The profound oral cavity cancer burden in the United States Commonwealth of the Northern Mariana Islands: A global health opportunity

Narayanan, Ajay; Finegersh, Andrey; Chang, Mary P.; Ogo, Joanne; Orosco, Ryan K.; Moss, William J.

doi:10.1016/j.amjoto.2019.07.011

Cited by 7 publications

(5 citation statements)

References 14 publications

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“…In other words, compared to their peers, FAS or non-CHamoru Micronesian youth are more likely to see someone using betel nut, have less difficulty accessing betel nut, and are less likely to believe that betel nut is undesirable. These findings are consistent with previous research showing that betel nut use is common among adults living in the Freely Associated States (Pobutsky & Neri, 2012) and that even the youth are aware of or use betel nut in their communities (Narayanan et al, 2020). Despite the fact that betel nut use is a public health concern among Pacific youth in general, youth who migrated to Guam from the FAS brought their traditional custom of using betel nut for fun, enjoyment, or even ritual purposes to the host culture Guam.…”

Section: Discussionsupporting

confidence: 92%

Ethnic Disparities in Betel Nut Use

Kawabata,

Dalisay,

Pokhrel

2024

International Perspectives in Psychology

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Adolescent substance use has been extensively studied in Western countries. However, knowledge of substance use, particularly betel nut use, among adolescents in the Pacific Islands, remains limited. The present study examined ethnic differences in betel nut use and intention to use, and factors explaining such ethnic differences, in Guam, a US-Affiliated Pacific Islands in the Western Pacific. Participants were 674 ethnically diverse students (49% female; Mage = 12.7, SD = 0.89) from eight local public middle schools. Self-report questionnaires were used to assess study variables. The results indicated that although the majority of participants did not use betel nut, there were significant differences in rates of betel nut use and intentions to use between ethnic groups. Compared with adolescents from other ethnic groups represented in the study, adolescents from the Freely Associated States (FAS) of Micronesia, or non-CHamoru Micronesians were more likely to use betel nut in the past 30 days and in their lifetime and to expect to use betel nut in the near future. These ethnic differences were partially mediated by proposed factors such as observation or familiarity with and access to betel nut and approval by parents, peers, and the community. In other words, FAS ethnicity was a significant predictor of higher levels of familiarity with betel nut; FAS ethnicity also predicted lower levels of difficulty in accessing betel nut and perceived disapproval of betel nut use from parents, peers, and the community. These, in turn, predicted more betel nut use and intention as reported by FAS adolescents. These findings can be used to inform the design and implementation of intervention and prevention programs to reduce ethnic disparities among at-risk youth vulnerable to betel nut use in the Pacific.

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Section: Discussionsupporting

confidence: 92%

Ethnic Disparities in Betel Nut Use

Kawabata,

Dalisay,

Pokhrel

2024

International Perspectives in Psychology

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“…On the other hand, youths mainly preferred only areca nut, although some chewed areca nut with slaked lime and tobacco and some also combined betel leaf to the mixture ( 22 ). This study was in line with that of Narayanan et al, who surveyed 300 participants over the age of 18 and found that 56.3% added betel leaf, 89.3% added slaked lime, and 84.7% of participants added tobacco to their BQ preparations ( 23 ).…”

Section: Discussionsupporting

confidence: 90%

The association between betel quid use and oral potentially malignant and malignant disorders in Southeast Asian and Pacific regions: a systematic review and meta-analysis with GRADE evidence profile

Jasim,

Li,

Octavia

et al. 2024

Front. Oral. Health

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BackgroundBetel quid (BQ) chewing is a prevalent habit in the Asian and Pacific regions. It is deeply intertwined within cultural customs, and has been reported to result in oral potentially malignant disorders (OPMDs) and malignant disorders (MDs).ObjectiveWe aim to present a summative and broad overview of the burden that BQ chewing has imposed on the residents of the Southeast Asian, Pacific, and Australasian regions, allowing us to quantify the level of impact it is currently causing on the risk of people developing oral cancer.MethodsThis scoping review and meta-analysis screened databases such as PubMed, MEDLINE, and Google Scholar for publications that investigated the association between BQ and OPMDs and MDs. The search strategy involved MeSH headings relating to BQ, OPMDs, and MDs, and a search for results during the period between January 2010 and June 2023 within the set geographical boundaries of the Southeast Asian and Pacific regions. This systematic review was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement for Scoping Reviews (PRISMA-ScR). R software was used to screen outliers. The included studies were further analysed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system.ResultsNine articles (n = 19,312 participants) presented odds ratio outcomes from 11 regionally different study groups. We indicated a strong correlation between BQ chewing and the increased risk of OMPDs and MDs. The risk was quantified through meta-analyses with an odds ratio (OR) of 8.18 (5.27–12.72) and an increased OR of 9.93 (7.36–13.39) when the outlier was removed. BQ chewing was further identified within various Australian communities and discovered to be produced locally in North Queensland.DiscussionA meta-analysis of two outcomes revealed substantial heterogeneity and minor evidence of publication bias, thus the association effect was included with and without these articles. The overall GRADE quality of evidence ranged from moderate to very high and highlighted five studies with a high level of imprecision.ConclusionThe lingering high prevalence of BQ in the Southeast Asia and Pacific regions, as well as its rising acceptance among non-ethnic Australians, is alarming and requires prompt and rigorous intervention to prevent the risk of oral cancer.Systematic Review RegistrationPROSPERO (CRD42023429694).

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“…This type of intervention might target parents or close adult extended family members and the impact that family norms and permissiveness around tobacco use may have on Guam youths' decisions to use substances. On the other hand, due to the cultural and traditional practice of betel nut chewing in the Pacific region [5,[18][19][20], there is a potential that betel nut use may be viewed by Guam youths as more acceptable than tobacco use, and thus, betel nut use behaviors may be more difficult to change. We recommended that more research be conducted to examine in-depth, both among Guam adolescents and their parents' awareness of the risk of betel nut chewing.…”

Section: Discussionmentioning

confidence: 99%

Types of Offers of Combustible Cigarettes, E-Cigarettes, and Betel Nut Experienced by Guam Youths

Dalisay,

Okamoto,

Teneza

et al. 2023

IJERPH

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The present study examined types of scenarios in which Guam youths are offered tobacco—namely, combustible cigarettes and e-cigarettes—and betel (areca) nut. We conducted 10 focus groups with public middle school students (n = 34) from Guam. Results suggested that the types of offer scenarios of combustible cigarettes, e-cigarettes, and betel nut referenced by the students fall into two categories—direct-relational offers and indirect-contextual offers. The results also suggested that both categories of offer scenarios were more likely to occur in school rather than in other locations such as the home. Family members were more likely to make offers than other types of people. Indirect-contextual offers were more easily avoidable depending on the substance offered, the location where the offer took place, and the person making the offer. Based on the findings, we provide brief suggestions on developing a school-based prevention curriculum focused on training young adolescents from Guam on ways to resist offers of cigarettes, e-cigarettes, and betel nut.

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The profound oral cavity cancer burden in the United States Commonwealth of the Northern Mariana Islands: A global health opportunity

Cited by 7 publications

References 14 publications

Ethnic Disparities in Betel Nut Use

Ethnic Disparities in Betel Nut Use

The association between betel quid use and oral potentially malignant and malignant disorders in Southeast Asian and Pacific regions: a systematic review and meta-analysis with GRADE evidence profile

Types of Offers of Combustible Cigarettes, E-Cigarettes, and Betel Nut Experienced by Guam Youths

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