Full project II (BENIT)
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Guam Cancer Research

Our Study

Betel Nut Intervention Trial (Benit)Areca nut, commonly known as betel nut, is the fourth most commonly consumed psychoactive substance in the world, following only alcohol, nicotine, and caffeine in prevalence of consumption(1-2). Affecting approximately 10% of the global population, its use is concentrated in South Asia, Southeast Asia, and some Pacific islands(3) and has been classified as a Group 1 carcinogen by the International Agency for Research on Cancer(4). Despite the global significance and carcinogenicity of betel nut, there has been very little behavioral or psychological research about betel nut chewing, and there has been no systematic research on the topic of betel nut cessation interventions. The current intervention builds directly upon the National Institutes of Health – National Cancer Institute’s U54 University of Guam/University of Hawaii Cancer Center Comprehensive Partnership to Advance Health Equity. Previous data collected through the partnership suggest that betel nut chewers, like smokers, generally want and intend to quit, but do not have specific plans of how or when they will quit. In addition, most betel nut chewers in the partnership’s previous study already have tried to quit on one or more occasions. These findings suggest that betel nut chewers could benefit from cessation programs modeled after smoking cessation programs. During 2014, partnership investigators conducted a feasibility study of our betel nut cessation program. The program was well received and yielded surprisingly high rates of self- reported betel nut cessation. The current study builds on the findings from the previous betel nut studies within the partnership, including the 2014 feasibility study.

Study Aims

  1. To test the effectiveness of a comprehensive cessation program versus a minimal  intervention control.
  2. To test whether it is possible to use saliva as an indicator of betel quid chewer status..

Participation Criteria:

  1. Self-described betel nut chewer (chewed betel nut for at least 3 years, and at a rate of at least 3 days per week)
  2. Must include tobacco when chewing betel nut
  3. Must be at least 18 years old
  4. Must reside in Guam or Saipan
  5. Must be able to understand, speak, and read English
  6. Must be able to provide a sign an informed consent form


Taking part in this study may or may not improve your heath directly. While researchers hope that education and group counseling may be useful for improving your ability to quit chewing betel quid and stay quit, there is no definitive proof of this yet. We do hope that information gained from this study will help us to understand how education and structured group counseling can improve quit rates for betel quid chewing, and this is the main reason why this study is being done.

Voluntary Participation and Withdrawal:

Participation in this study is voluntary. Participants may decide not to participate in any sections of the survey or may leave the study at any time.