Objective The objective of this study was to understand use behaviors of areca nut and corresponding risk perceptions in Chinese youth population and the association between them.

Study object and methods A total of 792 Chinese youth aged 18-24 participated in the study and completed the online survey using a self-administered questionnaire. The association between areca nut use behavior and perceptions of health risks as well as other socio-behavioral factors was analyzed using ordered logistic regression.

Result The areca nut use rate of the survey sample was 2.02%, and 16.04% had used areca nut. The ongoing areca nut use rate was higher in the young male population (2.87%) than in the female population (0%), and the ever use rate was also higher in the young male population (16.13%) than in the female population (15.81%). The main reasons for being using areca nut were “refreshing” (82.35%) and “releasing stress” (70.59%); the main reasons for ever trying to use areca nut were “curiosity” (55.47%) and “areca nut handed by others” (47.66%). The average score of the survey sample on the perceived health risks of areca nut use was 5.76, and the survey sample had the lowest perceptions of the three items of areca nut use causing inflammation of the gastric mucosa, perforation and malnutrition (73.74%) compared to the oral health hazards associated with areca nut. The regression results showed that insufficient knowledge of areca nut health risks (p=0.007) was an important cause of areca nut use in the survey sample, in addition to smoking (p=0.000), alcohol consumption (p=0.000), and birthplace or regular residence being the place of areca nut production and processing (p=0.000) were also risk factors for areca nut use in the survey sample.

Conclusion Areca nut use has become a relevant health issue in the Chinese youth population, and the rate of areca nut use among young people is related to their perceptions of the health risks of areca nut, which should be reduced through active promotion of the harm of areca nut.