The reasons for betel-quid chewing scale: assessment of factor structure, reliability, and validity

BACKGROUND: Despite the fact that betel-quid is one of the most commonly used psychoactive substances worldwide and a major risk-factor for head-and-neck cancer incidence and mortality globally, currently no standardized instrument is available to assess the reasons why individuals chew betel-quid. A measure to assess reasons for chewing betel-quid could help researchers and clinicians develop prevention and treatment strategies. In the current study, we sought to develop and evaluate a self-report instrument for assessing the reasons for chewing betel quid which contributes toward the goal of developing effective interventions to reduce betel quid chewing in vulnerable populations. METHODS: The current study assessed the factor structure, reliability and convergent validity of the Reasons for Betel-quid Chewing Scale (RBCS), a newly developed 10 item measure adapted from several existing “reasons for smoking” scales. The measure was administered to 351 adult betel-quid chewers in Guam. RESULTS: Confirmatory factor analysis of this measure revealed a three factor structure: reinforcement, social/cultural, and stimulation. Further tests revealed strong support for the internal consistency and convergent validity of this three factor measure. CONCLUSION: The goal of designing an intervention to reduce betel-quid chewing necessitates an understanding of why chewers chew; the current study makes considerable contributions towards that objective.