Paan (from Sanskrit parṇa meaning "leaf") is a preparation
combining betel leaf with areca nut and sometimes also with tobacco
widely consumed throughout South Asia,
Southeast Asia and
Taiwan. It is chewed for its stimulant and psychoactive
effects. After chewing it is either spat out or swallowed.
Slaked lime (chunnam) paste is commonly added to bind
the leaves. Some South Asian preparations include katha paste or
mukhwas to freshen the breath.
The origin and diffusion of paan (betel chewing) remains a somewhat
unresolved issue since there is little unequivocal evidence to support
the very early dates often quoted, though botanical evidence strongly
suggests that the areca palm was not native to South Asia. Paan
(under a variety of names) is also consumed in many other Asian
countries and elsewhere in the world by some Asian emigrants, with or
without tobacco. It is an addictive and euphoria-inducing formulation
with adverse health effects.
The spit from chewing betel nuts, known as "buai pekpek" in Papua New
Guinea, is often considered an eyesore. Because of this, many places
have banned selling and chewing "buai".
Paan made with areca nut and lime, with or without tobacco, causes
profuse red coloured salivation, known in
Tok Pisin as buai pekpek.
This saliva is spat, yielding stains and biological waste pollution in
public spaces. Many countries and municipalities have laws to prevent
Indonesia and Malaysia
Laos and Thailand
2 Effects on health
2.1 Effects of chewing paan during pregnancy
3 See also
5 External links
Betel leaf and areca nut consumption in the world
Beeda stall, Gallface Beach – Colombo
Chewing the mixture of areca nut and betel leaf is a tradition, custom
or ritual which dates back thousands of years from
India to the
Ibn Battuta describes this practice as follows: "The betel is
a tree which is cultivated in the same manner as the grape-vine; ...
The betel has no fruit and is grown only for the sake of its leaves
... The manner of its use is that before eating it one takes areca
nut; this is like a nutmeg but is broken up until it is reduced to
small pellets, and one places these in his mouth and chews them. Then
he takes the leaves of betel, puts a little chalk on them, and
masticates them along with the betel." Since the introduction of
tobacco from the Western Hemisphere to the Eastern Hemisphere, it has
been an optional addition to paan.
Paan chewing constitutes an important and popular cultural activity in
many Asian and Oceanic countries, including Bangladesh, Myanmar,
Cambodia, the Solomon Islands, Thailand, the Philippines, Laos, and
Vietnam. It is not known how and when the lime paste, areca nut and
the betel leaf were married together as one drug. Archaeological
evidence from Thailand,
Indonesia and the
Philippines suggests they
have been used in tandem for four thousand years or more.
Paan is a ubiquitous sight in many parts of South and Southeast Asia.
It is known as gillauri in Urdu, beeda in Hindi, killi and tambulum in
Telugu, thambula in Kannada, vetrrilai or thambulam in (Tamil), sireh
(in Malay language), sirih (in Indonesian), suruh (in Javanese), mark
(ໝາກ) in Lao, bulath in Sinhalese, buai in Tok Pisin, and foah
(in Dhivehi). In urban areas, chewing paan is generally considered a
nuisance because some chewers spit the paan out in public areas –
compare chewing gum ban in Singapore and smoking ban. The red stain
generated by the combination of ingredients when chewed are known to
make a colourful stain on the ground. This is becoming an unwanted
eyesore in Indian cities such as Mumbai, although many see it as an
integral part of Indian culture. This is also common in some of the
Persian Gulf countries, such as the UAE and Qatar, where many Indians
live. Recently, the Dubai government has banned the import and sale of
paan and the like.
According to traditional Ayurvedic medicine, chewing betel leaf is a
remedy against bad breath (halitosis), but it can possibly lead to
South Indian style Paan
Ghiyas-ud-din Khalji, the Sultan of Mandu (r. 1469–1500), describes
the elaborate way to prepare betel nut, folio from 16th century
cookbook, Nimmatnama-i Nasiruddin-Shahi
Paan pot in Kolkata
In a 16th-century cookbook, Nimmatnama-i Nasiruddin-Shahi, describes
Ghiyas-ud-din Khalji, the Sultan of Mandu (r. 1469–1500), watches as
tender betel leaves of the finest quality are spread out and rosewater
is sprinkled on them, while saffron is also added. An elaborate betel
chew or paan would contain fragrant spices and rose preserves with
chopped areca nuts.
It is a tradition in South
India and nearby regions to give two Betel
leaves, areca nut (pieces or whole) and Coconut to the guests (both
male and female) at any auspicious occasion. Even on a regular day it
is the tradition to give a married woman, who visits the house, two
Betel leaves, areca nut and coconut or some fruits along with a string
of threaded flowers. This is referred to as tambolam.
Paan (betel leaves) being served with silver foil at Sarnath near
Betel leaf used to make paan is produced in different parts of India.
Some states that produce betel leaf for paan include West Bengal,
Bihar, Assam, Andhra Pradesh, Uttar Pradesh. In West Bengal two types
of betel leaves are produced. These are "Bangala Patta (Country Leaf)"
and Mitha Patta (Sweet Leaf)". In West Bengal, Bangla patta is
produced mainly in district of Dinajpur, Malda, Jalpaiguri, and Nadia.
Mitha patta is produced in places such as Midnapur and South 24
The skilled paan maker is known as a paanwala in North India. In other
parts, paanwalas are also known as panwaris or panwadis. At North
India, there is a tradition to chew paan after Deepawali puja for
Furthermore, the use of paan is also prevalent in the Punjab. So much
so that shops selling paan legally have sprung up in western cities
such as Toronto, London, and Vancouver to name a few due to the large
number of people of Punjabi descent living in those regions.
In the Indian state of Maharashtra the paan culture is widely
criticised due to the cleanliness problems created by people who spit
in public places. In Mumbai, there have been attempts to put pictures
Hindu gods in places where people commonly tend to spit, in the
hope that this would discourage spitting, but success has been
limited. One of the great Marathi artists
P L Deshpande
P L Deshpande wrote a comic
story on the subject of paanwala (paan vendor), and performed a
televised reading session on
Doordarshan during the 1980s in his
Paan is losing its appeal to farmers because of falling demand.
Consumers prefer chewing tobacco formulations such as gutka over paan.
Higher costs, water scarcity and unpredictable weather have made betel
gardens less lucrative.
Indonesia and Malaysia
A Javanese woman preparing betel leaf, circa 1880.
Balinese cerana or betel nut container.
Five Tanggai dancers performs during a wedding ceremony. A tepak sirih
betel nut container is sit in front of them.
Bersirih, nyirih or menginang is a Malay-Indonesian tradition of
chewing materials such as nut, betel, gambier, tobacco, clove and
limestone. Menginang tradition or chewing betel nut is widespread
among Indonesian ethnic groups, especially among the Javanese,
Balinese and Malay people; dating back to more than 3000 years.
Records of travelers from
China showed that betel and areca had been
consumed since the 2nd century BCE.
In the Malay archipelago, the menginang or betel nut chewing has
become a revered activity in local tradition; being a ceremoniously
conducted gesture to honour guests. A complete and elaborate set of
sirih pinang equipment is called Tepak Sirih, pekinangan or cerana.
The set is usually made of wooden lacquerware, brass or silverwares;
and it consists of the combol (containers), bekas sirih (leaf
container), kacip (press-knife to cut areca nut), gobek (small pestle
and mortar), and ketur (spit container).
The Sirih Pinang has become a symbol of Malay culture, with the
Malay oral tradition having phrases such as "The betel opens the door
to the home" or "the betel opens the door to the heart". Menginang
is used at many formal occasions such as marriages, births, deaths,
and healings. A number of Malay traditional dances —such as the
South Sumatran Tanggai dance— are in fact describing the dancers
bringing cerana or tepak sirih equipment, ceremoniously presenting an
offering of betel nut to the revered guest.
Paan has been part of the indigenous culture in the Philippines. Known
mainly as tepak sirih in Malay, it is also commonly and simply
referred to as ngangà in Tagalog and mama or maman in Ilokano.
Ngangà literally means "to chew/gnaw". Nowadays, it is mostly popular
among the inhabitants of the Cordilleras, among the Lumads of
Mindanao, and among lowland barrio folks elsewhere in the Philippines.
Paan vendor at Bogyoke Market in Yangon, Myanmar
A woman at a roadside stall in
Myanmar preparing areca nuts wrapped in
betel leaves for chewing
Kwun-ya (ကွမ်းယာ) is the word for paan in Myanmar,
formerly Burma, where the most common configuration for chewing is a
betel vine leaf (Piper betel), areca nut (from
Areca catechu), slaked
lime (calcium hydroxide) and some aroma, although many betel chewers
also use tobacco.
Betel chewing has very long tradition in Burma, having been practised
since before the beginning of recorded history. Until the 1960s,
both men and women loved it and every household used to have a special
lacquerware box for paan, called kun-it (ကွမ်းအစ်),
which would be offered to any visitor together with cheroots to smoke
and green tea to drink. The leaves are kept inside the bottom of
the box, which looks like a small hat box, but with a top tray for
small tins, silver in well-to-do homes, of various other ingredients
such as the betel nuts, slaked lime, cutch, anise seed and a nut
cutter. The sweet form (acho) is popular with the young, but
grownups tend to prefer it with cardamom, cloves and tobacco.
Spittoons, therefore, are still ubiquitous, and signs saying "No
paan-spitting" are commonplace, as it makes a messy red splodge on
floors and walls; many people display betel-stained teeth from the
Paan stalls and kiosks used to be run mainly by people of
Indian origin in towns and cities. Smokers who want to kick the habit
would also use betel nut to wean themselves off tobacco.
Taungoo in Lower
Burma is where the best areca palms are grown
indicated by the popular expression "like a betel lover taken to
Taungoo". Other parts of the country contribute to the best paan
according to another saying "
Tada-U for the leaves, Ngamyagyi for the
Taungoo for the nuts,
Sagaing for the slaked lime,
the cutch". Kun, hsay, lahpet (paan, tobacco and pickled tea) are
deemed essential items to offer monks and elders particularly in the
old days. Young maidens traditionally carry ornamental betel boxes on
a stand called kundaung and gilded flowers (pandaung) in a shinbyu
(novitiation) procession. Burmese history also mentions an ancient
custom of a condemned enemy asking for "a paan and a drink of water"
before being executed.
An anecdotal government survey indicated that 40% of men and 20% of
Myanmar chew betel. An aggregate study of cancer
registries (2002 to 2007) at the
Hospitals, the largest hospitals in the country, found that oral
cancer was the 6th most common cancer among males, and 10th among
females. Of these oral carcinoma patients, 36% were regular betel
quid chewers. University of Dental Medicine,
Yangon records from
1985 to 1988 showed that 58.6% of oral carcinoma patients were regular
Since the 1990s, betel chewing has been actively discouraged by
successive governments, from the State Law and Order Restoration
Council (SLORC) onward, on the grounds of health and tidiness. In
April 1995, the
Yangon City Development Committee banned betel in
Yangon (Rangoon), in anticipation of Visit
Myanmar Year 1996, a
massive effort to promote the country as a tourist
destination. Effective 29 July 2007, betel chewing, along with
smoking, has been banned from the Shwedagon Pagoda, the country's most
important religious site. In 2010, the Ministry of Education's
Department of Basic Education and Burma's Anti-Narcotics Task Force
collaborated to prohibit betel shops from operating within 50 metres
(160 ft) of any school.
The consumption of paan has long been a very popular cultural
tradition throughout Pakistan, especially in Muhajir households, where
numerous paans were consumed throughout the day. In general,
though, paan is an occasional delicacy thoroughly enjoyed by many, and
almost exclusively bought from street vendors instead of any
preparations at home.
Pakistan grows a large variety of betel leaf,
specifically in the coastal areas of Sindh, although paan is
imported in large quantities from India, Bangladesh,
Sri Lanka and,
recently, Thailand. The paan business is famously handled and run by
muhajir traders, who migrated from western
Pakistan after the
independence in 1947 (also cite pg 60, of Pakistan, By Samuel Willard
Crompton, Charles F. Gritzner).
The culture of chewing paan has also spread in Punjab where a paan
shop can be found in almost every street and market. In the famous
Anarkali Bazar in
Lahore a street called paan gali is dedicated for
paan and its ingredients together with other Pakistani products.
The rate of
Oral cancer have grown substantially in
Pakistan due to
chewing of Paan.
Laos and Thailand
The chewing of the product is part of the culture of Cambodia, Laos
and Thailand. Cultivation of areca nut palm and betel leaves is common
in rural areas of these countries, being a traditional cash crop, and
the utensils used for preparation are often treasured. Now, many young
people have given up the habit, especially in urban areas, but many,
especially older people, still keep to the tradition.
In Vietnam, the areca nut and the betel leaf are such important
symbols of love and marriage that in Vietnamese the phrase "matters of
betel and areca" (chuyện trầu cau) is synonymous with marriage.
Areca nut chewing starts the talk between the groom's parents and the
bride's parents about the young couple's marriage. Therefore, the
leaves and juices are used ceremonially in Vietnamese weddings.
In Bangladesh, paan is chewed throughout the country by all classes.
Prior to British rule, it was chewed without tobacco. It is offered to
the guests and used in festivals irrespective of religion. A mixture
called Dhakai paan khili (like a roll) is famous in
Bangladesh and the
The sweet pan of the Khasi tribe is famous for its special quality.
Paan is also used in
Hindu puja and wedding festivals and to visit
relatives. It has become a ritual, tradition and culture of
Bangladeshi society. Adult women gather with pandani along with
friends and relatives in leisure time.
Betelnut Beauty kiosk in Taiwan
Paan is chewed mainly by Madheshis, although migrants in
also taken up chewing paan in recent times. Throughout Terai, paan is
as common as anywhere in northern India. There is some local
production, generally not commercial, but most leaves are imported
from India. Although not as ubiquitous as in the Terai, most residents
of Kathmandu occasionally enjoy paan. A sweet version of paan called
meetha paan is popular amongst many who do not like the strong taste
of plain (sada) paan. Some parents allow their children to consume
meetha in special occasion because it is tobacco-free.
Taiwan betel quid is sold from roadside kiosks, often by the
so-called betelnut beauties (Hokkien "pin-nn̂g se-si", Mandarin
"bīnláng xīshī", 檳榔西施) — scantily-clad girls selling a
quid preparation of betel leaf, betel nuts, tobacco and lime. It is a
controversial business, with critics questioning entrapment,
exploitation, health, class and culture.
Effects on health
Health effects of chewing paan: gum damage, tooth decay and oral
Health effects: Tobacco-filled paan induces profuse salivation that
stains mouth area.
International Agency for Research on Cancer
International Agency for Research on Cancer (IARC) and the World
Health Organization (WHO) accept the scientific evidence that chewing
betel quids and areca nut is carcinogenic to humans.
The main carcinogenic factor is believed to be areca nut. A recent
study found that areca-nut paan with and without tobacco increased
oral cancer risk by 9.9 and 8.4 times, respectively.
In one study (c. 1985), scientists linked malignant tumours to the
site of skin or subcutaneous administration of aqueous extracts of
paan in mice. In hamsters, forestomach carcinomas occurred after
painting the cheek-pouch mucosa with aqueous extracts or implantation
of a wax pellet containing powdered paan with tobacco into the cheek
pouch; carcinomas occurred in the cheek pouch following implantation
of the wax pellets. In human populations, they reported observing
elevated frequencies of micronucleated cells in buccal mucosa of
people who chew betel quid in the
Philippines and India. The
scientists also found that the proportion of micronucleated exfoliated
cells is related to the site within the oral cavity where the paan is
kept habitually and to the number of betel quids chewed per day. In
related studies, the scientists reported that oral leukoplakia
shows a strong association with habits of paan chewing in India. Some
follow-up studies have shown malignant transformation of a proportion
of leukoplakias. Oral submucous fibrosis and lichen planus, which are
generally accepted to be precancerous conditions, appear to be related
to the habit of chewing paan.
In a study conducted in Taiwan, scientists reported the extent of
cancer risks of betel quid (paan) chewing beyond oral cancer, even
when tobacco was absent. In addition to oral cancer, significant
increases were seen among chewers for cancer of the oesophagus, liver,
pancreas, larynx, lung, and all cancer. Chewing and smoking, as
combined by most betel chewers, interacted synergistically and was
responsible for half of all cancer deaths in this group. Chewing betel
leaf quid and smoking, the scientists claimed, shortened the life span
by nearly six years.
Lancet Oncology publication claims that paan masala may cause
tumours in different parts of the body and not just the oral cavity as
In a study conducted in Sri Lanka, scientists found high
prevalence of oral potentially malignant disorders in rural Sri Lankan
populations. After screening for various causes, the scientists
reported paan chewing to be the major risk factor, with or without
In October 2009, 30 scientists from 10 countries met at the
International Agency for Research on Cancer
International Agency for Research on Cancer (IARC), a World Health
Organization sponsored group, to reassess the carcinogenicity of
various agents including areca nut, a common additive in paan. They
reported there is sufficient evidence that paan chewing, even without
tobacco, leads to tumours in the oral cavity and oesophagus, and that
paan with added tobacco is a carcinogen to the oral cavity, pharynx
Effects of chewing paan during pregnancy
Scientific teams from Taiwan,
Malaysia and Papua New Guinea have
reported that women who chew areca nut formulations, such as paan,
during pregnancy significantly increase adverse outcomes for the baby.
The effects were similar to those reported for women who consume
alcohol or tobacco during pregnancy. Lower birth weights, reduced
birth length and early term were found to be significantly
Betel container (Victoria & Albert Museum)
Betel Chewing In Thailand
^ Oxford Dictionary paan
^ Mack, TM (2001). "The new pan-Asian paan problem". The Lancet. 357
(9269): 1638–9. doi:10.1016/S0140-6736(00)04860-1.
^ a b c The
World Health Organization
World Health Organization IARC Expert Group. "IARC
Monographs on the Evaluation of the
Carcinogenic Risk of Chemicals to
Humans, Vol. 37,
Tobacco Habits Other than Smoking; Betel-Quid and
Areca-nut Chewing; and Some Related Nitrosamines, Lyon" (PDF).
IARCPress. Archived from the original (PDF) on 18 March 2012.
^ Song, Han; Wan, Yi; Xu, Yong-Yong (2013). "
Betel Quid Chewing
Tobacco - A Meta-analysis of
Carcinogenic and Precarcinogenic
Effects". Asia Pac J Public Health.
^ Zumbroich, Thomas J. (2008). "The origin and diffusion of betel
chewing: A synthesis of evidence from South Asia,
Southeast Asia and
beyond". E-Journal of Indian Medicine. 1 (3): 87–140. Retrieved 25
^ a b IARC Working Group. "Betel-quid and areca-nut chewing and some
areca-nut-derived Nitrosamines" (PDF). The World Health
^ Price, Blair (2012). "
Betel nut: underground economies" Archived 22
October 2016 at the Wayback Machine.. PNGIndustryNews.net.
Paan spitting clampdown launched by Brent Council". BBC News. 23
^ "Fines may be effective in stopping people from spitting on the
streets". DNA India. 25 March 2010.
^ Archaeological evidence from Thailand,
Indonesia and the
^ Sengupta, Joy (9 October 2008). "Selling
Betel Leaves? You'll be
Deported Immediately". KhaleejTimes.com. Archived from the original on
15 September 2009.
^ Pattnaik, Naveen (1993). The Garden of Life: An Introduction to the
Healing Plants of
India (PDF). Doubleday. p. 70.
^ Mahapatra; et al. (21 March 2011). "
Paan loses flavour".
^ a b "Tradisi Bersirih dan Nilai Budayanya" (in Malay).
MelayuOnline.com. Retrieved 5 May 2014.
^ a b "Menginang, Cikal Bakal Tradisi Kretek Nusantara".
Kompasiana.com. Retrieved 5 May 2014.
^ a b "Menginang adalah". Academia.edu. Retrieved 13 May 2014.
^ "Filosofi Menginang (Makan Pinang)". Jakarta.Kompasiana.com.
Archived from the original on 5 May 2014. Retrieved 5 May 2014.
^ Betel-quid and Areca-nut Chewing and Some Areca-Nut Derived
Nitrosamines. 85. World Health Organization. 2004. p. 68.
^ a b Seekins, Donald M. (2006). Historical Dictionary of Burma
(Myanmar). Scarecrow Press. p. 109.
^ a b Forbes, Charles James (1878). British
Burma and its people. J.
^ Reid, Robert; Michael Grosberg (2005).
Myanmar (Burma). Lonely
Planet. p. 290. ISBN 978-1-74059-695-4.
^ Khin Myat (2 July 2007). "
Betel chewers face health dangers".
Myanmar Times. Archived from the original on 26 May 2013. Retrieved 17
^ a b Oo, Htun Naing; Myint, Yi Yi; Maung, Chan Nyein; Oo, Phyu Sin;
Cheng, Jun; Maruyama, Satoshi; Yamazaki, Manabu; Yagi, Minoru; Sawair,
Faleh A.; Saku, Takashi (2011). "
Oral cancer in Myanmar: A preliminary
survey based on hospital-based cancer registries". Journal of Oral
Pathology & Medicine. 40: 20–6.
^ Köllner, Helmut; Axel Bruns (1998).
Myanmar (Burma). Hunter
Publishing. pp. 13–14. ISBN 978-3-88618-415-6.
^ Shenon, Philip (14 June 1995). "
Yangon Journal; Burmese Generals Ask
Less Spit, More Polish". The New York Times. Retrieved 17 April
^ Ye Kaung Myint Maung (6 August 2006). "Smoking banned at Shwedagon".
Myanmar Times. Archived from the original on 26 May 2013. Retrieved 17
^ Nay Nwe Moe Aung (12 July 2010). "No more betel shops near schools".
Myanmar Times. Archived from the original on 16 July 2011. Retrieved
17 April 2012.
^ Meetha or saada, Karachi's love for paan is unmatched
^ Betel-leaf farming in coastal area
^ Mir, Amir (3 December 2005). "
Paan Gali, Lahore's very own Chandni
^ Public health: 'Paan, supari, gukta leading causes of oral cancer'
^ Total, Direct and Indirect Effects of
Paan on Oral Cancer
^ Smokeless tobacco (paan and gutkha) consumption, prevalence, and
contribution to oral cancer
^ "Vietnamese Legend: Story of the betel leaf and the areca nut".
^ Karim, ASM Enayet (2012). "Pan1". In Islam, Sirajul; Jamal, Ahmed A.
Banglapedia: National Encyclopedia of
Bangladesh (Second ed.). Asiatic
Society of Bangladesh.
^ Mark Magnier (22 January 2009). "Taiwan's 'betel nut beauties' drum
up business, and debate". Los Angeles Times.
^ WHO Report on the Global
Tobacco Epidemic, 2008: the MPOWER package
(PDF). Geneva: World Health Organization. 2008.
^ Warnakulasuriya, S.; Trivedy, C; Peters, TJ (2002). "
Areca nut use:
An independent risk factor for oral cancer". BMJ. 324 (7341):
799–800. doi:10.1136/bmj.324.7341.799. PMC 1122751 .
^ Dave, Bhavana J.; Trivedi, Amit H.; Adhvatyu, Siddharth G. (1992).
"Role of areca nut consumption in the cause of oral cancers. A
cytogenetic assessment". Cancer. 70 (5): 1017–23.
^ Merchant, Anwar; Husain, Syed S. M.; Hosain, Mervyn; Fikree, Fariyal
F.; Pitiphat, Waranuch; Siddiqui, Amna Rehana; Hayder, Syed J.;
Haider, Syed M.; Ikram, Mubashir; Chuang, Sung-Kiang; Saeed, Shaikh A.
Paan without tobacco: An independent risk factor for oral
cancer". International Journal of Cancer. 86 (1): 128–31.
^ Wen, Chi Pang; Tsai, Min Kuang; Chung, Wen Shen Isabella; Hsu, Hui
Ling; Chang, Yen Chen; Chan, Hui Ting; Chiang, Po Huang; Cheng,
Ting-Yuan David; Tsai, Shan Pou (2010). "Cancer risks from betel quid
chewing beyond oral cancer: A multiple-site carcinogen when acting
with smoking". Cancer Causes & Control. 21 (9): 1427–35.
doi:10.1007/s10552-010-9570-1. PMID 20458529.
^ Sharma, Dinesh C (2001). "Indian betel quid more carcinogenic than
anticipated". The Lancet Oncology. 2 (8): 464.
^ Amarasinghe, Hemantha K.; Usgodaarachchi, Udaya S.; Johnson, Newell
W.; Lalloo, Ratilal; Warnakulasuriya, Saman (2010). "Betel-quid
chewing with or without tobacco is a major risk factor for oral
potentially malignant disorders in Sri Lanka: A case-control study".
Oral Oncology. 46 (4): 297–301.
doi:10.1016/j.oraloncology.2010.01.017. PMID 20189448.
^ Secretan, Béatrice; Straif, Kurt; Baan, Robert; Grosse, Yann; El
Ghissassi, Fatiha; Bouvard, Véronique; Benbrahim-Tallaa, Lamia; Guha,
Neela; et al. (2009). "A review of human carcinogens—Part E:
Tobacco, areca nut, alcohol, coal smoke, and salted fish". The Lancet
Oncology. 10 (11): 1033–4. doi:10.1016/S1470-2045(09)70326-2.
^ Senn, M.; Baiwog, F.; Winmai, J.; Mueller, I.; Rogerson, S.; Senn,
N. (2009). "
Betel nut chewing during pregnancy, Madang province, Papua
New Guinea". Drug and Alcohol Dependence. 105 (1–2): 126–31.
doi:10.1016/j.drugalcdep.2009.06.021. PMID 19665325.
^ Yang, Mei-Sang; Lee, Chien-Hung; Chang, Shun-Jen; Chung, Tieh-Chi;
Tsai, Eing-Mei; Ko, Allen Min-Jen; Ko, Ying-Chin (2008). "The effect
of maternal betel quid exposure during pregnancy on adverse birth
outcomes among aborigines in Taiwan". Drug and Alcohol Dependence. 95
(1–2): 134–9. doi:10.1016/j.drugalcdep.2008.01.003.
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