Send to

Choose Destination
Ethn Health. 2019 Aug;24(6):724-735. doi: 10.1080/13557858.2017.1346177. Epub 2017 Jul 5.

Confirmatory factor analysis and structural equation modeling of socio-cultural constructs among chamorro and non-chamorro micronesian betel nut chewers.

Author information

a Department of Kinesiology and Rehabilitation Science , University of Hawai'i at Mānoa , Honolulu , HI , USA.
b Department of Educational Psychology , University of Hawai'i at Mānoa , Honolulu , HI , USA.
c University of Hawai'i Cancer Center , Honolulu , HI , USA.


Objectives: Betel nut chewing is embedded within the cultures of South Asia, and Southeast Asia, and the Western Pacific. The determinants of betel nut consumption are complex. Ongoing consumption of betel nut is affected by cultural, social, and drug-specific effects (i.e. dependence). This study's first objective was to assess the psychometric properties (i.e. reliability and validity) of the socio-cultural constructs in a survey developed for betel nut chewers. The study's second objective was to investigate the influence of socio-cultural variables on betel nut chewing behaviors among Chamorro and non-Chamorro Micronesians in Guam. Design: The current study was a secondary analysis of a larger study (N = 600; n = 375 chewers and n = 225 former chewers) that examined socio-cultural factors that influence why chewers chew betel nut, along with assessing chewing behaviors, perceptions of risks, probability of changing behaviors, and methods that could be used to reduce use or quit. The socio-cultural constructs of the survey were analyzed using confirmatory factor analysis and structural equation modeling. Results: The socio-cultural factors were a sufficient fit with data and the instrument is reliable and valid, as indicated by various model fit indices (χ2 (13) = 18.49 with p = .14, TLI = .99, CFI = 1.00, SRMR = .02, RMSEA = .03 with 90% CIs [.00,.07]). Cronbach's alpha, the sign and magnitude of the factor loadings, the inter-factor correlations, and the large proportion of variance extracted for each factor, all indicate that the instrument is reliable and valid. Additionally, multivariate analyses showed that socio-cultural reasons were important contributing or chewing betel nut. Participants cited chewing because their friends and family members chewed, the behavior is embedded within their culture, and it would be considered rude and disrespectful to not chew. Conclusion: Based on the findings, this study provides important implications pertaining to creating culturally appropriate cessation programs.


Betel nut; betel quid; chewers and former chewers

[Available on 2020-08-01]

Supplemental Content

Full text links

Icon for Taylor & Francis
Loading ...
Support Center