About 600 million people worldwide chew betel nut, making it the fourth most common addictive substance in the world, next to tobacco, alcohol, and caffeine (1, 2). In 2003, the International Agency for Research on Cancer, a subsidiary of the World Health Organization (WHO), classified betel nut as a Group 1 carcinogen, drawing global attention to the issue of betel nut consumption (3). The WHO Framework Convention on Tobacco Control (FCTC), a global convention addressing the control of tobacco and smokeless tobacco (including mixtures of betel nut and tobacco) (4), initiated measures to limit the use of tobacco in 2003 and smokeless tobacco in 2005. According to a July WHO report, the number of people who smoke tobacco is decreasing (5). However, the number of people who consume betel nut has increased over the past 2 decades (6). Heightened efforts are required to curb betel nut consumption.
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