Background and challenges to implementation:
BQ/AN use is prevalent among approximately 600 million people globally and, is a risk factor for oral and esophageal cancers. It has also shown effects on the cardiovascular, nervous, GI and metabolic, respiratory, and reproductive systems. Research is needed to understand and implement effective prevention and control of BQ/AN, screening and treatment for related cancers, policy, and economic impacts.

Intervention or response:
In 2016, the US National Cancer Institute and US National Institute of Dental and Craniofacial Research in collaboration with academic and government institutions based in U.S, Malaysia, Taiwan convened a group of experts to gain a greater understanding of the impact of BQ/AN use, both with and without tobacco. Consequently, a literature review is being conducted to further inform global research initiatives around BQ/AN policies and implementation strategies.

Results and lessons learnt:
The specific recommendations from the meeting are: 1) Expand global epidemiology of BQ/AN use (incl. understanding of the cultural and social norms) 2) Establish prevention and cessation programs for BQ/AN users 3) Create evidence-based screening and early diagnosis oral cancer programs 4) Carry out policy interventions around Trade, Bans including use, manufacture, sales and agriculture, Health service provision, Crop substitution, and Public Awareness Outreach. There are also lessons learned from tobacco control evidence that can inform interventions in prevention and policy to address the burden. The review will build on these findings by systemically emphasizing both research strengths and gaps to provide recommendations for future research and policy agendas.

Conclusions and key recommendations:
The evidence shows that BQ/AN are widely used globally. There are major differences between tobacco and BQ/AN use which impede governments and communities from taking actions. To reduce the use of BQ/AN and associated adverse health effects, it is imperative to address the research gaps, with a focus on the translation of that evidence to effective policy and programs.