The Reasons for Betel Quid Chewing Scale (RBCS) for Ex-Chewers: Assessment of Factor Structure, Reliability, Validity and Measurement Invariance across Gender in a Guamanian Sample

Abstract

Background

Over 600 million people chew betel nut worldwide and the behavior is classified by the World Health Organization (WHO) as a Group 1 carcinogen. Having a reliable and valid scale of reasons for chewing betel nut that can be used consistently across gender for both chewers and ex-chewers will assist practitioners to create culturally appropriate risk reduction and cessation programs and address an important public health concern.

Purpose/Objectives: We sought to: 1) examine factor structure, reliability, and validity of the Reasons for Chewing Scale (RBCS) for ex-chewers; 2) examine the influence of social-cultural factors on chewing behaviors; and 3) examine if measurement invariance (MI) of the RBCS held consistently across gender groups.

Methods

A Confirmatory Factor Analysis (CFA), a multigroup CFA for testing measurement invariance (MI), and Structural Equation Modeling (SEM) were applied to the RBCS using a convenience sample of (N = 223) of ex-chewers from Guam.

Results

The majority of the items in the RBCS were found to be moderately or strongly correlated to each other. The CFA model fit the ex-chewers’ data well and the model suggested that the RBCS was found to be reliable and valid. The multi-group CFA showed this scale functions equivalently for both male and female groups.

Conclusions/Importance: The RBCS is a valid and reliable measure that is invariant across gender and type of ex-chewer.

Keywords:

• betel nut
• areca nut
• ex-chewers
• reasons for chewing

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.

Additional information

Funding

This work was supported by the National Cancer Institute (NCI) Grant U54 CA143727.