title: Areca (Betel) Nut Chewing Practices in Micronesian Populations.
abstract: OBJECTIVE
  To describe the areca nut/betel quid chewing practices of Micronesian chewers living in Guam.
  
  
  METHODS
  Two studies were conducted using qualitative data from focus groups and quantitative cross-sectional data from the 2007 Guam Behavioral Risk Factor Surveillance System (BRFSS). Ten focus groups included 49 men and women aged 18-60 years living in Guam in 2007. Participants were areca nut/betel quid chewers selected to reflect Guam's age and ethnic group (Chamorro, Chuukese, Palauan, and Yapese) distributions. Salient themes were extracted from transcripts of the sessions by three expert reviewers. A second method, latent class analysis, was used to identify unique groups of chewers. The groups were then compared on demographics and chewing-related behaviors.
  
  
  RESULTS
  Areca nut and betel quid recipes collected from the focus groups showed that Chamorros had a preference for the ripe nut and swallowed the nut, whereas, the Chuukese, Palauan, and Yapese groups preferred the unripe nut and did not swallow it. Similarly, latent class analysis resulted in the identification of two groups of areca nut/betel quid chewers. Group 1 was all Chamorros. Compared to Group 2, the chewers in Group 1 preferred red and ripe nuts, did not add slake lime (calcium hydroxide) or tobacco, and swallowed the masticated areca nut (with or without Piper betle leaf).
  
  
  CONCLUSIONS
  The quantitative analysis confirmed the qualitative exploration of areca nut/betel quid chewers in Guam, thus providing evidence that chewing practices vary among Micronesian populations.
  
  
  CONCLUSIONS
  If future research should include an intervention, the differences in chewing practices among Micronesian populations should be taken into consideration to ensure programmatic success.
authors: University of Guam, College of Natural & Applied Sciences.
authors: Yvette C
authors: YC
authors: Paulino
authors: University of Hawaii at Manoa, Department of Human Nutrition, Food and Animal Sciences.
authors: Rachel
authors: R
authors: Novotny
authors: University of Guam, School of Education.
authors: Mary Jane
authors: MJ
authors: Miller
authors: Cancer Research Center of Hawaii, Epidemiology Department.
authors: Suzanne P
authors: SP
authors: Murphy