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Peng J, Petersen AB, Shavlik D, Xiao D, Yel D, Kheam T, Singh PN. Smoked, smokeless, and poly-tobacco use during pregnancy in relation to infant mortality in Cambodia: Findings from a nationwide sample. Tob Induc Dis 2024; 22:TID-22-163. [PMID: 39315292 PMCID: PMC11418014 DOI: 10.18332/tid/191718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2024] [Revised: 07/27/2024] [Accepted: 07/30/2024] [Indexed: 09/25/2024] Open
Abstract
INTRODUCTION Maternal cigarette smoking during pregnancy is an established risk factor for adverse maternal, fetal, and infant outcomes. In contrast, maternal smokeless tobacco use (i.e. e-cigarettes, snus, betel quid, iqmik) during pregnancy has a more complex risk profile due to its potential use as a smoking cessation aid or to reduce the harm from smoking tobacco. The overall aim of this study was to investigate the association between smoked, smokeless, and poly-tobacco (smoked + smokeless) use during pregnancy and infant mortality, in a national sample of women in Cambodia. METHODS The study used data from the National Adult Tobacco Survey of Cambodia (NATSC) that employed sampling methods and tobacco survey items from the CDC Global Adult Tobacco Survey but also included a supplement on reproductive health and birthing history. We selected 5342 women of the NATSC who reported complete data on at least one pregnancy, and our unit of analysis was the 15998 pregnancies from these women. We conducted a multivariable logistic regression to relate tobacco use to infant mortality. Taylor linearized variance estimators were used to account for clustering by sampling unit and mother. RESULTS We found that smokeless tobacco in the form of a betel quid was the most common form of tobacco used during pregnancy. In multivariable logistic regression, we found increased odds of infant death for all tobacco use categories (smoked, smokeless), but that the strongest effects were seen for habits that included smokeless tobacco (relative to never use of tobacco in any form): exclusive use of smokeless tobacco (adjusted odds ratio, AOR=2.08; 95% CI: 1.15-3.76), and poly-tobacco use (AOR=5.68; 95% CI: 1.03-31.46). In more detailed analyses that considered the composition of the betel quid (tobacco, areca nut/leaf, slaked lime), we found that even chewing of tobacco leaves with no processing or additives was associated with a three-fold increase in odds of infant death relative to a never user (AOR=3.05; 95% CI: 1.45-6.45). CONCLUSIONS We found that even among those pregnant women who limited their nicotine habit to chewing tobacco leaves with no processing or additives, there remained higher odds of fetal or infant death from that pregnancy.
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Affiliation(s)
- Jiahao Peng
- School of Public Health, Loma Linda University, Loma Linda, United States
| | - Anne Berit Petersen
- School of Nursing, Loma Linda University, Loma Linda, United States
- Loma Linda University Cancer Center, Loma Linda, United States
| | - David Shavlik
- School of Public Health, Loma Linda University, Loma Linda, United States
| | - Daliao Xiao
- Lawrence D. Longo MD Center for Perinatal Biology, Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, United States
| | - Daravuth Yel
- Cambodia Tobacco Free Initiative, World Health Organization, Phnom Penh, Cambodia
| | - They Kheam
- National Institute of Statistics, Phnom Penh, Cambodia
| | - Pramil N. Singh
- Loma Linda University Cancer Center, Loma Linda, United States
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Tang Y, Caswell E, Mohamed R, Wilson N, Osmanovic E, Smith G, Hartley SD, Bhandari R. A systematic review of validity of US survey measures for assessing substance use and substance use disorders. Syst Rev 2024; 13:166. [PMID: 38937847 PMCID: PMC11210012 DOI: 10.1186/s13643-024-02536-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 04/17/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND The steep rise in substance use and substance use disorder (SUD) shows an urgency to assess its prevalence using valid measures. This systematic review summarizes the validity of measures to assess the prevalence of substance use and SUD in the US estimated in population and sub-population-based surveys. METHODS A literature search was performed using nine online databases. Studies were included in the review if they were published in English and tested the validity of substance use and SUD measures among US adults at the general or sub-population level. Independent reviews were conducted by the authors to complete data synthesis and assess the risk of bias. RESULTS Overall, 46 studies validating substance use/SUD (n = 46) measures were included in this review, in which 63% were conducted in clinical settings and 89% assessed the validity of SUD measures. Among the studies that assessed SUD screening measures, 78% examined a generic SUD measure, and the rest screened for specific disorders. Almost every study used a different survey measure. Overall, sensitivity and specificity tests were conducted in over a third of the studies for validation, and 10 studies used receiver operating characteristics curve. CONCLUSION Findings suggest a lack of standardized methods in surveys measuring and reporting prevalence of substance use/SUD among US adults. It highlights a critical need to develop short measures for assessing SUD that do not require lengthy, time-consuming data collection that would be difficult to incorporate into population-based surveys assessing a multitude of health dimensions. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42022298280.
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Affiliation(s)
- Yuni Tang
- Department of Epidemiology and Biostatistics, School of Public Health, West Virginia University, Morgantown, WV, 26501, USA
- Highway Safety Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Erin Caswell
- Department of Epidemiology and Biostatistics, School of Public Health, West Virginia University, Morgantown, WV, 26501, USA
| | - Rowida Mohamed
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, WV, USA
- Biological Sciences Division, University of Chicago, Chicago, USA, IL
| | - Natalie Wilson
- Health Affairs Institute, West Virginia University, Morgantown, WV, USA
| | - Edis Osmanovic
- Health Affairs Institute, West Virginia University, Morgantown, WV, USA
| | - Gordon Smith
- Department of Epidemiology and Biostatistics, School of Public Health, West Virginia University, Morgantown, WV, 26501, USA
| | | | - Ruchi Bhandari
- Department of Epidemiology and Biostatistics, School of Public Health, West Virginia University, Morgantown, WV, 26501, USA.
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Hurd-Kundeti G, Petersen AB, Somsamouth K, Singh PN. Air Pollution in a Nationally Representative Sample: Findings from the National Adult Tobacco Survey of Lao PDR. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E3500. [PMID: 31546881 PMCID: PMC6765985 DOI: 10.3390/ijerph16183500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 09/07/2019] [Accepted: 09/16/2019] [Indexed: 12/21/2022]
Abstract
In Southeast Asia, household air pollution (HAP) from solid fuel use is the leading cause of disability-adjusted life years (DALYs), a risk which is compounded by exposure to other sources of indoor and outdoor air pollution including secondhand tobacco smoke (SHS). The purpose of this study was to measure the individual and combined prevalence of exposure to household and community sources of air pollution in a national sample of adults in Lao PDR. We analyzed data from the 2012 National Adult Tobacco Survey (NATSL) of Lao PDR-a multi-stage stratified cluster sample of 9706 subjects from 2822 households located in all 17 provinces. Our findings indicate a high prevalence of exposure to household air pollution from cooking fires (78%) and SHS exposure in the home (74.5%). More than a third (32.8%) reported exposure to both inside the home. Exposure to outdoor sources of smoke from cooking, trash, and crop fires was substantial (30.1% to 56.0%). The aggregation of exposures from multiple sources of household air pollution raises the need for initiatives that establish programmatic linkages in the health, environmental, and agricultural sectors to provide a comprehensive strategy to reduce risk factors for respiratory disease in Lao PDR and the region.
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Affiliation(s)
| | - Anne Berit Petersen
- Loma Linda University School of Nursing, 11262 Campus Street, Loma Linda, CA 92350, USA.
- Center for Health Research, Loma Linda University School of Public Health, 11234 Anderson St, Loma Linda, CA 92354, USA.
| | | | - Pramil N Singh
- Center for Health Research, Loma Linda University School of Public Health, 11234 Anderson St, Loma Linda, CA 92354, USA.
- Transdisciplinary Tobacco Research Program, Loma Linda University Cancer Center, 11234 Anderson St, Loma Linda, CA 92354, USA.
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Petersen AB, Muffley N, Somsamouth K, Singh PN. Smoked Tobacco, Air Pollution, and Tuberculosis in Lao PDR: Findings from a National Sample. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E3059. [PMID: 31443595 PMCID: PMC6747342 DOI: 10.3390/ijerph16173059] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 08/18/2019] [Accepted: 08/19/2019] [Indexed: 01/10/2023]
Abstract
In 2017, more than half of the global burden of incident tuberculosis (TB) came from the Western Pacific region. In Lao People's Democratic Republic (PDR), the high rates of tobacco use and use of polluting biomass fuels for cooking (e.g., wood, charcoal, crop waste, dung) represent significant risk factors for TB. The purpose of this study was to determine the association between self-reported (1) smoking and TB; and (2) exposure to air pollution (from both cooking fires and environmental tobacco smoke) and TB among adults in Lao PDR. We analyzed data from the 2012 National Adult Tobacco Survey (NATSL) of Lao PDR-a multi-stage stratified cluster sample of 9706 subjects from 2822 households located in all 17 provinces. Utilizing a nationally representative sample and inferential, multivariable methods, we observed a significant increase in odds of self-reported TB among those who smoked tobacco (OR = 1.73, 95% CI = (1.00 to 2.98)). Larger multivariable models identified independent contributions from exposure to tobacco pipes (OR = 21.51, 95% CI = (6.34 to 72.89)) and communal outdoor fires (OR = 2.27, 95% CI = (1.15 to 4.49)). An index measuring combined exposure to smoked tobacco, environmental tobacco smoke in enclosed workspace, indoor cooking fire, trash fires, and other outdoor communal fires also showed a positive association (OR per added exposure = 1.47, 95% CI = (1.14 to 1.89)). The findings of this study underscore the need for multi-sectoral collaboration between tobacco control, environmental health, TB prevention and treatment programs, national authorities, policy makers, civil groups, and the private sector to address the convergence of potential risk factors impacting respiratory health in Lao PDR.
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Affiliation(s)
- Anne Berit Petersen
- Department of Graduate Nursing, School of Nursing, Loma Linda University, 11262 Campus Street, Loma Linda, CA 92350, USA
- Center for Health Research, Loma Linda University, 11234 Anderson St, Loma Linda, CA 92354, USA
| | - Natassia Muffley
- Center for Health Research, Loma Linda University, 11234 Anderson St, Loma Linda, CA 92354, USA
| | - Khamphithoun Somsamouth
- Center for Information and Education for Health, Ministry of Health, Simuang Road, Vientiane, Lao PDR
| | - Pramil N Singh
- Center for Health Research, Loma Linda University, 11234 Anderson St, Loma Linda, CA 92354, USA.
- Transdisciplinary Tobacco Research Program, Loma Linda University Cancer Center, 11234 Anderson St, Loma Linda, CA 92354, USA.
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Kim SJ, Han JA, Kim YH, Choi BY, Kim SY, Lee HJ, Oh IH, Cho SI, Lee J, Lee SY. Test-retest reliability of health behavior items in the Community Health Survey in South Korea. Epidemiol Health 2015; 37:e2015045. [PMID: 26493776 PMCID: PMC4722222 DOI: 10.4178/epih/e2015045] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Accepted: 10/20/2015] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES Responses to health-related items on the Community Health Survey (CHS) provide evidence that is used to develop community-based health policy. This study aimed to assess the test-retest reliability of selected health behavioral items on the CHS according to item category, response period, and response scale. METHODS A sample of 159 men and women 20 to 69 years of age participated in a test-retest with an interval of 14 to 21 days. A total of 28 items relating to smoking, alcohol consumption, diet and weight control, and mental health were selected. We evaluated the test-retest reliability of the items using kappa statistics. RESULTS Kappa values ranged from 0.44 to 0.93. Items concerning habits had higher kappa values (mean, 0.7; standard error, 0.05) than items concerning awareness or attitudes (p=0.012). The kappa value of items with two- to four-point scales was 0.63, which was higher than the value of 0.59 for items with scales involving five or more points, although this difference was not statistically significant. Different kappa values were observed for each reference period, but no statistically significant differences were noted. CONCLUSIONS The test-retest reliability of the CHS items that we studied was associated with item category. Further study of the relationship between item category and reliability in domains other than health behaviors is required.
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Affiliation(s)
- Soo Jeong Kim
- Department of Health Administration, Division of Health Sciences, Dongseo Univeresity, Busan, Korea.,Center for Radiological Environment and Health Science, Dongseo University, Busan, Korea
| | - Jin A Han
- Department of Preventive Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Young Hwa Kim
- Gyeonggi Center for Hypertension and Diabetes, Suwon, Korea
| | - Bo Youl Choi
- Gyeonggi Center for Hypertension and Diabetes, Suwon, Korea.,Department of Preventive Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Su Young Kim
- Department of Preventive Medicine, Jeju National University School of Medicine, Jeju-si, Korea
| | - Hun Je Lee
- Department of Preventive Medicine, Inha University School of Medicine, Incheon-si, Korea
| | - In Hwan Oh
- Department of Preventive Medicine, Kyung Hee University School of Medicine, Seoul, Korea
| | - Sung-Il Cho
- Graduate School of Public Health and Institute of Health and Environment, Seoul National University, Seoul, Korea
| | - Jakyoung Lee
- Department of Preventive Medicine, Ajou University School of Medicine, Suwon, Korea.,Gyeonggi Center for Hypertension and Diabetes, Suwon, Korea
| | - Soon Young Lee
- Department of Preventive Medicine, Ajou University School of Medicine, Suwon, Korea.,Gyeonggi Center for Hypertension and Diabetes, Suwon, Korea
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Park MB, Nam EW, Lee SK, Kim CB, Ranabhat C. The Correlation of Different Cotinine Levels With Questionnaire Results: A Comparative Study for Different Measurement Methods of the Adolescent Smoking Rate in Korea. Asia Pac J Public Health 2015; 27:542-50. [PMID: 25556217 DOI: 10.1177/1010539514565447] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study compares the results of the Korea National Health and Nutrition Examination Survey (Self-Reported; KNHANEs [SR]) survey with urine-cotinine concentration (UCC) and the official index issued by the Korea Youth Risk Behavior Web-based Survey (KYRBS). We established standard cutoffs of 20 ng/mL, 30 ng/mL, 50 ng/mL, and 100 ng/mL to compare the results of UCC testing with those of self-reporting methods. The KYRBS demonstrated an overall current smoking rate of 12.25%, while the KNHANEs measured an overall rate of 9.63%. The UCC20 reported the highest current smoking rate at 25.6% overall. Methods that detected a lower prevalence of current smoking, in declining order, were the UCC30, UCC50, UCC100, online survey, and the KNHANEs (SR). The results of this study show that online surveys on smoking administered to adolescents have fewer false responses compared with the KNHANEs (SR). However, compared with UCC testing, online surveys still significantly underreport adolescent smoking rates.
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Affiliation(s)
| | | | - Seon Kui Lee
- Bureau of Healthcare Policy, Ministry of Health and Welfare, Sejong, Republic of Korea
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Singh PN, Natto Z, Saxena R, Banerjee H, Yel D, Khieng S, Job JS. Cotinine levels among betel quid users and cigarette smokers in Cambodia. Asia Pac J Public Health 2014; 25:84S-91S. [PMID: 24092815 DOI: 10.1177/1010539513493459] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Smokeless tobacco use in the form of the betel quid is common in the Western Pacific Region, and yet few studies have determined the nicotine delivery of this habit. During a validation substudy, we randomly sampled 201 adults from a rural province of Cambodia and determined nonparametric (bootstrapped) confidence intervals (CIs) for salivary cotinine levels in tobacco users. We found that cotinine levels for daily betel quid use among women (95% CI = 218.6-350.0 ng/mL) were (1) similar to the levels for daily cigarette smoking in men (95% CI = 240.2-317.1 ng/mL) and (2) significantly higher than the levels for daily cigarette smoking in women (95% CI = 71.8-202.7 ng/mL). The 95% confidence range for these habits exceeded the threshold for addiction. Our findings from rural Cambodia indicate that the typical betel quid habit among women supports the same level of nicotine addiction as the typical cigarette habit in men.
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Singh PN, Eng C, Yel D, Kheam T, Job JS, Kanal K. Maternal use of cigarettes, pipes, and smokeless tobacco associated with higher infant mortality rates in Cambodia. Asia Pac J Public Health 2013; 25:64S-74S. [PMID: 24092813 PMCID: PMC5043076 DOI: 10.1177/1010539513493458] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In the Western Pacific Region, rural women use loose tobacco in betel quid chewing and pipe smoking. We examined the relation between maternal use of tobacco and infant mortality (IM) in a national sample of 24 296 birth outcomes in adult women (n = 6013) in Cambodia. We found that (1) age-adjusted odds of IM were higher for maternal use of any tobacco (odds ratio [OR] = 1.69; 95% confidence interval [CI] = 1.27-2.26); (2) age-adjusted odds of IM were higher for cigarette use (OR = 2.54; 95% CI = 1.54- 4.1), use of pipes (OR = 3.09; [95% CI = 1.86-5.11]), and betel quid chewing (OR = 1.55; 95% CI = 1.10-2.17); and (3) these associations remained after multivariable adjustment for environmental tobacco smoke, malnutrition, ethnicity, religion, marital status, education, income, occupation, and urban/rural dwelling. In addition to finding the established association with cigarettes, we also found that maternal use of smokeless tobacco and pipes was associated with higher rates of infant death in Cambodia.
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Affiliation(s)
| | - Carlin Eng
- Loma Linda University, Loma Linda, CA, USA
| | - Daravuth Yel
- World Health Organization/Tobacco Free Initiative -Cambodia, Phnom Penh, Cambodia
| | - They Kheam
- National Institute of Statistics, Ministry of Planning, Phnom Penh, Cambodia
| | | | - Koum Kanal
- National Center for Maternal and Child Health, Ministry of Health, Phnom Penh, Cambodia
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Singh PN, Washburn D, Yel D, Kheam T, Job JS. Poverty does not limit tobacco consumption in Cambodia: quantitative estimate of tobacco use under conditions of no income and adult malnutrition. Asia Pac J Public Health 2013; 25:75S-83S. [PMID: 23666843 DOI: 10.1177/1010539513486919] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Current data indicate that under conditions of poverty, tobacco is consumed at the expense of basic needs. In a large national sample from Cambodia, we sought to determine whether tobacco consumption declines under extreme conditions of no income and malnutrition. Our major findings are as follows: (1) Among men, there was no significant difference in the number of cigarettes smoked for no income (425, 95% confidence interval [CI] = 395-456) versus >US$2 per day (442, 95% CI = 407-477); (2) among women, there was no significant difference in the amount of loose tobacco (ie, betel quid) consumed for no income (539 g, 95% CI = 441-637) versus >US$2 per day (558 g, 95% CI = 143-973); (3) for the contrast of no income + malnutrition versus >US$2 per day + no malnutrition in a linear model, there was no significant difference for men who smoked (462 vs 517 cigarettes/month, P = .82) or women who chewed (316 vs 404 g tobacco/month, P = .34), adjusting for confounders. Among the poorest and malnourished Cambodian adults, lack of resources did not appear to prevent them from obtaining smoked or smokeless tobacco.
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Singh PN, Natto Z, Yel D, Job J, Knutsen S. Betel quid use in relation to infectious disease outcomes in Cambodia. Int J Infect Dis 2012; 16:e262-7. [PMID: 22296863 PMCID: PMC3307941 DOI: 10.1016/j.ijid.2011.12.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2010] [Revised: 10/15/2011] [Accepted: 12/05/2011] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES The habitual chewing of betel quid (areca nut, betel leaf, tobacco) is estimated to occur among 600 million persons in Asia and the Asia-Pacific Region. Emerging data from rural Asia indicate that the betel quid is part of traditional medicine practices that promote its use for a wide range of ailments, including infectious disease. In the present study, we examined the association between betel quid, traditional medicine, and infectious disease outcomes. METHODS For the purpose of a nationwide, interviewer-administered, cross-sectional survey of tobacco use (including betel quid), we conducted a stratified three-stage cluster sampling of 13 988 adults aged 18 years and older from all provinces of Cambodia. RESULTS We found an association between the intensity of betel quid use and HIV/AIDS (odds ratio (OR) 2.06, 95% CI 1.09-3.89), dengue fever (OR 2.40, 95% CI 1.55-2.72), tuberculosis (OR 1.50, 95% CI 0.96-2.36), and typhoid (OR 1.48, 95% CI 0.95-2.30). These associations were even stronger in women - the primary users of betel quid in Cambodia. Multivariable analyses that controlled for age, gender, income, education, urban versus rural dwelling, receiving care from traditional medicine practitioners, and cigarette smoking did not alter the betel quid-infectious disease association. CONCLUSIONS Our findings raise the possibility of a role of betel quid use in the transmission of infectious disease through pathways such as immunosuppression, oral route of entry for a pathogen (i.e., through injury to the oral mucosa), and contamination (i.e., fecal-oral) of the betel quid ingredients.
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Affiliation(s)
- Pramil N Singh
- Department of Epidemiology, School of Public Health, Loma Linda University, Loma Linda, CA 92350, USA.
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