Nut Use Research Articles

A Mediation Model for Biculturalism and Cigarette and Betel Nut Use: The Case of Adolescents in Guam.

The present study examined the associations between biculturalism and cigarette and betel nut use and the potential mediating roles of cigarette and betel nut use risk perception and resistance to peer and adult influence among adolescents in Guam. Participants were 673 ethnically diverse students (49% female; Mage = 12.7, SD = .89) from eight public middle schools. The results showed that biculturalism was not associated with cigarette use directly; however, this association was mediated by cigarette use risk perception and resistance to peer and adult influence. In other words, higher biculturalism was associated with more risk perception and then more resistance to peer and adult influence, which sequentially predicted less cigarette use. Similarly, the association between biculturalism and betel nut use was mediated by betel nut use risk perception and resistance to peer and adult influence. Higher biculturalism was associated with greater risk perception and then more resistance to peer and adult influence, which in turn resulted in less betel nut use. These findings can be used to inform the design and implementation of intervention and prevention programs targeting youth who are vulnerable to substance use.

Cashew Nut Allergy

A severe health problem brought on by increased cashew nut use and dietary and cooking changes is cashew nut allergy. It is brought on by the use of trace amounts of Ana-o 3, Ana-o 1, and Ana-o 2 allergens from cashew nuts. Enzymatic processing, oral immunotherapy, and adrenaline auto-injector devices are effective treatment options. The labelling of foods containing cashew nuts is crucial for prevention

Should oral submucous fibrosis be restaged?

• The staging of OSF is based on the posteroanterior occurrence of fibrotic bands. • The pattern of areca nut use whether spit or swallowed dictated the sites involved. • The differences in OSF presentation may be attributed to salivary pooling. • The history and practice of betel quid placement and use have to be documented.

Systematic review of determinants and interventions of areca nut cessation: curbing a public health menace.

This letter presents a critical appraisal of a recent systematic review article published in Journal of Public Health. Systematic reviews are particularly important research articles that can meaningfully influence policy and research in the field due to their scientific value. We aimed to bring attention to certain methodological issues in this review that affect the validity of the findings on the very important topic of areca nut use and cessation.

EFFICACY OF ISOXSUPRINE AS AN ADJUVANT IN MANAGEMENT OF OSMF: A RANDOMIZED CLINICAL TRIAL

Introduction: Oral submucous brosis is a persistent, insidious mucosal condition that is primarily brought on by areca nut use. It can also be brought on by excessive use of peppers, dietary deciencies, autoimmune, genetics, and environmental factors. The aim of the Aim Of The Study: study was to evaluate the effectiveness of vasodilator isoxsuprine as an adjuvant in the oral submucous brosis management. Study Design: Twenty patients with OSMF were recruited and randomly two groups were divided. Group A: Patients got treated with Isoxsuprine hydrochloride 10 mg thrice daily and antioxidants (Lycopene) twice daily for 3 months. Whereas, in the Group B, antioxidants two times a day for 3 months were given. Both were instructed for mouth opening exercises. All individuals, mouth opening, burning sensation were recorded and reassessment was done at every 15 days during the treatment and after 3 months follow-up and followed by statistical analysis. Visual Analogue Scale Results: (VAS) score for severity of burning sensation was observed in both the groups A &B was statistically signicant whereas interincisal opening was higher in group A patients. Isoxsuprine Hydrochloride can be suggested as an adjunctive t Conclusion: herapy in oral submucous brosis management.

Prevalence, Habit Pattern, and Awareness on Harmful Effects of Tobacco/Areca Nut Use among Patients Visiting a Tertiary Care Center in Sri Lanka.

S.P. Kalpana Jeewanthi SubasingheBackground The carcinogenicity of tobacco and areca nut is well established worldwide. Areca nut is the fourth most common psychoactive substance identified recently. The effects of areca nut on the autonomic nervous system make the users dependent on the habit which has been an emerging health issue among Sri Lankan adults and adolescents. This study aimed to evaluate the prevalence and patterns of these risk habits among the patients attending a tertiary care center in Sri Lanka, and their awareness of the harmful effects of the habit. Method A hospital-based cross-sectional study was conducted among 512 patients using an interviewer-administered questionnaire. Results The sample consisted of 167 (33%) tobacco consumers. The average age of the initiation of tobacco consumption was 23.66 years (standard deviation ± 8.04). Age ( p = 0.001), gender ( p = 0.001), income ( p = 0.005), and educational level ( p = 0.001) are significantly associated with tobacco consumption. There is a strong likelihood for tobacco consumers to consume areca nut (odds ratio [OR] 30.58, 95% confidence interval [CI] 17.05-54.88) and alcohol (OR 11.16, 95% CI 6.91-17.98) at any stage in their lives. The majority of the tobacco consumers (61%) were smokeless tobacco users. Areca nut consumers are 0.44 times more likely to know its carcinogenic effects than nonconsumers (95% CI 0.28-0.69). Tobacco consumers are more likely to be aware of the harmful effects of tobacco consumption than nonconsumers (OR 1.11, 95% CI 0.45-2.74). Sixty percent have made at least one attempt to quit the habit. Sixty-two percent of the unsuccessful quitters reported the reason as "addiction." Conclusion Prevalence of smokeless tobacco consumption prevails at a high level among Sri Lankans. Tobacco and areca nut users are more likely to be aware of its harmful effects than the nonconsumers but unable to quit the habit due to the psychoactive properties of tobacco and areca nut.

Genetic and epigenetic instability induced by betel quid associated chemicals.

Over the years, betel quid chewing and tobacco use have attracted considerable interest as they are implicated as the most likely causative risk factors of oral and esophageal cancers. Although areca nut use and betel quid chewing may lead to apoptosis, chronic exposure to areca nut and slaked lime may promote pre-malignant and malignant transformation of oral cells. The putative mutagenic and carcinogenic mechanisms may involve endogenous nitrosation of areca and tobacco alkaloids as well as the presence of direct alkylating agents in betel quid and smokeless tobacco. Metabolic activation of carcinogenic N-nitrosamines by phase-I enzymes is required not only to elicit the genotoxicity via the reactive intermediates but also to potentiate the mutagenicity with the sporadic alkylations of nucleotide bases, resulting in the formation of diverse DNA adducts. Persistent DNA adducts provides the impetus for genetic and epigenetic lesions. The genetic and epigenetic factors cumulatively influence the development and progression of disorders such as cancer. Accumulation of numerous genetic and epigenetic aberrations due to long-term betel quid (with or without tobacco) chewing and tobacco use culminates into the development of head and neck cancers. We review recent evidence that supports putative mechanisms for mutagenicity and carcinogenicity of betel quid chewing along with tobacco (smoking and smokeless) use. The detailed molecular mechanisms of the extent of accumulation and patterns of genetic alterations, indicative of the prior exposure to carcinogens and alkylating agents because of BQ chewing and tobacco use, have not yet been elucidated.

Areca catechu (BETEL NUT) USE AND ADVERSE OBSTETRIC OUTCOMES

Areca (Areca catechu Linn.) nut is the fourth most widely used psychoactive drug in the world, and it has been associated with serious health problems. Chewing areca nut, commonly termed as betel nut, is popular in Asia and the South Pacific, but it has been associated with several health issues, such as oral cancer. All over the world, it has been used as a masticatory drug, most commonly in South-East Asia, the south pacific, and the tropical and sub-tropical regions. Areca nut active substance arecoline is widely and commonly used addictive drug globally, after caffeine, nicotine, and alcohol. Areca nut used in pregnancy has been associated with several birth defects and infants mortality. A systematic review of studies is carried out to investigate prenatal betel nut use and adverse perinatal outcomes. The review suggested that consumption of Areca nut hurts fetus and maternal health. There was a significant association between low birthweight and betel nut exposure in pregnancy. It is recommended that all pregnant women receive enough information and counseling on the potential negative health effects of betel nut products during their prenatal, antenatal, and postnatal periods.

Using the Theory of Planned Behavior to Explain and Predict Areca Nut Use Among Adolescents in India: An Exploratory Study.

ContextAreca nut, used alone or in combination with tobacco, contributes to the high oral cancer burden in India. Used widely by adolescents, who perceive it as a harmless substance, areca nut is addictive and considered a precursor to tobacco use. Given its serious implications for addictiveness and physical health, urgent preventive interventions for areca nut use are required in India and South-East Asia. Studies examining the role of health behavior theory in explaining and predicting areca nut use and for development of its prevention among adolescents are scarce.AimThis study explored the role of the components of Theory of Planned Behavior (TPB) such as attitudes, subjective norms, perceived behavioral control, and intention in predicting areca nut use among adolescents.Settings and DesignObservational study with cross-sectional design conducted with 1884 male and female adolescents attending low-income schools in Mumbai, India.Methods and MaterialSelf-administered surveys were used to gather data on age, gender, behavioral factors and areca nut use.Statistical Analysis UsedChi-square and Mann Whitney test for bivariate and logistic regression for multivariate analysis.ResultsAround 27.2% of 1884 participants were areca nut users. The mean age of users was 13.75 years. Intention-to-use and perceived behavioral control were statistically significant predictors of actual areca nut use (p<0.001). The components of TPB such as attitude, perceived subjective social norms, and perceived behavioral control had a statistically significant effect on the intention-to-use areca nut (p<0.05).ConclusionThis exploratory study indicates that constructs from TPB could help us understand and predict areca nut use. However, more rigorous future research is required to generate insights that help craft effective theory-based behavioral interventions for areca nut prevention and cessation in adolescents.

Social media, peer norms, and betel nut susceptibility and use: Evidence from early adolescents in Guam.

Betel (areca) nut is an addictive psychoactive substance considered to be carcinogenic. Yet not much is known about factors that may be promoting betel nut use. To fill this void, the present study examines the roles of exposure to betel nut-related posts on social media and peer norms regarding betel nut use in explaining betel nut susceptibility and use among adolescents. We conducted a representative survey of early adolescents (N = 673) attending all public middle schools on Guam, a United States-Affiliated Pacific Island in the Western Pacific. Results showed that exposure to betel nut-related posts on social media was positively associated with peer descriptive norms regarding betel nut use. Specifically, the more frequent early adolescents were exposed to betel nut posts on social media, the more likely they were to perceive betel nut use to be more prevalent among their general peers and close friends. Additionally, early adolescents' exposure to betel nut-related posts on social media was positively associated with both their susceptibility to use betel nut and reported use. Descriptive norms regarding close friends' betel nut use was also positively associated with both susceptibility to and use of betel nut. However, descriptive norms regarding general peers' betel nut use was unrelated with either betel nut susceptibility or use. Descriptive norms regarding close friends' betel nut use mediated the relationships that exposure to betel nut posts on social media had with both betel nut susceptibility and betel nut use. Implications are discussed.

Knowledge, Attitudes and Practices of Indian Immigrants in Australia towards Oral Cancer and Their Perceived Role of General Practitioners: A Cross-Sectional Study.

Oral cancer is highly prevalent in the Indian subcontinent. With the increasing immigration of Indians to Australia, a potential rise in oral cancer cases can be expected if they continue engaging in oral cancer risk practices. Unfortunately, little is known on this topic in the Australian context. This study aimed to generate new insights into this area by examining Indian immigrants’ knowledge, attitudes and practices regarding oral cancer in Australia and their perceived role of general practitioners in raising oral cancer awareness. Exploring these aspects could determine the oral cancer risk behaviours of Indians in Australia along with any contributing factors which could help identify potential preventative strategies. A cross-sectional survey was undertaken of 164 Indians across Australia. Data were analysed using SPSS software with descriptive statistics. Respondents had varying levels of knowledge about oral cancer (mean total score 61%), particularly around risk factors such as alcohol and areca nut use as well as oral cancer-related signs/symptoms. The majority (87.7%) had not received any information about oral cancer in a health care setting but were receptive (71–90%) to general practitioners playing a more active role in this area. Respondents were engaging in positive preventative oral health care though few were currently (6.7%) or previously (14.7%) chewing tobacco preparations. Further research is needed through larger studies to confirm the study findings and inform the development of culturally tailored strategies particularly involving general practitioners, to raise oral cancer awareness and provide early screening for Indian immigrants.

Detection of oral cancer using deep learning approach

Globally, oral cancer is becoming more and more of an issue, and in some nations, like Taiwan, India, and Sri Lanka, it is at the very top of the list. Tobacco, alcohol, and betel nut use are responsible for more than 95% of all mouth cancer cases (BQ). In Western nations, smoking and alcohol consumption are the two biggest risk factors, but in Asian nations, smoking and BQ usage are the two most risk factors. It is alarming how frequently people with advanced oral cancer arrive. The best method for minimising personal illness burden, lowering morbidity and mortality, and enhancing quality of life. The detection, evaluation, and treatment of oral cancer remain challenges for the dental profession. In the proposed approach, deep learning algorithm has been used to simulate the development of cancer diagnosis and therapy, and they are successful in predicting future outcomes of a cancer. For the best outcomes in the detection and diagnosis of oral cancer, an effective deep learning and feature selection approach utilising Alex net model has been applied.Overall, 500 images with different resolution were used in our system.

Dental Health Utilization in the Republic of Palau: A Survey to Determine Feasibility of an Oral Cancer Screening Program

PURPOSE Oral cancer is the 5th most common cancer in Palau. Betel nut use is a highly prevalent cultural tradition in Palau and also a carcinogen, whose effect may be synergistic with the addition of smokeless tobacco in betel quid in the development of oral cancer. Prognosis can be improved with early detection. The purpose of this study is to assess the feasibility of an oral cancer screening program using existing dental health infrastructure with mixed methods assessment of utilization of dental health resources by adults in Palau. METHODS An Internet-based survey was used. Both quantitative and qualitative assessments of dental health care utilization were explored. Quantitative analyses of survey responses were done using descriptive and analytical statistical functions. Open-ended survey questions were coded and analyzed for emergent themes to develop recommendations for the proposed intervention. RESULTS The survey was available (Facebook Ads) for 9 days. There were 223 completed surveys, age range was 18-75 (mean = 42.7 years), 177 (80.1%) identified as female, 60.4% reside on Koror, and 60.4% have some university/college level education. Dental care was seen to be important (mean score 82.27). Most felt there were no major barriers to seeing a dentist (n = 164, 72.5%). Themes pertaining to barriers to access focused on lack of availability of appointments and cost. Themes pertaining to facilitators included multilevel resources and services provided by dental clinics. CONCLUSION Dental care is important to Palauans, and most would prefer to have this occur in a clinic setting. The themes generated suggest that while there are important facilitators that are in place to promote seeking and obtaining dental care, the existing infrastructure and access to dental care currently do not support an oral cancer screening program. However, these data do provide important areas to address the delays associated with dental care that can improve access and support the implementation of oral cancer screening in the future.

Social Cognitive Theory Constructs That Predict Betel Nut Chewing Among Secondary Students in the Solomon Islands

Background: After alcohol, tobacco, and caffeine, areca or betel nut is the fourth most commonly abused substance in the world. The prevalence of betel nut use in the Solomon Islands is estimated at 68% in young people. Long-term use can result in detrimental health outcomes such as oral cancers and metabolic syndrome. Methods: The purpose of this quantitative cross-sectional study was to determine whether the constructs of social cognitive theory (SCT) can predict betel nut use in Year 12 secondary students in the Solomon Islands. Five SCT constructs of expectations (outcome expectations and outcome expectancies), self-efficacy, self-efficacy to overcome barriers, self-control, and environment were used to build a model for the study. Data were collected from a convenience quota sample of 138 Year 12 secondary students through a 37-item questionnaire. Results: Multiple linear regression and multiple logistic regression analysis indicated self-efficacy to overcome barriers (&lt;em&gt;p&lt;/em&gt; &lt; .01) was the only construct significantly related to intent to not chew betel nut. Conclusion: Social cognitive theory (SCT) was weakly predictive with low explained variance for not chewing betel nut in secondary students. Research findings contribute to knowledge useful for developers of school health programs and researchers working on strategies to improve intervention actions to reduce betel nut use. The SCT could be bolstered by newer theories like the integrative model or multi-theory model (MTM) of health behavior change for designing educational interventions aimed at limiting betel nut use in young people, especially school students.

Areca Nut and Oral Cancer: Evidence from Studies Conducted in Humans

Areca nut chewing is one of the major risk factors for oral cancer, with large-magnitude risks reported in studies comparing betel quid chewers and never users, and it has been evaluated as a group 1 carcinogen by the International Agency for Research on Cancer. Data from a high-quality meta-analysis examining risk estimates are presented in summary form with additional information from more recent studies (pooled adjusted relative risk, 7.9; 95% CI, 7.1 to 8.7). The risk of oral cancer increases in a dose-response manner with the daily number of quids consumed and the number of years chewing. In the Indian subcontinent and in Taiwan, approximately half of oral cancers reported are attributed to betel quid chewing (population attributable fraction, 53.7% for residents in Taiwan and 49.5% for the Indian population), a disease burden that could be prevented. Oral leukoplakia and oral submucous fibrosis are 2 main oral potentially malignant disorders caused by areca nut chewing that can progress to oral cancer with continued use. Ex-chewers seem to demonstrate lower risks than current chewers, but the impact of areca nut cessation on oral cancer risk has not been scientifically evaluated on the basis of randomized controlled studies. These data strongly reconfirm that betel quid chewing, primarily areca nut use, should be taken into account in assessing the cancer risk of South Asian, East Asian populations and Pacific Islanders for the development of oral cancer.

Association between socioeconomic status and severity of oral epithelial dysplasia using a Taiwanese Nationwide Oral Mucosal Screening Program: a retrospective analysis

BackgroundThe study aimed to investigate the association between socioeconomic status and severity of oral epithelial dysplasia (OED) using current data from the Taiwanese Nationwide Oral Mucosal Screening Program (TNOMSP).MethodsThis retrospective analysis was conducted in the Department of Oral and Maxillofacial Surgery at a general hospital in Taipei, Taiwan. A total of 134 participants were analysed from a previous study database of 150 patients. The inclusion criteria included age > 20 years and a history of either tobacco or betel nut use. Background information, including para-habits such as betel and tobacco use, was analysed using the Pearson chi-square (χ2) test; furthermore, the correlation of background information with OED severity was investigated using logistic regression (mild or moderate/severe).ResultsHigh school education level (P < 0.001), poor self-awareness (P = 0.002), current betel use (P < 0.001), and tobacco use (P = 0.003) were highly correlated with moderate- and severe OED (P < 0.05). The odds ratio (OR) of education status above senior high school was 0.03 (95% confidence interval [CI] 0.01–0.15, P < 0.001), while that of junior high school was 1. Current betel chewing (OR 6.57 [95% CI 1.17–37.0], P = 0.033) was significantly associated with OED severity compared with never or ex-use of betel.ConclusionsWe found a strong correlation between the severity of OED and current betel use and low education status. The current study revealed that the socioeconomic status, poor self-awareness, and para-habit history of the patients with OED should be evaluated to identify high-risk individuals using TNOMSP.

How Do Adolescents Assess and Rank the Risk of Areca Nut Use? Findings from a Study in Mumbai, India.

Objective:Areca nut use, along with tobacco, is a contributor to India’s high rates of oral cancer. Areca nut use is culturally accepted, often initiated early in adolescence, and said to lead to later tobacco use. Unlike tobacco prevention, there are scarce prevention or harm-reduction programmes or campaigns specifically targeted at areca nut. Methods:A participative ranking method was used to understand adolescents’ assessment of risks of areca nut. Five focus group discussions were conducted with 31 adolescents, 19 fe-male and 12 male, non-users and users of chewing tobacco, water-pipe (hookah) and areca nut. Participants categorized and ranked the risk of 16 activities, including the use of areca nut and various tobacco-products, and discussed reasons for these risk-rankings. Results:Despite differences between groups on the assessment of risks associated with the 16 different activities, all the groups, user and non-user, rated cigarette smoking as having the highest risk, chewing fennel and using mouth fresheners as no risk, and areca nut as low risk. The other activities were ranked differently by each group. Adolescents’ perceptions of smoking or online games as risky was influenced by greater exposure to messaging on harmful consequences of the activity through multiple channels such as mass media, interpersonal networks including parents, and classroom health-education sessions. Inadequate knowledge about the harmful consequences of areca nut use, greater social and cultural acceptability, and the sweet taste of commercially packaged areca nut influenced low-risk perceptions. Conclusion:Perceptions of risk from an activity often determines preventive behaviors. Presently, adolescents do not perceive areca use as risky. In comparison to smoking they con-sider it less harmful. More research is required to better understand areca nut use and its cul-tural determinants. However, targeted health communication messages and prevention poli-cies and programmes have to be initiated to reduce areca nut use and associated burden of oral cancer.

Oral cancer risk behaviours of Indian immigrants in Australia: a qualitative study

ObjectiveOral cancer is widespread in South Asia, particularly India. In Australia, Indians are one of the fastest‐growing communities. This study aimed to explore the oral cancer‐related knowledge, attitudes and practices of Indian immigrants in Australia. MethodsFourteen semi‐structured interviews were conducted with Indian immigrants residing across New South Wales and Victoria. Purposive and snowball sampling were used for recruitment. Data were analysed through a directed content analysis approach. ResultsAll participants were knowledgeable of oral cancer risks associated with tobacco and alcohol, but few were familiar with the harmful effects of areca nut preparations. Varied attitudes were evident with most participants acknowledging the importance of oral cancer check‐ups, yet very few followed this practice. All participants admitted engaging in oral cancer risk practices including areca nut use at least once or more in their lifetime. ConclusionOral cancer risk practices are common among Indian immigrants in Australia who possess limited knowledge with varying attitudes in this area. Implications for public healthPreventative strategies are needed to limit the use of oral cancer risk products among Indian immigrants. General practitioners and community organisations can play a key role in raising awareness in this area.

Factors Associated with Urinary 1-Hydroxypyrene and Malondialdehyde among Adults near a Petrochemical Factory: Implications for Sex and Lifestyle Modification.

Background: The association between the biomarkers of environmental exposure, oxidative stress, and health-related behaviors in community residents living in an endemic viral hepatitis area and near petrochemical industrial complexes remains unclear. From a health promotion perspective, healthcare providers must know what to do for residents concerned about their health and living environment, especially for individual-level and modifiable risk factors. Therefore, we aimed to explore the factors associated with urinary 1-hydroxypyrene (1-OHP) and malondialdehyde (MDA). Methods: A community-based, cross-sectional study was conducted between July 2018 and February 2019 in western coastal Yunlin County, Taiwan. All participants lived within a 10 km radius of a large petrochemical complex and did not work in the factory. This study was conducted with the local hospital through annual community health screening. Biological samples were collected and biomarkers determined and quantified in the central laboratory of the collaborating hospital. Results: A total of 6335 adult residents completed the study. The mean age was 47.7 (SD = 16) years. Out of the total population, 56.4% were female, 30.1% had metabolic syndrome (MetS), and 16.8% and 14.3% had hepatitis B virus antigen (HBsAg) and hepatitis C virus antibody (anti-HCV) positivity, respectively. The median 1-OHP and MDA level was 0.11 and 0.9 μg/g creatinine with an interquartile range of 0.07–0.18, and 0.4–1.5, respectively. The MDA levels correlated with specific diseases. The multivariable ordinal logistic regression model revealed that female sex, smoking, betel nut use, HBsAg, and anti-HCV positivity were associated with higher 1-OHP levels. In men, MetS was associated with higher 1-OHP levels and regular exercise with lower 1-OHP levels. High MDA levels were associated with smoking, betel nut users, HBsAg, and anti-HCV positivity. Conclusions: The findings highlight the importance of initiating individualized health promotion programs for residents near petrochemical factories, especially for adults with substance-use and cardiometabolic risk factors. Furthermore, it is crucial to provide further treatment to patients with viral hepatitis.

Exposure to tobacco and betel nut content on social media, risk perceptions, and susceptibility to peer influence among early adolescents in Guam

IntroductionThis study aimed to examine the associations between exposure to tobacco and betel nut-related content on social media, perceived risks of tobacco and betel nut use, and susceptibility to peer influence for tobacco and betel nut use among adolescents living in Guam, a United States-Affiliated Pacific Island in the Western Pacific. MethodsA representative survey of adolescents (N = 670) attending public middle schools on Guam was conducted. The survey measured exposure to tobacco and betel nut content on the following social media platforms: (a) Facebook, (b) Twitter, (c) Instagram, (d) Snapchat, and (e) WhatsApp. The survey also measured perceived risks of tobacco and betel nut use and susceptibility to peer influence for tobacco and betel nut use. ResultsGuam adolescents’ exposure to tobacco-related content on social media was found to be associated with lower perceived risks toward the use of tobacco (β = −0.18, p < 0.001) and betel nut (β = −0.16, p < 0.001). Also, exposure to tobacco-related content on social media was found to be associated with higher levels of susceptibility to peer influence for uses of both tobacco (β = 0.10, p < 0.05) and betel nut (β = 0.15, p < 0.001). Similarly, exposure to betel nut-related content on social media was associated with lower perceived risks of using betel nut (β = −0.20, p < 0.001) and tobacco (β = −0.24, p < 0.001). Also, exposure to betel nut-related content on social media was associated with increased susceptibility to peer influence for use of both betel nut (β = 0.35, p < 0.001) and tobacco (β = 0.29, p < 0.001). ConclusionsAdolescents’ exposure to tobacco- and betel nut-related content on social media may influence attitudinal risk factors associated with tobacco and betel nut use.