title: Betel-quid dependence and oral potentially malignant disorders in six Asian countries.
abstract: BACKGROUND
  Despite gradual understanding of the multidimensional health consequences of betel-quid chewing, information on the effects of dependent use is scant.
  
  
  OBJECTIVE
  To investigate the 12-month prevalence patterns of betel-quid dependence in six Asian populations and the impact of this dependence on oral potentially malignant disorders (OPMD).
  
  
  METHODS
  A multistage random sample of 8922 participants was recruited from Taiwan, mainland China, Indonesia, Malaysia, Sri Lanka and Nepal. Participants were evaluated for betel-quid dependency using DSM-IV and ICD-10 criteria and assessed clinically for oral mucosal lesions.
  
  
  RESULTS
  The 12-month prevalence of dependence was 2.8-39.2% across the six Asian samples, and 20.9-99.6% of those who chewed betel-quid were betel-quid dependent. Men dominated the prevalence among the east Asian samples and women dominated the prevalence in south-east Asian samples. 'Time spent chewing' and 'craving' were the central dependence domains endorsed by the Chinese and southern/south-east Asian samples respectively, whereas the Nepalese samples endorsed 'tolerance' and 'withdrawal'. Dependency was linked to age, gender, schooling years, drinking, smoking, tobacco-added betel-quid use and environmental accessibility of betel-quid. Compared with non-users, those with betel-quid dependency had higher pre-neoplastic risks (adjusted odds ratios 8.0-51.3) than people with non-dependent betel-quid use (adjusted odds ratio 4.5-5.9) in the six Asian populations.
  
  
  CONCLUSIONS
  By elucidating differences in domain-level symptoms of betel-quid dependency and individual and environmental factors, this study draws attention to the population-level psychiatric problems of betel-quid chewing that undermine health consequences for OPMD in six Asian communities.
authors.affiliation: Department of Public Health, Kaohsiung Medical University, Taiwan.
authors.forename: Chien-Hung
authors.initials: CH
authors.lastname: Lee
authors.forename: Albert Min-Shan
authors.initials: AM
authors.lastname: Ko
authors.forename: Cheng-Fang
authors.initials: CF
authors.lastname: Yen
authors.forename: Koung-Shing
authors.initials: KS
authors.lastname: Chu
authors.forename: Yi-Jun
authors.initials: YJ
authors.lastname: Gao
authors.forename: Saman
authors.initials: S
authors.lastname: Warnakulasuriya
authors.lastname: Sunarjo
authors.forename: Salah Osman
authors.initials: SO
authors.lastname: Ibrahim
authors.forename: Rosnah Binti
authors.initials: RB
authors.lastname: Zain
authors.forename: Walter K
authors.initials: WK
authors.lastname: Patrick
authors.forename: Ying-Chin
authors.initials: YC
authors.lastname: Ko
mesh_terms: D000328:Adult; D000368:Aged; D001114:Areca / Q000009:adverse effects*; D001208:Asia / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000139:chemically induced / Q000453:epidemiology*; D028321:Plant Preparations / Q000009:adverse effects*; D011230:Precancerous Conditions / Q000139:chemically induced / Q000453:epidemiology*; D015995:Prevalence; D012307:Risk Factors; D019966:Substance-Related Disorders / Q000453:epidemiology* / Q000517:prevention & control
chemical_list: D028321:Plant Preparations