Prevalence of Tobacco Smoking, Drinking and Betel Nut Chewing Among Taiwanese Workers in 1999

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(1)146. Prevalence of Tobacco Smoking, Drinking and Betel Nut Chewing Among Taiwanese Workers in 1999 Wen-Miin Liang, Hsien-Wen Kuo, Chang-Bi Wang Department of Public Health, China Medical College, Taichung, Taiwan, R.O.C.. Objective. In this study we determined the prevalence of and relevant factors associated with tobacco smoking, alcohol drinking and betel nut chewing among Taiwanese workers in 1999. Methods. We selected 1726 workers from the databank of Taiwan's Labor Insurance Bureau (7,597,386 workers) by proportional probability and interviewed them with a structured questionnaire. Results. The prevalence of tobacco smoking, alcohol drinking and betel nut chewing was 47.7%, 31.2% and 10.4% among males, and 5.9%, 3.4% and 1.9% among females, respectively. The results of the multivariate logistic regression analysis showed that the prevalence of smoking was higher among males, youth, mainland Chinese workers, workers with lower levels of education, and workers who reported experiencing both stress and anxiety in the workplace. In general, prevalence rates for drinking and betel nut chewing were similar to those of smoking, although prevalence rates were higher among slightly older workers. Drinking and betel nut chewing prevalence rates were highest among aborigines. C o n c l u s i o n s . The prevalence of consumption of all three substances was highly intercorrelated. Furthermore, ethnicity, health education and government policies play an important role in affecting the prevalence of these three lifestyle habits. ( Mid Taiwan J Med 2002;7:14654). Key words betel nut chewing, drinking, prevalence rates, relevant factors, Taiwanese workers, tobacco smoking. INSTRODUCTION. did not include the workplace. Because of the. It is widely accepted that a lifestyle. lack of adequate safety and health regulations. which includes regular consumption of. in the workplace, a large number of workers. tobacco, alcohol and betel nut chewing is. smoke while working. This poses a health risk. unhealthy, especially when workers are. to individual workers as well as a risk of fire. exposed to other harmful chemicals. In. and/or explosions. As such, there is an urgent. addition, there may be a greater risk of injury. need to ban smoking in the workplace.. due to accidents related to tobacco and. Drinking at the workplace during. alcohol [1-3]. In 1997, the Department of Health. working hours is banned in most factories and. (DOH) in Taiwan announced a ban on. offices in Taiwan and as such, drinking. smoking in designated public areas, but this. usually takes place after work, which results in absenteeism and loss of productivity. The. Received : February 2, 2002.. Revised : April 24, 2002.. Accepted : July 5, 2002.. incidence of cirrhosis and liver cancer is very. Address reprint requests to : Hsien-Wen Kuo, Department of. high in Taiwan which is due, in part, to the. Public Health, China Medical Co11ege, No 91, Hsueh-Shih. high prevalence of hepatitis B antigen among. Road, Taichung 404, Taiwan, R.O.C.. Taiwanese [4]. It has been shown that alcohol.

(2) Wen-Miin Liang, et al.. 147. consumption plays an important role in the. defined as consumption of at least one. development of these diseases [5]. In Taiwan,. alcoholic beverage (equivalent to 125 mL of. two million people habitually chew betel nut. normal strength beer) per week. Betel nut. [6] and approximately 80% of all oral cancer. chewing was defined as consumption of at. deaths are associated with this habit [7].. least 10 betel nuts per week [8]. The stress level. Tobacco, alcohol and betel nut consumption. in the workplace was rated on a scale of 1 to 3. have been shown to be harmful to health and. which represented no stress, stress but no. present a hazard in the workplace. Because. anxiety, and general stress and anxiety. Prior to. there is no reference data with regard to. the interviews, companies/factories were. worker consumption of alcohol, tobacco and. contacted to arrange time for the workers to. betel nut chewing in Taiwan, the authors wish. be interviewed privately in order to minimize. to use the results of the current study to. any potential worker stress. Before the study,. establish a reference for further studies.. the questionnaire was pre-tested to check the. Therefore, the objective of this study was to. wording,. determine the prevalence of, and factors. comprehension and was modified accordingly.. influencing tobacco smoking, alcohol drinking. A content validity test was conducted using. and betel nut chewing among Taiwanese. five experts, including public health, statistics,. workers.. environmental health and occupational. sequencing. and. ease. of. hygiene. Twenty subjects were used to test the. MATERIALS AND METHODS. We selected 1884 workers from the databank of Taiwan's Labor Insurance Bureau using a mixed sampling design (7,597,386 workers in 1999). Occupations were divided into 11 categories, and workers were selected on a proportional probability basis. The number of subjects selected from each company was dependent on the number of workers in each company. Generally, three workers were selected from each company (3. reliability. of. the. questionnaire.. Questionnaire items were coded and double keying was used to ensure that the data were reliably recorded. All data were analyzed by SAS 6.12 software (1992). Prevalence of lifestyle habits according to gender was analyzed by frequency. Factors that affected lifestyle habits were analyzed by multivariate logistic regression. All analyses were based on the maximum valid sample [9].. workers = 1 unit), but for companies with RESULTS. large numbers of workers, more than one unit might be selected based on probability. The prevalence of smoking, drinking. sampling. The proportions of the subjects'. and betel nut chewing was higher among. occupations, ages, genders and geographic. males (47.7%, 31.2% and 10.4%, respectively). locations were very similar to those of each. than. occupation in the general work population. Of. respectively). There was a significant. the. difference between geographic location and. 1884. workers,. 1726. (91.6%). were. interviewed.. females. prevalence. of. (5.9%,. betel. 3.4%. nut. and. and. 1.9%,. alcohol. A structured questionnaire was designed. consumption among males. There was a. to include workers' demographic information,. significant difference between geographic. health status, medical services/medicine. location and smoking among females. The. utilization, quality of life and lifestyle habits.. highest prevalence of alcohol consumption. The focus of the current study was on. (45.8%) and betel nut chewing (18.8%) was in. lifestyle habits with a particular emphasis on. eastern Taiwan among males, and the highest. tobacco, alcohol, and betel nut consumption.. prevalence of smoking (8.8%) among women. Tobacco smoking was defined as one pack or. was in northern Taiwan. The highest. more per month. Alcohol consumption was. prevalence of smoking (51.1%), alcohol.

(3) 148. Prevalence of Tobacco Smoking, Drinking and Betel Nut Chewing. consumption (36.3%) and betel nut chewing. workers descended from mainlanders (post-. (13.8%) was in the 31 to 44 year age group for. 1949) was significantly higher than workers. males. Aboriginal Taiwanese males had the. descended from Fujeinese (early immigrants).. highest prevalence of smoking (66.7%),. Prevalence of drinking (OR = 7.8) and betel. drinking (86.7%) and betel nut chewing. nut chewing (OR = 5.9) was highest among. (60.0%), whereas the prevalence for all three. aboriginal Taiwanese. Prevalence of all three. lifestyle habits for the 5 aboriginal female. lifestyle habits was significantly lower among. subjects was 0%. Prevalence of all three. workers who had graduated from college or. lifestyle habits was highest among males with. university compared with workers who had a. junior high school level educations and lowest. junior high school level (or below) education.. among males with college level educations.. Workers who reported feeling both stress and. Subjects who reported high levels of stress. anxiety in the workplace had a higher. and general anxiety at work had a higher. prevalence of all three lifestyle habits,. prevalence of all three lifestyle habits, but this. although only smoking and drinking were. was only significant among female workers. significant. who consumed alcohol. Prevalence of. respectively). There was no significant. smoking was highest among skilled labor. difference between the eleven kinds of. workers (male = 55.7%, female = 10.8%), and prevalence of betel nut chewing was highest among unskilled/semi-skilled workers (male = 16.7%, female = 3.5%). The prevalence of betel nut consumption was highest among male construction workers (24.1%), and prevalence of smoking was highest among male mine workers (68.2%). The highest prevalence of alcohol consumption was among male public administrators (44.4%), followed by male social service. workers. (42.2%).. For. females,. construction workers had the highest prevalence of smoking (13.0%), and the highest prevalence of drinking and betel nut chewing was among social service workers (7.5% and 4.5%, respectively) (Table 1). Because of the high inter-correlation. (OR. =. 1.7. and. OR. =. 1.5,. occupations. However, prevalence of smoking was highest among mine/stone workers, and the highest prevalence of drinking and betel nut chewing was found among social service workers (Table 2). The prevalence of consumption of all three substances was 6.2% for males and 1.0% for females. For workers who only consumed alcohol and tobacco, the prevalence was 15.4% for males and 0.5% for females. For workers who only smoked, the prevalence was 23.1% for males and 3.8% for females, and for workers who only consumed alcohol, prevalence was 8.8% for males and 1.7% for females. For workers who consumed none of the three substances, prevalence was 42.4% for males and 92.2% for females (Figs. A, B).. between education and occupation levels, the latter. data. were. excluded. from. the. DISCUSSION. multivariate analysis. The odds ratio for males. Over the past twenty years, there has. was 15.9, 13.7 and 5.6 times higher for smoking,. been considerable economic development in. drinking, and betel nut chewing, respectively,. Taiwan which has lead to a variety of socio-. than females. There was no difference in. economic changes, including lifestyle habits,. prevalence according to location of workers. such as smoking, drinking and betel nut. for the three lifestyle habits. The odds ratio for. chewing. Recent data have shown that the. workers below 30 years was five times higher. increase in cardiovascular disease and oral. than for workers over 60 years for smoking. malignancies may be associated with these. (OR = 0.2). There was a significantly higher. lifestyle habits [4]. As such, mortality rates. prevalence of drinking among workers aged. related to smoking, drinking and betel nut. 31 to 44 years compared to workers below 30. chewing have all significantly increased [5-7].. years (OR = 1.7). Prevalence of smoking among. In 1993, Wu [10] investigated the health status.

(4) Wen-Miin Liang, et al.. 149. A. B. Figure. A: Prevalence rates of smoking, drinking and betel nut chewing among male Taiwanese workers. B: Prevalence rates of smoking, drinking and betel nut chewing among female Taiwanese workers.. of 8446 Taiwanese adults (over 15 years old). Asian countries males smoked significantly. and the prevalence of smoking, drinking and. more than females.. betel nut chewing. Prevalence among males. In 1987, the Taiwan government eased. was 55.2%, 29.2% and 18.5%, respectively.. restrictions on the importation of tobacco and. Prevalence among females was 4.7%, 7.8% and. alcohol. The market percentage of imported. 0.7%, respectively. Wu's results showed that. cigarettes increased from 17.7% in 1987 to. prevalence of all three lifestyle habits was. 29.1% in 1996. In addition, the total number of. significantly. gender,. cigarettes sold in Taiwan increased from 34,584. occupation, ethnicity and education level. The. million cigarettes to 37,819 million cigarettes in. prevalence of daily drinking and daily betel. the same period of time. Average alcohol. nut chewing was highest among aboriginal. consumption per person per year in Taiwan. Taiwanese (20.0% and 20.6%), a finding. was 33.14 liters in 1987, and 36.3 liters in 1996. consistent with the results of this study.. [12]. Wu [10] reported that the prevalence. However, our results indicate that the. among male adults was 29.2% and 7.8% among. prevalence of smoking among male workers. female adults in 1993. The results of the. in 1999 (47.7%) was lower than Wu's results for. current study reveal that the prevalence of. male adults in 1993, but higher for females. An. drinking was 31.2% among male workers and. increasing number of women have started. 3.4% among female workers in 1999. The. working in recent years which may have. different prevalence rates reported by. indirectly influenced the number of female. previous studies may be due, in part, to. smokers. The prevalence of smoking among. methodological considerations. For example,. males and females varies in different countries. the definition of drinking varied among the. [11]. These data were collected from studies. studies. Wu [8] defined frequency of alcohol. correlated. with. conducted at different times. The highest. consumption as having 1 3 drinks per month.. prevalence of smoking among males in 1991. In the current study, alcohol consumption was. was in Laos (80.0%), followed by China (66.9%). defined as consumption of at least 125 mL of. and Hong Kong in 1996 (66.0%). Overall, the. normal strength beer (or its equivalent) once a. prevalence of smoking among males was. week. Therefore, it is difficult to obtain a. lower in western countries. Smoking among. meaningful comparison between the studies.. females was highest in New Zealand in 1996. Alcohol dependence and/or abuse in Taiwan. (26.0%), followed by Australia (25.0%). In. is low (5% to 9%) [13]. Lifetime prevalence rates. western countries, there was no significant. of alcohol abuse and/or dependence are 23%. difference between males and females. for Mexican-Americans in the US, 19% in New. regarding the prevalence of smoking, but in. Zealand and 18% in Canada [14]. Because of.

(5) 150. Table 1.. Prevalence of Tobacco Smoking, Drinking and Betel Nut Chewing Prevalence rates of smoking, drinking and betel nut chewing among Taiwanese workers based on. demographic factors (unit: %, total sample = 1,726) Male N Gender Residential location North West South East p Age (years) Below 30 31-44 45-59 Above 60 p Ethnic group Fujian Hakka Mainland Aboriginal Others p Education level Junior high or below Senior high Above college p Stress and anxiety none Stress only Stress & anxiety p Occupational level Un/semi-skilled Skilled Semi-professional General adminis. Specialist p Occupation categ. Agricultural Mine, stone Manufacture Water, electricity Construction Business Traffic, storage Finance, insurance Service business Social service Public adminis. p. Smoking. Female. Drinking. Betel nut chewing. N. Smoking. Drinking. Betel nut chewing. 859. 47.7. 31.2. 10.4. 867. 5.9. 3.4. 1.9. 450 152 204 48. 45.2 47.4 51.0 54.2 0.427. 26.8 33.6 34.8 45.8 0.015. 7.8 11.2 13.4 18.8 0.030. 476 143 190 58. 8.8 2.1 2.1 3.5 < 0.001. 5.3 0.7 1.6 0 -. 3.4 0 0 0 -. 197 406 235 21. 44.7 51.1 45.9 28.6 0.112. 22.5 36.3 31.0 14.3 0.002. 5.6 13.8 9.0 4.8 0.011. 292 409 149 17. 6.5 5.4 6.7 0 -. 3.4 3.4 3.4 0 -. 2.1 1.7 2.0 0 -. 661 90 79 15 13. 47.1 47.2 51.3 66.7 30.8 0.385. 30.9 32.6 23.1 86.7 15.4 < 0.001. 10.5 5.6 6.3 60.0 0 < 0.001. 653 103 90 5 14. 5.5 2.9 12.2 0 7.1 -. 3.5 1.0 5.6 0 0 -. 2.3 0 1.1 0 0 -. 254 331 274. 58.5 49.7 35.2 < 0.001. 34.8 33.9 24.4 0.014. 17.8 9.4 4.7 < 0.001. 250 342 274 0.083. 6.8 7.3 3.3 0.028. 3.6 5.0 1.1 0.052. 3.2 2.1 0.4. 228 507 116. 50.0 44.9 56.0 0.069. 31.4 30.5 33.9 0.773. 10.6 9.9 11.2 0.891. 236 493 109. 5.5 5.3 11.0 0.070. 2.1 3.3 7.3 0.045. 1.3 1.8 3.7 0.313. 216 223 145 201 22. 48.1 55.7 42.1 42.3 54.6 0.037. 32.4 33.0 29.7 28.1 27.3 0.800. 16.7 12.2 6.2 5.5 9.1 0.002. 257 130 226 160 27. 9.0 10.8 4.4 1.9 3.7 0.007. 3.9 6.2 3.5 0.6 3.7 0.150. 3.5 2.3 1.8 0.0 0.0 0.141. 20 44 283 98 58 103 52 37 39 64 55. 50.0 68.2 44.0 44.3 44.8 46.1 61.5 37.8 50.0 50.0 53.7 0.095. 30.0 40.9 24.6 32.7 31.0 32.4 32.7 21.6 34.2 42.2 44.4 0.061. 15.0 15.9 7.1 7.1 24.1 10.7 13.5 5.4 10.3 10.9 13.0 0.030. 32 31 281 21 47 124 17 53 46 134 70. 6.3 0.0 4.3 0.0 13.0 9.7 11.8 5.7 2.2 8.2 2.9 0.086. 0.0 0.0 2.5 4.8 2.2 4.0 0.0 3.8 0.0 7.5 4.3 0.248. 0.0 0.0 1.4 0.0 4.4 1.6 0.0 1.9 0.0 4.5 1.4 0.456. Data based on the largest valid sample, all tests are based on chi-squared tests; chi-squared test may be invalid due to small counts in cells..

(6) Wen-Miin Liang, et al.. Table 2.. 151. Factors that affect prevalence rates of smoking, drinking and betel nut chewing among Taiwanese. workers using multivariate logistic regression Smoking OR (95% CI) Gender Female Male Residential location North West South East Age (years) Below 30 31-44 45-59 Above 60 Ethnic Fujian Hakka Mainland Aboriginal Others Education level Junior high or below Senior high Above college Stress and anxiety None Stress only Both Occupation category Agricultural Mine, stone Manufacture Water, electricity Construction Business Traffic, storage Finance, insurance Service business Social service Public adminis.. Drinking OR (95% CI). Betel nut chewing OR (95% CI). 1 15.9 (11.4-22.2)***. 1 13.7 (9.0-20.7)***. 1 5.6 (3.2-10.0)***. 1 0.7 (0.5-1.1) 0.9 (0.6-1.2) 0.8 (0.5-1.5). 1 1.1 (0.8-1.7) 1.2 (0.8-1.7) 1.2 (0.7-2.3). 1 0.8 (0.5-1.6) 1.0 (0.6-1.7) 1.1 (0.4-2.7). 1 0.9 (0.7-1.3) 0.7 (0.5-1.0) 0.2 (0.1-0.6)**. 1 1.7 (1.1-2.4)** 1.3 (0.8-2.0) 0.4 (0.1-1.5). 1 1.4 (0.8-2.6) 0.7 (0.3-1.5) 0.2 (0.0-2.0). 1 1.0 (0.7-1.6) 1.8 (1.2-2.7)** 1.1 (0.4-3.3) 0.9 (0.3-2.8). 1 1.0 (0.6-1.6) 0.8 (0.5-1.3) 7.8 (2.4-25.6)*** 0.6 (0.1-2.6). 1 0.5 0.7 5.9 0.0. 1 0.6 (0.5-0.9)** 0.3 (0.2-0.4)***. 1 1.1 (0.8-1.6) 0.6 (0.4-0.9)*. 1 0.4 (0.3-0.7)** 0.2 (0.1-0.4)***. 1 0.9 (0.7-1.2) 1.7 (1.1-2.6)*. 1 1.1 (0.8-1.6) 1.5 (1.0-2.5)*. 1 1.3 (0.7-2.1) 1.7 (0.8-3.4). 1 1.7 (0.6-4.5) 0.8 (0.3-1.8) 1.0 (0.4-2.5) 1.0 (0.8-1.2) 1.0 (0.9-1.2) 1.5 (0.6-4.0) 0.9 (0.3-2.4) 1.1 (0.4-2.9) 1.2 (0.5-2.9) 0.9 (0.4-2.3). 1 1.6 (0.5-4.9) 1.0 (0.4-2.7) 1.5 (0.5-4.2) 1.0 (0.8-1.3) 1.1 (0.9-1.3) 1.0 (0.3-3.2) 1.1 (0.3-3.7) 1.5 (0.5-4.9) 2.7 (1.0-7.6) 2.2 (0.8-6.3). 1 1.2 (0.3-5.6) 0.6 (0.2-2.3) 0.9 (0.2-4.1) 1.2 (0.9-1.6) 1.0 (0.8-1.3) 1.0 (0.2-4.5) 0.9 (0.2-5.3) 1.0 (0.2-5.1) 1.5 (0.4-5.9) 1.2 (0.3-5.0). (0.2-1.3) (0.3-1.8) (1.9-18.3)** (0-999). Data based on the largest valid sample, all tests are based on Wald's tests. OR = odds ratio; 95% CI = 95% confidence interval. *p < 0.05, **p <0.01, ***p < 0.001.. changing socio-economic trends in Taiwan, the. 20.6% for adolescents and 38.4% for adults. prevalence of alcohol consumption is. [15,16].. increasing. The greater availability of imported. In Taiwan, betel nut chewing is most. brands, the greater social acceptability of. prevalent. social drinking and the ease with which. prevalence of chewing betel nut among adults. minors are able to purchase alcohol have all. was estimated to be 14.9%, but decreased to. contributed to the ever-increasing prevalence. 10.9% in 1996 [15,16]. For adolescents, the. of drinking in Taiwan. The estimated. prevalence was 7.3% in 1995 and 2.3% in 1996. prevalence of regular or occasional drinking is. [17]. Chiu [18] reported that for the entire. among. adults.. In. 1990,. the.

(7) 152. Prevalence of Tobacco Smoking, Drinking and Betel Nut Chewing. Taiwan population, the average prevalence of. 5%, and save 5%, 0.6% and 0.2% of health care. betel nut chewing was 8.8% (1.8 million. expenditure, and increase health care revenue. people) and that betel nut chewing was more. by 3%, 4%, and 16%, respectively. It is clear,. popular. aboriginal. therefore, that in addition to greater health. Taiwanese, which is consistent with the. among. males. and. education, there is an urgent need to increase. current study. In addition, the current study. revenue for health care expenditures by. found that betel nut chewing was more. earmarking taxes on these substances.. prevalent among males, aboriginal groups and. In. conclusion,. the. prevalence. of. workers with a low level of education (below. smoking, drinking and betel nut chewing. junior high school level). Ko [19] reported that. among male workers in Taiwan in 1999 was. there was a synergistic effect between betel. 47.7%, 31.2% and 10.4%, and 5.9%, 3.4% and 1.9%. nut chewing and both alcohol and tobacco. among female workers in Taiwan, respectively.. consumption for oral cancer. Ko [6] reported. There was a high degree of inter-correlation. that 86% of Taiwanese betel nut chewers were. between prevalence of consumption of the. smokers and 75% of them drank alcohol.. three substances. Age, gender, ethnicity,. About 10% of adults (over 15 years old) were. educational level and stress in the workplace. found to have combined betel nut chewing. affected the prevalence rates of these lifestyle. with either smoking or drinking at least once. habits among Taiwanese workers. Culture,. in their lives. The current study also showed. health education and government policies also. that 89% of both male and female workers. play an important role in affecting the trend. who chewed betel nuts also smoked, and that. of smoking, drinking and betel nut chewing.. 66% of male and 61% of female betel nut ACKNOWLEDGEMENTS. chewers also drank alcohol. In the current study, 6.2% of males and. The authors would like to thank the. 1.0% of females smoke, drink and chew betel. Institute of Occupational Safety and Health. nut, which is consistent with Wu [8] who. (IOSH), Council of Labor Affairs, Executive. reported that 4.4% of Taiwanese consume all. Yuan for their administrative and financial. three substances. Our results showed that. support and all the interviewers who. among male smokers, 51.7% drink and/or. participated in the program.. chew betel nuts (35.6% among female smokers). Among male drinkers, 71.7% smoke and/or chew betel nuts (35.6% among female. REFERENCES 1.. Choi SY, Kahyo H. Effect of cigarette smoking and. drinkers). Among male betel nut chewers,. alcohol consumption in the aetiology of cancer of. 96.2% smoke and/or drink (94.4% among. the oral cavity, pharynx and larynx. Int J Epidemiol. female betel nut chewers). It has been shown that less than half of male workers (42.4%). 1991;20:878-85. 2.. never smoke, drink or chew betel nut, although 92.1% of female workers never. Hammond SK, Sorensen G, Youngstrom R, et al. Occupational exposure to environmental tobacco smoke, JAMA 1995;274:956-60.. 3.. Shaffer HJ, Vander Bilt J, Hall MN. Gambling,. smoke, drink or chew betel nut. The. drinking, smoking and other health risk activities. prevalence of these lifestyle habits seem to be. among casino employees. Am J Ind Med 1999;36:365-. increasing due to various factors, such as greater economic independence, and changes in social concepts. In 2001, the National Health Insurance Act earmarked tax of tobacco and alcohol for health insurance expenditures. Lee [13] suggested that earmarked taxes for tobacco, alcohol and betel nut could reduce demand for these substances by 12%, 5% and. 78. 4.. Taiwan Department of Health, Public Health in Taiwan, Execute Yuan, Department of Health, 2001.. 5.. Blot WJ. Alcohol and cancer. [Review] Cancer Res 1992;52(7 Suppl):2119-23.. 6. Ko YC, Chiang TA, Chang SJ, et al. Prevalence of betel quid chewing habit in Taiwan and related socidemographic factors. J Oral Pathol Med 1992; 21:261-4. 7. Kwan HW. A statistical study on oral carcinomas in.

(8) Wen-Miin Liang, et al.. Taiwan with emphasis on the relationship with. Canino GJ, eds. Alcoholism in North America,. betel nut chewing: a preliminary report. Taiwan Yi. Europe and Asia. Oxford: Oxford University Press,. Xue Hui Za Zhi 1976;75:497-505. 8.. 9.. 153. 1992:289-308.. Lin RS, Chiang TL. The planning and exploring of. 15. Yen L, Lu DL, Huang MW, et al. An investigation of. national health interview survey. Technical report,. health behavior in Taiwanese adults; distribution,. Department of Health, 1990.. factors structure and related factors, Chinese J. SAS/STAT, User's Guide, Release 6.12 Edition, SAS Institute Inc., Cary, N.C. USA, 1992.. Public Health (Taiwan) 1991;14:358-67. 16. Yen D, Huang S, Ma K, et al. A study on the. 10. Wu TN. Prevalence of smoking, drinking, betel nut. cognition, attitudes, behavior and psychological. chewing and using transportation ways on/off-work. traits regarding smoking, drinking and betel nut. in Taiwanese, Technical Report, Department of. chewing among adolescents in Taiwan, Ministry on. Health, 1995.. Health. Taiwan, R.O.C., 1994.. 11. Chi HY, Huang SY, Chen TA. Survey of antismoking. 17. Yen LL. The recognition and behavior of adolescents. in the APACT Nations. Public Health Quarterly 2000;. and adults regarding betel nut chewing in Taiwan,. 26:273-81.. Technical Report, Department of Health, 1996.. 12. Taiwan Tobacco and Wine Monopoly Bureau. A. 18. Chiu CH, Hung CT, Chiou PS. The prevalence rates. History of the Taiwan Tobacco and Wine Monopoly. of smoking and betel nut chewing in Taiwan,. Bureau, Taipei, 1997.. Chinese Dental Journal 1997;16:28-36.. 13. Lee JL. The effects of tobacco, alcohol and betel on. 19. Ko YC, Huang YL, Lee CH, et al. Betel quid chewing,. health care utilization. University of London,. cigarette smoking and alcohol consumption related. Dissertation, U.K., 2000.. to oral cancer in Taiwan. J Oral Pathol Med 1995;. 14. Helzer JE, Canino GJ. Comparative analysis of alcoholism in ten cultural regions. In: Helzer JE,. 24:450-3..

(9) 154. 1999. 1999 7,597,386 1,726 47.7% 10.4%. 5.9%. 3.4%. 1.9% 31. 44. 2002;7:146-54. 404 2/2/2002 7/5/2002. 91 4/24/2002. 31.2%.

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