A substantial proportion of the world's population is engaged in chewing areca nut and the habit is endemic throughout the Indian subcontinent, large parts of south Asia and Melanesia. A large variety of ingredients, including tobacco, may be used along with areca nut constituting a betel quid. The composition and method of chewing can vary widely from country to country and these population variations are described in this review. Some populations are known to use areca nut without tobacco providing good opportunities to further research the carcinogenecity of areca nut. Some interesting trends on chewing patterns have emerged from recent data, suggesting a decline in the habit in some countries such as Thailand while the prevalence of areca nut use is rising in India and Taiwan.