Objectives: Most of the world's areca nut users reside in south and southeast Asia, but research is scarce. We examine areca nut use among Dai, a Chinese ethnic minority, and its implications.
Results: The history, common knowledge, traditional medical applications, social functions, and changing epidemiology of areca nut use are reviewed. Importantly, areca nut use is embedded in complex social meanings and practices, and is changing as long-standing customs are being shaped by new fashions. Its declining popularity among Dai has important implications for the management of substance misuse, as changing contextual factors such as customs and social norms have been more important than interventions or policies and laws.
Conclusions/Importance: The findings contribute to future strategies to curb the consumption of areca nut, and also help to explain unsuccessful control in China of other substances such as tobacco which overlooked social context. It is imperative that health professionals and researchers engage with the culture, health beliefs, and society of specific populations to formulate culturally appropriate and innovative oral health strategies.