The Karen at Sangkhlaburi District have a long historical and cultural background. Their socio-cultural patterns are unique and distinct. For instance, they like to have their bodies tattooed, smoke cigars, chew betel nuts, which is believed to prevent certain diseases and provide protection from insects, and wear earrings. Married and unmarried women dress differently. Their houses are made from bamboo and there must be a wooden spirit shrine in every house. Animistic belief has become a social frame as a livelihood guideline. Unmarried men and women are not allowed to have body contact and pre-marital sex is a violation of traditional and social norms. When this happens, an apology ritual must be performed otherwise violators will be excommunicated. Furthermore, Karen culture is matriarchal.