Introduction: Globally, 600 million people chew areca nut, also known as betel nut, with habitual use being a major risk factor for oral cancer. Taiwan and India have some of the highest age-standardized incidence and mortality rates of oral cancer, underscoring the significant health burden in these countries. Aims: This observational cross-sectional study aims to investigate the betel nut consumption habits in the Taiwanese and Indian populations and assess their awareness of its association with oral cancer. Methodology: An interview was conducted and completed by 516 adults across Taiwan and 989 in India to assess betel nut habits and awareness of oral cancer risks. Results: In Taiwan, 95.2% (n = 491) were aware that betel nut can cause oral cancer versus 51.3% (n = 507) in India. Lifetime prevalence of betel nut use in Taiwan was 19.2% (n = 99) versus 42.6% (n = 421) in India. Only in India was betel nut chewing (OR: 0.6, 95% CI: 0.4–0.8, p < 0.001) associated with decreased awareness of the oral cancer risk linked to betel nut use. Using the population attributable fraction (PAF), an estimated 70.5% (95% CI: 46.0–85.5%) of oral cancer cases in India and 53.7% (95% CI: 42.2–64.1%) in Taiwan are potentially attributable to betel nut use. Conclusions: Betel nut use remains prevalent in India and Taiwan, with lack of awareness posing a greater challenge in India and betel nut use being associated with higher risks of self-reported oral cancer symptoms. Effective intervention requires country-specific strategies to curb usage, improve awareness of associated risks and government strategies to reduce betel nut cultivation and availability.
Rehman et al. (2026) studied this question.