Areca Nut and Betel Quid Control Interventions: Halting the Epidemic

Abstract

Background: Areca nut (AN) and betel quid (BQ) are classified as Group 1 carcinogens. There are approximately 600 million AN/BQ users globally; the majority of users live in the Asia-Pacific region which, correspondingly, has the highest rates of oral cancer. Despite significant disease burden associated with AN/BQ use, there have been no systematic reviews of interventions to reduce product use. Objectives: To analyze interventions that prevent use of AN/BQ, present a basis for a future systematic review on the topic, and provide decision makers with examples of strategies that have demonstrated reduced AN/BQ use. Methods: To identify publications, we searched the literature using terms for AN/BQ and related synonyms in three databases: PubMed, Embase, and Scopus. Interventions that prevent AN/BQ use, that are published in English and that provide original data analysis, were included in this review. Interventions focused primarily on disease outcomes e.g. oral cancers (secondary prevention) were excluded. Results: Our search revealed 21 interventions targeting AN/BQ use between 1990 and 2018. Strategies include product bans, media campaigns, education, cessation, and taxation at individual and population levels, with varying evidence of impact. While these studies yielded some novel and promising findings, particularly regarding the impact of product bans, mass media campaigns, and cessation interventions, research on interventions specific to AN/BQ use remains limited. Conclusions: We have assessed published interventions that reduce AN/BQ use and identified future research priorities. These findings can be used to develop evidence-based interventions and help guide policymakers in implementing evidence-based policy to regulate these products.

Keywords:

• Areca nut
• betel quid
• oral cancer
• policy
• intervention
• ban
• media
• campaign
• education
• cessation
• taxation

Declaration of interest

The authors declare that they have no conflict of interest. The authors alone are responsible for the content and writing of the article.

Acknowledgements

The authors would like to express their appreciation to Alicia A. Livinski (National Institutes of Health Library) for her time assisting with this project, and to Rachel Abudu, Mishka Cira and Catherine Hidalgo (Center for Global Health, U.S. National Cancer Institute) for their help in finalizing the manuscript. The content of this publication does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government. The authors alone are responsible for the views expressed in this manuscript, and they do not necessarily represent the views, decisions, or policies of the institutions with which they are affiliated.

Additional information

Funding

This project has been funded in whole or in part with federal funds from the NCI, NIH, under Contract No. [HHSN261200800001E] and NCI Contract No. [75N91019D00024], Task Order No. [75N91019F00129].