Paan

On display are the items used in a chewing session. The betel leaves are variously folded. Slices of the dry areca nut are on the upper left and slices of the tender areca nut on the upper right. The pouch on the right has tobacco, an optional element. On the lower right, there are dried cloves.
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 paan spit.[1][2]
Betel leaves at a market in Mandalay, Burma

Paan (from Sanskrit parṇa meaning "leaf"[3]) is a preparation combining betel leaf with areca nut and sometimes also with tobacco.[4][5] It is chewed for its stimulant and psychoactive effects.[6] After chewing it is either spat out or swallowed. Paan has many variations. 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.[7] 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.[8]

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".[9]

Effects on health

Health effects of chewing paan: gum damage, tooth decay and oral cancer
Health effects: Tobacco-filled paan induces profuse salivation that stains mouth area.

The 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.[8][10][11][12] 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.[13]

In one study (c. 1985),[5] 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,[5] 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,[14] 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.

A Lancet Oncology publication claims that paan masala may cause tumours in different parts of the body and not just the oral cavity as previously thought.[15]

In a study conducted in Sri Lanka,[16] 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 tobacco.

In October 2009, 30 scientists from 10 countries met at the 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 and oesophagus.[17]

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 higher.[18][19]

Culture

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 Pacific. 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.[20]

Paan is a ubiquitous sight in many parts of South and Southeast Asia. It is known as glory in Urdu, beeda in Hindi and vetrrilai or thambulum in Tamil, thambula in Kannada, killi or tambulam in (Telugu), 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.[21]

According to traditional Ayurvedic medicine, chewing betel leaf is a remedy against bad breath (halitosis),[22] but it can possibly lead to oral cancer.

India

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 Varanasi

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 Parganas.

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 blessings.

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 of 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 wrote a comic story on the subject of paanwala (paan vendor), and performed a televised reading session on Doordarshan during the 1980s in his unique style.

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.[23]

Indonesia and Malaysia

A Javanese woman preparing betel leaf, circa 1880.

Bersirih, nyirih or menginang is a Malay-Indonesian tradition of chewing materials such as nut, betel, gambier, tobacco, clove and limestone.[24] 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.[25] Records of travelers from China showed that betel and areca had been consumed since the 2nd century BCE.[25]

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 equipments 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).[24]

The Sirih Pinang has become a symbol of Malay culture.,[26] 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".[26] Menginang is used at many formal occasions such as marriages, births, deaths, and healings.[27] 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.

Philippines

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.

Myanmar

Paan vendor at Bogyoke Market in Yangon, Myanmar

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.[28]

Betel chewing has very long tradition in Burma, having been practised since before the beginning of recorded history.[29] 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.[30] 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.[30] 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 habit. 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".[31] Other parts of the country contribute to the best paan according to another saying "Tada-U for the leaves, Ngamyagyi for the tobacco, Taungoo for the nuts, Sagaing for the slaked lime, Pyay for 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 women in Myanmar chew betel.[32] An aggregate study of cancer registries (2002 to 2007) at the Yangon and Mandalay General Hospitals, the largest hospitals in the country, found that oral cancer was the 6th most common cancer among males, and 10th among females.[33] Of these oral carcinoma patients, 36% were regular betel quid chewers.[33] University of Dental Medicine, Yangon records from 1985 to 1988 showed that 58.6% of oral carcinoma patients were regular betel chewers.

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.[29] 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.[34][35] Effective 29 July 2007, betel chewing, along with smoking, has been banned from the Shwedagon Pagoda, the country's most important religious site.[36] 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.[37]

Pakistan

The consumption of paan has long been a very popular cultural tradition throughout Pakistan, especially in Memon and 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 Memon traders, who migrated from western India, when Pakistan was formed 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.[38]

Cambodia, 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.

Vietnam

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.[39]

Bangladesh

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 subcontinent.

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[40] along with friends and relatives in leisure time.

Betelnut Beauty kiosk in Taiwan

Nepal

Paan is chewed mainly by Madheshis, although migrants in Terai have 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 paan because it is tobacco-free.

Taiwan

In 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.[41]

See also

References

  1. ↑ "Paan spitting clampdown launched by Brent Council". BBC News. 23 March 2010.
  2. ↑ "Fines may be effective in stopping people from spitting on the streets". DNA India. 25 March 2010.
  3. ↑ Oxford Dictionary paan
  4. ↑ Mack, TM (2001). "The new pan-Asian paan problem". The Lancet. 357 (9269): 1638–9. doi:10.1016/S0140-6736(00)04860-1.
  5. 1 2 3 The 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.
  6. ↑ Song, Han; Wan, Yi; Xu, Yong-Yong (2013). "Betel Quid Chewing Without Tobacco - A Meta-analysis of Carcinogenic and Precarcinogenic Effects". Asia Pac J Public Health. doi:10.1177/1010539513486921.
  7. ↑ 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 February 2015.
  8. 1 2 IARC Working Group. "Betel-quid and areca-nut chewing and some areca-nut-derived Nitrosamines" (PDF). The World Health Organization.
  9. ↑ Price, Blair (2012). "Betel nut: underground economies". PNGIndustryNews.net.
  10. ↑ WHO Report on the Global Tobacco Epidemic, 2008: the MPOWER package (PDF). Geneva: World Health Organization. 2008. ISBN 978-92-4-159628-2.
  11. ↑ Warnakulasuriya, S.; Trivedy, C; Peters, TJ (2002). "Areca nut use: An independent risk factor for oral cancer". BMJ. 324 (7341): 799–800. PMC 1122751 Freely accessible. PMID 11934759. doi:10.1136/bmj.324.7341.799.
  12. ↑ 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. PMID 1515978. doi:10.1002/1097-0142(19920901)70:5<1017::AID-CNCR2820700502>3.0.CO;2-#.
  13. ↑ 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. (2000). "Paan without tobacco: An independent risk factor for oral cancer". International Journal of Cancer. 86 (1): 128–31. PMID 10728606. doi:10.1002/(SICI)1097-0215(20000401)86:1<128::AID-IJC20>3.0.CO;2-M.
  14. ↑ 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. PMID 20458529. doi:10.1007/s10552-010-9570-1.
  15. ↑ Sharma, Dinesh C (2001). "Indian betel quid more carcinogenic than anticipated". The Lancet Oncology. 2 (8): 464. doi:10.1016/S1470-2045(01)00444-2.
  16. ↑ 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. PMID 20189448. doi:10.1016/j.oraloncology.2010.01.017.
  17. ↑ 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. PMID 19891056. doi:10.1016/S1470-2045(09)70326-2.
  18. ↑ 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. PMID 19665325. doi:10.1016/j.drugalcdep.2009.06.021.
  19. ↑ 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. PMID 18282667. doi:10.1016/j.drugalcdep.2008.01.003.
  20. ↑ Archaeological evidence from Thailand, Indonesia and the Philippines.
  21. ↑ Sengupta, Joy (9 October 2008). "Selling Betel Leaves? You’ll be Deported Immediately". KhaleejTimes.com. Archived from the original on 15 September 2009.
  22. ↑ Pattnaik, Naveen (1993). The Garden of Life: An Introduction to the Healing Plants of India (PDF). Doubleday. p. 70. ISBN 978-0-385-42469-1.
  23. ↑ Mahapatra; et al. (21 March 2011). "Paan loses flavour".
  24. 1 2 "Tradisi Bersirih dan Nilai Budayanya" (in Malay). MelayuOnline.com. Retrieved 5 May 2014.
  25. 1 2 "Menginang, Cikal Bakal Tradisi Kretek Nusantara". Kompasiana.com. Retrieved 5 May 2014.
  26. 1 2 "Menginang adalah". Academia.edu. Retrieved 13 May 2014.
  27. ↑ "Filosofi Menginang (Makan Pinang)". Jakarta.Kompasiana.com. Retrieved 5 May 2014.
  28. ↑ Betel-quid and Areca-nut Chewing and Some Areca-Nut Derived Nitrosamines. 85. World Health Organization. 2004. p. 68. ISBN 978-92-832-1285-0.
  29. 1 2 Seekins, Donald M. (2006). Historical Dictionary of Burma (Myanmar). Scarecrow Press. p. 109. ISBN 978-0-8108-5476-5.
  30. 1 2 Forbes, Charles James (1878). British Burma and its people. J. Murray.
  31. ↑ Reid, Robert; Michael Grosberg (2005). Myanmar (Burma). Lonely Planet. p. 290. ISBN 978-1-74059-695-4.
  32. ↑ Khin Myat (2 July 2007). "Betel chewers face health dangers". Myanmar Times. Archived from the original on 26 May 2013. Retrieved 17 April 2012.
  33. 1 2 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. doi:10.1111/j.1600-0714.2010.00938.x.
  34. ↑ Köllner, Helmut; Axel Bruns (1998). Myanmar (Burma). Hunter Publishing. pp. 13–14. ISBN 978-3-88618-415-6.
  35. ↑ Shenon, Philip (14 June 1995). "Yangon Journal; Burmese Generals Ask Less Spit, More Polish". The New York Times. Retrieved 17 April 2012.
  36. ↑ Ye Kaung Myint Maung (6 August 2006). "Smoking banned at Shwedagon". Myanmar Times. Archived from the original on 26 May 2013. Retrieved 17 April 2012.
  37. ↑ 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.
  38. ↑ Mir, Amir (3 December 2005). "Paan Gali, Lahore's very own Chandni Chowk". DNA.
  39. ↑ "Vietnamese Legend: Story of the betel leaf and the areca nut". Viet-American Foundation.
  40. ↑ Karim, ASM Enayet (2012). "Pan1". In Islam, Sirajul; Jamal, Ahmed A. Banglapedia: National Encyclopedia of Bangladesh (Second ed.). Asiatic Society of Bangladesh.
  41. ↑ Mark Magnier (22 January 2009). "Taiwan's 'betel nut beauties' drum up business, and debate". Los Angeles Times.

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