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Despite gradual understanding of the multidimensional health consequences
of betel-quid chewing, information on the effects of dependent use is
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).
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.
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.
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
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