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Betel nut use in the Pacific

Betel nut is the fourth most commonly used psychoactive substance in the world after tobacco, alcohol and caffeine. Its main active psychoactive component, called arecoline, is thought to cause adverse health effects.
The International Agency for Research on Cancer (IARC) stated that the betel nut is a carcinogen causing oral cancer (IARC, 2004). In some areas of the Western Pacific Region, the mortality rate (based on a five-year cumulative mortality rate) from oral cancer has been reported to be up to 80% (WHO, 2012). Other health effects associated with betel nut chewing include adverse pregnancy outcomes, cardiovascular disease, diabetes, liver cancer and breast cancer (WHO, 2012).

Betel nut chewing has been part of the culture and tradition of some Pacific Island countries for around 2,000 years (WHO, 2012). In some countries in the northern Pacific and Melanesia region, more than 50% of the population chews betel nut (WHO, 2012). This behaviour was associated with middle-aged men in the past, but in recent years more women and adolescents chew it. Urbanisation, studying abroad, international marriage and travel have all introduced betel nut chewing to other Pacific Island nations.

Betel nut and tobacco

In some Pacific Island countries, tobacco is also chewed or smoked when chewing betel nut. Using tobacco with betel nut quickens the development of oral cancer and other health conditions. It also heightens the risk of developing a dependence on betel nut.

Public health responses

Despite the health implications of betel nut chewing and the high cost burden of treating them, only a few public health interventions have been implemented. Legislations such as bans on betel nut chewing in public places, restricting betel nut sales to minors and restricting importation of betel nut for trade have been enacted.

A lack of understanding about betel nut use and the related health effects has led to inadequate efforts to addressing the issue. Therefore, there is a significant role that public health and health professionals can play to help reduce betel nut use in the Pacific region.

Two POLHN courses, Betel nut (basic) and Betel nut (advanced) have been specifically designed for healthcare professionals to gain knowledge about betel nut use and to provide guidance on how to assist betel nut chewers. It is recommended to attempt the basic module first to have a better and broader understanding about betel nut, the health effects and public health interventions. Subsequently, the ‘advanced’ module will help healthcare professionals to recognise oral lesions among betel nut chewers and help betel nut chewers to quit chewing.

Information Credit: Zoe Joo


  • World Health Organisation. (2012). Review of Areca (Betel Nut and Tobacco Use in the Pacific: A Technical Report. Retrieved from
  • International Agency for Research on Cancer. (2004). Betel-quid and areca-nut chewing and some areca-nut-derived nitrosamines. Retrieved from