Evaluation of a self-rating screening test for areca quid abusers in Taiwan

Areca quid chewing is a popular habit and areca is a well-known ethnopsychopharmalogic agent in southeast Asia. While the chewing habit is legal and also socially acceptable in many places of Taiwan, the public health problem of high oral cancer incidence has remained a priority on the health care list in our local health department. Helping areca quid chewers to reduce or even stop the habit will be paramount in the oral cancer prevention programme. Hence, in order to identify the appropriate strategy for stopping the chewing habit, it is important to distinguish whether an areca quid chewer has reached the level of substance abuse.In accordance with the Diagnostic and Statistical manual of Mental disorder (fourth edition, DSM-IV), we developed a specific self-report questionnaire modified from the famous SCAN system, DSM-IV and ICD-10. The initial screening test for areca quid abusers had 52 questions. Its components included the onset age and frequency, subjective craving and feeling, social problems, physical problems, oral symptoms, psychological and abstinence-related problems, the motivation and capacity to abstain, and demographic data. The answers were divided into 'Yes' or 'No'. One hundred and twenty-five areca quid users (53 men, 72 women) were recruited. The abusers tended to have older age, less education, and higher daily consumption of areca quid. There were no differences on motivation to quit chewing (abstinence) between abusers and non-abusers. There were no statistical differences on tobacco-smoking and alcohol-drinking behavior. Based on the statistical analysis of receiver operation characteristic (ROC) curves, 11 questions were chosen for the Self-report Screening Test for Areca quid Abuser (SSTAA). An areca quid chewer's answers with a score of 4 or more in these 11 questions would be considered an areca quid abuser. The modified process of SSTAA is performed for the evaluation of the native culture-related substance user. At this current stage, the SSTAA developed from the study is the first instrument for screening areca quid abuser.