title: Betel-quid and oral submucous fibrosis: a cross-sectional study in Hunan province, China.
abstract: BACKGROUND
  The development of betel-quid (BQ) processing industry in Hunan has increased the usage of this substance and may produce significant health consequences. However, the update data for the prevalence of BQ chewing and its effect on oral submucous fibrosis (OSF) are limited.
  
  
  METHODS
  A population-based survey was conducted to investigate the prevalence of BQ chewing and OSF in Hunan. A questionnaire interview and an oral examination were conducted. A multivariate logistic regression model was used to study the effect of socio-demographic characteristics on area-specific behaviors of BQ chewing.
  
  
  RESULTS
  A total of 2356 subjects participated in this survey, with a 78.5% of response rate. The lifetime prevalence of BQ chewing was 16.2% (2.9% for ex-chewers and 13.3% for current-chewers). The findings from multivariate logistic regression model showed that a higher prevalence of this habit was among individuals who were males, urban residents, 15-49 years old, educated for 9-12 years, smokers, and drinkers. Male chewers occupied a fairly higher percentage of the combined use of tobacco and/or alcohol (86.1-87.5%) than the non-chewers (50.6-56.7%). The overall prevalence of OSF was 1.0%. Compared with the subjects without OSF (1.7-23.2%), a significantly higher proportion of OSF patients were a current-chewer (62.3% in men and 100.0% in women).
  
  
  CONCLUSIONS
  BQ chewing is a vital risk factor for OSF in Hunan. A high prevalence of BQ chewing found among the younger cohort (15-49 years old) is an urgent warning for this oral premalignant disorder.
authors.affiliation: Department of Stomatology, Second Xiangya Hospital, Central South University, Changsha, Hunan Province, China.
authors.forename: Shan-Shan
authors.initials: SS
authors.lastname: Zhang
authors.forename: Wen-Hui
authors.initials: WH
authors.lastname: Li
authors.forename: Yi-Jun
authors.initials: YJ
authors.lastname: Gao
authors.forename: Zhi-Wen
authors.initials: ZW
authors.lastname: Liu
authors.forename: Lin
authors.initials: L
authors.lastname: Liu
authors.forename: Jie-Qing
authors.initials: JQ
authors.lastname: Tang
authors.forename: Tian-You
authors.initials: TY
authors.lastname: Ling
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D001114:Areca; D002681:China / Q000453:epidemiology; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009754:Nuts; D009914:Oral Submucous Fibrosis / Q000139:chemically induced / Q000453:epidemiology*; D015995:Prevalence; D017678:Sex Distribution; D019966:Substance-Related Disorders / Q000453:epidemiology*; D055815:Young Adult