Development and Validation of a Self-Administered Screening Test for Betel Quid Use Disorders in Betel Quid Chewers in Hunan, China

Abstract

Processed betel quid product chewing is a public health problem in areca non-plant areas in China. However, there is no valid instrument to screen for betel quid use disorder (BQUD) in mainland China. We developed a self-administered screening test for betel quid use disorders (SST-BQUD) and tested its reliability and validity in a sample of betel quid chewers (BQCers) in Hunan, China. Methods: Items of SST-BQUD were selected from the test results of an item pool, which includes 52 questions related to the psychosocial and behavioral presentations of BQUD. All participants, in a self-administered manner, completed the item pool. A subsample completed the re-test one week later. Two psychiatrists interviewed all participants to ascertain the presence of BQUD. The receiver Operating Characteristic curve was used to determine the best cut-off value to discriminate BQUD. Results: One hundred and twelve BQCers were recruited. Based on the statistical analysis of receiver operating characteristic (ROC) curves, 14 yes/no questions were selected for SST-BQUD. As indicated by Cronbach's α coefficient, the internal consistency was 0.876. The area under the curve of SST-BQUD was 0.881, representing a satisfactory diagnostic value. The one-week re-test reliability test was 0.771 (P<0.001), suggesting good stability over time. The optimal cut-off score for BQUD screening was six, with a sensitivity of 0.921 and a specificity of 0.716, implying the satisfactory accuracy of SST-BQUD to screen for BQUD. Conclusion:The standard version of SST-BQUD consists of 14 items. The total score of SST-BQUD was the sum of affirmative answers, with higher scores denoting a more severe BQUD symptom. If one answered six or more times "yes" to these 14 questions, they can be classified with BQUD. The SST-BQUD is a valid screening method for BQUD among BQCers in betel quid processed area.