Ethnic Disparities in Betel Nut Use: A Focus on Adolescents from Micronesia

Adolescent substance use has been extensively studied in Western countries. However, our knowledge of substance use, particularly betel nut use, among adolescents in the Pacific Islands remains limited. The present study examined ethnic differences in betel nut use and intention to use, and factors explaining such ethnic differences, in Guam, a U.S.-Affiliated Pacific Island in the Western Pacific. Participants were 674 ethnically diverse students (49% female; M age = 12.7, SD = 0.89) from eight local public middle schools. Self-report questionnaires were used to assess study variables. Results indicated that although the majority of participants did not use betel nut, there were significant differences in rates of betel nut use and intentions to use between ethnic groups. Compared with adolescents from other ethnic groups represented in the study, adolescents from the Freely Associated States (FAS) of Micronesia or non-CHamoru Micronesians were more likely to use betel nut in the past 30 days and in their lifetime, and to expect to use betel nut in the near future. These ethnic differences were partially mediated by proposed factors such as observation or familiarity with and access to betel nut, and approval by parents, peers, and the community. In other words, FAS ethnicity was a significant predictor of higher levels of familiarity with betel nut; FAS ethnicity also predicted lower levels of difficulty in accessing betel nut and perceived disapproval of betel nut use from parents, peers, and the community. These, in turn, predicted more betel nut use and intention as reported by FAS adolescents. These findings can be used to inform the design and implementation of intervention and prevention programs to reduce ethnic disparities among at-risk youth vulnerable to betel nut use in the Pacific.