Development and validation of a self-rating scale for betel quid chewers based on a male-prisoner population in Taiwan: The Betel Quid Dependence Scale

Abstract Background Betel quid is a substance that commonly used among male labor in Taiwan, and the dependence potential has been reported in some studies, but no instrument has been developed specifically to assess areca/betel quid dependence. Objective To develop a reliable and valid research instrument/screening tool for the measurement of betel quid dependence. Methods There were 223 male prisoners with a history of betel quid chewing behavior before they were incarcerated in Kaohsiung Prison enrolled in this study. The items of the Betel Quid Dependence Scale (BQDS) were developed by the authors and were designed referring to previous research findings and the diagnostic criteria of Substance Dependence in DSM-IV. Results The BQDS has high internal consistency (Cronbach's α  = 0.921), and a three-factor structure consisting of “physical and psychological urgent need,” “increasing dose” and “maladaptive use,” which accounted for 61.2% of the total variance. There were 94 (42.2%) male-prisoners who satisfied DSM-IV criteria for dependent use, and the receiver operating characteristic (ROC) curve showed that the BQDS had an optimal cut-off score of 4, the optimal sensitivity was 0.926 and the specificity was 0.977, with the predictive accuracy up to 99.3%. Conclusions The BQDS has good internal consistency and construct validity, and was proved to have optimal reliability and criterion validity in this special sample. Further investigation is suggested in different samples such as the general population or oral submucous fibrosis (OSF) patients to test the generalization of this instrument.