Comparative Epidemiology of Betel Nut Use Versus Ecstasy Use among Taiwanese Adolescents: Findings from a National Survey

Aims: To investigate whether variation may exist in betel nut- and ecstasy-involved adolescents in terms of sociobehavioral characteristics, the experience of psychoactive substance use, and behavioral/emotional problems. Methods: Students (n = 53,528) aged 12-18 sampled via stratified , multistage, random cluster sampling in 2004, 2005, and 2006 throughout Taiwan were categorized into four groups: betel nut- and ecstasy-naive (n = 51,009), betel nut use only (n = 1965), ecstasy use only (n = 196), and use of both (n = 152). Participants completed a questionnaire with information on sociodemographic features, substance-use experiences, and the Chinese adaptation of the Youth Self Report. Results: Having a job, a larger weekly allowance, truancy, sexual experience, and externalizing behaviors were all in strong association with the involvement of either betel nut or ecstasy use. Compared with ecstasy-only users, betel nut-only users were more likely to be male, from the Eastern region of Taiwan, with initiation motivated by family members or friends, and having excess risks for Anxiety/Depression, Thought Problems, and Attention Problems . In contrast, ecstasy-only users were more likely to be female and involved in using other illegal drugs, with their initiation motivated by entertainment and with the drug use taking place in such settings. Conclusions: The variation in the experience of psychoactive substance use and behavioral problems for betel nut and ecstasy users suggests the existence of subgroups of drug-using adolescents in Taiwan. The identification of such heterogeneity may guide the efforts to reduce substance use and develop subgroup- tailored preventive programs