Factors affecting commencement and cessation of betel quid chewing behaviour in Malaysian adults

Background  

Betel quid chewing is a common habit widely practiced in Southern Asian populations. However, variations are seen in the content of a betel quid across the different countries. Factors associated with commencement and cessation of this habit has been numerously studied. Unfortunately, data on Malaysian population is non-existent. This study aims to determine the factors associated with the inception and also cessation of betel quid chewing behaviour among Malaysian adults.     

Betel quid chewing as a source of manganese exposure: total daily intake of manganese in a Bangladeshi population

Background  

A relationship between betel quid chewing in Bangladeshi populations and the development of skin lesions and tremor has been previously reported, for people exposed to high levels of arsenic (As) through drinking contaminated groundwater. Exposure to manganese (Mn) is also known to induce neurotoxicity and levels of Mn in Bangladeshi groundwater are also high. The present study evaluates betel quid chewing as an overlooked source of Mn exposure in a Bangladeshi population.     

Incidence of oral cancer in relation to nickel and arsenic concentrations in farm soils of patients' residential areas in Taiwan

Background  

To explore if exposures to specific heavy metals in the environment is a new risk factor of oral cancer, one of the fastest growing malignancies in Taiwan, in addition to the two established risk factors, cigarette smoking and betel quid chewing.     

Risk of betel quid chewing on the development of liver cirrhosis: a community-based case-control study

PURPOSE: The role of betel quid on the development of liver cirrhosis is unclear; we thus designed a community-based case-control study to evaluate the association between betel quid chewing and liver cirrhosis. METHODS: A total of 42 cases of liver cirrhosis and 165 matched controls were included for analysis. Questionnaires were administered to obtain histories of betel quid chewing, alcohol consumption, smoking, and family history of liver disease. Hepatitis B surface antigen and anti-hepatitis C antibody were also determined by immunoassay. RESULTS: Individuals with more betel quid chewing (more than 55 quid-years vs. less than 55 quid-years and never-chewers, matched odds ratio [OR(m)] = 2.2; 95% confidence interval [CI]: 1.0-5.0) had higher risks for liver cirrhosis. The combined effects on liver cirrhosis by betel quid chewing and the number of other risk factors, including hepatitis B virus (HBV) infection, smoking, and alcohol drinking, were also observed. When individuals with less betel quid chewing (less than 55 quid-years and never-chewers) and with no other risk factors used as a reference, betel quid chewers expressing greater betel quid chewing (more than 55 quid-years) and more risk factors of HBV infection, cigarette smoking, and habitual alcohol drinking expressed a greater risk of liver cirrhosis (OR(m) = 70.8; 95% CI: 4.0-1260.1). CONCLUSIONS: Our results suggest that betel quid chewing may play an important role in the development of hepatic cirrhosis. Larger study and cohort studies would be necessary to provide further evidence regarding this finding.     

Betel quid use and mortality in Bangladesh: a cohort study

Objective

To evaluate the potential effects of betel quid chewing on mortality. (A quid consists of betel nut, wrapped in betel leaves; tobacco is added to the quid by some users).

Methods

Prospective data were available on 20 033 individuals aged 18–75 years, living in Araihazar, Bangladesh. Demographic and exposure data were collected at baseline using a standardized questionnaire. Cause of death was defined by verbal autopsy questionnaires administered to next of kin. We estimated hazard ratios (HR) and their 95% confidence intervals (CI) for associations between betel use and mortality from all causes and from specific causes, using Cox proportional hazards models. We adjusted for age, sex, body mass index, educational attainment and tobacco smoking history.

Findings

There were 1072 deaths during an average of 10 years of follow-up. Participants who had ever used betel were significantly more likely to die from all causes (HR: 1.26; 95% CI: 1.09–1.44) and cancer (HR: 1.55; 95% CI: 1.09–2.22); but not cardiovascular disease (HR: 1.16; 95% CI: 0.93–1.43). These findings were robust to adjustment for potential confounders. There was a dose–response relationship between mortality from all causes and both the duration and the intensity of betel use. The population attributable fraction for betel use was 14.1% for deaths from all causes and 24.2% for cancer.

Conclusion

Betel quid use was associated with mortality from all causes and from cancer in this cohort.     

网吧环境和槟榔致口腔颊黏膜细胞DNA损伤研究

目的 研究网吧环境和槟榔对口腔颊黏膜细胞DNA的损伤。方法 通过系统抽样抽取长沙市岳麓区5家网吧,在网吧内及网吧所在社区通过单纯随机抽样的方法选取无吸烟、饮酒等习惯的18~40岁健康男性,分别作为对照组(n=50)、网吧上网组(n=41)、咀嚼槟榔组(n=47)、网吧上网且咀嚼槟榔组(n=58)。收集受试者口腔颊黏膜细胞标本,采用单细胞凝胶电泳(single cell gel electrophoresis, SCGE)及颊细胞微核试验(buccal micronucleus cytome, BMCyt)检测DNA损伤情况。结果 网吧上网组和咀嚼槟榔组较对照组SCGE尾部DNA百分含量(%Tail DNA)及BMCyt微核频率(‰MN)显著增高(P＜0.05)。网吧上网且咀嚼槟榔组较网吧上网组和咀嚼槟榔组%Tail DNA及‰MN均显著增高(P＜0.05)。DNA损伤程度与网吧上网累积时间和槟榔咀嚼量呈剂量效应关系。结论 网吧环境和槟榔可分别导致口腔颊黏膜细胞DNA损伤,两者同时暴露会进一步增加DNA损伤程度。     

嚼食槟榔地区槟榔使用现状研究

摘要:目的　为嚼食槟榔地区流行病学研究提供数据。方法　查阅近年来国内、外相关文献,对我国、东南亚及南亚、西方等嚼食槟榔地区槟榔使用现状及问题进行综述。结果　我国及东南亚及南亚地区,槟榔嚼食率较高,而戒断率较低,西方地区槟榔嚼食率相对较低,长期嚼食槟榔对口腔健康会产生影响。结论　嚼食槟榔地区不断蔓延,公众对于槟榔知晓率偏低,有关部门应采取相对措施,控制槟榔咀嚼率。     

Yauk gyar mann yin (Be a man!): masculinity and betel quid chewing among men in Mandalay,Myanmar

Betel quid chewing is associated with various oral cancers and other health concerns, including reproductive health issues. Nevertheless, the practice is widespread in Myanmar, especially among men. This qualitative study elucidates the gendered aspects of betel quid chewing by examining how it links with masculine ideology among male betel quid chewers in Mandalay, Myanmar. Data were collected through in-depth interviews, focus-group discussions, key-informant interviews and participant observation. The thematic content analysis was guided by Connell’s concept of hegemonic masculinity and Butler’s notion of gender performativity. The findings indicated that young Mandalay men were drawn to betel quid chewing by the value they gave to satisfying their curiosity, power competition, risk-taking and a display of manliness. Thus, the practice of betel quid chewing, as defined by our participants, was perceived as manly, trendy, stylish and sexually attractive. For adult men, betel quid chewing was a social lubricant that assisted them in talking with clients and co-workers, thus enhancing their economic opportunities with other men. It also helped working-class men to work harder. Betel quid chewing harm-reduction programmes therefore need to be mindful of masculinity issues as well as the economic aspects of betel quid chewing.     

The effect of stimulants and their combined use with cigarettes on mortality: the case of betel quid

Ten percent of the world’s population use betel quid, making betel quid the fourth most used substance in the world. In Taiwan, there are an estimated 1.5 million users and the majority of them are also smokers. The number of people who died from oral cancer rose more than five times over the period from 1987 to 2006. In this study, we employ propensity score matching and the Weibull hazard model with instrumental variables to examine the health effects of betel quid chewing, in particular the health effect of its combined use with cigarettes. We show that betel quid chewing and smoking have a significant negative effect on health, and that the 10-year death hazard for joint users of betel quid and cigarettes doubles that for abstainers. Moreover, betel quid chewing is as harmful to health as smoking. We also find that betel quid chewing and smoking significantly increase the odds of dying from oral and oesophagus cancers.     

Betel quid chewing and risk of adverse pregnancy outcomes among aborigines in Southern Taiwan

It is known that substance use is associated with increased risk of adverse pregnancy, outcomes. The aims of this study were to estimate the prevalence of alcohol, cigarette, betel quid and drug use during pregnancy and to assess the risk of adverse effects of betel quid chewing on pregnancy outcomes in aboriginal women in southern Taiwan. The study population included 62 women with adverse pregnancy outcomes and 124 age-matched women. Subjects were interviewed at their homes by trained interviewers using a structure questionnaire. Prevalences of various substance use in aborigines with adverse pregnancy outcomes were estimated as follows: alcohol, 43.6%; smoking, 14.5%; betel quid chewing, 43.6% and over-the-counter drug use, 8.1%; whereas in the comparison group it was alcohol, 38.7%; smoking, 8.1%; betel quid chewing, 28.2% and none used drugs. Univariate analysis revealed that adverse pregnancy outcomes were associated with maternal betel quid chewing, maternal illness during pregnancy, and the number of pregnancies (gravidity) experienced. After adjusting for maternal illness and number of previous pregnancies covariates, the prevalence of adverse pregnancy outcome was computed to be 2.8-fold higher among betel quid chewing women as compared to non-chewers (AOR=2.8, 95% CI=1.2-6.8). Among the aboriginal women, prenatal care is essential not only for routine care, but also to focus health education on the harmful effects of substance use, especially betel quid use during pregnancy.     

Population Burden of Betel Quid Abuse and Its Relation to Oral Premalignant Disorders in South,Southeast, and East Asia: An Asian Betel-Quid Consortium Study

Objectives. We investigated the population burden of betel quid abuse and its related impact on oral premalignant disorders (OPDs) in South, Southeast, and East Asia.Methods. The Asian Betel-Quid Consortium conducted a multistage sampling of 8922 representative participants from Taiwan, Mainland China, Malaysia, Indonesia, Nepal, and Sri Lanka. Participants received an interviewer-administered survey and were examined for oral mucosal disorders.Results. The prevalence of betel quid abuse was 0.8% to 46.3% across 6 Asian populations. The abuse frequency was over 40.5% for current chewers, with the highest proportion in Nepalese and Southeast Asian chewers (76.9%−99.6%). Tobacco-added betel quid conferred higher abuse rates (74.4%−99.6%) among Malaysian, Indonesian, and Sri Lankan men than did tobacco-free betel quid (21.8%−89.1%). Gender, lower education level, younger age at chewing initiation, and clustering of familial betel quid use significantly contributed to higher abuse rates. Indonesian betel quid abusers showed the highest prevalence of OPDs and had a greater risk of OPDs than did nonabusers.Conclusions. Betel quid abuse is high in regions of Asia where it is customarily practiced, and such abuse correlates highly with OPDs. By recognizing abuse-associated factors, health policies and preventive frameworks can be effectively constructed to combat these oral preneoplasms.The chewing of betel quid, a combination of areca nut, betel leaf, slaked lime, and region-dependent flavoring ingredients, is a uniquely Asian, culturally derived lifestyle habit. Bred from ancient tradition, its use is socially accepted in all groups, including women and young children, although other substance use such as tobacco smoking is deemed objectionable.1,2 Chemical composition studies have showed that areca nut includes psychoactive alkaloids, of which arecoline contributes the most quantity.3 By raising epinephrine and norepinephrine plus modulation of cholinergic and monoamine transmission, areca nut exerts neurobiological effects on the sympathetic and parasympathetic nervous systems.3–5 In human studies, tolerance and withdrawal symptoms have been clearly detected in regular betel quid chewers.6–8 Such a pharmacological profile is comparable with nicotine, a well-known substance that leads to abuse and dependence. In recent decades, successful marketing of commercially manufactured betel quid has dramatically increased its accessibility and widespread use throughout Asia.9 An increased availability indicates that betel quid may be abused throughout different cultures, but the extent is unknown.Studies on the natural history of oral cancer suggest that several oral premalignant disorders (OPDs), including oral lichen planus (OLP), oral submucous fibrosis (OSF), oral leukoplakia (OL) and oral erythroplasia, precede the development of this neoplasm.10 In Asia, the prevalence of oral precancerous conditions and lesions was estimated to be 1.7% to 11.7% in western India,11 4.4% to 12.7% in southern Taiwan,12,13 0.1% to 4.7% in the Hunan province of Mainland China,14 1.4% in Malaysia,15 and 6.7% in the central Sri Lanka.16 Although there is evidence to support that chronic consumption of betel quid products, with or without added tobacco, is a central etiological agent for OPD and neoplasms of the oral cavity, pharynx, esophagus and larynx,10,17–23 no data are available concerning the oral precancerous consequences among betel quid abusers.To study the health effects of betel quid consumption in Asian populations and mobilize outreach activities in disease prevention, in 2008, the Center of Excellence for Environmental Medicine at Kaohsiung Medical University in Kaohsiung, Taiwan, in consultation with the World Health Organization (WHO) Collaborating Centre for Oral Cancer in the United Kingdom, launched an international collaborative project that constitutes the Asian Betel-quid Consortium (ABC) study. Six large research centers from East Asia (Kaohsiung Medical University, Taiwan, and Central South University, Changsha, Mainland China), Southeast Asia (Airlangga University, Surabaya, Indonesia and University of Malaya, Kuala Lumpur, Malaysia), and South Asia (University of Peradeniya, Peradeniya, Sri Lanka and Kathmandu University, Kavrepalanchwok, Nepal) participated in this investigation. Because of varying practices and particular marketing of betel quid products in those countries (detailed explanations shown in Table A, available as a supplement to the online version of this article at http://www/ajph.org), present study actions are promisingly warranted. The purposes of this report are twofold: (1) to present the current population burden of betel quid abuse and the factors associated with this behavior in the investigated Asian communities, and (2) to evaluate the impact of betel quid abuse on oral premalignant disorders.     

Confirmatory factor analysis and structural equation modeling of socio-cultural constructs among chamorro and non-chamorro micronesian betel nut chewers

Objectives: Betel nut chewing is embedded within the cultures of South Asia, and Southeast Asia, and the Western Pacific. The determinants of betel nut consumption are complex. Ongoing consumption of betel nut is affected by cultural, social, and drug-specific effects (i.e. dependence). This study’s first objective was to assess the psychometric properties (i.e. reliability and validity) of the socio-cultural constructs in a survey developed for betel nut chewers. The study’s second objective was to investigate the influence of socio-cultural variables on betel nut chewing behaviors among Chamorro and non-Chamorro Micronesians in Guam.

Design: The current study was a secondary analysis of a larger study (N?=?600; n?=?375 chewers and n?=?225 former chewers) that examined socio-cultural factors that influence why chewers chew betel nut, along with assessing chewing behaviors, perceptions of risks, probability of changing behaviors, and methods that could be used to reduce use or quit. The socio-cultural constructs of the survey were analyzed using confirmatory factor analysis and structural equation modeling.

Results: The socio-cultural factors were a sufficient fit with data and the instrument is reliable and valid, as indicated by various model fit indices (χ² (13)?=?18.49 with p?=?.14, TLI?=?.99, CFI?=?1.00, SRMR?=?.02, RMSEA?=?.03 with 90% CIs [.00,.07]). Cronbach’s alpha, the sign and magnitude of the factor loadings, the inter-factor correlations, and the large proportion of variance extracted for each factor, all indicate that the instrument is reliable and valid. Additionally, multivariate analyses showed that socio-cultural reasons were important contributing or chewing betel nut. Participants cited chewing because their friends and family members chewed, the behavior is embedded within their culture, and it would be considered rude and disrespectful to not chew.

Conclusion: Based on the findings, this study provides important implications pertaining to creating culturally appropriate cessation programs.     

Betel nut chewing is associated with increased risk of cardiovascular disease and all-cause mortality in Taiwanese men

BACKGROUND: Betel nut chewing is related to several kinds of cancer, metabolic syndrome, and type 2 diabetes. Whether it is associated with a greater risk of cardiovascular disease (CVD) and all-cause mortality, however, remains unclear. OBJECTIVE: We aimed to investigate the association between betel nut chewing and CVD and all-cause mortality. DESIGN: A baseline cohort of 56,116 male participants > or = 20 y old were recruited from 4 nationwide health screening centers in Taiwan in 1998 and 1999. Cox proportional hazards regression analyses were used to estimate the relative risks (RRs) of CVD and all-cause mortality for betel nut chewers during an 8-y follow-up period. RESULTS: There were 1549 deaths during the follow-up period, 309 of which were due to CVD. After adjustment for age, body mass index, diabetes, hypertension, lipids, smoking, alcohol consumption, physical activity, income, and education level, the RRs (95% CI) of CVD and all-cause mortality among the former betel nut chewers were 1.56 (1.02, 2.38) and 1.40 (1.17, 1.68), respectively, and those among current chewers were 2.02 (1.31, 3.13) and 1.40 (1.16, 1.70), respectively, compared with persons who had never chewed betel quid. Current and former betel nut chewers had a higher risk of CVD mortality (RR: 2.10; P < 0.05) than did current and former smokers. Greater frequency of betel nut chewing was associated with greater CVD and all-cause mortality. CONCLUSIONS: Betel nut chewing was independently associated with a greater risk of CVD and all-cause mortality in Taiwanese men. Regular screening for betel nut chewing history may help prevent excess deaths in the future. An anti-betel nut chewing program is urgently warranted for current chewers.     

A Qualitative Study on Tobacco Smoking and Betel Quid Use Among Burmese Refugees in Australia

Anecdotal evidence suggests that there are high rates of smoking among Burmese men in Wollongong, Australia. A qualitative study was undertaken to explore the beliefs and experiences of Burmese refugees in Wollongong on smoking to guide the development of smoking cessation interventions. Three focus groups were conducted with Burmese refugees. Ten semi-structured interviews were conducted with service providers involved with Burmese refugees. Qualitative content analysis was used to categorise responses to the questions. Participants were aware of the health effects of tobacco smoking but had little knowledge of support for quitting. Many participants chewed betel quid and were unaware of the health consequences. Service providers noted the lack of resources on smoking and betel quid use for Burmese people. Smoking cessation interventions for Burmese people should consider the co-related use of betel quid due to the possibility of inadvertently encouraging use of betel nut as an alternative to tobacco.     

Tobacco, betel quid, alcohol, and illicit drug use among 13- to 35-year-olds in I-Lan, rural Taiwan: prevalence and risk factors.

OBJECTIVES: This study determined the prevalence of and risk factors for substance use among rural Taiwanese. METHODS: We used a survey of a representative sample of 6318 participants aged 13 to 35 years in I-Lan, Taiwan, in 1996 through 1997. RESULTS: Perceived use of illicit drugs by peers, tobacco smoking, betel quid chewing, and male gender were the strongest predictors of illicit drug use. The prevalence of illicit drug use ranged from 0.3% among those who did not use any other substance to 7.1% among those using tobacco, betel quid, and alcohol. CONCLUSIONS: Preventive measures should address substance use in general rather than aiming at single substances.     

Areca nut chewing and mortality in an elderly cohort study

Compared with the well-documented association with betel-related cancer, little is known about the long-term effect of areca nut chewing on other fatal diseases. The authors' analyses were based on a population-based cohort study in Taiwan, including 4,049 participants aged 60 years or older enrolled in 1989 and 2,462 participants aged 50-66 years enrolled in 1996. Information regarding betel quid chewing and covariates was collected at baseline and was updated at subsequent interviews. Proportional hazards analysis was performed to determine the effect of chewing on all-cause and cause-specific deaths. During a mean follow-up of 9.5 years, 2,309 deaths occurred. Ever chewers were at higher risk of only total (hazard ratio = 1.19, 95% confidence interval: 1.05, 1.35) and cerebrovascular (hazard ratio = 1.66, 95% confidence interval: 1.19, 2.30) deaths. Furthermore, increased chewing-years or quid-years appeared to be associated with increased mortality risk (linear trend: p = 0.02 for total mortality and p = 0.001 for cerebrovascular mortality). The authors found that, although betel quid chewing resulted in a statistically significant increase in the risk of total and cerebrovascular deaths in the elderly population, the associations were weak and should be interpreted with caution. Further studies are needed to confirm these findings and to better understand the possible mechanisms of death.     

Betel Nut Chewing Increases the Risk of Metabolic Syndrome and Its Components in a Large Taiwanese Population Follow-Up Study Category: Original Investigation

Betel nut chewing is a popular habit in Taiwan, and it is associated with adverse metabolic effects. The aim of this study was to investigate correlations between betel nut chewing with metabolic syndrome (MetS) and its components in a longitudinal study using data from the Taiwan Biobank. A total of 121,423 participants were included in the baseline study, and 27,002 received follow-up examinations after a median of 4 years. The association between betel nut chewing and MetS was analyzed using multiple logistic regression after controlling for confounders. The baseline prevalence of MetS was 22.5%. Multivariable analysis showed that a history of chewing betel nut was significantly associated with baseline MetS (odds ratio (OR) = 1.629; 95% confidence interval (CI) = 1.535 to 1.730, p < 0.001) and five components of MetS in all participants. A long history of chewing betel nut (per 1 year; OR = 1.008; 95% CI = 1.004 to 1.013, p < 0.001) was associated with baseline MetS, abdominal obesity, hypertriglyceridemia and low high-density lipoprotein (HDL) cholesterol. In addition, high cumulative dose (per 1 year × frequency × daily score; OR = 1.001; 95% CI = 1.001–1.002; p < 0.001) was significantly associated with baseline MetS. At the end of the follow-up, a history of chewing betel nut (OR = 1.352; 95% CI = 1.134 to 1.612, p = 0.001) was significantly associated with MetS and its components including abdominal obesity, hypertriglyceridemia and low HDL-cholesterol in the participants without baseline MetS. In addition, a longer history of betel nut chewing was associated with MetS (per 1 year; OR = 1.021; 95% CI = 1.008 to 1.035, p = 0.002), abdominal obesity and hypertriglyceridemia at follow-up. However, cumulative dose (p = 0.882) was not significantly associated with follow-up MetS. Chewing betel nut and a long history of betel nut chewing were associated with baseline MetS and its components. In the participants without MetS at baseline, chewing betel nut and a long history of chewing betel nut were associated with the development of MetS after 4 years of follow-up. However, a cumulative dose of betel nut chewing was not associated with follow-up MetS. Betel nut chewing cessation programs are important to reduce the incidence of MetS in Taiwan.     

A population-based study of the association between betel-quid chewing and the metabolic syndrome in men

BACKGROUND: Betel-quid chewing, an established risk factor for oropharyngeal malignancy, is associated with hyperglycemia and obesity. Associations with other characteristics of the metabolic syndrome have not been reported. OBJECTIVE: This study examined associations between betel-quid chewing and the metabolic syndrome, allowing for recognized risk factors and exploring dose-response effects in a population-based study. DESIGN: Age-specific prevalence rates of the metabolic syndrome were examined in betel-quid chewing and nonchewing men (n = 19,839) recruited into the Keelung Community-based Integrated Screening program in 2001-2003. The independent effect of betel-quid chewing on metabolic syndrome risk was examined by using multiple logistic regression with control for well-recognized risk factors (eg, education, physical activity, and dietary factors) and dose-response effects were examined by using trend tests. RESULTS: The age-adjusted prevalence of the metabolic syndrome was highest in current chewers (25.13%), next highest in ex-chewers (22.04%), and lowest in nonchewers (15.73%) (P < 0.0001). Odds ratios (95% CIs) for the metabolic syndrome were 1.38 (1.19, 1.60) and 1.78 (1.53, 2.08) in ex-chewers and current chewers, respectively, adjusted for other significant correlates such as a family history of hypertension and diabetes mellitus. Meaningful odds ratios for the metabolic syndrome components ranged from 1.24 for hyperglycemia (95% CI: 1.09, 1.64) to 1.90 (95% CI: 1.66, 2.19) for hypertriacylglycerolemia. Increasing odds ratios for the metabolic syndrome with higher consumption of betel quid (whether by rate of use, duration of use, or cumulative exposure) suggest dose-response effects. CONCLUSIONS: After adjustment for well-established risk factors, our study showed independent predictive dose-response effects of betel-quid chewing for the metabolic syndrome and its components in a population-based study of men with a 15% prevalence of betel-nut chewing.     

Tobacco Chewing and Associated Factors Among Youth of Western Nepal: A Cross-sectional Study

Background:

Smokeless tobacco is found to be as addictive and harmful as smoking but have not been explored into, especially among youth.

Objectives:

This study was conducted to find the prevalence of tobacco chewing among college students in Nepal and the factors that have influence over their use.

Study design:

A cross-sectional study with a self-administered questionnaire.

Materials and Methods:

Five colleges of different streams in Pokhara city were selected for the study. A total of 816 students participated. The study was conducted during the period of May 2006–February 2007, using a semi-structured, self-administered questionnaire.

Results:

Overall prevalence of ever tobacco chewing was 21.3% (males 30.2% and females 10.9%) among the youth with average age of initiation 15.7 years. Pan masala and gutka were used by 63.6% and frequency of use varied widely and only 5.7% said they were daily users. Reasons cited for chewing were most commonly ‘just like it’ or ‘friends chew’. Multiple logistic regression analysis showed age, ever smoking status, being ever alcoholic, and having friends or family members who chewed were significantly associated with students’ tobacco chewing. Almost one-tenth of the students believed they were addicted to chewing tobacco and 42.5% of them had tried to quit the habit.

Conclusion:

The study shows a high prevalence of tobacco chewing by Nepali youth. Important factors that influenced the habit were having chewer friends, their own smoking and alcohol status and having family members who chewed. It is pertinent to consider these when formulating cessation and prevention programs