Betel Use in Pregnancy

Thesis (Master's)--University of Washington, 2015

University of Washington Abstract Betel Use in Pregnancy Sahira Khalid Chair of the Supervisory Committee: Peter Milgrom, Professor Oral Health Sciences Purpose: The purpose of this study is to pilot test a short questionnaire, which will gain information on pregnant women’s views on the risks associated with using betel nut, and to establish the questionnaire’s internal consistency and concurrent validity, which will be done by relating it to the developed craving scale. Study setting: This study was conducted at a Pongee State Hospital, Maternal and Child Department, Federated States of Micronesia. Participants were receiving prenatal care. Methods: This is a convenience sample. Members of the Dental Department staff confidentially administered the surveys in May and July 2015. Independent samples t-test was used to find difference between the mean number of betel nut users who also used tobacco and those who did not use tobacco with their betel nut use in terms of their responses on the dependence symptom scale (craving scale). Spearman’s rank correlation was used to test for a relationship between the dependence symptom scores and health risk beliefs assessment scores for betel nut users who used betel nut at some point in their lives. Chi-square test of association was used to test for association between the level of education of the respondents and their betel nut use (chewers or non-chewers) and to test for association between their betel nut use and whether they smoked or not during pregnancy, alcohol use, and substance abuse. Results: In this study, 80% of the 55respondents had ever used betel. More than one sixth of all users (14.7%) used betel in the previous month, and 26 (76.5%) also used tobacco with the betel. Although not statistically significant, the mean (± SD) dependence symptom scale score among users who also used tobacco from cigarette was 8.25 ± 0.822 versus 6.00 ± 2.00 among those who used betel nut alone (t (22) = -0.8, p = 0.432). The dependency score was positively but not significantly associated with frequency of tobacco use (e.g., mean (SD) = 11±1.761) among most frequent users versus a mean (SD) = 9.14±0.688 among the never users [F(3,28) = 1.968, p = 0.142)]. 83.3% of the users who did not believe that after the birth of a child, it is safe for a new mom to chew betel nut also agreed or strongly agreed that encouragement should be given to pregnant women so that they stop chewing betel nut (χ2 = 13.698, p < 0.05). 88% of the users who did not believe that after the birth of a child, it is safe for a new mom to chew betel nut also agreed or strongly agreed that more help should be given to pregnant women who want stop chewing betel nut (χ2 = 18.429, p < 0.05). There was no significant relationship found between the craving scale and the health risk belief assessment scale for both, users who had ever used betel (ρ = -0.240, p = 0.238) and who used betel within the past 30 days using Spearman’s rank correlation (ρ = -0.394, p = 0.085). Conclusion: Dependence was observed in pregnant betel users who also chewed tobacco versus those who used betel nut alone. The beliefs which prompted the pregnant women to chew are: to reduce morning sickness/nausea, for relief and relaxation, to avoid having a smelly mouth, and to prevent them from feeling tired or to work for a longer time. The health belief scale and craving were 80% reliable and had high internal consistency, and the items in the questionnaire are well inter-correlated. There was no significant relationship found between the craving scale and the health risk belief assessment scale for both, users who had ever used betel (ρ = -0.240, p = 0.238) and who used betel within the past 30 days using Spearman’s rank correlation (ρ = -0.394, p = 0.085). Additional studies are required to corroborate the data of this preliminary study and develop effective betel nut cessation intervention program. One possible next step is the collection of samples tied to birth records, examining pregnancy outcomes more thoroughly. Future studies should also involve adolescents or parents who are introducing betel to young children.