Areca Nut and Betel Quid Health Risk Reduction and Cessation: Intervention Development in Hawai’i

Project Dates

07/01/2022 – 12/31/2024

Funding Source

Ingeborg v.F. McKee Fund – Hawaiʻi Community Foundation


Areca nut is a nut that people chew. It is found in South Asia, Southeast Asia, East Africa, and the Western Pacific. Over 600 million people worldwide chew it. Chewing betel nut has been determined to be carcinogenic by the World Health Organization and has been linked to many types of cancer such as throat cancer and has been linked to physical illnesses such as cardiac arrhythmias and cardiovascular disease. The research topic of understanding why chewers chew and if they are able to quit, is under-researched. We conducted a study with Micronesian betel nut chewers and ex-chewers on Guam (N = 600). We developed surveys and conducted interviews to examine sociocultural and psychological reasons for chewing and probability of reducing or quitting. Eventually a risk reduction and cessation program was conducted on Guam based on the survey results. To date, a study of this nature has not been performed in Hawaii. According to the US Census, there are approximately 25,000 Micronesians living in Hawaii. Of that population, about 10-15% chew which results in a range of about 2,500-3,750 betel nut chewers in Hawaii. The purpose of this current application is to replicate the pilot study conducted on Guam to the Micronesian population of betel nut chewers and ex-chewers in Hawaii. Chewing practices in Hawaii are likely different from those in Guam and therefore, the following aims will be employed over 18 months: Specific Aim 1 is to collect data to better understand: 1) patterns of and reasons for chewing, 2) possibility of quitting, and 3) how and why ex-chewers successfully quit using the already existing surveys from the Guam study. Revisions will be made to the surveys based on the feedback received from participants in Hawaii. We propose a mixed methods study (survey and interviews) with chewers and ex-chewers (total N = 16; n = 8- chewers and n = 8 ex-chewers ). Specific Aim 2 is to conduct a detailed quantitative survey (N = 300; n = 150 chewers and n = 150 ex-chewers) of chewers and ex-chewers. The survey study will help us to understand: 1) how feasible recruitment will be of Micronesian betel nut chewers and ex-chewers in Hawaii and 2) help us to better understand characteristics of Micronesian chewers and e-chewers in Hawaii. This will help to inform the design and curriculum of a future intervention study. This pilot study is being used to gather preliminary data that will be used to apply for larger funding in the future that will include an intervention study.

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