Open Access Open Badges Research article

The reasons for betel-quid chewing scale: assessment of factor structure, reliability, and validity

Melissa A Little1*, Pallav Pokhrel1, Kelle L Murphy2, Crissy T Kawamoto1, Gil S Suguitan3 and Thaddeus A Herzog1

Author Affiliations

1 University of Hawaii Cancer Center, 701 Ilalo St., B4, Honolulu, HI 96813, USA

2 University of Hawaii Department of Kinesiology and Rehabilitation Science, 1337 Lower Campus Road PE/A 231, Honolulu, HI 96822, USA

3 University of Guam Cancer Research Center, UOG Station, Mangilao, GU 96923, USA

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BMC Oral Health 2014, 14:62  doi:10.1186/1472-6831-14-62

Published: 3 June 2014



Despite the fact that betel-quid is one of the most commonly used psychoactive substances worldwide and a major risk-factor for head-and-neck cancer incidence and mortality globally, currently no standardized instrument is available to assess the reasons why individuals chew betel-quid. A measure to assess reasons for chewing betel-quid could help researchers and clinicians develop prevention and treatment strategies. In the current study, we sought to develop and evaluate a self-report instrument for assessing the reasons for chewing betel quid which contributes toward the goal of developing effective interventions to reduce betel quid chewing in vulnerable populations.


The current study assessed the factor structure, reliability and convergent validity of the Reasons for Betel-quid Chewing Scale (RBCS), a newly developed 10 item measure adapted from several existing “reasons for smoking” scales. The measure was administered to 351 adult betel-quid chewers in Guam.


Confirmatory factor analysis of this measure revealed a three factor structure: reinforcement, social/cultural, and stimulation. Further tests revealed strong support for the internal consistency and convergent validity of this three factor measure.


The goal of designing an intervention to reduce betel-quid chewing necessitates an understanding of why chewers chew; the current study makes considerable contributions towards that objective.

Areca nut; Betel-quid; Reasons for chewing; Betel nut