Severity of Betel Quid Use Disorders (BUD) Among Adult Indian Betel Quid Chewers

Oral cancer is a major public health problem in India, with the highest number of cases and deaths in the world, and Betel Quid (BQ) chewing is responsible for almost 50% of cases. BQ Use Disorder (BUD) prevalence and severity have never been investigated among Indian BQ chewers.

In total, 1281 adult routine BQ chewers attending five dental healthcare centers were interviewed using a pretested 11-item BUD questionnaire based on the DSM-5 substance use disorder (SUD) diagnostic criteria. Demographic, lifestyle, and other BQ-related variables also were collected.

Females were almost 80%, and two-thirds were rural residents. BQ was used prevalently with friends; the average initiation age was 24 years, and two-thirds used BQ daily. Severe and mild-to-moderate BUD was detected in 49% and 45% of individuals, respectively. The average BUD score (range 0-11) was 5.2. Sex-standardized severe BUD prevalence was 54.9% (95% confidence interval, 49.8%-59.7%). Female sex, older age, being married, using BQ with friends, and adding tobacco were inversely associated with severe BUD. Multicollinearity was noted among these factors.

Severe BUD was highly prevalent in Indian BQ chewers. Intervention programs aimed at assisting chewers to quit the habit should account for this dramatic situation. Appropriate measures should be taken to effectively influence cessation rates.