# Full Project I: Adolescent Tobacco and Areca Nut Use Prevention in Guam

> **NIH NIH U54** · UNIVERSITY OF HAWAII AT MANOA · 2022 · $141,350

## Abstract

ABSTRACT
People of the U.S. Affiliated Pacific Islands (USAPI) face significant health disparities in terms of higher
morbidity and mortality due to cancer and other diseases. Approximately half a million people live in the
USAPI and Pacific Islanders constitute one of the fastest growing demographic groups in the U.S. Morbidity
and mortality due to lung and bronchus cancer and head-and-neck cancer appear to be markedly higher in
the USAPI than the U.S. nationally. The higher rates for lung/bronchus and oral cancer incidence in the
USAPI may be due to higher rates of tobacco and areca (betel) nut use in the region. Areca nut is the fruit of
a type of palm, Areca catechu, which is commonly chewed with or without tobacco mixed with the nut, for
stimulating effects. Our recent research suggests that tobacco product use, including electronic or e-
cigarette use, among Guam middle school students may be 4-5 times higher than the U.S. national
average. Clearly, preventing tobacco product use (i.e., cigarette, chewing tobacco, e-cigarette use) and
areca nut use among USAPI adolescents is likely to reduce cancer disparities faced by the USAPI in the
long run. Currently there are NO culturally grounded, evidence-based tobacco and betel nut
prevention programs designed for USAPI youth. The long-term goal of this research project is to develop
a culturally grounded, evidence-based tobacco and betel nut prevention program that may be delivered in
the classrooms across schools in the USAPI. The project will continue a productive collaboration between
researchers from the University of Hawaii Cancer Center (UHCC) and University of Guam (UOG), which
initiated as a pilot study funded by the previous cycle of the UHCC/UOG Partnership grant (U54). The
proposed study will adapt and test Ho'ouna Pono, an innovative video-based classroom substance use
prevention curriculum developed for Native Hawaiians, who are Pacific Islanders and culturally similar to
Pacific Islanders in the USAPI. In addition to the video-based curriculum, we will test a social media-based
social marketing campaign to prevent tobacco and betel nut use initiation and escalation. Of the 8 public
middle schools in Guam, 4 will be randomly assigned to the "video-based curriculum + social marketing
campaign" condition (i.e., treatment) and 4 will be assigned to the "social marketing campaign only"
condition (i.e., control). The decision to provide an intervention, albeit weaker, to the control group as well
was guided by the ethics of good community practice. If efficacious, the school-based tobacco and betel nut
use prevention curriculum may be delivered throughout the USAPI so as to reduce the adolescent tobacco
and betel nut use prevalence in the region. Ultimately, the program may contribute to reducing the high
cancer burden faced by the USAPI.

## Key facts

- **NIH application ID:** 10490853
- **Project number:** 5U54CA143727-13
- **Recipient organization:** UNIVERSITY OF HAWAII AT MANOA
- **Principal Investigator:** Pallav Pokhrel
- **Activity code:** U54 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $141,350
- **Award type:** 5
- **Project period:** 2009-09-28 → 2025-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10490853

## Citation

> US National Institutes of Health, RePORTER application 10490853, Full Project I: Adolescent Tobacco and Areca Nut Use Prevention in Guam (5U54CA143727-13). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10490853. Licensed CC0.

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