• betel-nut;
  • gender;
  • metabolic syndrome;
  • smoking;
  • socioeconomic status



This study had two purposes: (1) To explore the mediating effects of substance use—as indicated by alcohol consumption, cigarette smoking, and betel-nut chewing—on the relationship between socioeconomic status (SES) and metabolic syndrome; and (2) to examine the way gender moderates any mediating effects of substance use.

Design and Sample

Secondary analyses were conducted on a cross-sectional national dataset. The data from 3,107 males and 3,081 females of Taiwanese were analyzed.


The prevalence of metabolic syndrome, education level, occupation, age, body weight, body height, and behaviors were collected.


In male subjects, SES had no direct effect on metabolic syndrome; however, cigarette smoking and betel-nut chewing, but not alcohol consumption, were found to have mediating effects on SES and metabolic syndrome. In females, SES was found to have a direct effect on metabolic syndrome; however, substance use had no mediating effects on the relationship between SES and metabolic syndrome. These differences, in males and females indicated that the mediating effect of substance use on the relationship between SES and metabolic syndrome is moderated by gender.


Our study suggests that health care providers may need to provide gender-specific health promotion programs to prevent metabolic syndrome.