Abstract C01: Awareness of oral cancer among betel quid users in a high-risk refugee community
Authors: Depalo Danielle K. , Shi Lucy L. , Bradford Ella , Chen Amy Y. 
Published: February 2019

Abstract
Introduction: Chronic mastication of betel nut (BN), a psychoactive substance, has been associated with oral cancer. However, BN continues to be used regularly among members of South and Southeast Asian cultures, including within the refugee resettlement area of Clarkston, GA. Our objective is to understand usage patterns of BN in this high-risk refugee population and assess knowledge gaps that may explain this disconnect.
Methods: Patients from two clinics in Clarkston, GA were approached for the study. Patients who reported familiarity with BN were administered a survey on BN usage and health awareness; subsequently, an educational brochure was reviewed, and a post-test was administered. Results and frequencies were analyzed using Microsoft Excel (Redmond, WA).
Results: 48 patients familiar with BN were surveyed. The most common ethnic groups were South (71%) and Southeast Asian (20%). 64.6% reported use themselves and 68.1% reported use by a family member; the average length of use was 3.34 and 15.24 years, respectively (p=0.0041). 42.8% reported social use, 28.6% reported usage during celebrations only, and 28.6% reported daily use. 69.6% reported consuming the nut only in quid form, composed of a mixture of the nut, leaf, spices, and other additives; 10.8% were unaware of the ingredients used. 32.4% reported using BN with tobacco. With regards to addiction, 29.5% reported concern about the habit, 40.9% wished they or their relatives could quit, and 31.8% had tried to quit. Only 13.6% have ever received resources on cessation.
In this cohort, 75% believed BN was harmful for health, 9.1% believed it was beneficial, and 15.9% were unsure. The most common reasons cited for harm were teeth discoloration (29.26%), cancer (29.26%), tobacco contents (14.6%), and addiction (14.6%). Only 52.3% in this cohort believed BN alone could cause cancer, while 18.2% did not and 29.5% were unsure. In contrast, 88.6% believed BN with tobacco could cause cancer. Similarly, awareness of oral cancer symptoms was also low; 68.8% recognized cheek pain, 18.8% recognized ear pain, and 70% recognized a picture of tongue cancer.
Conclusions: Our study illustrates patterns of BN usage and demonstrates notable knowledge gaps regarding health consequences of BN and oral cancer presentations in a high-risk refugee community. Our findings also highlight a lack of educational resources available to our cohort, despite reported interest in quitting. As recreational BN usage becomes more widespread, community initiatives are important in driving cessation.
Citation Format: Danielle K. Depalo, Lucy L. Shi, Ella Bradford, Amy Y. Chen. Awareness of oral cancer among betel quid users in a high-risk refugee community [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 C01.