Theories and Practices on Developing Various Models of Betel Quid Cessation in Taiwan

This review examines the development and outcomes of Taiwan's betel quid cessation models over two decades. Betel quid, the world's fourth most used psychoactive substance, receives far less cessation attention than tobacco.

We present a narrative synthesis of program evaluations and national implementation data from Taiwan (2007-2025), analyzing the Transtheoretical Model, Health Belief Model, Theory of Planned Behavior, social cognitive theory, and ecological and nudge frameworks against program design and outcomes.

Six models were developed sequentially. In the 8 h community program, 96% initiated cessation by course end, 53% stopped chewing entirely, and 64% remained abstinent at 1 year tracking. A 4 h workplace program achieved 69% point-prevalence cessation among 166 workers (consumption: 49.8-2.1 quids/day). A 3 min clinic intervention advanced 32% of 246 patients a stage. Case management matched group delivery in stage progression while reaching remote populations; school prevention improved student knowledge and attitudes in 54-73 schools yearly. An AI-assisted curriculum-design tool remains in pilot testing.

Taiwan shows that theory-driven, culturally sensitive, multi-model programs can substantially reduce betel quid use, offering a transferable framework for other high-prevalence regions. Most outcome evidence comes from single-group, self-reported evaluations; confirmation in controlled trials is a regional priority.