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Arevalo MVPN, Maslog EAS, Manlongat KD, Ornos EDB, Chitapanarux I, Eala MAB, Dee EC. Social determinants of sex disparities in cancer in Southeast Asia. iScience 2023; 26:107110. [PMID: 37456827 PMCID: PMC10339016 DOI: 10.1016/j.isci.2023.107110] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023] Open
Abstract
Sex disparities in cancer exist along the cancer spectrum, ranging from genomic predisposition and behavioral risk factors to access to screening, diagnostics, treatment, and survivorship care. A growing body of research is studying the biological underpinnings of these differences, from cancer risk to tumor biology to treatment response. It is well known, however, that the social determinants of health play a large role across the cancer disease continuum, which encompasses risk, prevention, diagnosis, treatment, survivorship, rehabilitation, and palliative care. Less literature focuses on the gendered disparities that are epidemiologic in nature, especially in Southeast Asia (SEA), a diverse region that is home to nearly 670 million people, where most are lower middle income countries, and where socioeconomic and cultural factors increase cancer risk for women. In this review, we highlight the social drivers of gendered disparities, namely the geographic, environmental, sociocultural, economic, and political forces that contribute to the increased mortality and poorer health outcomes in the region.
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Affiliation(s)
| | | | | | - Eric David B. Ornos
- College of Medicine, University of the Philippines, 1000 Manila, Philippines
| | - Imjai Chitapanarux
- Division of Radiation Oncology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Northern Thai Research Group of Radiation Oncology (NTRG-RO), Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Michelle Ann B. Eala
- College of Medicine, University of the Philippines, 1000 Manila, Philippines
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA, USA
| | - Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Aung AA, Soe Zin SN, Ko Ko A, Thet AC. The Association between Betel Quid Chewing and Metabolic Syndrome Among Urban Adults in Mandalay District of Myanmar. J ASEAN Fed Endocr Soc 2023; 38:50-56. [PMID: 38045670 PMCID: PMC10692404 DOI: 10.15605/jafes.038.02.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 01/24/2023] [Indexed: 12/05/2023] Open
Abstract
Background As the prevalence of metabolic syndrome, obesity and diabetes increase worldwide, the need to identify modifiable lifestyle risk factors also increases, especially those that may be relatively unique to a specific population. To explore a possible association between betel quid chewing and metabolic syndrome, a community-based cross-sectional study was conducted. Methodology Three hundred ninety-one (391) adults were interviewed and the following parameters were measured: triglycerides, HDL-cholesterol, glucose, waist circumference, body mass index and blood pressure. Multiple logistic regression was used to determine the association between betel quid chewing and metabolic syndrome while controlling for confounders. Results The prevalence of metabolic syndrome was similar in chewers and non-chewers, 50% and 49%, respectively. After controlling for other factors, development of metabolic syndrome was positively associated with number of betel quids chewed per day, age greater than 40 years, and a positive family history of hypertension and diabetes. Regarding the duration of betel chewing, when analyzed by sex, the risk was doubled in men compared to non-chewers (OR 2.15; 95% CI = 1.21, 3.84). As a result, a man chewing more than 10 pieces (OR 2.49; 95% CI = 1.36, 4.57) of betel quids per day for more than 10 years had a two-fold increased chance of developing the metabolic syndrome. Conclusions Frequency and duration of betel quid chewing may represent a behavioral lifestyle target for approaches to reduce the incidence of metabolic syndrome.
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Affiliation(s)
- Aye Aye Aung
- Department of Endocrinology, University of Medicine, Mandalay, Myanmar
| | - Sai Ni Soe Zin
- Department of Endocrinology, University of Medicine, Mandalay, Myanmar
| | - Aung Ko Ko
- Department of Endocrinology, University of Medicine, Mandalay, Myanmar
| | - Aung Cho Thet
- Department of Endocrinology, University of Medicine, Mandalay, Myanmar
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Aye YM, Hong SA, Thepthien B, Tiraphat S. Betel quid chewing and its prevalence and determinants: data from Myanmar Demographic Health and Survey of 2015-2016. J Public Health (Oxf) 2022; 44:e181-e191. [PMID: 33791792 DOI: 10.1093/pubmed/fdab044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 01/15/2021] [Accepted: 02/12/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Although betel quid chewing with tobacco use is one of the major behavioral risk factors for chronic diseases, the prevalence is rather on the increase in Myanmar. This study determined prevalence of betel quid chewing at the national and subnational levels and its associations with tobacco and sociodemographic factors. METHODS This study is a secondary data analysis of Myanmar demographic health survey 2015-2016 with a total of 11 773 women and 4251 men aged 18-49 years. Chi-square tests and multivariable logistic regression tests were performed. RESULTS Prevalence of betel quid chewing was 61.8% in men and 19.5% in women and by regions it ranged from 34 to 82.2% and from 5-8 to 52.9%, respectively. The prevalence of the concurrent use with tobacco was 25.8 and 2.3%, respectively. Women with older age, low education and low wealth and occupation and living with spouse were associated with betel quid chewing, while low education, living with spouse and Myanmar speaker were associated with men. Tobacco use was inversely and positively associated with betel quid chewing in men and women, respectively (P-interaction <0.0001). CONCLUSION Implementation of culturally sensitive intervention and policies including effective community awareness campaigns for anti-betel quid chewing is strongly recommended in Myanmar.
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Affiliation(s)
- Yin Min Aye
- ASEAN Institute for Health Development, Mahidol University, Nakhon Pathom 73170, Thailand
| | - S A Hong
- ASEAN Institute for Health Development, Mahidol University, Nakhon Pathom 73170, Thailand
- Institute for Health and Society, Hanyang University, Seoul 04763, Republic of Korea
| | - B Thepthien
- ASEAN Institute for Health Development, Mahidol University, Nakhon Pathom 73170, Thailand
| | - S Tiraphat
- ASEAN Institute for Health Development, Mahidol University, Nakhon Pathom 73170, Thailand
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Yang P, Saqr A, Lam K, Harbin Z, Assanasen C. Cultural Variations of Areca Nut Utilization and Its Availability in San Antonio, Texas. J Immigr Minor Health 2021; 24:1088-1093. [PMID: 34637038 DOI: 10.1007/s10903-021-01292-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2021] [Indexed: 10/20/2022]
Abstract
Unknown in the U.S., areca nut (AN) is the fourth most used psychoactive substance in the world and is associated with oral cancers. We investigated the availability of AN in San Antonio ethnic grocery stores and assessed AN practices in immigrant communities. Grocery stores were contacted to assess AN availability. A survey on AN knowledge and utilization were administered at four community sites with large immigrant populations. 13 of the 19 identified grocery stores carried AN. Most survey participants (n = 66) recognized AN. Most Southeast Asians and South Asians knew what AN is, knew someone who uses it, and knew where to buy it. Most South Asian participants knew its harmful effects. AN usage is associated with older age, male sex, and recent immigration. AN is widely available and utilized among immigrant populations in San Antonio. Further work is needed to raise AN awareness among healthcare workers.
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Affiliation(s)
- Phillip Yang
- Joe R. and Teresa Lozano Long School of Medicine, UT Health San Antonio, 7703 Floyd Curl Drive, MC 7985, San Antonio, TX, 78229, USA.
| | - Aziz Saqr
- School of Dentistry, UT Health San Antonio, San Antonio, TX, USA
| | | | - Zachary Harbin
- Joe R. and Teresa Lozano Long School of Medicine, UT Health San Antonio, 7703 Floyd Curl Drive, MC 7985, San Antonio, TX, 78229, USA
| | - Chatchawin Assanasen
- Joe R. and Teresa Lozano Long School of Medicine, UT Health San Antonio, 7703 Floyd Curl Drive, MC 7985, San Antonio, TX, 78229, USA.,Department of Pediatrics, Joe R. and Teresa Lozano Long School of Medicine, UT Health San Antonio, San Antonio, TX, USA
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Yoshikawa K, Yamada H, Matsushima M. Betel quid chewing and its associated factors in Myanmar: A quantitative study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 92:103047. [PMID: 33268051 DOI: 10.1016/j.drugpo.2020.103047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 11/12/2020] [Accepted: 11/15/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Betel quid is more widely consumed than tobacco in Myanmar. It brings adverse health effects regardless of whether it contains tobacco; however, Myanmar has no clear prevention strategy. This study aims to show a broader picture of the prevalence of betel quid chewing and the observable characteristics of its consumers in Myanmar by comparing it to tobacco usage. METHODS This study used the 2015-2016 Myanmar Demographic and Health Survey data. First, we identified characteristics of betel quid consumers by a logit model. Next, we focused on exploring who would be likely to become heavy users, conditioned on being a betel quid consumer by controlling for possible sample selection bias. RESULTS We found differences in characteristics for betel chewers and tobacco smokers, and for betel quid users and heavy users. CONCLUSION These results suggest that betel quid consumption should be regulated by a specific prevention strategy rather than by Myanmar's existing tobacco prevention strategy.
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Affiliation(s)
- Kanako Yoshikawa
- Osaka School of International Public Policy, Osaka University, 1-31 Machikaneyamacho, Toyonaka, Osaka 560-0043, Japan.
| | - Hiroyuki Yamada
- Faculty of Economics, Graduate School of Economics. Keio University, 2-15-45 Mita, Minato-ku, Tokyo, 108-8345 Japan
| | - Midori Matsushima
- Faculty of Humanities and Social Sciences, Graduate School of Humanities and Social Sciences, International Public Policy, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8577 Japan
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Papke RL, Bhattacharyya I, Hatsukami DK, Moe I, Glatman S. Betel Nut (areca) and Smokeless Tobacco Use in Myanmar. Subst Use Misuse 2020; 55:1385-1394. [PMID: 31220988 PMCID: PMC7774082 DOI: 10.1080/10826084.2019.1624774] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Betel nut (areca) is the world's fourth most commonly used addictive substance. Arecoline, a muscarinic agonist in areca, is also a partial agonist for the addiction-related high-affinity brain nicotine receptors. In many countries, smokeless tobacco is commonly mixed with areca. Objective: We sought to evaluate the knowledge of self-harm, and addiction associated betel quid use in an unban population. Methods: We conducted a survey study of 200 betel quid users in Yangon, Myanmar, and a survey of betel quid vendors to determine the relative amounts of areca and tobacco in the available quids. Results: The data determined that a large majority of the survey subjects (84%) used tobacco with their areca. Users had a general awareness that betel chewing was "a bad habit" (85%) and 80% were aware of the cancer risks. Understanding areca addiction remains a challenge since, aside from the strong muscarinic activity of arecoline stimulating salivation, overt neurologic effects are difficult for even the users to identify. Fifty eight percent of the respondents indicated that chewing betel quid had effects like drinking coffee, and 55.5% indicated that it had effects like drinking alcohol. Data obtained from the quid vendors indicated that 75% added tobacco in equal amounts to areca. Conclusion: The concomitant use of nicotine and areca indicates that betel quid addiction includes a significant component of nicotine dependence. However, the additional activities of areca, including the muscarinic effects of arecoline, indicate that potential cessation therapies should optimally address other factors as well.
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Affiliation(s)
- Roger L Papke
- Department of Pharmacology and Therapeutics, University of Florida, College of Medicine, Gainesville, Florida, USA
| | - Indraneel Bhattacharyya
- Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida, College of Dentistry, Gainesville, Florida, USA
| | - Dorothy K Hatsukami
- Department of Psychiatry and the Masonic Cancer Center, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Ingyin Moe
- Ko Shwe Ventures Pte. Ltd, Yangon, Myanmar
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Wangdi K, Jamtsho T. Prevalence and Correlates of Current Alcohol Use among Bhutanese Adults: A Nationally Representative Survey Data Analysis. Indian J Psychol Med 2019; 41:38-45. [PMID: 30783307 PMCID: PMC6337926 DOI: 10.4103/ijpsym.ijpsym_412_18] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Alcohol-related ailments are among the 10 leading causes of morbidity and mortality in Bhutan. The objectives of this article were to determine the prevalence and explore the correlates of current alcohol use among Bhutanese adults. MATERIALS AND METHODS This is a retrospective study of secondary data from the National Health Survey 2012 of Bhutan. The outcome variable of interest was current alcohol use. The questionnaire was developed following the World Health Organization (WHO) STEPwise approach to Surveillance (STEPS) of noncommunicable diseases. Univariate and multivariate logistic regression was performed to identify the correlates of current alcohol use. The prevalence of current alcohol use was 30.9%. The correlates of current alcohol use were male sex [adjusted odds ratio (AOR) = 1.85; 95% confidence interval (CI) 1.47-2.36], widowhood (AOR = 2.92, 95% CI, 1.22-6.99), and chewing betel quid >20 times per week (AOR = 2.07, 95% CI, 1.08-4.03). Primary (AOR = 0.67, 95% CI, 0.50-0.91), high (AOR = 0.52, 95% CI, 0.38-0.71), and university (AOR = 0.46, 95% CI, 0.29-0.73) educated participants were less likely to be current alcohol users when compared with those who had no education. Compared with unskilled workers, services and sales workers were less likely to use alcohol regularly (AOR = 0.64, 95% CI, 0.49-0.82). Homemade alcohol Ara was the most common drink. CONCLUSION The national prevalence of current alcohol use in Bhutan is higher than the national average in the WHO South-East Asia Region. Prevention should target the correlates and limit the availability of locally home-brewed Ara.
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Affiliation(s)
- Kinley Wangdi
- Research School of Population Health, College of Medicine, Environment and Biology, The Australian National University, Canberra, Australia.,Phuensholing General Hospital, Phuentsholing, Bhutan
| | - Tshering Jamtsho
- School of Demography, ANU College of Arts and Social Sciences, The Australian National University, Canberra, Australia
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Mehrtash H, Duncan K, Parascandola M, David A, Gritz ER, Gupta PC, Mehrotra R, Amer Nordin AS, Pearlman PC, Warnakulasuriya S, Wen CP, Zain RB, Trimble EL. Defining a global research and policy agenda for betel quid and areca nut. Lancet Oncol 2017; 18:e767-e775. [PMID: 29208442 DOI: 10.1016/s1470-2045(17)30460-6] [Citation(s) in RCA: 108] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 05/23/2017] [Accepted: 06/05/2017] [Indexed: 01/02/2023]
Abstract
Betel quid and areca nut are known risk factors for many oral and oesophageal cancers, and their use is highly prevalent in the Asia-Pacific region. Additionally, betel quid and areca nut are associated with health effects on the cardiovascular, nervous, gastrointestinal, metabolic, respiratory, and reproductive systems. Unlike tobacco, for which the WHO Framework Convention on Tobacco Control provides evidence-based policies for reducing tobacco use, no global policy exists for the control of betel quid and areca nut use. Multidisciplinary research is needed to address this neglected global public health emergency and to mobilise efforts to control betel quid and areca nut use. In addition, future research is needed to advance our understanding of the basic biology, mechanisms, and epidemiology of betel quid and areca nut use, to advance possible prevention and cessation programmes for betel quid and areca nut users, and to design evidence-based screening and early diagnosis programmes to address the growing burden of cancers that are associated with use.
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Affiliation(s)
- Hedieh Mehrtash
- National Cancer Institute, National Institutes of Health, Rockville, MA, USA.
| | - Kalina Duncan
- National Cancer Institute, National Institutes of Health, Rockville, MA, USA
| | - Mark Parascandola
- National Cancer Institute, National Institutes of Health, Rockville, MA, USA
| | | | - Ellen R Gritz
- MD Anderson Cancer Center, University of Texas, Houston, TX, USA
| | | | - Ravi Mehrotra
- National Institute of Cancer Prevention and Research and WHO-FCTC Smokeless Tobacco Global Knowledge Hub, Uttar Pradesh, India
| | | | - Paul C Pearlman
- National Cancer Institute, National Institutes of Health, Rockville, MA, USA
| | - Saman Warnakulasuriya
- Department of Oral Medicine, King's College London and WHO Collaborating Centre for Oral Cancer and Precancer, London, UK
| | - Chi-Pang Wen
- National Health Research Institutes, Zhunan, Taiwan; Graduate Institute of Biomedical Sciences, College of Medicine and Department of Medical Research, China Medical Univerity, Taichung, Taiwan
| | - Rosnah Binti Zain
- Oral Cancer Research and Coordinating Centre, Faculty of Dentistry, University of Malaya, Kuala Lumpur, Malaysia
| | - Edward L Trimble
- National Cancer Institute, National Institutes of Health, Rockville, MA, USA
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