Behavioral and Psychosocial Risk Factors that Lead Individuals to Initiate and/or Maintain Betel Quid Chewing in Developed and Developing Countries: A Systematic Review
Arvind Muthukrishnan, Ravleen Nagi, L Ashok, GP Sujatha, Roopa S Rao, Surendra Lakshminarayana, Anitha Krishnan Pandarathodiyil, Shankargouda Patil
Citation Information :
Muthukrishnan A, Nagi R, Ashok L, Sujatha G, Rao RS, Lakshminarayana S, Pandarathodiyil AK, Patil S. Behavioral and Psychosocial Risk Factors that Lead Individuals to Initiate and/or Maintain Betel Quid Chewing in Developed and Developing Countries: A Systematic Review. J Contemp Dent Pract 2022; 23 (12):1267-1279.
Background: Betel quid (BQ) is the fourth most commonly used psychoactive substance and its use is highly prevalent among southeast Asian countries due to the influence of psychosocial, behavioral, and environmental factors. As a result, even young children and women are becoming addicted and find it difficult to achieve long-term abstinence. Systematic research addressing the influence of behavioral and psychosocial factors on BQ chewing is scarce, hence pointing to the need for understanding the interplay of these factors to develop tailored intervention strategies for BQ cessation.
Objective: The objective of this systematic review is to assess various behavioral and psychosocial risk factors from pre-existing literature that lead individuals to initiate and/or maintain BQ chewing in developed and developing countries.
Materials and methods: The electronic retrieval systems and databases PUBMED [MEDLINE], EMBASE, SCOPUS, WEB OF SCIENCE, GOOGLE SCHOLAR, and SCIENCE DIRECT were searched independently by two authors for relevant articles from January 2011 to July 2021 using combinations of keywords. Primary studies published in English focusing on the behavioral and psychosocial risk factors for BQ chewing were included.
Results: Out of the initial 264 articles searched, 12 articles met the selection criteria. Included studies addressed the influence of behavioral and psychosocial factors toward the initiation and/or maintenance of BQ chewing. Included studies reported that dependent BQ was not able to quit BQ chewing due to habituation, addiction, and withdrawal symptoms. Few social BQ chewers in Southeast Asian countries were not willing to initiate quitting as they considered AN as an important social and cultural identifier and claimed that they could not resist chewing in a peer group, and it has become part of their social life.
Conclusion: In the future, studies should take into consideration behavioral and psychosocial risk factors, which are major barriers toward successful quitting. These factors should be integrated into areca nut cessation guidelines, and there is a need to develop more comprehensive culture-specific intervention approaches to achieve long-term abstinence.
Little MA, Pokhrel P, Murphy KL, et al. The reasons for betel-quid chewing scale: Assessment of factor structure, reliability, and validity. BMC Oral Health 2014;14:62. DOI: 10.1186/1472-6831-14-62.
Lee C-H, Chiang S-L, Ko AM-S, et al. Betel-quid dependence domains and syndrome associated with betel-quid ingredients among chewers: An Asian multi-country evidence. Addiction 2014;109(7):1194–1204. DOI: 10.1111/add.12530
Williams S, Malik A, Chowdhury S, et al. Sociocultural aspects of areca nut use. Addict Biol 2002;7(1):147–154. DOI: 10.1080/135562101200100147.
Murphy KL, Liu M, Herzog TA. Confirmatory factor analysis and structural equation modeling of socio-cultural constructs among chamorro and non-chamorro micronesian betel nut chewers. Ethn Health 2019;24(6):724–735. DOI: 10.1080/13557858.2017.1346177
Mirza SS, Shafique K, Vart P, et al. Areca nut chewing and dependency syndrome: is the dependence comparable to smoking? A cross sectional study. Subst Abuse Treat Prev Policy 2011;6:23. DOI: 10.1186/1747-597X-6-23
Sariah A, Guo S, Zuo J, et al. Acute and chronic effects of betel quid chewing on brain functional connectivity. Front Psychiatry 2020;11:198. DOI: 10.3389/fpsyt.2020.00198
Huang X, Liu Z, Mwansisya TE, et al. Betel quid chewing alters functional connectivity in frontal and default networks: A resting-state fMRI study. J Magn Reson Imaging 2017;45(1):157–166. DOI: 10.1002/jmri.25322.
Kumar A, Oswal K, Singh R, et al. Assessment of areca nut use, practice and dependency among people in Guwahati, Assam: A cross-sectional study. Ecancermedicalscience 2021;15:1198. DOI: 10.3332/ecancer.2021.1198
Guha N, Warnakulasuriya S, Vlaanderen J, et al. Betel quid chewing and the risk of oral and oropharyngeal cancers: A meta-analysis with implications for cancer control. Int J Cancer 2014;135(6):1433–1443. DOI: 10.1002/ijc.28643.
Osborne PG, Chou T-S, Shen T-W. Characterization of the psychological, physiological and EEG profile of acute betel quid intoxication in naïve subjects. PLoS One 2011;6(8):e23874. DOI: 10.1371/journal.pone.0023874.
Murphy KL, Herzog TA. Sociocultural factors that affect chewing behaviors among betel nut chewers and ex-chewers on Guam. Hawaii J Med Public Health 2015;74(12):406–411. PMID: 26668772.
Lin C-C, Tamí-Maury I, Ma W-F, et al. Social and cultural context of betel quid consumption in Taiwan and implications for prevention and cessation interventions. Subst Use Misuse 2017;52(5):646–655. DOI: 10.1080/10826084.2016.1246572.
Mawali SB, Buddahim NA, Hassan FAJ, et al. Determinants of betel quid chewing: Implication for oral health education program 2018;37:68–74.
Yen H-Y, Chen P-H, Ko Y-C, et al. Betel quid chewing, personality and mood: Betel quid chewing associated with low extraversion and negative mood. Subst Use Misuse 2018;53(11):1782–1787. DOI: 10.1080/10826084.2018.1432652.
Htin K. Effect of belief and knowledge on betel quid chewing behavior in Myanmar: Variation across socioeconomic status. Kokubyo Gakkai Zasshi 2019;3(86):53–70.
Sadath A, Jose K, Km J, et al. Factors influencing betel quid chewing among the indigenous tribal population in Wayanad, Kerala: A qualitative study. Kerala J Psychiatry 2019;32(1).
Lee C-Y, Chang Y-Y. Betel quid chewing and cessation in the sociocultural context of Paiwan people from Taiwan: A qualitative study. J Ethn Subst Abuse 2021;20(3):395–414.
Huang B, Zachar JJ. Social and behavioural determinants of areca nut consumption in adolescents. Oral Dis 2020;26(8):1820–1826. DOI: 10.1111/odi.13467
Luchini C, Stubbs B, Solmi M, et al. Assessing the quality of studies in meta-analyses: Advantages and limitations of the Newcastle Ottawa Scale. World J Meta-Anal 2017;5(4):80–84. DOI: 10.13105/wjma.v5.i4.80
Moola S, Munn Z, Tufanaru C, et al. Chapter 7: Systematic reviews of etiology and risk. In: Aromataris E MZ, editor. JBI Manual for Evidence Synthesis. JBI 2020. Available from: https://reviewersmanual.joannabriggs.org/
Ghani WMN, Razak IA, Yang Y-H, et al. Factors affecting commencement and cessation of betel quid chewing behaviour in Malaysian adults. BMC Public Health 2011;11:82. DOI: 10.1186/1471-2458-11-82.
Anand R, Dhingra C, Prasad S, et al. Betel nut chewing and its deleterious effects on oral cavity. J Cancer Res Ther 2014;10(3): 499–505. DOI: 10.4103/0973-1482.137958.
Burton-Bradley BG. Arecaidinism: Betel chewing in transcultural perspective. Can J Psychiatry 1979;24(5):481–488. DOI: 10.1177/070674377902400517.
Hashemzadeh M, Rahimi A, Zare-Farashbandi F, et al. Transtheoretical model of health behavioral change: A systematic review. Iran J Nurs Midwifery Res 2019;24(2):83–90. DOI: 10.4103/ijnmr.IJNMR_94_17
Hussain A, Zaheer S, Shafique K. School-based behavioral intervention to reduce the habit of smokeless tobacco and betel quid use in high-risk youth in Karachi: A randomized controlled trial. PLoS One 2018;13(11):e0206919. DOI: 10.1371/journal.pone.0206919.
Sharma A, Gupta SK, Agrawal S, et al. A health education intervention study on tobacco consumption among the urban slum residents of Central India. Int J Prev Med 2019;10:96. DOI: 10.4103/ijpvm.IJPVM_141_18.
