6. Areca nut consumption pattern in India

 

India is the world leader in Areca nut production. India consumes most of its domestic areca nut produce. Paan (Betel quid, Tambula) made out of areca nut, betel leaf and slaked lime with or without tobacco is chewed in India. Both major variants of areca nuts, such as Chaali (white supari), Kempadike (red supari) are used for making the betel quid. Betel quid made out of areca nut slices / pieces, sweetened rose petals (Gulkand), cardamum, clove, fennel seeds, grated coconut etc. wrapped in betel leaf laced with catechu extract and lime is a popular dessert among the urban consumers. Apart from this, areca nut is also consumed in the form of Paanmasala, Gutkha and Mawa. All the three are dry preparations, wherein Paanmasala and Gutkha are produced by major companies and are packed in attractive sachets. Whereas Mawa is prepared by Paan vendors as per the preferences of the consumer. It essentially consists of tobacco (Zarda, Kiwam etc.) Chaali (or roasted Chali) and slaked lime. Paanmasala is basically a preparation of areca nut (mostly red supari), Catechu extract, cardamom, lime and number of natural and artificial perfuming and flavoring materials. Gutkha is the variant of Paanmasala in which, in addition to ingredients of Paanmasala, flavored chewing tobacco is added. Usually, Paanmasaala is prepared out of red supari (Kempadike) or roasted Chali (also called as Pakka supari). 

As per a nationwide representative cross-sectional study conducted in 2016-17, about 23.9% of the adult population consume areca nut in India. This translates into approximately 22.38 crore people consuming areca nut in one or the other form in 2016-17. Majority users (13.29 crore) consumed areca nut with tobacco. In four states, Meghalaya, Assam, Mizoram and Manipur, over half of the population consume areca nut. Furthermore, Karnataka, Uttar Pradesh, Tamil Nadu, Maharashtra and Odisha constitute nearly 55% of the country’s areca nut users. The age-wise pattern suggests that areca nut consumption without tobacco began to decline from age 51 onwards. But in the case of areca nut consumption with tobacco and in both forms, it increased with age. Higher consumption of areca nut with tobacco & without tobacco was found among daily wage/casual labourers compared to the educated and affluent class. Compared to the Hindus, Muslims were found to consume more betel quid with and without tobacco. Urban–rural differences by state suggest that in 18 states, areca nut consumption was higher in urban areas than in rural areas. Interestingly, consumption of areca nut without tobacco was higher in urban areas than their rural counterparts.

In general, the practice of Tambula (Betel quid, Paan) chewing among the general public is based on four factors.

1. Social acceptability. 
2. Religious beliefs
3. Perceived health benefits
4. Addiction.

In India, due to the historical reasons, Tambula (Betel quid) has a very high level of social acceptability. Majority believes in the health benefits of Tambula due to the higher influence of traditional medicinal systems such as Ayurveda and Unani. None of the Hindu rituals will be complete without offering Tambula to the deity and to the priests. Interestingly tobacco has no place in Hindu rituals. Unlike few countries such as Papua New Ginea and Taiwan, areca nut addiction is not a reason for areca nut consumption in India. However, those who are addicted to the tobacco, consume areca nut in the form of betel quid (Tambula), Gutkha, Mawa. 

***  

5. Areca nut consumption pattern in Sri Lanka & Bhutan

 

Sri Lanka

Usually in Sri Lanka, matured nuts (ripened fruits) are harvested and used mostly to make Chali (white supari). Small quantity of Neeradike (fermented areca nut) is produced by storing it in water tanks for local consumption. Betel quid is made out of areca nut slices, betel leaf, slaked lime and tobacco.

As per one study in 2011, the prevalence of betel quid with tobacco in the rural area (17.6%) was significantly higher than in the urban area (1.6%). The prevalence was lowest among males between 18 and 24 years of age (2.7%) and highest among those over 65 years (36%). In rural areas, the prevalence of betel quid chewing was 18.2% among Sinhalese and 6.6% among others. Another survey in 2018 showed the prevalence of daily Betel quid chewing to be 53.8%: 15.7% without tobacco and 47.4% with tobacco.

 

Bhutan

Like in northeastern states (Assam and Meghalaya etc.) of India, the harvested areca fruit is processed in Bhutan as well. The harvested mature areca fruits are fermented to preserve it for a long time.  Fermented betel nut is called as “Doma” in Bhutan. Doma is an integral part of Bhutanese tradition and culture. Invariably the betel quid chewers either add tobacco to the betel quid or indulge in smoking.

The prevalence of Doma consumption in Bhutan is 45% and it is more common in females, armed forces personnel, professionals, rural residents and it was less common in people with higher education. In Bhutanese cultures, spitting is frowned upon. Hence, the consumer swallows the juice from chewing Doma. 

***

4. Areca nut consumption pattern in Malaysia & Indonesia

 

Malaysia

The composition of the Betel quid in Malaysia mostly comprises of dried areca nut slices produced from fully ripened areca nuts, slaked lime and betel leaf. Tobacco is not chewed with betel quid by most of the consumers. Betel quid chewing is associated with traditions and rituals and has some cultural significance as well.

In Malaysia, the Betel quid chewing habit is prevalent in rural areas among the older generation. A nationwide survey in 2011 showed that Malaysian woman (10.5%) had a higher quid chewing rate than men (4.8%). This habit was most common among those above 50 years. With regards to ethnicity, Indian females were found to have the highest prevalence (28.9%), closely followed by the Sabah and Sarawak Indigenous females (28.4%).

Indonesia

The composition of the Betel quid in Indonesia mostly comprises of areca nut, betel leaf and slaked lime. Catechu extract is also added along with spices such as cardamom or clove for flavor. Areca nut of different variety are used in different provinces. For example, in Papua, areca nut of 6-7 months maturity is used along with betel spike and lime. The practice is similar to Papua New Guinea. Whereas in certain provinces, boil dried “red supari” is consumed and in certain provinces dried or fresh fully ripened areca nuts are consumed along with betel leaf and slaked lime. Tobacco is not an ingredient of betel quid in Indonesia. However, after the Betel quid has been chewed for several minutes, a lump of fine-cut tobacco is added to the mouth.

The survey conducted in various provinces of Indonesia in 2011 found that the prevalence of Betel quid (Tambula) chewing is higher for women (46.8%) than men (12.0%). The betel quid is attached with cultural and traditional value and no ritual will be complete without offering areca nut and betel leaf to the deity and priest.

***

3. Areca nut consumption pattern in Bangladesh, Pakistan & Myanmar

 

Bangladesh

In Bangladesh mostly matured areca fruits (9-10 months’ maturity) which are harvested and sun dried is used in betel quid. Betel quid is always chewed with tobacco. The betel quid is consumed due to addiction and euphoria, rather than any other cultural significance.

A population-based survey in Bangladesh found the prevalence of past and current use of areca nut to be around 35%. The study found the usage among women is more frequent and intense than in men. A screening program in some rural parts of Bangladesh have found that almost 40% of adult villagers used areca nut with slaked lime and tobacco in various combinations.

Pakistan

In Pakistan, chewable tobacco is a culturally acceptable practice, whereas Cigarette smoking is not.  Hence very high percentage of population consume chewable tobacco. This chewable tobacco is consumed with Betel quid (Paan/ Tambola) or with Areca nut (supari). Gutka is also a very popular form.

Studies conducted in Karachi, Pakistan in 2007, have found 30–40% of population use areca nuts in the form of Gutka, or betel quid or packaged white supari (Chali) along with tobacco. Generally white supari is used in betel quid (slices or cut pieces). Gutka is prepared out of red supari (Kempadike). Adolescents prefer chali with tobacco, while adults over 30 years prefer Betel quid.

Myanmar.

In Myanmar, Chali produced by sun drying matured areca fruits (9-10 months’ maturity) is used for making betel quid. Betel quid is almost always consumed with chewable tobacco. 

As per a population survey in 2009, about 30% of the adult population was using chewable tobacco with betel quid. As per another study in 2018, the prevalence of tobacco with betel quid chewing was found to be 43.2% (male, 62.2%, female, 24.1%) in adults (25–64 years) and 5.7% (male, 11%, female, 1.5%) in youths (13–15 years). As per the survey in 2020, almost always, the betel quid comprises areca nut, betel leaf, slaked lime and tobacco.

 ***

 

2. Areca nut consumption pattern in China & Taiwan

In Chaina, Hainan province produces 95% of areca nut and rest is produced in Yunnan, Guangdong, Guangxi, Fujian provinces. Green immature areca nuts of size 3-5 cm long (perhaps 4-5 months’ maturity) are dried without removing the husk. These areca nuts are dried by exposing it to the hot smoke emanating from the wood chips. These charred areca nuts are split into two pieces and flavored with various spices and mint along with sweeteners and sold in packets. The flavor of the areca nut is highly related to consumer preference. The usual approach of flavor improvement is by marinating the areca nut with some additives (such as sweeteners, mint and spices). During the process of chewing the areca nut, those additives release a unique taste and smell. These processing steps produce “fibrous shell of the dried betel nut infused with flavor”. Tobacco is generally not added to this flavored product. 

In China, 95% of areca is planted in Hainan, of which 95% to 97% is processed into chewing products.  The proportion of Hunanese chewing betel nut reaches 38.42%, among which the proportion of people aged 30 to 40 is as high as 50.36%. The prevalence of betel nut consumption in local areas of Hunan such as Xiangtan was as high as 64.5%-82.7% as per 2010 survey.

Due to the ancient culture, prevailing social acceptance and the prevailing medical use in traditional Chinese medicines, areca nut consumption has become a culture in Hainan. Interestingly, tobacco is never mixed with the processed areca nut. In the Xiangtan area of Hunan, there is a tradition of “Crossing arms, walking on the street, chewing betel nut, making friends.” There is a common belief that “To welcome guests, areca nut and cigarettes are necessary.” Always the Spring festival is celebrated by eating and distributing areca nuts.  Dai, an ethnic minority, a population of approximately 1.25 million that resides predominantly in Yunnan Province invariably consume areca nut. Areca nut chewing is an important social activity among Dai, especially in family gatherings and auspicious occasions such as ceremonies and festivals and when honoring individuals.

In Taiwan, as per one survey conducted in 2017, 6.1 % of the respondents chew betel quid. Among the consumers, men outnumber women. One community survey conducted in southern Taiwan in 2011, found that 10.7% of men and 2.5% of women were current chewers. The indigenous population (Aborigines) in Taiwan is reported to have a Betel quid prevalence of 54.3% and 33.8% in men and women respectively, which is significantly higher than the rest of the population (20.2% in men, 0.6 in women) as per a 2008, report.

Unlike practices in other countries, tobacco is never added to Betel quid in Taiwan. However, a majority of Betel quid chewers are also cigarette smokers. One study conducted in 2010, that included 231,935 men aged 20 years and older found that 90.0% of current male chewers are cigarette smokers.

In Taiwan, green areca nuts of 2-3 months’ maturity are used for making the betel quid. The whole nut is consumed in two ways, one with betel leaf smeared with slaked lime. In another method, the whole nut is split into two halves consumed with lime paste and betel vine spike. There are three main types of betel quid (Tambula) namely the lao-hwa, the stem quid, and regular Tambula are seen Taiwan. 

• Lao-hwa is prepared by inserting a piece of betel vine spike (inflorescence) with red lime paste (often made of slaked lime and local flavouring) into an unripe nut.
• Stem quid is similar except that the stem of the betel vine replaces the inflorescence piece.
• Betel quid (Tambula) is prepared by smearing lime on the betel leaf and consumed with whole betel nut of 2-3 months’ maturity.

Most of the betel quid consumers chew Lao-hwa, whereas the rest consume other variants. Betel quid chewing is highly popular among the truck/Taxi drivers and late-night workers. Mostly it is consumed for stimulatory / relaxing effect. Unlike other countries, a very limited cultural or traditional value is attached to the betel quid consumption in Taiwan.