Elsevier

Public Health

Volume 117, Issue 5, September 2003, Pages 339-345
Public Health

Betel nut chewing and related factors in adolescent students in Taiwan

https://doi.org/10.1016/S0033-3506(03)00082-9Get rights and content

Abstract

Objective. To investigate the prevalence of betel nut chewing and related factors among adolescent students in general, manufacturing, commercial, agricultural and medical technology schools in Taiwan. To make suggestions regarding how health authorities can reduce the number of students taking up the habit.

Materials and methods. A cross-sectional survey was designed, and 10,288 students answered the questionnaire.

Results. Significantly more male than female students were betel nut chewers. The less urbanized areas were also associated with a higher prevalence of the habit. The prevalence of the habit grew with increasing age. By analysing betel nut chewing behaviour, it was found that most students started chewing betel nuts because of curiosity, and most obtained betel nuts from their friends and classmates. Betel nut chewing behaviour is definitely related to peer pressure. Most betel nut chewers did not realize that withdrawal could lead to physiological reactions, and they were ignorant of any risk to health even though they were compulsive betel nut chewers. The health-harming behaviours of both smoking and drinking were found in many betel nut chewers, particularly smoking.

Conclusion. This study confirmed the need for a health education programme dealing with the health risks of betel nut chewing for students at risk. The health authorities could also develop a programme for betel nut chewing among Taiwan's adolescent students, emphasizing the dangers of this habit.

Introduction

The stately betel tree (Areca catechu L.) grows in humid, warm climates such as India and South-east Asia. Betel nut chewing has become a very popular habit in these areas. The planting of betel trees has become an important agricultural business in Taiwan, with an output of over 170,000 tonnes in 1998.1 Not only has there been a tremendous increase in the planting of betel trees, but the population of betel nut chewers is also growing. In Taiwan, betel trees are usually planted in the central and southern areas, mostly in Chia-yi, Tai-tung and Pin-tung. In previous years, betel nut chewing was a common habit in some particular areas and among particular ethnic groups.

Of oral cancer patients in Taiwan, 59.0–88.2% were habitual betel nut chewers, and several studies have shown that a high rate of oral cancer is associated with the habit of chewing betel nuts.2., 3., 4., 5., 6. In addition to oral cancer, other studies have shown that chewing betel nuts is related to oral leukoplakia and submucosal fibrosis.7., 8. Recent studies have shown that betel nut chewing has become more and more popular, and the number of betel nut chewers is increasing every year.9 There are more than three million betel nut chewers in Taiwan.10 The distribution of the betel nut chewing population is concentrated in blue-collar workers or less-educated people in urban areas.11 However, the situation is changing and the habit is gradually spreading to younger generations and more highly educated people,12 and becoming generally widespread in all areas of Taiwan.13 The early prevention of betel nut chewing among adolescents and students is essential for lowering the incidence rate of oral cancer and submucous fibrosis. In Taiwan, the death rate due to oral cancer has ranked fifth in the 10 leading causes of cancer death in recent years.14

The study of students in different areas of Taiwan found that increasing numbers of them chewed betel nuts. More than 10.0% of students reported themselves to be betel nut chewers.12., 15. In southern Taiwan, more than 15.0% of junior high school students chewed betel nuts, and more than 40.0% of vocational school students chewed betel nuts.15 Many students who chew betel nuts also smoke tobacco and drink alcohol.9 People who chew betel nuts, smoke and drink are exposed to an oral cancer risk that is 123 times higher than in people without these habits. Compared with people who chew betel nuts but do not smoke or drink, the risk of oral cancer is 22 times higher than in non-chewers.11 Since betel nut chewing is harmful, the Department of Health in Taiwan is undertaking a programme of betel nut chewing prevention.

When habits such as smoking, drinking and betel nut chewing are formed during teenage years, these will probably be sustained in adulthood. In considering the long-term effects, the early harmful consumption and damage to health gets progressively worse.10 Up to now, although studies with respect to the prevalence of betel nut chewing among students have been reported, the investigation of teenagers who were exposed early to betel nut chewing has not been defined in detail. The prevalence and differences of adolescent betel nut chewing along with the different demographics, the extent of urbanization of these areas, and gender were investigated in this study. In addition, the reason for trying betel nut chewing for the first time and its related risk factors; and the relationship of betel nut chewing, smoking and drinking were also analysed. Finally, this study also identified those at high risk for potential betel nut chewing.

Section snippets

Study sample

The subjects in this study included students from general senior and vocational senior high schools, and the first three grades of junior colleges in the north, central, south and east areas of Taiwan. The participating schools were selected using stratification, cluster and random sampling. Three schools were selected from each category, and the first, second and third grade of each selected school were clustered. Two classes were sampled at random from every grade. Questionnaires were given

Results

The study population consisted of 14,413 adolescent students, and 10,288 valid samples (response rate 71.4%) were available for analysis. The distribution of the valid samples is shown in Table 1 with the various areas, genders and types of school.

As shown in Table 2, the percentage of non-chewers, ex-chewers and current chewers was 90.4, 5.7 and 3.9%, respectively. The prevalence of current betel nut chewing students in eastern and southern Taiwan was slightly higher than in other areas. The

Discussion

Table 2 shows that 6.6% of males and 1.5% of females chewed betel nuts. There was a significant difference between the genders. This finding was in agreement with other studies concerning junior or senior high school students' betel nut chewing habits.13., 15., 16. The prevalence of betel nut chewing among students increased when urbanization of the related areas decreased.16 A similar tendency was found in senior high schools (Table 2). There was a significant difference in the degree of

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