抄録
Betel chewing with tobacco is widely practiced in Palau and poses serious health risks, including oral diseases and cancer. Although global tobacco use is declining, the practice of chewing betel quid mixed with tobacco remains culturally embedded, highlighting a gap between global health trends and local practices. Research on this behavior in the Pacific Islands is limited, despite its social and cultural significance. This study aimed to clarify how cultural norms, social practices, and health perceptions shape betel chewing with tobacco in Palau, focusing on usage patterns, perceived benefits, and public health implications. Qualitative data were collected through focus group discussions and in-depth interviews with chewers across generations, alongside key informant interviews. The findings showed that betel chewing typically begins in early adolescence (approximately 14 years of age) because of family influence. Although temporary interruptions may occur during pregnancy or illness, resumption is common. Betel nuts mixed with tobacco are more common than betel nuts alone, and cultural norms, such as social bonding and stress relief, shape their use. Participants perceived benefits, such as increased alertness, energy, and focus, despite health risks. Many wished to quit; however, social and cultural influences often outweighed their health concerns. These results highlight Palau as a rare case in which culturally supported chewing of betel with tobacco was qualitatively and quantitatively documented, offering insights for public health interventions. The findings suggest that effective interventions require not only health education but also culturally sensitive socially grounded approaches that respect traditional practices while addressing health harms.
