title: Betel quid use in relation to infectious disease outcomes in Cambodia.
abstract: OBJECTIVE
  The habitual chewing of betel quid (areca nut, betel leaf, tobacco) is estimated to occur among 600 million persons in Asia and the Asia-Pacific Region. Emerging data from rural Asia indicate that the betel quid is part of traditional medicine practices that promote its use for a wide range of ailments, including infectious disease. In the present study, we examined the association between betel quid, traditional medicine, and infectious disease outcomes.
  
  
  METHODS
  For the purpose of a nationwide, interviewer-administered, cross-sectional survey of tobacco use (including betel quid), we conducted a stratified three-stage cluster sampling of 13 988 adults aged 18 years and older from all provinces of Cambodia.
  
  
  RESULTS
  We found an association between the intensity of betel quid use and HIV/AIDS (odds ratio (OR) 2.06, 95% CI 1.09-3.89), dengue fever (OR 2.40, 95% CI 1.55-2.72), tuberculosis (OR 1.50, 95% CI 0.96-2.36), and typhoid (OR 1.48, 95% CI 0.95-2.30). These associations were even stronger in women - the primary users of betel quid in Cambodia. Multivariable analyses that controlled for age, gender, income, education, urban versus rural dwelling, receiving care from traditional medicine practitioners, and cigarette smoking did not alter the betel quid-infectious disease association.
  
  
  CONCLUSIONS
  Our findings raise the possibility of a role of betel quid use in the transmission of infectious disease through pathways such as immunosuppression, oral route of entry for a pathogen (i.e., through injury to the oral mucosa), and contamination (i.e., fecal-oral) of the betel quid ingredients.
authors.affiliation: Department of Epidemiology, School of Public Health, Loma Linda University, Loma Linda, CA 92350, USA. psingh@llu.edu
authors.forename: Pramil N
authors.initials: PN
authors.lastname: Singh
authors.forename: Zuhair
authors.initials: Z
authors.lastname: Natto
authors.forename: Daravuth
authors.initials: D
authors.lastname: Yel
authors.forename: Jayakaran
authors.initials: J
authors.lastname: Job
authors.forename: Synnove
authors.initials: S
authors.lastname: Knutsen
mesh_terms: D000293:Adolescent; D000328:Adult; D001114:Areca; D002160:Cambodia / Q000453:epidemiology; D003715:Dengue; D005260:Female; D015658:HIV Infections; D006801:Humans; D016015:Logistic Models; D008297:Male; D008519:Medicine, Traditional / Q000706:statistics & numerical data*; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D019966:Substance-Related Disorders / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D014030:Tobacco, Smokeless; D014397:Tuberculosis, Pulmonary; D014435:Typhoid Fever; D055815:Young Adult