Palauans who chew betel nut: social impact of oral disease

Int Nurs Rev. 2014 Mar;61(1):148-55. doi: 10.1111/inr.12082.


Background: Chewing betel nut is a tradition extending from Southeast Asia to the Pacific. Globally, betel nut is the fourth main psychotropic substance containing a stimulant, arecoline, that has a similar effect to nicotine. In Palau, there is broad acceptance of betel nut chewing. One of the largest immigrant groups in Hawaii is the Palauans. Chewing betel nut has significant social implications that make it difficult for those who engage in this practice to separate potential oral disease from the social importance. However, little is known about the social impact of oral disease from chewing betel nut on Palauans in Hawaii.

Aim: The study aimed to describe the perceptions of betel-chewing Palauans in Hawaii regarding betel nut and to determine the social impact of oral disease among these individuals.

Methods: Descriptive study conducted on the island of Oahu, Hawaii with 30 adult Palauans. Data were collected using the Oral Health Impact Profile-14 to measure perceptions of social impact of oral disease on well-being. Demographic and general health information was collected.

Results: Participants perceived little negative social impact of oral disease on well-being.

Discussion: Families, peers and society exert a strong influence on the decision to chew betel nut, a known carcinogen. Participants in this study showed little concern on the impact of betel nut chewing on their oral health. They continue the habit in spite of the awareness of potential for oral disease.

Implications for nursing and health policy: Nurses face challenges in educating Palauans about the negative aspects of betel nut, particularly those related to oral health especially when they do not perceive problems. Nurses must be involved in the development of health policies to design and implement strategies to promote behavioural change, and to ensure clinical services that are culturally sensitive to betel nut chewers.

Keywords: Betel Nut; Hawaii; Oral Health; Palua; Social Impact.

MeSH terms

  • Adult
  • Areca*
  • Attitude to Health*
  • Female
  • Hawaii / epidemiology
  • Humans
  • Male
  • Mouth Diseases / chemically induced*
  • Mouth Diseases / epidemiology
  • Palau / ethnology
  • Psychological Distance*
  • Risk Factors