An Instagram-Based Study to Understand Betel Nut Use Culture in Micronesia: Exploratory Content Analysis

Abstract

<jats:sec> <jats:title>Background</jats:title> <jats:p>A 2012 World Health Organization report recognizes betel nut use as an urgent public health threat faced by the Western Pacific region. However, compared with other addictive substances, little is known about how betel nuts are depicted on social media platforms. In particular, image-based social media platforms can be powerful tools for health communication. Studying the content of substance use on visual social media may provide valuable insights into public health interventions.</jats:p> </jats:sec> <jats:sec> <jats:title>Objective</jats:title> <jats:p>This study aimed to explore and document the ways that betel nut is portrayed on the photo-sharing site Instagram. The analysis focuses on the hashtag #pugua, which refers to the local term for betel nut in Guam and other parts of Micronesia.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>An exploratory content analysis of 242 Instagram posts tagged #pugua was conducted based on previous research on substance use and Instagram and betel nut practices in Micronesia. In addition, the study examined the social engagement of betel nut content on the image-based platform.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>The study findings revealed content themes referencing the betel nut or betel nut tree, betel nut preparation practices, and the unique social and cultural context surrounding betel nut activity in Guam and Micronesia. In addition, certain practices and cultural themes encouraged social engagement on Instagram.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>The findings from this study emphasize the cultural relevance of betel nut use in Micronesia. These findings provide a basis for empirically testing hypotheses related to the etiological roles of cultural identity and pride in shaping betel nut use behavior among Micronesians, particularly youths and young adults. Such research is likely to inform the development of culturally relevant betel nut prevention and cessation programs.</jats:p> </jats:sec>

Exposure to tobacco and betel nut content on social media, risk perceptions, and susceptibility to peer influence among early adolescents in Guam

“…On the other hand, there is no organized betel nut industry. Most betel nut content on Instagram appears to originate organically, from lay-people ( Buente et al, 2020a ). However, a conspicuous presence of youth-centric pro-betel nut messages have been noted in the betel nut content on Instagram originating from Micronesia, including Guam ( Buente et al, 2020a , Buente et al, 2020b ).…”

“…Most betel nut content on Instagram appears to originate organically, from lay-people ( Buente et al, 2020a ). However, a conspicuous presence of youth-centric pro-betel nut messages have been noted in the betel nut content on Instagram originating from Micronesia, including Guam ( Buente et al, 2020a , Buente et al, 2020b ). Clearly, Instagram is a powerful medium for communication as the platform is largely image-based, which young people are likely to find more attractive ( Laestadius et al, 2016 ).…”

“…A number of recent articles have demonstrated the presence of pro-tobacco content, advertisements as well as user-generated content, on social media platforms such as Facebook and Instagram (e.g., Allem et al, 2017 , O’Brien et al, 2020 ). Similarly, Buente et al, 2020a , Buente et al, 2020b have shown the high prevalence of betel nut contents on Instagram that highlight the cultural and social significance of betel nut in Micronesia, the island region where Guam is located, and the near absence of contents on health implications of betel nut use.…”

“…A recent study conducted in Guam, a USAPI in the Western Pacific, suggested that lower perceived risks regarding tobacco and betel nut use and susceptibility to peer influence may be two of the important proximal risk factors associated with tobacco and betel nut use among USAPI youths ( Pokhrel et al, 2019 ). Recent research has also implied that social media may play a role in promoting substance use among youth in the USAPI ( Buente et al, 2020a ). Yet not much is known about the role of social media use in influencing risk factors for USAPI youths’ use of addictive and harmful substances, and in particular, their risk factors for using tobacco and betel nut.…”

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“…Betel chewing stretches from the African continent to the islands of Micronesia and has been common since the dawn of time. Like other psychostimulants, chewing betel nuts is known to induce a feeling of euphoria, well-being, a feeling of warmth and an increased ability to work [48].…”