Areca nut, also known as betel nut, is the fourth most commonly consumed psychoactive substance in the world, following only alcohol, nicotine, and caffeine in prevalence of consumption. Although betel nut is chewed by approximately 600 million people globally, its use is concentrated in South Asia, Southeast Asia, and some Pacific islands. Betel nut has been classified as a Group 1 carcinogen by the International Agency for Research on Cancer. Betel nut chewing has been associated with oral and oropharyngeal cancer, oral lesions, oral leukoplakia, submucous fibrosis, gum disease, and cancer of the pharynx and esophagus. Despite the global significance and carcinogenicity of betel nut, there has been very little behavioral or psychological research about betel nut chewing, and there has been no systematic research on the topic of betel nut cessation interventions. The proposed research builds directly upon our prior research. Our survey data suggest that betel nut chewers, like smokers, generally want and intend to quit, but do not have specific plans of how or when they will quit. In addition, most betel nut chewers in our sample already have tried to quit on one or more occasions. These findings suggest that betel nut chewers could benefit from cessation programs modeled after smoking cessation programs. During 2014, we conducted a feasibility study of our betel nut cessation program. The program was well received and yielded surprisingly high rates of self- reported betel nut cessation. Our primary aim is to test the efficacy of an intensive group-based betel nut cessation program. Betel nut cessation will be bio-verified by employing biomarkers developed in our previous research. Participants (n=324) will be betel nut chewers from Guam and Saipan who are willing to attempt to quit chewing. Participants will be randomly assigned either to an intensive intervention condition or to a minimal intervention control condition. Participants in the intervention condition will receive a group-based cessation program consisting of five hour-long sessions over the span of 22 days, as well as a brochure with advice about quitting betel nut. Participants in the control condition will receive a brochure with advice about quitting betel nut. The proposed intervention trial will allow us to assess the 1-month and 6-month efficacy of the intervention compared to a minimal control intervention. We hypothesize that the intensive betel nut cessation intervention will produce a significantly greater cessation rate compared to the minimal control condition at the 6-month follow-up assessment.

National Institute of Health (NIH)
National Cancer Institute (NCI)
Specialized Center--Cooperative Agreements (U54)
Project #
Application #
Study Section
Special Emphasis Panel (ZCA1-PCRB-C (O1))
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
University of Guam
United States
Zip Code
Faouzi, Malika; Neupane, Ram P; Yang, Jian et al. (2018) Areca nut extracts mobilize calcium and release pro-inflammatory cytokines from various immune cells. Sci Rep 8:1075
David, Annette M; Haddock, Robert L; Bordallo, Renata et al. (2017) The use of tobacco tax revenues to fund the Guam Cancer Registry: A double win for cancer control. J Cancer Policy 12:34-35
Murphy, Kelle L; Liu, Min; Herzog, Thaddeus A (2017) Confirmatory factor analysis and structural equation modeling of socio-cultural constructs among chamorro and non-chamorro micronesian betel nut chewers. Ethn Health :1-12
Hernandez, Brenda Y; Bordallo, Renata A; Green, Michael D et al. (2017) Cancer in Guam and Hawaii: A comparison of two U.S. Island populations. Cancer Epidemiol 50:199-206
Leon Guerrero, Rachael T; Novotny, Rachel; Wilkens, Lynne R et al. (2017) Risk factors for breast cancer in the breast cancer risk model study of Guam and Saipan. Cancer Epidemiol 50:221-233
Hernandez, Brenda Y; Zhu, Xuemei; Goodman, Marc T et al. (2017) Betel nut chewing, oral premalignant lesions, and the oral microbiome. PLoS One 12:e0172196
Paulino, Yvette C; Hurwitz, Eric L; Ogo, Joanne C et al. (2017) Epidemiology of areca (betel) nut use in the mariana islands: Findings from the University of Guam/University of Hawai`i cancer center partnership program. Cancer Epidemiol 50:241-246
Badowski, Grazyna; Somera, Lilnabeth P; Simsiman, Brayan et al. (2017) The efficacy of respondent-driven sampling for the health assessment of minority populations. Cancer Epidemiol 50:214-220
Paulino, Yvette C; Ettienne, Reynolette; Novotny, Rachel et al. (2017) Areca (betel) nut chewing practices of adults and health behaviors of their children in the Freely Associated States, Micronesia: Findings from the Children's Healthy Living (CHL) Program. Cancer Epidemiol 50:234-240
Somera, Lilnabeth P; Lee, Hye-Ryeon; Badowski, Grazyna et al. (2016) Health Information Seeking, Source Trust, and Culture: A Comparative Analysis of Health Information Trends and Needs Between Guam and the United States. J Health Commun 21:469-78

Showing the most recent 10 out of 33 publications