Betel Nut Use in Vanuatu: Investigating Opportunities to Reduce Harm

Abstract

Background Betel nut use is a public health concern in the Asia-Pacific region and is an emerging issue in Vanuatu. Chewing betel nut gives rise to a myriad of health problems, and the consequences may be severe. However, there are few studies and interventions used to reduce the harm of betel nut. Aim and objectives This study aims to explore betel nut use in Vanuatu and identify opportunities to reduce the harm of betel nut use. The objectives were to examine existing and future opportunities to reduce the harm of betel nut use and to identify appropriate opportunities in Vanuatu's context by adopting the World Health Organization’s tobacco control model, MPOWER and using a harm reduction approach. Methods A literature review was undertaken to explore relevant issues on betel nut and identify opportunities to reduce its harms. Ten participants with expertise in health, agriculture, education or noncommunicable disease control were interviewed. Each participant was interviewed using a face-to-face and semi-structured interview approach. Interview questions were on issues relating to betel nut use and appropriate measures to reduce its harm in Vanuatu. The general inductive approach was used to analyse findings. Results The literature review revealed that there is a lack of studies on policies and strategies to reduce the harm of betel nut use. Several countries have attempted to control betel nut through policies and forms of community awareness. The key informant interviews showed that there was an increasing trend of betel nut use due to urbanisation in Vanuatu. Participants suggested using policies to restrict the sales of betel nut and raising awareness on the dangers of betel nut through the existing strong community network. The MPOWER and harm reduction approach were found to be appropriate frameworks to identify suitable strategies to reduce the harm of betel nut use in Vanuatu. Conclusion and recommendations There is an opportunity to intervene in betel nut use in Vanuatu before it grows in popularity as it has done in neighbouring countries, with the goal of reducing long-term harm to health. The MPOWER framework provides a helpful model for addressing this public health challenge: implementing a mechanism to monitor betel nut use would be helpful, as would be alerting the public and health professionals to the potential risks of betel nut use, through partnerships, communities, schools, faith organisations, work environments and healthcare providers. Longterm strategies include restricting the sale and cultivation of betel nut. Further research could focus on investigating the patterns of betel nut use in the Northern provinces where there is heavy betel nut use.