The Effect of a Financial Incentive Designed of Transtheoretical Model–Based Interventions on Betel Quid Cessation

Background: Betel quid (BQ) and cigarette smoking (CS) are oral cancer risk factors. It has been estimated that hundreds of million people mainly in the Asia-Pacific region were consume certain variety of BQ. BQ is the fourth most commonly used psychoactive substance in the world and require assist the chewers to withdraw it. In Taiwan, Health Promotion Administration (HPA) has initiated a hospital-based in-reach screening services for oral cancer to chewers and smokers since 2010 and proposed a financial incentive BQ cessation program designed based on Transtheoretical Model (TTM) to BQ chewers within entrusted “Cancer Control Advanced Program” hospitals in 2017. Aim: This study aims to examine whether this strategy can assist BQ chewers to diminish or quit chewing BQ. Methods: This study was a longitudinal study design used an administration database. BQ chewers were interviewed with 3 times within 1 year follow by a uniform TTM-based BQ cessation intervention by HPA-trained health educators. A face-to-face questionnaire interview were conducted to obtain baseline information, 3 interventions' behavior change stages as well as final BQ chewing status. Generalized linear mixed model was used to determine the association between TTM changing process and effectiveness of BQ chewing behavior changes. Results: A total of 5476 BQ chewers completed 3 times interventions and classified into high-reduction group (N = 2698), middle-reduction group (N = 1978), and low-reduction group (N = 800) after 1-year follow-up. We found BQ chewers were primarily men and aged 40 to 60 years. Over half participants chewed BQ ≤10 BQ per day. Most of them were higher percentage on cigarette smoking and alcohol drinking. Almost 45% BQ chewers did not have regular oral mucosa screening. The stages of change were shift from precontemplation and contemplation stage to action and maintenance stage during 3 interventions. After adjusting for covariates, participants in preparation stage compared with those in precontemplation stage were associated with an increasing odds ratio in middle-reduction BQ (odds ratio = 2.79, 95% confidence interval = 2.27-3.44) and in high-reduction BQ (odds ratio = 3.75, 95% confidence interval = 3.02-4.66). Moreover, BQ chews who chewed BQ ≤10 BQ per day and did not a cigarette smoking had higher chance to had high-reduction of BQ. Conclusion: This modified TTM BQ cessation provides according to behavior change 5 stages could benefit from hospital-based health education to lower BQ, however, future relapse rate should be concerned.