title: Betel quid chewing in rural Bangladesh: prevalence, predictors and relationship to blood pressure.
abstract: BACKGROUND
  Betel quid is chewed by 600 million people worldwide and it has been linked to obesity and cardiovascular disease. The purpose of our study was to examine the prevalence and predictors of betel quid chewing in a rural area of Bangladesh, and determine its effects on body mass index (BMI) and blood pressure.
  
  
  METHODS
  In this population-based prospective study, we analysed data on 19 934 Bangladeshi adults. Linear and multivariate logistic regression was used to determine the socio-demographic predictors of betel quid chewing and the effect of betel quid on change in BMI and on systolic and diastolic blood pressure, pulse pressure, arterial pressure, overweight or obesity, and hypertension.
  
  
  RESULTS
  At baseline, betel quid was chewed by 33.2% of the cohort (35.5% of men, 31.6% of women). In a subsample in which we collected methods of use, 17.5% chewed it without tobacco and 82.5% chewed it with tobacco. In multivariate analysis, betel quid chewing was associated with female sex, older age, tobacco smoking and lower socio-economic status, as measured by fewer years of formal education and not owning land. Betel quid was chewed more times per day among women and older persons. At follow-up, persons who chewed betel quid without tobacco had higher systolic blood pressure, diastolic blood pressure and arterial pressure in comparison with never users. After controlling for other explanatory variables, chewing betel quid without tobacco was associated with general hypertension [odds ratio (OR) 1.48, 95% confidence interval (CI) 1.04-2.10] and systolic hypertension (OR 1.55, 95% CI 1.01-2.37). We did not observe associations of betel quid chewing with BMI or overweight.
  
  
  CONCLUSIONS
  Betel quid chewing is likely contributing to high blood pressure in Bangladesh, particularly among women.
authors.affiliation: Department of Epidemiology, University of California, Los Angeles, CA, USA. jeheck@ucla.edu
authors.forename: Julia E
authors.initials: JE
authors.lastname: Heck
authors.forename: Erin L
authors.initials: EL
authors.lastname: Marcotte
authors.forename: Maria
authors.initials: M
authors.lastname: Argos
authors.forename: Faruque
authors.initials: F
authors.lastname: Parvez
authors.forename: Alauddin
authors.initials: A
authors.lastname: Ahmed
authors.forename: Tariqul
authors.initials: T
authors.lastname: Islam
authors.forename: Golam
authors.initials: G
authors.lastname: Sarwar
authors.forename: Rabiul
authors.initials: R
authors.lastname: Hasan
authors.forename: Habibul
authors.initials: H
authors.lastname: Ahsan
authors.forename: Yu
authors.initials: Y
authors.lastname: Chen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001114:Areca; D001459:Bangladesh / Q000453:epidemiology; D001794:Blood Pressure; D015992:Body Mass Index; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008137:Longitudinal Studies; D008297:Male; D008409:Mastication; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D012044:Regression Analysis; D012307:Risk Factors; D012424:Rural Population; D012737:Sex Factors; D014030:Tobacco, Smokeless