Residential Socioeconomic Environments and Areca Nut Use in Taiwan: A Comparison with Alcohol and Tobacco Use in Multilevel Analysis

Abstract

Background

While the association between residential socioeconomic environments and the use of globally common substances such as alcohol and tobacco has been well documented in Western countries, it remains little known about regionally important substances, such as areca nut in Asia. Objective: This study was aimed to develop residential environmental indicators in the context of Taiwan and examine their associations with areca nut use, in comparison to alcohol and tobacco use. Methods: Data were drawn from 13,392 adults across 168 townships in the 2014 National Survey on Substance Use in Taiwan. Residential socioeconomic environment variables were derived from the census and analyzed using factor analysis. Multilevel logistic regression models were used to examine the association of individual- and residential-level factors with the use of areca nut (use/nonuse), alcohol (harmful use, low-risk use, or nonuse), and tobacco (nicotine dependence, regular active use, or nonuse). Results: A three-factor structure of socioeconomic environments derived from 16 residential-level variables consisted of Rural Disadvantage, Affluence, and Family Fragmentation. Multilevel analyses showed that areca nut use was associated with both individual-level (male sex, age group 35-44 years, being divorced/widowed/separated, low educational attainment, and the occupational group of labors) and residential-level (Rural Disadvantaged and Family Fragmented) variables; such a profile was most similar to that of nicotine dependence. Conclusions: A three-factor structure could be derived for the residential-level socioeconomic environments in the Taiwanese context. Rural Disadvantaged and Family Fragmented were associated with areca nut use, which have implications for interventions targeted at the community level.

Keywords:

• Areca nut
• residential environments
• multilevel analysis
• alcohol
• tobacco
• substance use

Acknowledgements

We thank the collaborating researchers of the 2014 National Survey of Substance Use in Taiwan for their help in the design and implementation of the survey, including Wen-Ing Tsay, Yen-Tyng Chen, Po-Chang Hsiao, Ya-Hui Yu, Te-Tien Ting, Chuan-Yu Chen, Yu-Kang Tu, Jiun-Hau Huang, Hao-Jan Yang, Chung-Yi Li, Carol Strong, Cheng-Fang Yen, Chia-Feng Yen, and Jui Hsu. We thank Prof Yu-Kang Tu (Department of Epidemiology and Preventive Medicine, National Taiwan University) for his advice on statistical analysis. We also thank Ms. Chien-Yu Lin (Institute of Health Behaviors and Community Sciences, National Taiwan University) for producing the maps. Dr. Chia-Yueh Hsu was supported by grants from Wan Fang Hospital (107-wf-swf-05 and 109-wf-swf-04).

Declaration of interest

The authors declare that they have no conflict of interest. The authors alone are responsible for the content and writing of the article.

Author contributors

YL, SSC, and WJC originated the study. YL and SSC equally contributed to the writing, data analyses, and the interpretation of findings. WJC led the research team conducting the survey and collecting the data. CYH provided statistical expertise and contributed to data analysis. SCW, CYC, and WJC helped interpret findings and review drafts of the article. All the authors reviewed and approved the final draft.

Additional information

Funding

This work was supported by grants from the Food and Drug Administration, Ministry of Health and Welfare, Taiwan (103TFDA-N-001 and 104TFDA-N-005 to Wei J. Chen). The content is solely the responsibility of the authors and does not necessarily represent the official views of the TFDA.