研究背景：
檳榔是口腔癌重要的危險因子，現今第四期國家癌症防治計畫（108-112年）分析目前的口腔癌防治的困境，認為現在嚼檳行為雖有下降，但過去累積許多嚼檳人口，將使口腔癌發生率不會立即下降(衛生福利部, 2019)。推動多年檳榔防制，有明顯降低年輕人檳榔使用，然過去累積的嚼檳成癮者，恐也畏懼著口腔癌的發生。關於嚼檳成癮者面對口腔癌的認知、想法和行為，或有哪些障礙或考量因素，導致嚼檳成癮者難以改變，有待值得深入探討。
研究目的：
本研究以質性深入訪談，從口腔癌病人的角度，回溯其當初嚼檳成癮歷程、戒檳經驗與自覺罹癌風險的生命經驗，瞭解從口腔癌病人的檳榔人生中，探究其認知、行為和困難改變之影響因子。
研究設計：
以探索性的質性研究，研究對象為具嚼檳榔的經驗且經診斷為口腔癌的病人，深入探討癌前嚼檳行為的形成、嚼檳罹癌風險的觀點及無法離開檳榔的歷程，並以質性內容分析法進行歸納和分析。
研究方法：以質性研究方法學的質性內容分析法，於訪談後將文本資料繕打成逐字稿，從口腔癌病人癌前的嚼檳成癮歷程、戒檳經驗和自覺罹癌風險的經驗脈絡中，分析其意義單元(Meaning units)、編碼(Coding)、主題(Theme)和建立類別(Category)，闡明或描述訪談內容中的範疇、關係和連結。
研究結果：
經過歸納和分析後，瞭解這些受訪者在罹癌前與檳榔之間的關係。將其對開始接觸檳榔、面對檳榔對健康危害的可能風險及檳榔困難戒斷的關係，歸納為：初戀檳榔；遊走剃刀；愛檳不悔，共三大類別，再從這三個類別，分出共7個主題、14個次主題。
研究結論：
深入理解檳榔成癮者的行為與認知，詮釋與檳榔的愛戀、遊走檳榔的罹癌風險邊緣及與檳榔的愛與糾結，應跳脫不良健康行為的框架，看見隱藏在深層嚼檳的社會脈絡和文化的潛在影響。除建立檳榔防制的友善職場，減少檳榔對健康的傷害，另也瞭解嚼檳成癮者的思維與困難，給予公共衛生在檳榔防治和口腔癌防治的政策面和實務面之建議。

Betel nut is an important risk factor for oral cancer. The prevention of health hazards on betel quid chewing has been implemented for many years, which has significantly reduced the use of betel nut among young people. However, many betel nut chewers are afraid of the occurrence of oral cancer. The study used qualitative in-depth interviews to explore the patients' experience about the betel nut chewing , the cancer perceptions of risk and the difficulty of staying away from betel nut. This qualitative study involved one-on-one, semi-structured interviews with oral cancer patients. Purposive sampling was used to recruit patients with the experience of betel nut chewing. Twelve patients with oral cancer were interviewed, and through the analysis the three categories, seven themes, and fourteen sub-themes were extracted from the data (i) First love with betel nut (ii) the risk like wandering on the razor (iii) The obsession with betel nut without regret. The implication and recommendations for practice, including the betel nut chewing social behavior and culture are clearly identified in this study.

Ariely, D., & Wertenbroch, K. (2002). Procrastination, deadlines, and performance: Self-control by precommitment. Psychological science, 13(3), 219-224.

Baumann, E., Scherer, H., Link, E., Wiltfang, J., Wenz, H. J., Koller, M., & Hertrampf, K. (2019). Exploratory Research Focusing on Oral Cancer Prevention: Challenges of Dealing With
Informational and Cognitive Barriers. Qual Health Res, 29(13), 1930-1941. doi:10.1177/1049732318802263

Baumeister, R. F., Dale, K., & Sommer, K. (1998). Freudian defense mechanisms and empirical findings in modern social psychology: Reaction formation, projection, displacement, undoing, isolation, sublimation, and denial. Journal of personality, 66(6), 1081-1124.

Berkman, L. F., Glass, T., Brissette, I., & Seeman, T. E. (2000). From social integration to health: Durkheim in the new millennium. Social Science & Medicine, 51(6), 843-857. doi:https://doi.org/10.1016/S0277-9536(00)00065-4

Chan, C. W., Yang, S. B., Gu, C., Wang, X., & Tao, L. (2015). Perception of cervical cancer risk and screening behavior: a literature review. Int J Nurs Knowl, 26(1), 2-18. doi:10.1111/2047-3095.12028

Chatrchaiwiwatana, S. (2006). Dental caries and periodontitis associated with betel quid chewing: analysis of two data sets. J Med Assoc Thai, 89(7), 1004-1011.

Chen, Y.-L., Shen, W. W., & Lu, M.-L. (2011). The Betel Nut Withdrawal: An Often Overlooked Psychiatric Condition? Taiwanese Journal of Psychiatry, 25(1).

Chen, Y., & Yang, Q. (2017). How do cancer risk perception, benefit perception of quitting, and cancer worry influence quitting intention among current smokers: A study using the 2013 HINTS. Journal of Substance Use, 22(5), 555-560.

Chu, N.-S. (1994). Effect of betel chewing on performance reaction time. Journal of the Formosan Medical Association, 93(4), 343-345.

Elo, S., & Kyngas, H. (2008). The qualitative content analysis process. Journal of advanced nursing, 62(1), 107-115. doi:10.1111/j.1365-2648.2007.04569.x

Glanz, K., Rimer, B. K., & Viswanath, K. (2008). Health behavior and health education: theory, research, and practice: John Wiley & Sons.

Guo, S.-E., Huang, T.-J., Huang, J.-C., Lin, M.-S., Hong, R.-M., Chang, C.-H., & Chen, M.-Y. (2013). Alcohol, betel-nut and cigarette consumption are negatively associated with health promoting behaviors in Taiwan: a cross-sectional study. BMC Public Health, 13(1), 1-8.

Gupta, P. C., & Ray, C. S. (2004). Epidemiology of betel quid usage. Annals-Academy of medicine singapore, 33(4 Suppl), 31-36.

Hay, J. L., Orom, H., Kiviniemi, M. T., & Waters, E. A. (2015). “I don’t know” my cancer risk: exploring deficits in cancer knowledge and information-seeking skills to explain an often-overlooked participant response. Med Decis Making., 35(4), 436-445.

Hsieh, H. F., & Shannon, S. E. (2005). Three approaches to qualitative content analysis. Qual Health Res, 15(9), 1277-1288. doi:10.1177/1049732305276687

Hung, L.-C., Kung, P.-T., Lung, C.-H., Tsai, M.-H., Liu, S.-A., Chiu, L.-T., . . . health, p. (2020). Assessment of the risk of oral cancer incidence in a high-risk population and establishment of a predictive model for oral cancer incidence using a population-based cohort in Taiwan. 17(2), 665.

Jacob, B. J., Straif, K., Thomas, G., Ramadas, K., Mathew, B., Zhang, Z.-F., . . . Hashibe, M. (2004). Betel quid without tobacco as a risk factor for oral precancers. Oral Oncology, 40(7), 697-704. doi:https://doi.org/10.1016/j.oraloncology.2004.01.005

Kao, S. Y., & Lim, E. (2015). An overview of detection and screening of oral cancer in Taiwan. Chin J Dent Res, 18(1), 7-12.

Karlsson, N., Loewenstein, G., & Seppi, D. (2009). The ostrich effect: Selective attention to information. Journal of Risk and uncertainty, 38(2), 95-115.

Klein, W. M., & Stefanek, M. E. (2007). Cancer risk elicitation and communication: lessons from the psychology of risk perception. CA Cancer J Clin, 57(3), 147-167. doi:10.3322/canjclin.57.3.147

Lee, C. H., Ko, A. M., Yang, F. M., Hung, C. C., Warnakulasuriya, S., Ibrahim, S. O., . . . Ko, Y. C. (2018). Association of DSM-5 Betel-Quid Use Disorder With Oral Potentially Malignant Disorder in 6 Betel-Quid Endemic Asian Populations. JAMA Psychiatry, 75(3), 261-269. doi:10.1001/jamapsychiatry.2017.4307

Lee, C. Y., & Chang, Y. Y. (2021). Betel quid chewing and cessation in the sociocultural context of Paiwan people from Taiwan: a qualitative study. J Ethn Subst Abuse, 20(3), 395-414. doi:10.1080/15332640.2019.1657544

Liang, S. Y., Chuang, Y. H., & Wu, S. F. (2012). [Preliminarily application of content analysis to qualitative nursing data]. Hu Li Za Zhi, 59(5), 84-90. doi:10.6224/JN.59.5.84

Lin, C. C., Tamí-Maury, I., Ma, W. F., Lam, C., Tsai, M. H., Lin, M. T., . . . Gritz, E. R. (2017). Social and Cultural Context of Betel Quid Consumption in Taiwan and Implications for Prevention and Cessation Interventions. Subst Use Misuse, 52(5), 646-655. doi:10.1080/10826084.2016.1246572

Lincoln, Y. S., & Guba, E. G. (1985). Naturalistic inquiry: sage.

Madathil, S. A., Rousseau, M. C., Wynant, W., Schlecht, N. F., Netuveli, G., Franco, E. L., &
Nicolau, B. (2016). Nonlinear association between betel quid chewing and oral cancer: Implications for prevention. Oral Oncol, 60, 25-31. doi:10.1016/j.oraloncology.2016.06.011

O'Donoghue, T., & Rabin, M. (2001). Choice and procrastination. The Quarterly Journal of Economics, 116(1), 121-160.

Organization, W. H., Humans, I. W. G. o. t. E. o. C. R. t., & Cancer, I. A. f. R. o. (2004). Betel-quid and areca-nut chewing and some areca-nut-derived nitrosamines (Vol. 85): IARC.

Powe, B. D., & Finnie, R. (2003). Cancer fatalism: the state of the science. Cancer Nurs, 26(6), 454-465; quiz 466-457. doi:10.1097/00002820-200312000-00005

Schultz, W. (2015). Neuronal Reward and Decision Signals: From Theories to Data. Physiol Rev, 95(3), 853-951. doi:10.1152/physrev.00023.2014

Stich, H. F., Stich, W., & Parida, B. B. (1982). Elevated frequency of micronucleated cells in the buccal mucosa of individuals at high risk for oral cancer: betel quid chewers. Cancer Lett, 17(2), 125-134. doi:10.1016/0304-3835(82)90024-6

Su, S.-Y., Chen, W.-T., Chiang, C.-J., Yang, Y.-W., & Lee, W.-C. (2020). Oral cancer incidence rates from 1997 to 2016 among men in Taiwan: Association between birth cohort trends and betel nut consumption. Oral Oncology, 107, 104798. doi:https://doi.org/10.1016/j.oraloncology.2020.104798

Tilburt, J. C., James, K. M., Sinicrope, P. S., Eton, D. T., Costello, B. A., Carey, J., . . . Nowakowski, K. E. e. (2011). Factors influencing cancer risk perception in high risk populations: a systematic review. Hereditary Cancer in Clinical Practice, 9(1), 1-15.

Tversky, A., & Kahneman, D. (1981). The framing of decisions and the psychology of choice. Science, 211(4481), 453-458. doi:10.1126/science.7455683

Yang, T. Y., & Lin, H. R. (2017). Taking actions to quit chewing betel nuts and starting a new life: taxi drivers' successful experiences of quitting betel nut chewing. J Clin Nurs, 26(7-8), 1031-1041. doi:10.1111/jocn.13599

Yap, S. F., Ho, P. S., Kuo, H. C., & Yang, Y. H. (2008). Comparing factors affecting commencement and cessation of betel quid chewing behavior in Taiwanese adults. BMC Public Health, 8, 199. doi:10.1186/1471-2458-8-199

方谷豪, 侯勝博, & 楊桂蓉. (2007). 瀝青公會從業人員檳榔依賴行爲、戒斷經驗及相關因素探討. [The Characteristics and Factors associated with the Habit of Betel Quid Chewing among Taiwan Industrial Asphalt Association Employees]. 台灣耳鼻喉頭頸外科雜誌, 42(6), 186-205. doi:10.6286/2007.42.6.186

台灣癌症登記中心. (2019). 癌症五年相對存活率-民國103-107年. Retrieved from http://tcr.cph.ntu.edu.tw/uploadimages/Survival_103_107.pdf

何明洲. (2021). 檳榔嚼食者的認知神經科學取向研究：系統性回顧. [Cognitive Neuroscientific Approach in Betel-quid Chewers: A Systematic Review]. 中華心理學刊, 63(4), 309-334. doi:10.6129/cjp.202112_63(4).0001

吳淑真. (2003). 檳榔依賴行為量表之發展. (碩士), 國立成功大學, 台南市. Retrieved from https://hdl.handle.net/11296/m2q297

李仁豪, 何明洲, 唐子俊, & 張芳庭. (2012). 檳榔依賴量表（BNDS）的發展. [Development of the Betel Nut Dependency Scale (BNDS)]. 54(3), 331-348. doi:10.6129/cjp.2012.5403.04

林晏鈴, & 張婉菁. (2010). 師徒功能與工作壓力之關係：以組織社會化為中介變項. [The Mediating Effect of the Organizational Socialization on Mentoring: Job Stress Relationship]. 人力資源管理學報, 10(3), 75-96. doi:10.6147/jhrm.2010.1003.04

侯念祖. (2004). 確當的勞動、敎育與文化：工匠勞動的意義. [The Right Kind of Labour, Education and Culture: The Significances of Craftsmen's Labour]. 思與言：人文與社會科學, 42(1), 65-119. doi:10.6431/twjhss.200403.0065

馬維芬, 李佳霙, & 林正介. (2017). 連接自我與家鄉的信物-檳榔在台灣原住民族文化中的角色. 護理雜誌, 64(3), 65-73.

張致偉, & 黃基森. (2006). 臺灣檳榔種植文化與策略發展之探討. (第四屆土地研究學術研討會).

許玲欣. (2011). 檳榔防制管理機制之探討–以台北市計程車司機為例. 國立臺北大學, Available from Airiti AiritiLibrary database. (2011年)

郭淑珍, & 丁志音. (2006). 茶行裡的檳榔客：嚼食檳榔的社會脈絡初探. [Areca Quid Chewing Customers in a Teashop: A Contextual Analysis of Areca Quid Chewing]. (63), 143-208. doi:10.29816/tarqss.200609.0004

陳曉悌, 李怡娟, & 李汝禮. (2003). 健康信念模式之理論源起與應用. [Health Belief Model of Theory Origins and Application]. 台灣醫學, 7(4), 632-639. doi:10.6320/fjm.2003.7(4).20

楊奕馨, 陳鴻榮, 曾筑瑄, & 謝天渝. (2002). 台灣地區各縣市檳榔嚼食率調查報告. [Prevalence Rates of Areca/betel Quid Chewing in Counties of Taiwan]. Taiwan Journal of Oral Medicine & Health Sciences, 18(1), 1-16. doi:10.7059/tjomhs.200210.0001

楊翠雲, 林惠如, & 馮翠霞. (2013). 以傅柯知識權力觀點論述健康團體角度下的戒檳榔行為. [Behaviors of Betel Nut Cessation from the Perspective of Health Professionals: Discourse of Foucault's Theory of Power-Knowledge]. 30(3), 48-55. doi:10.6692/kjn-2013-30-3-6

衛生福利部. (2019). 第四期國家癌症防治計畫（108-112 年）. Retrieved from https://www.hpa.gov.tw/File/Attach/1094/File_13858.pdf

衛生福利部國民健康署. (2022). 108年癌症登記報告. Retrieved from https://www.hpa.gov.tw/Pages/Detail.aspx?nodeid=269&pid=14913