Tobacco Free Initiative


Review of Areca (Betel) Nut and Tobacco Use in the Pacific

A Technical Report

Publication details

Number of pages: 68
Publication date: 2012
ISBN: 978-92-9061-569-9


Executive summary

There is evidence to show that the frequency of betel nut use is increasing in the Western Pacific Region and that its use is more frequently associated with the chewing of tobacco. Betel nut chewing induces oral precancerous lesions that have a high propensity to progress. Betel nut itself has been classified as a Group 1 carcinogen (carcinogenic to humans) by the International Agency for Cancer Research (IARC). While it is clear that the use of betel nut alone is a threat to health, its combination with tobacco greatly increases an individual’s risk of premature illness and death. In countries in the Western Pacific Region where this is observed, betel nut and tobacco chewing has become a significant public health problem.

With the entry into force of the WHO Framework Convention on Tobacco Control (WHO FCTC), there has been increasing concern about the promotion of smokeless tobacco use. The groundwork for this report began in 2006 when the Tobacco Free Initiative (TFI), the Western Pacifi c Regional Office, commissioned the Secretariat of the Pacifi c Community (SPC) to review the use of betel (areca) nut and tobacco in the Western Pacifi c Region. This was followed in August 2010 by a meeting of national focal points in tobacco control from the countries that report high use of betel nut and tobacco. Proposed actions have been mapped and linked to the Regional Action Plan for the TFI in the Western Pacifi c Region (2010-2014). This document is envisioned as a supplement for countries that wish to highlight specifi c tobacco control indicators and actions related to reduction of smokeless tobacco use.

A major effort needs to be made to provide decision-makers with evidence of the serious harm caused by betel nut chewing, with and without tobacco. Community-based strategies are also needed to overcome cultural beliefs and practices that are barriers to sound public health measures that can save lives and prevent unnecessary suffering from oral cancer and other diseases.