, even after controlling for current age. No significant differences in prevalence use due to language spoken, occupation, marital status or borough of residence in London were found. We conclude that, although there are some indications of a change in behavior among younger individuals, betel nut chewing is a practice very much present among Bangladeshi women born and brought up in a bicultural context.     

Yauk gyar mann yin (Be a man!): masculinity and betel quid chewing among men in Mandalay,Myanmar

Betel quid chewing is associated with various oral cancers and other health concerns, including reproductive health issues. Nevertheless, the practice is widespread in Myanmar, especially among men. This qualitative study elucidates the gendered aspects of betel quid chewing by examining how it links with masculine ideology among male betel quid chewers in Mandalay, Myanmar. Data were collected through in-depth interviews, focus-group discussions, key-informant interviews and participant observation. The thematic content analysis was guided by Connell’s concept of hegemonic masculinity and Butler’s notion of gender performativity. The findings indicated that young Mandalay men were drawn to betel quid chewing by the value they gave to satisfying their curiosity, power competition, risk-taking and a display of manliness. Thus, the practice of betel quid chewing, as defined by our participants, was perceived as manly, trendy, stylish and sexually attractive. For adult men, betel quid chewing was a social lubricant that assisted them in talking with clients and co-workers, thus enhancing their economic opportunities with other men. It also helped working-class men to work harder. Betel quid chewing harm-reduction programmes therefore need to be mindful of masculinity issues as well as the economic aspects of betel quid chewing.     

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.     

湖南地区食用槟榔流行病学研究

目的探讨湖南地区居民咀嚼槟榔的原因和安全性,为槟榔的开发提供科学依据。方法采用多阶段抽样方法进行湖南省城乡居民咀嚼槟榔情况调查,运用国家规定的方法开展槟榔加工前后化学成分的检测及毒理学试验。结果湖南省居民咀嚼槟榔率为38.40%,其中城区为42.65%,乡村为34.12%;咀嚼槟榔的年限城区5年以下占24.72%,乡村5年以下占46.91%;日咀嚼槟榔数量的中位数城区为23.6 g,乡村为22.8 g;过瘾、提神醒脑和交际需要是居民咀嚼槟榔的前三位原因;检测17种槟榔成分,镉、锡、铅、总砷、柠檬烯、薄荷醇、香兰素加工前后无变化,加工后含量增加的有水份、脂肪和乙基麦芽酚3种,含量减少的有铁、粗纤维、锌、锰、铜、粗多糖和槟榔碱7种。毒理学实验证明,槟榔干果为无毒级,无遗传毒性和亚慢性毒作用。结论湖南地区城乡居民咀嚼槟榔已成为一种生活嗜好,食用槟榔对人体健康的影响仍有待于进一步研究。     

Betel Nut Chewing in Hawai‘i: Is it Becoming a Public Health Problem? Historical and Socio-Cultural Considerations

This article examines the socio-cultural significance of betel nut use among Micronesians, in light of the recent migration of Micronesians to Hawai‘i. The different ways of chewing betel nut are the result of historical changes within Micronesia over time due to Spanish and US colonialism as well as the introduction of tobacco. These divergent ways of chewing may have different risks or impacts on health and it remains to be seen whether or not betel nut will become a significant public health problem in Hawai‘i.