title: Symptoms with betel nut and betel nut with tobacco among Micronesian youth.
abstract: Betel nut has been stated to be addictive, but evidence is lacking. This study describes dependence symptoms among adolescents using betel alone or with tobacco. In the first study, participants were 151 9th graders in Saipan. In the second study, participants were 269 9th graders in Pohnpei and Yap. Participants completed a confidential questionnaire adapted from the U.S. National Survey of Drug Use and Health, which measured dependence symptoms. The 15 items were summed to form a scale, with a range of 0-15, where higher scores indicated greater endorsement of dependence symptoms. In the first study, 39.1% had used betel. More than two-thirds of all users (69.5%) used betel in the previous month: 87.8% also used tobacco with the betel. The mean (SD) dependence symptoms scale score among tobacco users was 8.2±4.0 versus 3.4±2.9 among those who used betel alone [t(7)=3.3, p=0.015]. In the second study, 38% from Pohnpei and 85% from Yap had used betel and most of the current users used it in the previous month (67% from Pohnpei, 91% from Yap). Among those who had used betel in the previous month, 90% from Pohnpei and 64% from Yap were using betel with tobacco. The dependence score was positively associated with frequency of tobacco use (e.g., mean (SD)=11.3 (±2.4) among most frequent users versus a mean (SD)=4.8 (±3.5) among the never users [F(3109)=28.8, p<0.001]). Betel nut users who also use tobacco may benefit from tobacco cessation strategies.
authors.affiliation: Department of Oral Health Sciences, University of Washington, Box 357475, Seattle, WA 98195-7475, USA. Electronic address: dfrc@uw.edu.
authors.forename: Peter
authors.initials: P
authors.lastname: Milgrom
authors.affiliation: Department of Oral Health Sciences, University of Washington, Box 357475, Seattle, WA 98195-7475, USA. Electronic address: ohnmar_tut@hotmail.com.
authors.forename: Ohnmar K
authors.initials: OK
authors.lastname: Tut
authors.affiliation: Pohnpei State Hospital, Kolonia, Pohnpei, Federated States of Micronesia. Electronic address: mgallen@fsmhealth.fm.
authors.forename: Marcelle
authors.initials: M
authors.lastname: Gallen
authors.affiliation: Department of Oral Health Sciences, University of Washington, Box 357475, Seattle, WA 98195-7475, USA. Electronic address: llman@uw.edu.
authors.forename: Lloyd
authors.initials: L
authors.lastname: Mancl
authors.affiliation: Center for Alcohol and Addiction Studies, Brown University, Box G-S121-4, Providence, RI 02912, USA. Electronic address: Nichea_Spillane@Brown.edu.
authors.forename: Nichea
authors.initials: N
authors.lastname: Spillane
authors.affiliation: Department of Oral Health Sciences, University of Washington, Box 357475, Seattle, WA 98195-7475, USA. Electronic address: dchi@uw.edu.
authors.forename: Donald L
authors.initials: DL
authors.lastname: Chi
authors.affiliation: Department of Oral Health Sciences, University of Washington, Box 357475, Seattle, WA 98195-7475, USA. Electronic address: ramsay@uw.edu.
authors.forename: Douglas S
authors.initials: DS
authors.lastname: Ramsay
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D001114:Areca / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008849:Micronesia / Q000453:epidemiology; D019966:Substance-Related Disorders / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D064424:Tobacco Use / Q000453:epidemiology*
keywords: Adolescents; Areca; Betel nut; Craving; Dependence; Tobacco