Background Areca nut, the main component of betel quid (BQ) and the fourth most-used psychoactive substance worldwide, is consumed by over 600 million people, primarily in South Asia, and is a recognized carcinogen linked to serious health risks, especially oral conditions such as precancerous lesions and oral cancer. This study aimed to assess the dependency among BQ users and identify the key sociodemographic and behavioral predictors that significantly influence this dependency.

Method This cross-sectional study was carried out between January and June 2023 on a randomly selected sample of 400 individuals from Bhaluka Upazila in the Mymensingh district of Bangladesh. A structured questionnaire collected data on sociodemographics, BQ consumption, chewing motivations, quitting intentions, and dependency levels. Data analysis was conducted using SPSS and Jamovi, employing confirmatory factor analysis, structural equation modeling, and binary logistic regression.

Results The study used a seven-item, three-factor adapted Betel Quid Dependency Scale with good reliability (Cronbach’s α = 0.83). The study revealed that approximately half of the participants (48.5%) were BQ-dependent, with a higher prevalence observed among females. Key predictors of dependence included education levels, expenditures on BQ, tobacco with BQ, and unsuccessful attempts to quit. Among BQ-tobacco users, more than half of the females primarily consumed smokeless tobacco, and the rate of failed quit attempts among females was more than twice that of males. The reasons for chewing BQ were found to predict dependency, while the intention to quit BQ had an opposing effect.

Conclusion The study validated a shortened version of the Betel Quid Dependence Scale and identified key sociodemographic and behavioral determinants of dependence, including education level, intention to quit, previous quit attempts, and expenditure on betel quid. It recommends implementing health education campaigns, providing behavioral support, strengthening anti-tobacco policies, and designing targeted interventions for high-risk populations to reduce BQ dependency.

The authors have declared no competing interest.

This research was carried out independently, without financial support from any public, non-government, commercial, or non-profit funding agencies.

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The Patuakhali Medical College Research Ethics Committee provided ethical approval for this survey (Reference no: PkMC–REC–23–01–S12). All ethical issues involved in this study, including privacy, confidentiality, and anonymity, were carefully maintained following the Helsinki Declaration. Before beginning the data collection procedure, respondents were given a brief overview of the study's goals and objectives. They were fully informed of their right to engage or reject participation in the study. Their signed consent was then acquired using a separate consent form affixed with the semi-structured interviewer-administered survey questionnaire. The participants in the study were assured that any personally identifiable information they provided would be kept private and anonymous and that the study's findings would only be shared and published for the public interest.

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