Successful End to Tobacco Education Project for the Karen Community

In 2018, WellShare successfully completed the Communities Eliminating Tobacco Inequities (CETI) program, working with the Karen refugee community. In partnership with the Karen Organization of Minnesota (KOM), this project focused on Karen communities in St. Paul and Roseville and aimed to increase the knowledge and awareness about tobacco use and cessation program options, leading to less tobacco use among Karen community members.

Here are some of the program€™s strategies, accomplishments, and lessons learned:


*Betel Quid

We delivered adult and youth tobacco classes and equipped community leaders to provide tobacco education to eliminate the use of tobacco in indoor and outdoor settings.

Much of WellShare€™s work revolved around betel quid (pictured right), a popular form of tobacco among Karen community members that is made of betel nut combined with tobacco, betel leaf, and other ingredients.

WellShare educated religious leaders about the harms of tobacco, and educated healthcare providers about the Karen community. We also created and facilitated an intergenerational council to advise the Karen Tobacco Free Program. On the policy side, WellShare also worked to pass tobacco-free grounds policies for large Karen events.


WellShare successfully raised the profile of betel quid as a public health issue in the Karen community. This included dispelling myths about the betel quid and betel nut, establishing them as harmful. In addition, WellShare covered secondhand smoke in classes and educated people about a federal policy prohibiting smoking within 25 feet of a public housing doorway. Finally, WellShare engaged community members on the harms of tobacco in supporting Roseville€™s T21 movement to increase the legal age to buy tobacco to 21 years old.

Lessons learned

One of the community requests was to better prepare people for tobacco cessation, as current cessation services are only available in English. WellShare was able to respond by educating and preparing Karen community members for cessation with the help of Karen Community Health Workers.

Understanding the importance of strong relationships, WellShare successfully leveraged partnerships with KOM, clinics, and churches. One of the challenges was to create relationships with health providers, as many are not aware of the scope of the problem of tobacco and betel quid use in the Karen community yet and have many time constraints. In addition to partnership building, WellShare also added more Karen staff as community health workers and educated them about the harms of tobacco. These community health workers were not just translators but became community experts on tobacco-related topics.

Today, betel nut is still categorized as a spice and available to youth in stores. This project illustrated the importance of working closely with the Karen community to address high smoking and betel quid use. It also demonstrates how it was possible to work on policy, systems, and make environmental changes to reduce the harms of tobacco and betel quid.

*Betel Quid Photo Credit:

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