{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T16:05:20Z","timestamp":1789661120173,"version":"4.0.1"},"reference-count":38,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,8,4]],"date-time":"2025-08-04T00:00:00Z","timestamp":1754265600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,8,4]],"date-time":"2025-08-04T00:00:00Z","timestamp":1754265600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Oral Diseases"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To systematically review evidence on how cultural practices influence oral squamous cell carcinoma (OSCC) risk in Middle\u2010Eastern populations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This PRISMA\u2010conform systematic review searched PubMed, Scopus, and regional databases (1990\u2013Dec 2024) for studies examining cultural practices and OSCC risk in the Middle East. Forty studies were qualitatively synthesized; 20 provided data for random\u2010effects meta\u2010analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Smokeless tobacco (shammah: pooled OR 3.9, 95% CI 2.5\u20136.2) and qat chewing (pooled OR 2.7, 1.9\u20133.8) were major risk factors, exhibiting dose\u2013response relationships and contributing to significant regional incidence variations. Opium use was associated with increased risk in one Iranian study (OR 2.55, 1.47\u20134.43). Waterpipe (pooled OR 2.6, 1.8\u20133.9) and cigarette smoking (pooled OR 3.7, 2.9\u20134.8) also significantly increased risk. A Mediterranean dietary pattern showed protection (pooled OR 0.6, 0.4\u20130.9). Education below secondary level tripled risk (pooled OR 2.6, 1.9\u20133.5). Female\u2010to\u2010male incidence ratios approached parity in high\u2010shammah use regions, diverging from typical global patterns.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Culturally embedded, dose\u2010dependent tobacco and qat habits are primary drivers of OSCC risk in the Middle East, modified by sex and socioeconomic status. Prevention strategies must extend Framework Convention measures to smokeless tobacco, address combined tobacco\u2010qat use, and employ gender\u2010 and equity\u2010sensitive approaches, guided by the unique cultural context.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/odi.70060","type":"journal-article","created":{"date-parts":[[2025,8,5]],"date-time":"2025-08-05T06:58:22Z","timestamp":1754377102000},"page":"48-55","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Cultural Practices and Oral Cancer Risk in the Middle East: A Systematic Review"],"prefix":"10.1111","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2999-6852","authenticated-orcid":false,"given":"Omar","family":"Museedi","sequence":"first","affiliation":[{"name":"Department of Diagnostic Sciences, College of Dentistry University of Baghdad  Baghdad Iraq"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9983-1661","authenticated-orcid":false,"given":"Bashar","family":"Abdullah","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Sciences, College of Dentistry University of Baghdad  Baghdad Iraq"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2103-0746","authenticated-orcid":false,"given":"Saman","family":"Warnakulasuriya","sequence":"additional","affiliation":[{"name":"Faculty of Dentistry, Oral and Craniofacial Sciences King's College London  London UK"},{"name":"WHO Collaborating Centre for Oral Cancer  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,8,4]]},"reference":[{"issue":"3","key":"e_1_2_9_2_1","first-page":"218","article-title":"The Effect of the Extract of the Miswak (Chewing Sticks) Used in Jordan and the Middle East on Oral Bacteria","volume":"45","author":"Ababneh H.","year":"1995","journal-title":"International Dental Journal"},{"key":"e_1_2_9_3_1","first-page":"20","article-title":"Harm Perceptions of Waterpipe Tobacco Smoking Among University Students in Five Eastern Mediterranean Region Countries: A Cross\u2010Sectional Study","volume":"16","author":"Abu\u2010Rmeileh N. 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