Betel nut chewing in Hawai'i: is it becoming a public health problem? Historical and socio-cultural considerations.

This article examines the socio-cultural significance of betel nut use among Micronesians, in light of the recent migration of Micronesians to Hawai'i. The different ways of chewing betel nut are the result of historical changes within Micronesia over time due to Spanish and US colonialism as well as the introduction of tobacco. These divergent ways of chewing may have different risks or impacts on health and it remains to be seen whether or not betel nut will become a significant public health problem in Hawai'i.