title: Population burden of betel quid abuse and its relation to oral premalignant disorders in South, Southeast, and East Asia: an Asian Betel-quid Consortium Study.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Public Health, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Chien-Hung
authors.initials: CH
authors.lastname: Lee
authors.forename: Albert Min-Shan
authors.initials: AM
authors.lastname: Ko
authors.forename: Saman
authors.initials: S
authors.lastname: Warnakulasuriya
authors.forename: Tian-You
authors.initials: TY
authors.lastname: Ling
authors.lastname: Sunarjo
authors.forename: Palandage Sunethra
authors.initials: PS
authors.lastname: Rajapakse
authors.forename: Rosnah Binti
authors.initials: RB
authors.lastname: Zain
authors.forename: Salah Osman
authors.initials: SO
authors.lastname: Ibrahim
authors.forename: Shan-Shan
authors.initials: SS
authors.lastname: Zhang
authors.forename: Han-Jiang
authors.initials: HJ
authors.lastname: Wu
authors.forename: Lin
authors.initials: L
authors.lastname: Liu
authors.lastname: Kuntoro
authors.forename: Budi
authors.initials: B
authors.lastname: Utomo
authors.forename: Supun Amila
authors.initials: SA
authors.lastname: Warusavithana
authors.forename: Ishak Abdul
authors.initials: IA
authors.lastname: Razak
authors.forename: Norlida
authors.initials: N
authors.lastname: Abdullah
authors.forename: Prashanta
authors.initials: P
authors.lastname: Shrestha
authors.forename: Tien-Yu
authors.initials: TY
authors.lastname: Shieh
authors.forename: Cheng-Fang
authors.initials: CF
authors.lastname: Yen
authors.forename: Ying-Chin
authors.initials: YC
authors.lastname: Ko
mesh_terms: D000328:Adult; D001114:Areca; D001208:Asia / Q000453:epidemiology; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D038622:Internationality; D008297:Male; D008409:Mastication; D008875:Middle Aged; D009062:Mouth Neoplasms; D011230:Precancerous Conditions / Q000453:epidemiology* / Q000209:etiology*; D019966:Substance-Related Disorders / Q000453:epidemiology*; D011795:Surveys and Questionnaires