Comparing factors affecting commencement and cessation of betel quid chewing behavior in Taiwanese adults.

BACKGROUND: Betel quid is the fourth most common used substance in the world after tobacco, alcohol and caffeine. Although factors related to betel quid chewing or cessation of behaviors were reported previously, few studies simultaneously compared both behaviors in the same population. In addition, it is essential to consider time-to-event concept, since the chance of developing or stopping habit may vary over time. The purpose of this study was to compare the risk factors for commencement and cessation of betel quid chewing behaviors in a time-to-event setting. METHODS: A stratified multi-stage cluster sampling with selection probabilities proportional to size (PPS) was designed for Taiwanese adults with aged 18 years old and above. Kaplan-Meier estimates and Cox proportional hazard regression models were used to compare and calculate the hazard rate ratios for related factors to commencement or cessation of chewing habits. RESULTS: In Taiwan, men had a higher betel quid chewing rate (M: 20.9%, W: 1.2%), but woman chewers had a lower cessation rate (M: 27.5%, W: 12.7%). The hazard rate ratio (HRR) of having chewing habit changed from 4.22 (men vs women) univariately to 1.38 multivariablely, which indicated gender differences were confounded by other factors. In multivariable analysis, the risk factors of gender, education and ethnicity were significantly associated with both starting and cessation of betel quid chewing behavior. The factors of occupation, cigarette smoking and alcohol drinking were only associated with starting habit. CONCLUSION: Commencement or cessation of chewing behavior involves a scenario of time, hence it is preferable to use a time-to-event approach for the comparison. The cessation rates of betel quid chewing were decreasingly associated with the daily consumption of betel quid. Hence, reducing of daily amount in betel quid cessation program may be associated with future stopping habit.

Awareness of HIV/AIDS prevention and acceptance of HIV testing among residents in Likoma Island, northern Malawi.

To evaluate the awareness of HIV/AIDS prevention education, and the acceptance of HIV testing among residents on Likoma Island, Malawi, a cross-sectional, population-based study of 579 residents aged > or =15 years from seven villages on Likoma Island was conducted during July and August 2007. Most of the subjects studied could correctly answer questions about their awareness of AIDS and knowledge of the ways to reduce HIV transmission. Moreover, the proportion of respondents (65.8%) who possessed complete knowledge of HIV/AIDS prevention was greater than the national average. By contrast, condom utilization was slightly lower. Our results also showed that a high proportion of respondents (70.3%) had been HIV tested at any time, 93.5% of them voluntarily. Among correlated factors, females [adjusted odds ratio (AOR)=1.7, 95% CI 1.1-1.6] and polygamous individuals (AOR=3.3, 95% CI 1.5-7.0) were more likely to receive an HIV test. Past experience of being HIV tested was a strong predictor of possessing good knowledge and attitudes towards HIV/AIDS prevention. We conclude that antiretroviral treatment provided by Likoma District Hospital has led to the successful scale-up of HIV testing in Likoma Island and consequently improved the awareness of HIV/AIDS. However, the use of condoms remains largely unsupported, and there is therefore still a need to intensify general HIV/AIDS education on the island.