暗网AV

Shown above is the betel quid--the nut packaged with added ingredients.

Culturally, the chewing of areca nut鈥攐r betel nut鈥攃an be traced throughout history and is widespread not only throughout the Micronesian region but globally in parts of Asia, Africa, Europe and the United States.
 
But research detailing the impact the various methods of chewing areca nut has on the human body is less established than the practice itself鈥攍eaving little information available to help doctors, researchers, and even the public understand the effects.Leon Guerrero
 
Dr. Rachael Leon Guerrero, a Principal Investigator for the 暗网AV鈥檚 recently renewed U54 cancer research grant, said two of the three research projects in the grant focus on understanding not only the effects chewing the areca nut but the behavioral aspect as well鈥攁nswering questions such as what are some of the factors that lead people to chew the areca nut, and what will it take to get them to stop?
 
鈥淲e鈥檙e serving both a local and global need,鈥� Leon Guerrero said. 鈥淏ecause betel nut and the oral cancer rate is higher here than it is in the U.S. Mainland鈥攊t鈥檚 an issue very unique to the region, but it鈥檚 also worldwide.鈥�
 
Grant Renewal

Since 2003, the 暗网AV and the University of Hawaii Cancer Center (UHCC) have been working in collaboration to advance health equity in Pacific Islanders through cancer research, education and outreach.

Last fall, the UOG was awarded a $4.3 million grant to support its ongoing partnership with the UHCC which addresses cancer health disparities among Pacific Islanders in Guam, Hawaii, and neighboring U.S. Associated Pacific Islands.

Over the years, the National Cancer Institute has invested nearly $27M ($15M UOG, $12M UHCC) in support of this partnership, funding that will continue through August 2020.
 
Paulino holds the ingredients of the betel quid. Current Project

UOG Associate Professor of Health Sciences Dr. Yvette Paulino鈥攚ho has spent nearly 10 years researching cancer risk factors with funding through the cancer grant鈥攕aid multiple projects analyzing the biomarkers, chemistry, social and cultural factors, oral potentially malignant disorders (OPMD), and more have lead up to the current project: an intervention study with a trial cessation intervention.
 
Broken up into two distinctions鈥�class one or what appears to be low risk and class two or what appears to be high risk鈥攖hose who chew betel nut are defined by how they prefer their product鈥攅ither just the nut or packaged with other ingredients, which is referred to as the betel quid.  
 
鈥淏ased on our analysis, we were able to identify the high-risk group as those who chew the young betel nut and add other ingredients to it, particularly tobacco,鈥� Paulino said. 鈥淚 think the more you can educate people, I think they鈥檒l start to listen, but the only concrete thing I can stay about betel nut chewing is that it鈥檚 always evolving.鈥�
 
Both Leon Guerrero and Paulino said there is little research that directly links chewing just the areca nut and developing cancer.
 
鈥淭here is very little epidemiologic evidence that states the areca nut alone causes cancer,鈥� Paulino said. 鈥淎t least in what we鈥檙e seeing, when you add tobacco it does increase the risk for oral cancer,鈥� which is why the class two chewers are the main targets of the intervention study.
 
Collaboration is Key

Last month, Paulino attended the International Conference on Betel Quid and Areca Nut held in Kuala Lumpur, Malaysia鈥攁 two-day gathering of stakeholders from around the world looking to understand the cultural, medical and economic impact of chewing areca nut and betel quid.
 
鈥淭en percent of the world鈥檚 population chews betel nut鈥攁bout 600 million people,鈥� Paulino said. 鈥淚n other countries, they are finding ways of commercializing it. In 2007, 12 percent of people on Guam were chewers.鈥�
 
Collaborating with people and researchers from around the world helps propel the research forward, she said, since there are so many aspects to understanding the impact.Shown above are the different elements to betel nut shewing including different types of areca nuts, ingredients such as cardamom seeds and cigarettes, scissors, the betel nut leaf, and lime used in chewing.
 
鈥淲hen you start to involve investigators from the different disciplines, you come up with a better approach鈥攏ot just to the research but translating the information into public health measures like programs or policies or education,鈥� Paulino said. 鈥淚 appreciate that we鈥檙e working more and more collaboratively. You can鈥檛 do it by yourself, and you have the expertise at the University to bring those people together.鈥�
 
Next Step

The trial cessation intervention, which was modeled after a tobacco cessation program, was recently approved by UOG鈥檚 Institutional Review Board (IRB) and is pending review from University of Hawaii鈥檚 IRB. Depending on the results on the intervention, Paulino said a fully developed cessation program could be the next step to helping people who wish to quit chewing betel quid.
 
For more information, call the Guam Cancer Research Center at (671) 735-3036 or visit online at .