Comparing factors affecting commencement and cessation of betel quid chewing behavior in Taiwanese adults

Shue-Fang Yap,Hsiao-Ching Kuo,Yi-Hsin Yang,Pei-Shan Ho

doi:10.1186/1471-2458-8-199

Abstract

BackgroundBetel quid is the fourth most common used substance in the world after tobacco, alcohol and caffeine. Although factors related to betel quid chewing or cessation of behaviors were reported previously, few studies simultaneously compared both behaviors in the same population. In addition, it is essential to consider time-to-event concept, since the chance of developing or stopping habit may vary over time. The purpose of this study was to compare the risk factors for commencement and cessation of betel quid chewing behaviors in a time-to-event setting.MethodsA stratified multi-stage cluster sampling with selection probabilities proportional to size (PPS) was designed for Taiwanese adults with aged 18 years old and above. Kaplan-Meier estimates and Cox proportional hazard regression models were used to compare and calculate the hazard rate ratios for related factors to commencement or cessation of chewing habits.ResultsIn Taiwan, men had a higher betel quid chewing rate (M: 20.9%, W: 1.2%), but woman chewers had a lower cessation rate (M: 27.5%, W: 12.7%). The hazard rate ratio (HRR) of having chewing habit changed from 4.22 (men vs women) univariately to 1.38 multivariablely, which indicated gender differences were confounded by other factors. In multivariable analysis, the risk factors of gender, education and ethnicity were significantly associated with both starting and cessation of betel quid chewing behavior. The factors of occupation, cigarette smoking and alcohol drinking were only associated with starting habit.ConclusionCommencement or cessation of chewing behavior involves a scenario of time, hence it is preferable to use a time-to-event approach for the comparison. The cessation rates of betel quid chewing were decreasingly associated with the daily consumption of betel quid. Hence, reducing of daily amount in betel quid cessation program may be associated with future stopping habit.

Highlights

Betel quid is the fourth most common used substance in the world after tobacco, alcohol and caffeine
Scientific evidence has shown that chewing betel quid contributes independently to the risk of oral cancer, oral mucosal lesions, oral leukoplakia and oral submucous fibrosis [3]
Study population and survey sampling design A stratified multi-stage cluster sampling with selection probabilities proportional to size (PPS) was designed to conduct and collect study participants

Summary

Introduction

Betel quid is the fourth most common used substance in the world after tobacco, alcohol and caffeine. The purpose of this study was to compare the risk factors for commencement and cessation of betel quid chewing behaviors in a time-to-event setting. Betel quid is the fourth most universally used substance in the world after tobacco, alcohol and caffeine [1]. Scientific evidence has shown that chewing betel quid contributes independently to the risk of oral cancer, oral mucosal lesions, oral leukoplakia and oral submucous fibrosis [3]. These relevant health risks emphasize the necessity for betel quid cessation. Betel quid chewing is a serious public health issue in Taiwan, and an effective strategy is necessary to implement betel quid cessation [3]

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