Perceived stress and betel quid dependence associated with reasons for betel quid chewing among male chewers: a mixed methods study

Aims: Social culture concerns and betel quid (BQ) dependence may be the potential reasons for BQ chewing. This study's purpose was to identify the correlates of reasons for male BQ chewing.

Methods: We adopted a mixed-methods design. The study was conducted between October 2021 and August 2023 at a medical center of northern Taiwan. The Reasons for Betel-Quid Chewing Scale, Numeric Rating Scale, and Betel Quid Dependence Scale were used to quantitatively assess reasons for BQ chewing, stress, and BQ dependence, respectively. Semi-structured questions were used to interview for qualitative data.

Results: Among 150 BQ users, the most common reasons for BQ chewing were stimulation, reinforcement, and social/cultural factors. Chewers who reported more pressure to chew were more likely to be younger, have less educational level, be employed, have greater stress, and have more BQ dependence. Content analysis of qualitative data showed three themes: physical and psychological demands, peer pressure, and perceived greater effectiveness.

Conclusion: Employment was the factor most commonly associated with reasons for BQ chewing and with each construct. Study findings can help healthcare professionals understand reasons for BQ chewing, thereby helping them educate chewers to cope with withdrawal symptoms and successfully quit.