Abstract B12: Betel nut use and oral cancer in a high-risk refugee community in the United States: The effectiveness of an awareness initiative
Authors: Shi Lucy L. , Bradford Ella , Depalo Danielle K. , Chen Amy Y. 
Published: February 2019

Abstract
Introduction: Betel nut (BN) is a psychoactive substance that is commonly used in Asian cultures, including among members of the refugee resettlement area of Clarkston, GA. While the association between chronic BN mastication and oral cancer has been established, these health consequences may not be appreciated by users in these communities. Our objective is to investigate patient awareness of BN health risks and to assess the efficacy of a pilot visually guided educational initiative.
Methods: Patients from two clinics in Clarkston, GA were approached for the study. Patients who reported familiarity with BN (familiar cohort) were administered a pilot visually guided survey on BN usage and health risks; subsequently, an illustrated educational brochure was reviewed, and a post-test was administered. Patients who denied familiarity with BN (unfamiliar cohort) were administered another baseline survey followed by the same educational brochure and post-test survey. Results were analyzed using univariate regression and Chi-squared analyses (STATA 12, College Station, TX).
Results: 48 patients were surveyed for the familiar cohort and 25 for the unfamiliar cohort. Among the familiar cohort, the largest ethnic group was South Asians (71%) followed by Southeast Asians (20%). 42.8% reported social use, 28.6% reported usage during celebrations only, and 28.6% reported daily use. The most common reasons for use were for taste (40.9%), enjoyment (38.6%), addiction (25%), and tradition (18.2%). Among the familiar cohort, 75% believed BN was harmful for health compared to 8% among the unfamiliar cohort (p&lt;0.0001). The most common reasons cited were teeth discoloration (29.26%), cancer (29.26%), tobacco contents (14.6%), and addiction (14.6%). Among the familiar cohort, 52.3% believed BN alone could cause cancer compared to 4% among the unfamiliar cohort (p&lt;0.0001); in contrast, 90% and 100% of subjects believed smoking tobacco could cause cancer, respectively. Following the educational intervention, patient knowledge that BN mastication is harmful improved for the familiar (100%, p=0.011) and unfamiliar cohorts (100%, p&lt;0.0001). Post-intervention patients in the familiar cohort were more likely to recognize that BN alone could cause cancer (87.5%, p=0.0005) and identify oral cancer in an image (p=0.011). Post-intervention patients in the unfamiliar cohort also improved their ability to recognize an image (p=0.0002) and symptoms of oral cancer (p&lt;0.0001).
Conclusions: Our study highlights knowledge gaps on the carcinogenic properties of BN among a high-risk refugee population and awareness of the signs of oral cancer in the entire community. Our results demonstrate the efficacy of a pilot visually guided educational brochure to improve patient knowledge of BN and oral cancer presentations. These efforts may help to limit BN use and encourage early detection of cancer in these communities.
Citation Format: Lucy L. Shi, Ella Bradford, Danielle K. Depalo, Amy Y. Chen. Betel nut use and oral cancer in a high-risk refugee community in the United States: The effectiveness of an awareness initiative [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr B12.