Trends in betel quid chewing behavior in Taiwan - Exploring the relationship between betel quid chewing and smoking

Objectives: The goals of this study were to compare the prevalence of betel quid chewing between 2001 and 2005, and to analyze the relationship between chewing and smoking. Methods: Two sets of nationally representative data from the National Health Interview Surveys (NHIS), 2001 (n=16,136) and 2005 (n=18,871) were compared. The prevalence of chewing was calculated by age, educational level, occupation, level of income, geographic areas, smoking status, daily amount, and age of initiation. The analysis was carried out with the use of SAS 9.1.3 software. Results: The prevalence of chewing in men increased from 14.6% to 15.8% over the 4 year period, with 160,000 new daily chewers added to the addicted population. The amount of betel quid consumed also increased from 18.3 to 19.6 pieces a day, amounting to an annual addition of 700 million pieces. The weight of betel quid consumed daily by the heaviest chewers was equivalent to the amount of rice staple consumed. The majority of chewers (85.2%) also smoked, and nearly all of them (94.1%) started to smoke either before they started to chew or began the two habits at the same time. The chewing habit reduced sharply (77.0%) after smokers quit smoking. Conclusions: Despite an observed reduction in the smoking rate, the prevalence and the amount of chewing increased between 2001 and 2005. As most chewers also smoke, they suffer from double jeopardy. In view of the fact that most smokers who quit smoking also quit chewing, an effective tobacco control policy would be a prerequisite for betel quid control.