In Papua New Guinea, betel nut is as routine as a morning cup of coffee in other cultures.

In parts of Southeast Asia, betel nut chewing is practiced by a majority of the adult population in rural areas.

The public health dimension of this prevalence is severe.

Oral cancer rates in countries with high betel nut use are dramatically elevated.

Taiwan, for example, has one of the highest rates of oral cancer in the world, and the association with betel nut use is well-established.

India faces a similar burden.