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RE S EARCH ART ICL E Open Access

Alcohol, betel-nut and cigarette consumption arenegatively associated with health promotingbehaviors in Taiwan: A cross-sectional studySu-Er Guo1 , Tung-Jung Huang2 , Jui-Chu Huang3 , Ming-Shyan Lin4 , Rei-Mei Hong5 , Chia-Hao Chang5

and Mei-Yen Chen5*

Abstract

Background: Oral cancer is the 2nd most common cause of death due to cancer in the south-western coastal

region of Taiwan; the standardized mortality of oral cancer is higher than elsewhere in the world. According to theevidence, alcohol, betel-nut and cigarette (ABC) consumption cause oral, nasopharyngeal and related cancers. Thisstudy describes the relationships between ABC consumers and health promoting behaviors among communityadults living around an area with a high prevalence of oral cancer.Methods: A population-based, cross-sectional study design was conducted in oral cancer epidemic areas insouth-western coastal Taiwan in 2010, 6,203 community residents over 20 years of age participated.Demographic data, ABC habits, and health-promoting behaviors were explored. A logistic regression analyseswere used to identify factors associated with ABC consumers.Results: A high percentage of participants consumed alcohol, betel-nut and cigarettes. Betel-nut and cigaretteconsumers took low levels of exercise, adopted a poor diet, and had poor oral hygiene. After adjusting forpotential confounders, the logistic regression model indicated that middle aged males of poor education andlow economic status, who did not exercise regularly and had poor oral hygiene, were more likely to chew

betel quid and smoke cigarettes.Conclusions: It has identified that BC consumers are negatively associated with health promoting behaviors.Further research is required to understand the reasons why the subjects consume ABC, and explore ways toprevent initiation and enhance cessation of ABC habits in this population.

Keywords: Alcohol, Betel-nut, Cigarette, Nursing-led community health, Health promotion, Oral cancer

BackgroundNurse-led health promotion program to prevent chronicdisease and related cancersEach year the International Council of Nurses (ICN)provides a theme or mission on International Nurse s

Day for global nursing reflection and direction. Duringthe last 5 years (2008 2012) themes have concernedserving communities, with nurses leading primary healthcare, chronic care and closing the gap from evidence to

action [ 1]. These missions motivated community nursesin Taiwan to actively participate in providing health pro-motion programs, cooperating with public health nurses,school health nurses and faculty members from theschools of nursing to take a leading role concerning

community health development. The World HealthOrganization (WHO) has said that chronic diseases,such as heart disease, stroke, cancer, chronic respiratory diseases and diabetes, correspond to 63% of all deaths inthe world [2]. Alcohol and cigarettes contribute to thesechronic diseases [ 3], and ABC consumption causes oralcancer [ 4]. In this study, the authors found that the in-cidence of oral cancer is 123-fold higher in ABC con-sumption, compared to non-ABC consumption [4].

* Correspondence: [email protected] College of Nursing & the Chronic Diseases and Health Promotion ResearchCenter, Chang Gung University of Science and Technology, No. 2, Chia-puRd. West Sec, Putz City, Chiayi County 61363, R.O.C. TaiwanFull list of author information is available at the end of the article

2013 Guo et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the CreativeCommons Attribution License (http://creativecommons.org/licenses/by/2.0 ), which permits unrestricted use, distribution, andreproduction in any medium, provided the original work is properly cited.

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students in a Post-RN Bachelor of Nursing Degree Pro-gram who held registered nursing license and received 2consequent training programs, each of 2 hours duration.In session 1, we focused on understanding researchbackground and practicing interview skills. In session 2,20 research assistants were grouped into 10 pairs to pre-test and be familiar with all items of the questionnaire.Finally, research assistants were divided 2 groups tointerview each elder and a 90% correct rate of inter-raterreliability was confirmed among the 10 pairs. The ques-tionnaire consisted of 2 sections and the characteristicsof the participant, as described below.

Instruments ABC habits were measured using 5 questions: (A) do you drink alcohol? Participants were classified as lessconsumption if they had never drank alcohol or had

not drank for one year, or regular consumption if they were currently drinking ; (B) do you chew betel-nut?

Participants were classified as less consumption if they had never chewed betel-nut or no longer chewed , orregular consumption if they were currently chewingone quid or more per day [4]; (C) do you smoke ciga-rettes? Participants were classified as less consumption

if they rarely or never smoked or regular consumption

if they were a current smoker one cigarette or moreper day [4]; (D) when did you begin to consume alco-hol, betel nut chewing or smoke cigarettes? if partici-pants answered that they no longer partook of these 3

habits, they were asked question (E).

How long is itsince you quit drinking alcohol, betel nut chewing orsmoking cigarettes?

Health - promoting behavior was measured using 5items including physical activity, requiring participantsto answer the questions: (A) do you take regular exer-cise? Participants were classified as not often if theiranswer was never or sometimes, or often if they usu-ally exercised for >30 min per day, 3 times per week,or 150 minutes per week. (B) Vegetable and fruithabits: do you have 3 portions of vegetables and 2portions of fruit every day? The answer was classifiedas not often if they answered never or sometimes,and as often if they usually had at least 3 portions orone and half bowl-sized portions of vegetables, and atleast 2 portions or one bowl-size of fruit >5 days perweek. (C) Regular dental check-up behavior: do yougenerally go to the dental clinic for a check up every half-year? the answer was classified as not regular if the answer was never or more than one year before visiting a dentist, or regular if they answered thatthey attended regularly or at least within half a year .(D) Teeth brushing behavior: do you think that youshould brush your teeth after meals? the answer wasclassified as incorrect if they did not brush their teeth

after meals and use dental floss at least once per day,or correct if they brushed their teeth after meals andused dental floss at least once per day . (E) Frequency of brushing teeth: how many times do you brush yourteeth per day?

Participants characteristics were obtained throughstructured questions relating to age (year of birth), gen-der, marital status, economic status (3 levels were cate-gorized as good, fair/not bad, poor/bad), and educationalattainment (receiving educational year or graduatedschool level).

Statistical analysisAnalysis was conducted using SPSS 17 statistical soft-ware (SPSS INC., Chicago, IL). Coded data weresubjected to range and manual checks for accuracy. Tocompare personal factors or health promoting behavior

in various ABC consumption groups, the Chi-squarestatistic for testing equality of proportions or rates wasused. Final models using binary logistic regression foranalyzing betel-nut and cigarette consumption werechosen, based on likely and relevant confounders afterunivariate analysis (candidate correlates were excludedfrom the final analyses if p > 0.05 in the univariate ana-lysis with outcome variable). Statistical significance wasset at p < 0.05.

ResultsDemographics and health related behavior

According to the statistics on household registration,the total of adult residents living in the 27 villageswas 47,798 [19]. As several worked out of thesetownships, the baseline questionnaire was sent to6,911 residents; 708 (10.2%) were not recruited tothis study due to being too young, and others wererejected as they were unavailable for interview. Of the remaining 6,203 participants, 83.4% had lived inthe community for >20 years and 57% were female(3,501). The mean age was 49.4 (SD = 16.4, range20 95) years, with 78% (4,819) being in the rangefrom 20 to 64 years. More than half (3552, 58%)were not educated past middle school. The majority (78%) was married, 39% had no occupation, and25.1% worked in farming or fishing. Twenty-one per-cent (1,268) rated their economic status as poor anddifficult, while 78% considered it average.

More than one-third of the participants (2,153; 35%)reported that they regularly consumed alcohol, 17%(1,017) chewed betel-nut and 26% (1,576) smoked ciga-rettes. Furthermore, 14% (872) reported regularly con-suming betel-nut and cigarettes, and 9% (522) regularly consumed ABC. The beginning mean (median, range)age of using ABC was 23 (20, 12 71), 24 (21, 13 65),and 21 years of age (21, 10 71), respectively.

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ABC consumption is associated with personal factors andhealth promoting behaviorThere were few differences between the personal factorsand health promoting behavior in the alcohol, betel-nutchewing and cigarette smoking groups. Table 1 showsthat subjects at study entry who consumed alcohol regu-larly were predominantly male (p < 0.001), with a high

school or college education (p < 0.001), below 64 years of age (p < 0.001), with good or fair economic status (p 21 0 = none habit of betel-nut or cigarette consumption, 1 = one habit of betel-nut or cigarette, 2 = both habits of betel-nut and cigarette.2 Often: regular physical activity at least 30 minutes per day or 150 minutes a week.3 B = betel-nut.4 C = cigarette.* p < .05 ** p< .01 *** p < .001.


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consumption than females (OR = 9.77, p < 0.001). Partici-pants with middle and high school education were 1.65(p < 0.001) and 2.5 (p < 0.001) times more susceptible tobetel-nut and cigarette consumption regularly than thosewith a college education, respectively. Those aged 40 64were 1.85 times (p < 0.01) more susceptible to regularbetel-nut and cigarette consumption than those agedover 65, although there was a relationship between vege-table and fruit intake and BC consumption in univariateanalysis (Table 2). However, after controlling other con-founders, vegetable and fruit intake was not an import-ant correlate in the logistic regression model. Subjectsthat were less physically active, did not attend regulardental check-ups, and incorrectly brushed their teethwere 1.25, 1.29 and 1.42 times more susceptible to BChabits than others, respectively.

DiscussionThe findings indicate a high prevalence of ABC con-sumption among adult community residents aroundareas with a high incidence of oral cancer. Regular users

of betel quit and cigarettes are associated with low socialeconomic status and adopting a less health promotinglifestyle. ABC consumption was also significantly associ-ated with males.

High prevalence of ABC consumption among adultresidents around high oral cancer areasThis study did not use random sampling, but a signifi-cantly higher percentage of ABC consumption, com-pared with national data, was identified. The prevalenceof ABC consumption was identified in 35%, 17%, and26% of participants, respectively. In addition, whenconsidering the gender difference, males that regularly consumed ABC were 53.2%, 32.7% and 50.2%, respect-ively. These numbers were higher than the nation-widepercentages among both genders. In males aged over18 years, the prevalence of current ABC behavior was

18.8, 13.0 and 35.0%, respectively [10]. These differencesmay be due to location and professions. Most peoplewho live in south-western coastal Yunlin County arefarmers and fishermen. Based on the finding of Lee et al.[20], the highest prevalence of betel quid chewing andcigarette smoking in Taiwan is in agriculture or fisheries.This study also found that 14% regularly consumedboth betel quid and cigarettes, and 9% consumed A, Band C regularly. This finding is similar to Ko et al. [ 5],which shows that, despite the Taiwan governmentconducting several strategies during the last two de-cades, problems persist.

To compare these habits with other countries, Ghaniet al. [8] reported that in Malaysian adults 8.2% werebetel quid chewers, a habit that was more prevalentamong females. Females >40 years old with Indian ethni-city and a history of smoking were likely to develop aquid chewing habit. Despite betel nut and cigarette con-sumption, the prevalence of alcohol consumption issimilar to Germany and South Korea. Donath et al. [ 21]found higher alcohol consumption in rural than urbanareas in Germany, and Chung et al. [ 22] found that of the males, 90% are likely to drink excess alcohol inSouth Korea.

The age of starting to use ABC was very young - 12 yearsold for drinking alcohol, 13 for betel nut chewing and 10for smoking cigarettes. Moreover, many betel nut users be-come cigarette smokers and alcohol drinkers. In the last10 years, the Taiwan government incorporated severalstrategies to reduce the prevalence of ABC consumption,including legislation to increase the price or tax [ 7].However, it is unknown why western coastal adults liv-ing around areas with high incidence of oral cancer par-take of these 3 unhealthy habits. Do they know theetiology and mechanism(s) of oral cancer associated withABC? Do the health and education policies penetrateinto rural areas and the socially economic disadvantaged

Table 3 The logistic regression of betel-nut and cigaretteconsumption and associated factorsVariables Odds ratio 95% CI P

Gender

Male 2.28 9.77 8.08 ~ 11.82

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community residents? This may suggest that to understandmore fully the complexity of consumption of ABC; investi-gators need to develop and use sensitive measures that cancapture the multidimensional aspects of ABC behavior inthese areas.

Participants who chewed betel-nut and consumed cig-arettes tended to be male, less well educated, middle-aged, with poor economic status and an unhealthy lifestyle (Table 2). These findings are similar to the resultsof Shieh et al. [23] who described the prevalence of chewing betel-nut and cigarette smoking in the generalpopulation 18 or more years of age in Chiayi city, asouth-western coastal city of Taiwan. Based on this find-ing, the researchers will develop culturally and linguistic-ally competent health education materials for this groupin the future.

This study shows an inconsistent finding in the logis-

tic regression model that alcohol users tend to have abetter education, higher economic status, adopt morephysical activity and receive regular dental check-ups.This phenomenon could be due to the questionnairenot including measuring and quantifying alcohol type,such as the brands of wine they drank, although beer ispopular nation-wide with the percentage of alcohol be-ing below 5%. Small volumes of alcohol may have posi-tive effects on health [ 15]. The consequence couldexplain the false higher figure of alcohol consumptionin this study. Therefore, we suggest a further study to con-sider the issue of health literacy and adequate ABC infor-

mation, culture-oriented educational material or adaptedlanguage-sensitive pamphlets, and that it should take thealcohol type into account for middle aged community resi-dents in regions with a high prevalence of oral cancer.

More specific health promotion programs are necessaryinitiated in the western coastal rural areasComparing the data with nationwide statistics, partici-pants exercised (56.5 vs. 48%) and used dental floss (55.4 vs. 39%) less often than the general population [ 7]. Betelnut and cigarette users also used dental floss signifi-cantly less (9.0%) and took less exercise (14.5%) thanthose without these 2 habits (Table 2). Oral health andexercise are recognized as important health-related be-havior conducive to good mental and physical well-being[7,13]. Experts recommend brushing teeth often or atleast twice a day, flossing teeth daily and regularly at-tending dental check-ups every 6 months [ 13]. Profes-sional oral health resource and access to dental servicesare limited in rural areas. Therefore, community nursesshould conduct health promoting programs related tothe low cost, but effectiveness, of oral hygiene and phys-ical activity through community-based health develop-ment, specifically for the social economic minority andmales in rural areas.

In March 1995, Taiwan s national health insurance(NHI) program was set up with the goal of providinghigh quality, affordable healthcare to all (NHI covers99% of the population) [ 24]. However, in the last 5 years,financial difficulties and conflicts between governmentand the public led to the NHI program becoming un-stable. Enhancing health promoting programs might re-duce the health-related incidence of chronic disease.Furthermore, national statistics showed that life expect-ancy in Yunlin County is 3 years less in males comparedwith Taiwan population (73.4 vs. 76.1 years) [ 24]. It iscommon for men to die at a younger age than womenworldwide [1], but the average is 6 years in Taiwan (76.1 vs. 82.6 years) [24].

Several studies have indicated that it is not only themale gender that is associated with these 3 kinds of be-havior [22,25], but that socioeconomic inequalities are

important [ 10,26,27], with poor education, low economicstatus and living in rural areas being associated withABC use [21,26]. Our findings indicate that 4.5% (122)of alcohol, 13.4% (360) of betel nut, and 13.3% (357) of cigarette users reported abstinence for >1 year. There-fore, it is possible to initiate health promoting programsto reduce the prevalence of ABC behaviors if the ap-propriate and cultivated culture-tailed strategies areused. Physical inactivity is a modifiable risk factor forseveral chronic conditions and a leading cause of pre-mature mortality. An increasing proportion of adultsworldwide do not engage in a level of physical activity

sufficient to prevent or alleviate these adverse effects[13]. It is time, therefore, that we had nurse-led pri-mary healthcare with an emphasis on health promotingstrategies for disadvantaged people living in highbehaviour-related cancer areas.

A few limitations must be considered when interpretingour findings. First, the cross-sectional nature of the dataposes a limitation and prevents the inference of causal rela-tionships. Second, self-reporting often underestimates truealcohol intake; and because there were more women par-ticipants in this study, the prevalence of ABC users mighthave been an underestimate. Third, several unaccountedfactors (i.e., exposure to media messages about tobacco oralcohol or betel-nut, price or cost of ABC, psychiatric dis-orders, and use of other substances) could have affectedthe residents ABC behavior.

ConclusionThis is the preliminary outcome of a nursing faculty s lon-gitudinal cohort study that cooperated with a multidiscip-linary research team in an area of high prevalence of behavior-related cancer. It has identified that a high per-centage of community adults living around the westerncoastal region regularly consumed ABC. Betel-nut andcigarette users were usually male, middle aged, with a poor


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attitude to health promoting behavior. Betel nut chewersare likely to smoke and drink, and usually do not takepart in regular physical activity and have poor oral hy-giene. Further research is required to understand thereasons why the subjects consume ABC, and exploreways to prevent initiation and enhance cessation of ABChabits in this population.

Competing interests The authors hereby declare that there were no competing interests.

Authors contributionsSEG: Conceptualization of the study, study design, data analysis, discussionand editing of the final draft for publication. TJH: Conceptualization of thestudy and data collection. JCH: Data collection. MSL: Data collection. RMH:Editing of the final draft for publication. CHC: Data analysis. MYC:Conceptualization of the study, study design, proposal writing, data analysis,discussion and editing of the final draft for publication. All authors read andapproved the final manuscript.

Acknowledgments The study was supported by a grant from the Taiwan Formosa PlasticCompany (FCRPF 690011). We also thank all participants living around thewestern coastal region in Yunlin County who helped in the success of thisstudy.

Author details1 College of Nursing, Chang Gung University of Science and Technology(CGUST); Director of the Chronic Diseases and Health Promotion ResearchCenter, CGUST, Chang Gung, Taiwan. 2Chang Gung Memorial Hospital,Yunlin, Taiwan. 3 Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Yunlin, Taiwan. 4 Divisionof Cardiology, Department of Internal Medicine, Chang Gung MemorialHospital, Yunlin, Taiwan. 5 College of Nursing & the Chronic Diseases andHealth Promotion Research Center, Chang Gung University of Science and

Technology, No. 2, Chia-pu Rd. West Sec, Putz City, Chiayi County 61363, R.O.C. Taiwan.

Received: 9 August 2012 Accepted: 12 March 2013Published: 21 March 2013

References1. International Council of Nurses: [http://www.icn.ch/images/stories/

documents/publications/PUBLICATIONS].2. World Health Organization: [http://www.who.int/topics/chronic_diseases/en/ ].3. Australian Institute of Health and Welfare: Risk factors contributing to chronic

disease, Cat No. PHE 157. Canberra: AIHW; 2012.4. Ko YC, Huang YL, Lee CH, Chen MJ, Lin LM, Tsai CC: Betel-nut chewing,

cigarette smoking and alcohol consumption related to oral cancer in Taiwan. J Oral Pathol Med 1995, 24:4503.

5. Ko YC, Chiang TA, Chang SJ, Hsief SF: Prevalence of betel quid chewinghabit in Taiwan and related socio-demographic factors. J Oral Pathot Med 1992, 21:2614.

6. Tsai W, Wu M, Wang G, Lee K, Lee C, Lu Y, Yen H, Chu C, Chen Y, Lin T:Chewing areca nut increases the risk of coronary artery disease in Taiwanese men: a case-control study. BMC Publ Health 2012, 12:162.doi:10.1186/1471-2458-12-162.

7. Bureau of Health Promotion: [http://olap.bhp.doh.gov.tw/Search/ ListHealth1.aspx?menu=1&mode=12&year=98].

8. Ghani WM, Razak IA, Yang Y, Talib NA, Ikeda N, Axell T, Gupta PC, Handa Y,Abdullah N, Zain RB: Factors affecting commencement and cessation of betel quid chewing behavior in Malaysian adults. BMC Publ Health 2011,11:82. doi:10.1186/1471-2458-11-82.

9. Lee KW, Kuo WR, Tsai SM, Wu DC, Wang WM, Fang FM, Chiang FY:Different impact from betel quid, alcohol and cigarette: Risk factors forpharyngeal and laryngeal cancer. Int J Cancer 2005, 117(Suppl 5):8316.doi:10.1002/ijc.21237.

10. Wen CP, Tsai SP, Cheng TY, Chen CJ, Levy DT, Yang HJ, Eriksen MP:Uncovering the relation between betel quid chewing and cigarettesmoking in Taiwan. Tob Control 2005, 14:1622. doi:10.1136/tc.2004.008003.

11. Yang YH, Lee HY, Tung S, Shieh TY: Epidemiological survey of oralsubmucous fibrosis and leukoplakia in aborigines of Taiwan. J Oral PathoMed 2001, 30:21319. doi:10.1034/j.1600-0714.2001.300404.x.

12. Wang SC, Tsai CC, Huang ST, Hong YJ: Betel nut chewing and relatedfactors in adolescent students in Taiwan. Public Health 2003, 117:33945.doi:10.1016/S0033-3506(03)00082-9.

13. World Health Organization: [http://www.who.int/mediacentre/factsheets/ fs349/en/index.html].

14. Kim J, Kim K, Moon J: Alcohol use behaviors and risk of metabolicsyndrome in South Korean middle-aged men. BMC Publ Health 2011,11:489. doi:10.1186/1471-2458-11-489.

15. Shield KD, Taylor B, Kehoe T, Patra J, Rehm J: Mortality and potential yearsof life lost attributable to alcohol consumption in Canada in 2005.BMC Publ Health 2012, 12:91. doi:10.1186/1471-2458-12-91.

16. Lee CH, Ko YC, Huang HL, Chao YY, Tsai CC, Shieh TY, Lin LM: Theprecancer risk of betel quid chewing, tobacco use and alcoholconsumption in oral leukoplakia and oral submucous fibrosis inSouthern Taiwan. Brit J Cancer 2003, 88(Suppl 3):36672. doi:10.1038/sj.bjc.6600727.

17. Chapman KR, Mannino DM, Soriano JB, Vermeire PA, Buist AS, Thun MJ,Connell C, Jemal A, Lee TA, Miravitlles M, Aldington S, Beasley R:Epidemiology and costs of chronic obstructive pulmonary disease.Eur Respir J 2006, 27(Suppl 1):188207. doi:10.1183/09031936.06.00024505.

18. Erhardt L: Cigarettesmoking: An undertreated risk factor forcardiovascular disease. Atherosclerosis 2009, 205(Suppl 1):2332.doi:10.1016/j.atherosclerosis.2009.01.007.

19. Household registration office: [http://mailiao.household.yunlin.gov.tw/ population/population02.asp?m2=16&yy=99&mm=08].

20. Lee CF, Ho PS, Kuo YS, Yang YH: Prevalence of betel quid chewing andcigarette smoking to compare by occupation and profession in Taiwan.The Taiwan J Oral Med Sci 2008, 24:182204.

21. Donath C, GraSZel E, Baier D, Pfeiffe C, Karagulle D, Bleich S, Hillemacher T:Alcohol consumption and binge drinking in adolescents: Comparisonof different migration backgrounds and rural vs. urban residence- arepresentative study. BMC Publ Health 2011, 11:84. doi:10.1186/1471-2458-11-84.

22. Chung W, Lim S, Lee S: Why is high-risk drinking more prevalent amongmen than women? Evidence from South Korea. BMC Publ Health 2012,12:101. doi:10.1186/1471-2458-12-101.

23. Hsieh CJ: Investigation of areca quid chewing and cigarette smoking prevalencerates and the health conscience of betel quid to health for adults in Chiayi city ,Master thesis. Kaohsiung Medical University: Department of Oral Hygiene; 2003.

24. Ministry of the Interior: [http://sowf.moi.gov.tw/stat/week/list.htm].25. Sebena R, Orosova O, Mikolajczyk RT, van Dijk JP: Selected sociodemographic

factors and related differences in patterns of alcohol use amonguniversity students in Slovakia. BMC Publ Health 2011, 11:849. doi:10.1186/ 1471-2458-11-849.

26. Leinsalu M, Kaposvari C, Kunst AE: Is income or employment a strongerpredictor of smoking than education in economically less developedcountries? A cross-sectional study in Hungary. BMC Publ Health 2011,11:97. doi:10.1186/1471-2458-11-97.

27. Martinez P, Roislien J, Naidoo N, Clausen T: Alcohol abstinence anddrinking among African women: Data from the World Health Surveys.BMC Publ Health 2011, 11:160. doi:10.1186/1471-2458-11-160.

doi:10.1186/1471-2458-13-257Cite this article as: Guo et al. : Alcohol, betel-nut and cigaretteconsumption are negatively associated with health promotingbehaviors in Taiwan: A cross-sectional study. BMC Public Health 201313:257.

http://www.icn.ch/images/stories/documents/publications/PUBLICATIONShttp://www.icn.ch/images/stories/documents/publications/PUBLICATIONShttp://www.who.int/topics/chronic_diseases/en/http://dx.doi.org/10.1186/1471-2458-12-162http://olap.bhp.doh.gov.tw/Search/ListHealth1.aspx?menu=1&mode=12&year=98http://olap.bhp.doh.gov.tw/Search/ListHealth1.aspx?menu=1&mode=12&year=98http://dx.doi.org/10.1186/1471-2458-11-82http://dx.doi.org/10.1002/ijc.21237http://dx.doi.org/10.1136/tc.2004.008003http://dx.doi.org/10.1034/j.1600-0714.2001.300404.xhttp://dx.doi.org/10.1016/S0033-3506(03)00082-9http://www.who.int/mediacentre/factsheets/fs349/en/index.htmlhttp://www.who.int/mediacentre/factsheets/fs349/en/index.htmlhttp://dx.doi.org/10.1186/1471-2458-11-489http://dx.doi.org/10.1186/1471-2458-12-91http://dx.doi.org/10.1038/sj.bjc.6600727http://dx.doi.org/10.1038/sj.bjc.6600727http://dx.doi.org/10.1183/09031936.06.00024505http://dx.doi.org/10.1016/j.atherosclerosis.2009.01.007http://mailiao.household.yunlin.gov.tw/population/population02.asp?m2=16&yy=99&mm=08http://mailiao.household.yunlin.gov.tw/population/population02.asp?m2=16&yy=99&mm=08http://dx.doi.org/10.1186/1471-2458-11-84http://dx.doi.org/10.1186/1471-2458-11-84http://dx.doi.org/10.1186/1471-2458-12-101http://sowf.moi.gov.tw/stat/week/list.htmhttp://dx.doi.org/10.1186/1471-2458-11-849http://dx.doi.org/10.1186/1471-2458-11-849http://dx.doi.org/10.1186/1471-2458-11-97http://dx.doi.org/10.1186/1471-2458-11-160http://dx.doi.org/10.1186/1471-2458-11-160http://dx.doi.org/10.1186/1471-2458-11-97http://dx.doi.org/10.1186/1471-2458-11-849http://dx.doi.org/10.1186/1471-2458-11-849http://sowf.moi.gov.tw/stat/week/list.htmhttp://dx.doi.org/10.1186/1471-2458-12-101http://dx.doi.org/10.1186/1471-2458-11-84http://dx.doi.org/10.1186/1471-2458-11-84http://mailiao.household.yunlin.gov.tw/population/population02.asp?m2=16&yy=99&mm=08http://mailiao.household.yunlin.gov.tw/population/population02.asp?m2=16&yy=99&mm=08http://dx.doi.org/10.1016/j.atherosclerosis.2009.01.007http://dx.doi.org/10.1183/09031936.06.00024505http://dx.doi.org/10.1038/sj.bjc.6600727http://dx.doi.org/10.1038/sj.bjc.6600727http://dx.doi.org/10.1186/1471-2458-12-91http://dx.doi.org/10.1186/1471-2458-11-489http://www.who.int/mediacentre/factsheets/fs349/en/index.htmlhttp://www.who.int/mediacentre/factsheets/fs349/en/index.htmlhttp://dx.doi.org/10.1016/S0033-3506(03)00082-9http://dx.doi.org/10.1034/j.1600-0714.2001.300404.xhttp://dx.doi.org/10.1136/tc.2004.008003http://dx.doi.org/10.1002/ijc.21237http://dx.doi.org/10.1186/1471-2458-11-82http://olap.bhp.doh.gov.tw/Search/ListHealth1.aspx?menu=1&mode=12&year=98http://olap.bhp.doh.gov.tw/Search/ListHealth1.aspx?menu=1&mode=12&year=98http://dx.doi.org/10.1186/1471-2458-12-162http://www.who.int/topics/chronic_diseases/en/http://www.icn.ch/images/stories/documents/publications/PUBLICATIONShttp://www.icn.ch/images/stories/documents/publications/PUBLICATIONS

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