Craving with Areca and Areca with Tobacco among Micronesian Youth

Objective: Areca (betel) use is common in Micronesia. Usually immature nuts are split, coated with lime, and wrapped in a betel leaf. One study reported 63.4% of 309 Saipan students (mean age 16.3±1.5) used Areca. A recent study reported 54.7-68.6% of 100 7th and 8th graders in Yap and Pohnpei used Areca at least once/month and 55% of those youth used tobacco much of the time. Areca has been stated to be addictive, but evidence is lacking. This study was to describe craving among adolescents who habitually use Areca alone or with tobacco and to test the hypothesis that craving is associated with tobacco.  Method: The data source is a survey of 151 9th graders (mean age 14.7±1.0, 75 females) in Saipan conducted in 2014. Students completed an anonymous questionnaire that asked if they ever used betel, age of first use, and frequency of use. They also were asked if they used tobacco with betel and how often. The questionnaire included 15 true/false questions on craving adapted from the U.S. National Survey of Drug Use and Health. The 15-items were summed to form a scale, range 0 to 15 (α=0.835) where higher scores indicate greater craving. Result:   59/151 (39%) ever used betel. First use was age 11±2. 57% used betel in the previous month or more frequently and 49% used either the week of the survey. 79% (34/44) also used tobacco much/nearly all the time with betel. The mean craving score among tobacco users was 8.2±4.0 versus 5.4±3.8 among those who used betel alone (T=1.87, p=0.069). Neither age of initiation of betel nut use nor gender were related to the craving score. Conclusion: Results suggest a trend for craving associated with tobacco use among habitual users. If confirmed, tobacco cessation strategies may be helpful.