EXPLORING THE COMBINED USE OF ARECA NUT AND TOBACCO: FROM TRADITIONAL PRACTICES TO MODERN PUBLIC HEALTH CONCERNS

Abstract

Areca nut and tobacco are widely used psychoactive substances, particularly in South and Southeast Asia, with deep cultural and traditional roots. However, their prolonged use is associated with serious health consequences. This integrative review synthesizes the current knowledge on the chemical composition, biological effects, addiction potential, and socio-cultural aspects of areca nut and tobacco use. Areca nut contains alkaloids, such as arecoline, and polyphenols, which exhibit both pharmacological and toxicological properties. Tobacco contains nicotine and numerous carcinogenic compounds, contributing to addiction and various life-threatening illnesses. The co-consumption of areca nut and tobacco increases the risk of oral submucous fibrosis, oral squamous cell carcinoma, cardiovascular diseases, and reproductive disorders. Arecoline and nicotine exert their effects through cholinergic receptors, leading to addiction and systemic toxicity. The prevalence of areca nut and tobacco use is further reinforced by cultural normalization in low- and middle-income countries, contributing to increased healthcare costs and premature mortality. Culturally-specific integrated public health measures, including smoking cessation programs, educational campaigns, and pharmacological and behavioral interventions, are urgently needed to control the high prevalence of areca nut and tobacco use. Future research should focus on identifying genetic susceptibility, evaluating long-term cessation interventions, and developing interdisciplinary policy frameworks to address these preventable health burdens effectively.