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Background: Indigenous tribes are at higher risk of substance misuse, including betel quid. Available studies in this area focused on health hazards, while socio-behavioural aspects of betel quid practices are less studied, especially among the tribal population in India. Objectives: The study was conducted to explore the factors influencing betel quid use among indigenous tribes in Wayanad, Kerala Methods: Using a purposive sampling method, we selected 12 persons with betel quid use form Paniya and Kattunaicker tribal community at Wayanad. Qualitative in-depth interviews were used for data collection. The thematic analysis was done to understand the key themes and categories. Results: We identified that betel quid chewing among tribes often initiated in young age, with influence of the home environment, parental, peer and spouse related factors. Key themes that emerged were the trajectory of betel quid use, betel quid intake, dependency, access and availability of betel quid in tribal dominant areas. Conclusion: As our study result indicated many features of betel quid dependency, community level screening for identifying the potential cases and provision of treatment services might be required. Future studies to assess proper intervention for betel quid chewing can be undertaken.

Factors influencing Betel quid chewing among indigenous tribal population in Wayanad, Kerala: A qualitative study