Instagrammed betel nut practices hint at relevant cessation strategies

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A study led by Wayne Buente, an associate professor of communication in the College of Social Sciences (CSS) at the University of Hawaiʻi at Mānoa, analyzed the ways that people from Guam and the Marianas depict betel nut, also known as the areca nut, on the photo-sharing site Instagram. The study determined that people of the Marianas use Instagram to convey their offline practices of areca nut culture. The study was published in the July issue of the Journal of Medical Internet Research, the leading peer-reviewed journal for digital medicine, health, and health care in the internet age (

A 2012 World Health Organization report recognized areca nut use as an urgent public health threat faced by peoples of the Western Pacific region. Betel nut chewing is known to cause a sense of euphoria, well-being, feelings of warmth, and an increased capacity to work, in addition to a red-staining of the mouth. There are a number of health issues associated with betel nut consumption, most notably oral cancer.

The study’s findings emphasize the cultural significance of betel nut use in Micronesia and suggest that more research is needed to develop culturally relevant areca nut prevention and cessation programs.

Buente and his co-researchers performed a content analysis of over 250 Instagram posts with the hashtag #pugua, a local term for areca nut in the Marianas. A majority of #pugua content on Instagram featured the betel nut, betel palm tree, or betel pepper leaves, as well as areca nut preparation practices.

“As a form of networked visual communication, a single hashtag could have the potential to build and maintain social networks of people from Guam,” Buente said. “Our study explored how Chamorro cultural values and practices are manifested in #pugua content on Instagram.”

Study findings
Since Instagram is a mobile app that encourages interactive engagement of content through likes and comments, research results determined that Instagram #pugua posts with moderate or high social engagement were centered on visual content privileging Chamorro culture, betel nut practices, and the betel nut palm tree and leaves.

In contrast to prior research, however, there was little evidence of actual betel nut use and consumption by the #pugua Instagram account posters, which is typically a prominent feature in marijuana, hookah, and vaping content on image-based social media.

Study co-authors were Hanae Kurihara Kramer, an associate professor of communication in CSS; Pallav Pokhrel, an associate professor, and Ian Pagano, an assistant specialist, at the UH Cancer Center; and Francis Dalisay, an associate professor at the University of Guam.

The research project was supported by the National Cancer Institute of the National Institutes of Health under Award Numbers U54CA143727 and U54CA143728.

Original article

Buente W, Dalisay F, Pokhrel P, Kramer HK, Pagano I. An Instagram-Based Study to Understand Betel Nut Use Culture in Micronesia: Exploratory Content Analysis
J Med Internet Res 2020;22(7):e13954
DOI: 10.2196/13954
PMID: 32673220

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