Open Access Research article

The role of betel-quid chewing in smoking cessation among workers in Taiwan

Fu-Li Chen1*, Peter Y Chen2, Tao-Hsin Tung13, Yu-Ching Huang1 and Min-Chien Tsai1

Author Affiliations

1 Department of Public Health, College of Medicine, Fu Jen Catholic University, No.510, Jongjheng Rd., Sinjhuang, New Taipei city, Taiwan

2 Department of Psychology, Auburn University, Auburn, Alabama, USA

3 Department of Medical Research and Education, Cheng-Hsin General Hospital, Taipei city, Taiwan

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BMC Public Health 2014, 14:755  doi:10.1186/1471-2458-14-755

Published: 28 July 2014



Current smokers exhibit a higher rate of betel-quid chewing than non-smokers. However, little is known regarding the extent to which betel-quid chewing may affect attempts to quit smoking and smoking cessation. The aim of the present study is to examine the association between betel-quid chewing and patterns of quitting smoking. Specifically, we explore whether betel-quid chewing is associated with (1) current smokers who have never attempted to quit versus those who have attempted to quit and have failed, those who are in the process of quitting, and successful cessation smokers, and (2) current smokers who have attempted to quit and have failed versus those who have successfully quit smoking.


A telephone survey of 7,215 workers was conducted and obtained an 88.6% response rate. In the survey, the respondents’ smoking and betel-quid chewing statuses were recorded and a list of covariates was assessed.


After controlling for the effect of the covariates, betel-quid chewing was found to be more highly associated with current smokers who have never attempted to quit, compared to current smokers who are in the process of quitting (OR = 12.72; 95% CI = 1.05–154.26), successful cessation smokers (OR = 3.62; 95% CI = 2.32–5.65), and smokers who have attempted to quit and have failed (OR = 1.37; 95% CI = 1.06–1.77), respectively. In addition, betel-quid chewing is more highly associated with a failure to quit smoking than with successfully quitting smoking (OR = 3.46; 95% CI = 2.17–5.51).


The findings support four plausible reasons why betel-quid chewing may dissuade smokers from quitting. These reasons highlight additional avenues for potentially reducing the smoking population in workplaces, such as considering work contexts and social norms, and product sales in smoking-cessation campaigns.

Betel-quid chewing; Smoking cessation; Workers