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Betel addiction in Pakistani children - an evil that needs to be stopped.

Byline: Sajid Ali, Marium Farooqi, Asfandyar Sheikh and Syed Salman Ahmed

Madam, as the world\'s population continues to expand, the rate of addictive habits and the diseases associated with them are also increasing. The use of addictive substances is becoming a major health concern amongst the Asian children. In South Asian countries like Pakistan, with a current population of 190 million,1 addictive habits show a progressive upward climb. Addiction to substances like betel quid, areca nut, areca palm, betel palm, cigarette smoking and crushed areca/betel nut (gutka) is becoming very common in Pakistan, especially in Karachi. The more frequently abused substance is betel quid, which is the leaf of a vine, the Piper betel. In Pakistan, betel quid (tam baku wala paan) is betel leaf filled with areca nut (a psychoactive agent), tobacco, spices and slaked lime. The leaf is chewed by more than 10% of the people worldwide who are mostly uneducated and belong to the low socioeconomic class.2

Furthermore, people who continue to chew betel quid are often unaware that their children are more prone to get addicted to it at earlier ages than they did. Such children have been found to become addicted to it during their teenage years or at ages younger than that.3 Such children after getting addicted to it proceed towards ill health and mortality as betel plays a significant role in causing oral, pharyngeal and oesophageal cancers. It also causes dental and oral hygiene problems and stains the teeth.4 Predisposing its chewers to manganese neurotoxicity, the constituents of paan, which is routinely sold by road-side vendors in Pakistan and India at relatively affordable costs,5 has also shown to be associated with cirrhotic diseases like hepatitis and other infections that are presently becoming common health concerns faced by South Asian countries.6

The habit of betel nut chewing has to be stopped as it is a potential threat to our upcoming generations due to increased addiction in children. An initiative can be taken by the schooling system to educate children about such health jeopardising addictions. The government should ban the import of betel nut and strictly prohibit its sale by street vendors. Moreover, the media should alert the masses about the health hazards related to its chewing and addiction. These objectives cannot be accomplished until and unless we work as a team and endeavour to provide ample knowledge to the people of all classes and ages.


1. Pakistan Demographics Profile 2012. (Online) (Cited 2012 December 15). Available from URL: pakistan/demographics_profile.html.

2. Williams S, Malik A, Chowdhury S, Chauhan S. Sociocultural aspects of areca nut use. Addic Biol 2002; 7: 147-54.

3. Gupta PC, Ray CS. Epidemiology of betel quid usage. Ann Acad Med Singapore 2004; 33(4 Suppl): 31-6.

4. Al-Rmalli SW, Jenkins RO, Haris PI. Betel quid chewing as a source of manganese exposure: total daily intake of manganese in a Bangladeshi population BMC Public Health 2011; 11: 85. doi:10.1186/1471-2458-11-85.

5. Wang LY, You SL, Lu SN, Ho HC, Wu MH, Sun CA, et al. Risk of hepatocellular carcinoma and habits of alcohol drinking, betel quid chewing and cigarette smoking: a cohort of 2416 HBsAg-seropositive and 9421 HBsAg-seronegative male residents in Taiwan. Cancer Causes Control 2003; 14: 241-50.

6. Shah SM, Merchant AT, Luby SP, Chotani RA. Addicted schoolchildren: prevalence and characteristics of areca nut chewers among primary school children in Karachi, Pakistan. J Paediatr Child Health 2002; 38: 507-10.
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Publication:Journal of Pakistan Medical Association
Date:Jul 31, 2013
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