Factors influencing Betel quid chewing among indigenous tribal population in Wayanad, Kerala : A qualitative study


Betel quid; betel chewing; substance use; indigenous tribe: South India

How to Cite

Sadath, A., Jose, K., KM, J., & TM, S. kumar. (2019). Factors influencing Betel quid chewing among indigenous tribal population in Wayanad, Kerala : A qualitative study. Kerala Journal of Psychiatry , 32(1), 17-24. https://doi.org/10.30834/KJP.32.1.2019.173


Background: Indigenous tribes are at higher risk of substance misuse, including betel quid. Available studies in this area focused on health hazards, while socio-behavioural aspects of betel quid practices are less studied, especially among the tribal population in India.

Objectives: The study was conducted to explore the factors influencing betel quid use among indigenous tribes in Wayanad, Kerala

Methods: Using a purposive sampling method, we selected 12 persons with betel quid use form Paniya and Kattunaicker tribal community at Wayanad. Qualitative in-depth interviews were used for data collection. The thematic analysis was done to understand the key themes and categories.

Results: We identified that betel quid chewing among tribes often initiated in young age, with influence of the home environment, parental, peer and spouse related factors. Key themes that emerged were the trajectory of betel quid use, betel quid intake, dependency, access and availability of betel quid in tribal dominant areas.

Conclusion: As our study result indicated many features of betel quid dependency, community level screening for identifying the potential cases and provision of treatment services might be required. Future studies to assess proper intervention for betel quid chewing can be undertaken.



Gupta PC, Warnakulasuriya S. Global epidemiology of areca nut usage. Addiction biology. 2002;7(1):77-83.

Gupta PC, Ray CS. Epidemiology of betel quid usage. Annals of the Academy of Medicine, Singapore. 2004;33(4 Suppl):31-6.

Rajan G, Ramesh S, Sankaralingam S. Areca nut use in rural Tamil Nadu: a growing threat. Indian journal of medical sciences. 2007;61(6):332-7.

Travasso C. Betel quid chewing is responsible for half of oral cancer cases in India, finds study. BMJ: British Medical Journal. 2013;347:f7536.

Song H, Wan Y, Xu YY. Betel quid chewing without tobacco: a meta-analysis of carcinogenic and precarcinogenic effects. Asia-Pacific journal of public health. 2015;27(2): Np47-57.

Ghani WM, Razak IA, Yang YH, Talib NA, Ikeda N, Axell T, et al. Factors affecting commencement and cessation of betel quid chewing behaviour in Malaysian adults. BMC Public Health. 2011;11:82.

Ghani WMN, Razak IA, Yang Y-H, Talib NA, Ikeda N, Axell T, et al. Factors affecting commencement and cessation of betel quid chewing behaviour in Malaysian adults. BMC Public Health. 2011;11(1):82.

Lin C-F, Wang J-D, Chen P-H, Chang S-J, Yang Y-H, Ko Y-C. Predictors of betel quid chewing behaviour and cessation patterns in Taiwan aborigines. BMC Public Health. 2006;6(1):271.

Ma WF, Li CI, Gritz ER, Tami-Maury I, Lam C, Lin CC. [A Symbol of Connectedness Between the Self and the Tribal Home: Betel Quid in the Lives of Indigenous Taiwanese]. Hu li za zhi The journal of nursing. 2017;64(3):65-73.

Mia MN, Hanifi S, Rahman MS, Sultana A, Hoque S, Bhuiya A. Prevalence, pattern and sociodemographic differentials in smokeless tobacco consumption in Bangladesh: evidence from a population-based cross-sectional study in Chakaria. BMJ Open. 2017;7(1):e012765.

Shrestha N, Mehata S, Pradhan PMS, Joshi D, Mishra SR. A nationally representative study on socio-demographic and geographic correlates, and trends in tobacco use in Nepal. Scientific Reports. 2019;9(1):2682.

Sadath A, Uthaman S, Shibu Kumar T. Mental health in tribes: A case report. Indian Journal of Social Psychiatry. 2018;34(2):187-8.

Palliyal S. Assessment of Betel Quid Habits and Risk of Precancerous Oral Lesions Among Paniya Tribes of Wayanad, India - A Cross-Sectional Study. Journal of Global Oncology. 2018;4(Supplement 2):12s-12s.

Herzog TA, Murphy KL, Little MA, Suguitan GS, Pokhrel P, Kawamoto CT. The Betel Quid Dependence Scale: replication and extension in a Guamanian sample. Drug and alcohol dependence. 2014;138:154-60.

Census of India 2011. In: Sheet PPT-ID, editor. Office of the Registrar General Census Commissioner, India. Delhi: Indian Census Bureau; 2011.

Mohindra K, Narayana D, Anushreedha S, Haddad S. Alcohol use and its consequences in South India: Views from a marginalised tribal population. Drug and Alcohol Dependence. 2011;117(1):70-3.

Mohindra K, Narayana D, Harikrishnadas C, Anushreedha S, Haddad S. Paniya voices: a participatory poverty and health assessment among a marginalized South Indian tribal population. BMC public health. 2010;10(1):149.

Guest G, Bunce A, Johnson L. How many interviews are enough? An experiment with data saturation and variability. Field methods. 2006;18(1):59-82.

Lin C-C, Tamí-Maury I, Ma W-F, Lam C, Tsai M-H, Lin M-T, et al. Social and Cultural Context of Betel Quid Consumption in Taiwan and Implications for Prevention and Cessation Interventions. Substance Use & Misuse. 2017;52(5):646-55.

Whitesell M, Bachand A, Peel J, Brown M. Familial, social, and individual factors contributing to risk for adolescent substance use. J Addict. 2013;2013:579310-

Hendricks G, Savahl S, Florence M. Adolescent peer pressure, leisure boredom, and substance use in low-income Cape Town communities. Social Behavior and Personality: an international journal. 2015;43(1):99-109.

Tamíâ€Maury I, Ma WF, Lin MT, Lin CC, Tsai MH, Li CI, et al. A qualitative study of attitudes to and perceptions of betel quid consumption and

its oral health implications in Taiwan. Community dentistry and oral epidemiology.2019;47(1):58-64.

Odgers CL, Caspi A, Nagin DS, Piquero AR, Slutske WS, Milne BJ, et al. Is it important to prevent early exposure to drugs and alcohol among adolescents? Psychol Sci. 2008;19(10):1037-44.

Jordan CJ, Andersen SL. Sensitive periods of substance abuse: Early risk for the transition to dependence. Developmental Cognitive Neuroscience. 2017;25:29-44.

Lee C-Y, Wu C-F, Chen C-M, Chang Y-Y. Qualitative study for betel quid cessation among oral cancer patients. PLoS One. 2018;13(7):e0199503.

Ko YC, Chiang TA, Chang SJ, Hsieh SF. Prevalence of betel quid chewing habit in Taiwan and related sociodemographic factors. Journal of oral pathology & medicine: official publication of the International Association of Oral Pathologists and the American Academy of Oral Pathology. 1992;21(6):261-4.

Goswami A, Reddaiah V, Kapoor S, Singh B, Dwivedi S, Kumar G. Tobacco and alcohol use in rural elderly Indian population. Indian journal of psychiatry. 2005;47(4):192-7.

Yang M-S, Lee C-H, Chang S-J, Chung T-C, Tsai E-M, Ko AM-J, et al. The effect of maternal betel quid exposure during pregnancy on adverse birth outcomes among aborigines in Taiwan. Drug and Alcohol Dependence. 2008;95(1):134-9.

Yang MS, Chang FT, Chen SS, Lee CH, Ko YC. Betel quid chewing and risk of adverse pregnancy outcomes among aborigines in Southern Taiwan. Public Health. 1999;113(4):189-92.