中華心理衛生協會

Purpose: Around Asia, betel nuts, the seed of the Areca palm, are often wrapped in a leaf along with flavorings and chewed for a mild euphoric effect. The harmful aspects of betel nut chewing as a possible cause of oral cancer have been well documented. Given the prevalence of the practice, it is important to understand the psychosocial process. A previous study found that the chewer's outcome expectancy predicted the intention and behavior of betel nut chewing via refusal self-efficacy. Social influence directly predicted intention and behavior, supporting the attitude social-influence efficacy (ASE) model. Although research has consistently indicated an association between substance abuse disorders and depression, few studies have examined the relation between depression and chewing betel nut. The purpose of this study is to explore whether depression affects the behavior of betel nut chewing directly or indirectly through cognitive factors. We examine a modified ASE model with 2 hypotheses: 1) high positive outcome expectancy, low negative outcome expectancy, high social influence factor, low refusal self-efficacy and high depressed mood affect betel chewing intention and behavior; and 2) refusal self-efficacy and social influence factors influence betel chewing intention and behavior, while outcome expectancy and depression indirectly affect betel chewing intention and behavior via refusal self-efficacy. Methods: Using stratified and cluster sampling, 3, 246 valid responses were obtained from students age 18 to 22 (1,498 males and 1, 748 females) from 14 colleges in Southern Taiwan in 2003. Measurements included demographic data, betel nut outcome expectancy, social influence, betel nut refusal self-efficacy, betel nut chewing intention, betel nut chewing behavior, and the Ko depression inventory (KDI). U We compared the 2 competing models and examined the relationship among the variables through structural equation modeling (SEM). Results: The second hypothesis model had a better fit than the first one. Outcome expectancy predicted behavior by way of refusal self-efficacy. Low refusal self-efficacy and high social influence directly influenced betel nut chewing intention and behavior. Furthermore, depression via cognitive variables (low refusal self-efficacy and high positive outcome expectancy) predicted intention and behavior. Conclusions: The results indicate that social, cognitive, and emotional factors are the main determinants of betel nut chewing among college students. Also, emotion can affect behavior via cognition. The results of the study serve educational and counseling purposes and illuminate the importance of coping with depression, reduction of positive outcome expectancy, and reinforcement of refusal self-efficacy in preventing the use of betel nut.