Roughly 10% of the world's population chews areca nut, known as betel nut for the Piper betle leaf often chewed with the nut. It is the fourth most widely used addictive substance after nicotine, ethanol, and caffeine. Capturing the wide variability in chewing patterns among Micronesian ethnic subgroups is important, as it may lead to differing betel nut-oral cancer associations. A Betel Nut Measurement Tool (BENUT) was developed in 2007-2009 with Micronesian ethnic subgroups living in Guam. Subsequently, eighty-two betel nut chewers (42 males; 40 females) participated in the validation of BENUT against four weekly betel nut recalls. Concordance between the instruments was measured with Cohen's kappa. Areca nut comparisons were made on variety (red/white); maturity (unripe/ripe); and the addition of the Piper betle leaf, slaked lime, and tobacco (yes/no). Correlations were used for frequency measures (never, sometimes, usually, always) of ingestion and of adding the aforementioned ingredients. The BENUT was effective in measuring most variables with correlations of 0.60-0.93. The lowest correlations were: Piper betle leaf addition (0.10; 95% CL=-0.05-0.47 in males), Piper betle leaf frequency (0.25; 95% CL=0.09-0.41 in males), and slaked lime frequency (0.05; 95% CL=-0.05-0.14 in males and 0.12; 95% CL=0.04-0.19 in females). Occasional users of the Piper betle leaf among men and of the slaked lime among men and women tended to underestimate their use on the questionnaire. The BENUT is a valid instrument, and with modifications to the frequency of Piper betle leaf/slaked lime questions, can be used in epidemiologic studies in the region.

Citation Format: Yvette C. Paulino, Rachel Novotny, Alan Katz, Lynne Wilkens, Eric Hurwitz. Development and validation of an areca (betel) nut usage measurement tool for Micronesia. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr B15. doi:10.1158/1538-7755.DISP13-B15