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ABSTRACT
Background: There are few published studies addressing multiple substance uses and their effects on subsequent cessation of betel quid (BQ) chewing in the Asia Pacific region. Objectives: This study aims to investigate the usage patterns of BQ chewing, cigarette smoking, and alcohol drinking, and their correlates with subsequent BQ cessation among a male inmate population. Methods: Data from 473 male inmates with a history of BQ use who were incarcerated in Taiwan Kaohsiung Prison was used for this analysis. Participants were asked to report their lifetime usage patterns of cigarette, alcohol, and BQ, and their cessation status of each substance. A stepwise logistic regression analysis was performed to identify predictors of voluntary BQ cessation. Results: Seventy-five percent of all participants reported habitual use of all three substances. A total of 185 (39%) participants reported voluntary cessation of BQ prior to incarceration, and 288 (61%) reported cessation because of incarceration. Inmates who quit smoking before incarceration were more likely to voluntarily quit BQ. Inmates who had drinking habits were less likely to quit BQ, but those who quit drinking before incarceration were more likely to quit BQ. Inmates who preferred the type of BQ known as lao-hwa quid were more likely to quit BQ, and a longer chewing history correlated with a lower likelihood of quitting BQ. Conclusions Importance: Our data suggest that coexisting habitual use of cigarette, alcohol, and BQ is very common in this inmate population. BQ cessation is significantly associated with not only inmates' usage patterns of cigarette and alcohol, but also their cessation status of these substances.
Glossary
Areca nut added with lao-hwa quid: Is a cut areca nut which adds slaked lime and an unriped fruit of piper linn (called lao-hwa quid) in the center.
Areca nut wrapped in a betel leaf: Is an areca nut with added slaked lime and is wrapped with betel leaf of piper linn.
Betel quid: Is a mixture of various substances and is a common preparation of areca nut. The main ingredients are nut of Areca Catechu tree, inflorescence of Piper betel, leaves of Piper betel, and slaked lime.
Voluntary cessation: Voluntary discontinuation of using a substance, rather than discontinued due to a restricted environment, for at least 6 months.
Acknowledgment
The authors would like to thank Dr. Walter K. Patrick, who passed away on May 22, 2014, for his continuous encouragement and support of Kaohsiung Medical University's work in oral health improvement and oral cancer prevention, and for his critical review of this manuscript.
Declaration of interest
The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.
Additional information
Notes on contributors
Chen-Yi Lee
Chen-Yi Lee, PhD, Behavioral Science, Assistant Professor at Kaohsiung Medical University. Her research interests focus on dental behavioral sciences such as child dental fear and betel quid dependence. She recently has affiliated with an international research relating to betel quid use in Southeast Asia.
Beibei Lu
Beibei Lu, PhD, Epidemiology, Post-doctoral Research Fellow at Moffitt Cancer Center. Her research interest is extensive, primarily on epidemiology, cancer and population health. She has published on various public health issues.
Tien-Yu Shieh
Tien-Yu Shieh, DDS, Dentistry, Emeritus Professor with Kaohsiung Medical University. His research interests focus on oral diseases, oral surgery, and betel quid use. He is involved in various national and international researches on oral cancer.
Yong-Yuan Chang
Yong-Yuan Chang, ScD, Mental Health, Associate Professor at Kaohsiung Medical University. His research interest is extensive, primarily on epidemiology, mental health, and health psychology. He has published on public health issues, psychiatry, nursing, dentistry, and medicine. Recently he is involved in international comparisons of dependence risk among betel quid chewers.