Epidemiology of areca (betel) nut use in the mariana islands: Findings from the University of Guam/University of Hawai`i cancer center partnership program

Abstract

Background Areca (betel) nut is considered a Group 1 human carcinogen shown to be associated with other chronic diseases in addition to cancer. This paper describes the areca (betel) nut chewing trend in Guam, and health behaviors of chewers in Guam and Saipan. Methods The areca (betel) nut module in the Guam Behavioral Risk Factor Surveillance Survey was used to calculate the 5-year (2011-2015) chewing trend. To assess the association between areca (betel) nut chewing and health risks in the Mariana Islands, a cross-section of 300 chewers, ≥ 18 years old, were recruited from households in Guam and Saipan. Self-reported sociodemographics, oral health behaviors, chronic disease status, diet, and physical activity were collected. Anthropometry was measured. Only areca (betel) nut-specific and demographic information were collected from youth chewers in the household. Results The 5-year areca (betel) nut chewing prevalence in Guam was 11% and increased among Non-Chamorros, primarily other Micronesians, from 2011 (7%) to 2015 (13%). In the household survey, most adult chewers (46%) preferred areca nut with betel leaf, slaked lime, and tobacco. Most youth chewers (48%) preferred areca nut only. Common adult chronic conditions included diabetes (14%), hypertension (26%), and obesity (58%). Conclusion The 5-year areca (betel) nut chewing prevalence in Guam is comparable to the world estimate (10-20%), though rising among Non-Chamorros. Adult and youth chewers may be at an increased risk for oral cancer. Adult chewers have an increased risk of other chronic health conditions. Cancer prevention and intervention strategies should incorporate all aspects of health.

Oral Cavity Cancer Outcomes in Remote, Betel Nut-Endemic Pacific Islands

“…6 An increased oral cancer burden has been noted in Guam, however the oral cavity cancer profile in the western Pacific islands has been minimally evaluated overall. 5 Further investigation is important as collectively, thousands of islands with endemic betel nut use populated by millions of people are encompassed within the regions of Polynesia, Micronesia and Melanesia. 2,3 The authors perform a single-institution retrospective review at the only regional hospital complex in the CNMI to further evaluate the oral cavity carcinoma burden in the Pacific islands.…”

“…4 Prior studies have suggested a dramatically increased oral cancer burden in this region relative to the United States (US) mainland driven by betel nut use. 5 Currently, chewing remains commonplace; many view it as an integral part of the API cultural identity. 6 An increased oral cancer burden has been noted in Guam, however the oral cavity cancer profile in the western Pacific islands has been minimally evaluated overall.…”

Areca alkaloids measured from buccal cells using DART‐MS serve as accurate biomarkers for areca nut chewing

“…Areca nut (AN) chewing is a culturally ingrained habit practiced by approximately 600 million people worldwide including in Guam, where AN is chewed by approximately 11% of the population (2011–2015 prevalence) . Betel quid (BQ) is a masticatory mixture composed of AN from the Areca catechu palm, betel leaf from the Piper betle L. vine, and slaked lime (calcium hydroxide) with tobacco and/or spice additions depending on ethnicity…”

An undergraduate curriculum to study health risk factors of college students in Guam: The Pacific Islands Cohort of College Students (PICCS)

“…Stress re ected the number of Yes responses to the stress experience assessment in Total Fitness & Wellness, 15 and recoded to high (≥ 6 Yes responses) and low to average (< 6 Yes responses). Nutritional and physical activity variables were recoded: fast-food to frequent (≥ 3 times per week) and infrequent (< 3 times per week), fruits and vegetables to frequent (≥ 3 times per day) and infrequent (< 3 times per day), and physical activity via the Physical Activity Readiness Questionnaire 12,13 to active (PARQ score ≥ 5) and sedentary (PARQ score < 5). Alcohol de ned as any alcohol consumption in the last 30 days including binge drinking (≥ 5 drinks for men or ≥ 4 drinks for women on any occasion) and chronic drinking (≥ 60 drinks in a month).…”

“…Self-reported data included demographics, areca nut use, 10 sexually transmitted infections (STIs) awareness, 11 physical activity, 12,13 sleep, 14 stress, 15 and questions adopted from the Behavioral Risk Factor Surveillance System (BRFSS) including alcohol, dental visits, e-cigarettes, fruit and vegetable consumption, health care access, medical marijuana, and tobacco use. 16…”