The Social Contexts of Drug Offers and Their Relationship to Drug Use of Rural Hawaiian Youth

Adult Familial Influences on Rural Native Hawaiian and Pacific Islander Youths' E-Cigarette Use

Background: Over the past decade, youth e-cigarette use has grown into a national epidemic, with Native Hawaiian and Pacific Islander (NHPI) youths' rates among some of the highest in the nation. Family factors significantly contribute to NHPI youths' decisions to engage in or resist substance use, yet few studies have specifically examined familial influences on NHPI youths' substance use decision-making and behaviors. Objective: The objective of this study is to examine adult familial influences on rural NHPI youths' decisions to engage in e-cigarette use. Method: Seventeen gender-specific focus groups with NHPI youths (N = 69) from eight public schools on Hawai'i Island were conducted. Results: Two family-related themes emerged from the data: 1) parental substance use permissiveness, and 2) family normalization of e-cigarette use. Conclusions: Examining adult familial contributors to NHPI youths' e-cigarette use needs to be part of a comprehensive effort to address NHPI health and substance use disparities. Prevention interventions should be explicit in addressing the family and relational context of NHPI youths' substance use.

Exploring Native Hawaiian and Pacific Islander Youths' E-Cigarette Resistance Strategies: Implications for Tobacco Product Use Prevention

This study examined the e-cigarette and vaping resistance strategies used by Native Hawaiian and Pacific Islander (NHPI) youths in rural Hawai'i. Focus groups (N = 17) were conducted in eight geographically dispersed elementary, middle/intermediate, and multilevel schools in low-income communities on Hawai'i Island. Sixty-nine youths (67% NHPI, Mage = 12.5 years) participated in this study. The resistance strategies discussed across the greatest number of groups were "refuse" (saying no), "explain" (providing reasons for vaping refusal), "avoid" (avoiding people or places where e-cigarettes were used), and "leave" (walking away from a situation where e-cigarettes were being used). Participants described the challenges in using these strategies within contexts characterized by widespread peer and family vaping and strong social demands to use e-cigarettes. The findings suggest the need for multi-level interventions based on youths' resistance strategies to meaningfully reduce youth vaping use in rural and/or NHPI communities.

Tobacco use among native Hawaiian and Pacific Islander youth in the U.S. and USAPI: a systematic review of the literature

With rates of tobacco use among youth in the United States on the rise, further analysis of disproportionately impacted populations, like Native Hawaiian and other Pacific Islanders (NHPIs), is needed. NHPIs face a unique set of challenges compared to other ethnic minorities that contribute to their health disparities from tobacco use. This systematic literature review investigated empirical studies published between 2010-2020 on tobacco use among NHPI youth and young adults. Using comprehensive literature search engines and focused author searches of tobacco researchers in NHPI communities, 7,208 article abstracts were extracted for potential inclusion. Explicit inclusionary and exclusionary criteria were used to identify peer-reviewed articles related to tobacco use correlates and interventions for NHPI youth populations. A total of 17 articles met our criteria for inclusion in this study. Community influences, peer pressure, social status, variety of flavors, craving, and stimulation were correlates found in smoking and vaping for NHPI youth. There were also few published tobacco use prevention and intervention studies focused specifically on NHPI youth. Our study addresses the needs of an under-researched population that is heavily affected by the adverse consequences of short-term and long-term use of cigarettes and e-cigarettes. Additional research should focus on developing effective and culturally relevant interventions to reduce NHPI health disparities.

Tobacco product use and cultural connectedness among Native Hawaiian/Pacific Islander, Asian American, and Filipino American young adults in Hawai'i

Tobacco product use rates among Native Hawaiian/Pacific Islander (NHPI), Asian American, and Filipino American young adults in Hawai'i have risen rapidly in recent years following the introduction of electronic nicotine delivery systems. Though some research has examined tobacco use correlates for these demographics of young adults, research examining protective factors, such as cultural connectedness, is lacking. Additionally, research that disaggregates Asian Americans from Pacific Islanders is scarce, despite the differing risk and protective factors that have been determined for each group. This study separately examined cultural connectedness among NHPIs, Asian Americans, and Filipino Americans to help fill the gaps in the current tobacco product literature. The findings indicated that Asian Americans and Filipino Americans who identify more with their own cultures are less likely to use e-cigarettes; however, this relationship was not supported for NHPIs. No significant evidence was found to indicate a relationship between cultural connectedness and combustible cigarette use among any of the sampled groups. The lack of relationship between cultural connectedness and e-cigarette use among Native Hawaiians may be explained by measurement limitations in the study, and suggest the need for more culturally competent scales (e.g., an enculturation scale) that account for Indigenous status.

Examining risk and protective predictors of substance use among low-income Native Hawaiian and Pacific Islander adolescents

Substance use (SU) among adolescents is a critical public health concern that increases the risk for negative outcomes. Although Asian American (AA) adolescents tend to report low rates of SU, Native Hawaiian and Pacific Islander (NH/PI) adolescents often report significantly higher rates of use. Yet, NH/PI youth are seldom studied as a separate group. Consequently, little is known about the factors involved in SU among NH/PI adolescents and how to prevent it. This prospective study investigated the effect of ecological risk and protective factors at the individual, family, and school levels on SU for NH/PI adolescents. This prospective study utilized longitudinal data from 120 NH/PI adolescents who were7 part of an SU prevention program. Information was collected at two time points-Time 1 and Time 2 (32 weeks later)-and included adolescents' SU behaviors and individual, family, and school factors. The parents of these adolescents also provided data; all information was self-report. Positive academic attitudes at Time 1 were negatively associated with alcohol and other drug (e.g., marijuana) use at Time 2. Specifically, NH/PI adolescents who had more positive attitudes toward their school, peers, and teachers reported less alcohol and other SU. Prevention efforts may be most effective for NH/PI adolescents if addressed within the school context. This may include programs implemented in schools, utilizing teachers as role models, and/or promoting prosocial peer relationships to support positive behaviors. Additional implications are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Deep-Structure Adaptations and Culturally Grounded Prevention Interventions for Native Hawaiians: a Systematic Review of the Literature

Research has shown that Native Hawaiians disproportionately suffer from behavioral disorders and chronic physical diseases, yet they have historically lacked effective and culturally relevant prevention interventions to address their pervasive health disparities. This article systematically reviewed the recent culturally relevant prevention intervention literature focused on Native Hawaiians. In this review, we assessed 14 peer-reviewed articles published between 2015 and 2020 that met inclusion and exclusion criteria pertaining to the development and/or evaluation of prevention interventions for Native Hawaiians. The reviewed studies evaluated ten different interventions that were developed using deep-structure adaptation or culturally grounded procedures, and primarily focused on prevention of substance use, obesity/diabetes, and pregnancy/sexually transmitted infections (STIs). Compared with the prior related literature reviews, the present review suggests an overall advancement in prevention science for Native Hawaiians, evidenced by an increase in federal funding and randomized controlled clinical trials of prevention interventions for the population. This review provides an update to the state of the science for Native Hawaiian prevention interventions and points to areas of future research and development.

Parental Support, Parent-Adolescent Conflict, and Substance Use of Native Hawaiian and Other Pacific Islander Youth: Ethnic Differences in Stress-Buffering and Vulnerability Effects

This research study examined the overall and ethnic-specific effects of parental emotional and instrumental support, parent-adolescent interpersonal conflict, and negative life events (i.e., major life stressors, such as parental job loss or school suspension) on the substance use of Caucasian, Asian-American, Filipino, and Native Hawaiian and other Pacific Islander (NHOPI) youth in Hawai'i. Adolescents (N = 3,561) from 10 public middle/intermediate schools completed paper/pencil surveys, and multiple regression and structural equation models were developed to examine overall and ethnic-specific effects. Parental support was found to buffer against the influence of negative life events on substance use in the overall sample; however, this effect was not observed for either Caucasian or NHOPI youth in ethnic-specific analyses. The impact of parent-adolescent conflict and negative life events on substance use was more pronounced for both Filipino and NHOPI youth. While the study may have had some limitations related to regional specificity and measurement, the findings nonetheless point to the differential effects of risk and protective factors for NHOPI youth, compared with other youth ethnic groups in Hawai'i. Implications of these findings for culturally specific, family-focused prevention research and practice for NHOPI youth are discussed.

An Efficacy Trial of the Ho'ouna Pono Drug Prevention Curriculum: An Evaluation of a Culturally Grounded Substance Abuse Prevention Program in Rural Hawai'i

This study reports on the drug use outcomes in an efficacy trial of a culturally grounded, school-based, substance abuse prevention curriculum in rural Hawai'i. The curriculum (Ho'ouna Pono) was developed through a series of pre-prevention and pilot/feasibility studies funded by the National Institute on Drug Abuse, and focuses on culturally relevant drug resistance skills training. The present study used a dynamic wait-listed control group design (Brown, Wyman, Guo, & Pena, 2006), in which cohorts of middle/intermediate public schools on Hawai'i Island were exposed to the curriculum at different time periods over a two-year time frame. Four-hundred and eighty six youth participated in the study. Approximately 90% of these youth were 11 or 12 years of age at the start of the trial. Growth curve modeling over six waves of data was conducted for alcohol, marijuana, cigarettes/e-cigarettes, crystal methamphetamine, and other hard drugs. The findings for alcohol use were contrary to the hypothesized effects of the intervention, but may have been a reflection of a lack equivalence among the cohorts in risk factors that were unaccounted for in the study. Despite this issue, the findings also indicated small, statistically significant changes in the intended direction for cigarette/e-cigarette and hard drug use. The present study compliments prior pilot research on the curriculum, and has implications for addressing Native Hawaiian and Pacific Islander health disparities.

The Validation of a School-Based, Culturally Grounded Drug Prevention Curriculum for Rural Hawaiian Youth

The purpose of this study was to validate a school-based, culturally grounded drug prevention curriculum for rural Native Hawaiian youth. Faculty and administrators from eight geographically dispersed middle-, intermediate-, or multilevel schools on Hawai'i island were interviewed on the cultural relevance and feasibility of implementation of the curriculum (Ho'ouna Pono). While all participants appreciated the culturally specific content interwoven throughout the curriculum's structure, several of them expressed concerns that the curriculum would compete with resources needed to implement Common Core national standards. Implications for the implementation, adoption, and sustainability of school-based prevention curricula are discussed.

An Evaluation of the Ho'ouna Pono Curriculum: A Pilot Study of Culturally Grounded Substance Abuse Prevention for Rural Hawaiian Youth

This pilot study evaluated the Ho'ouna Pono curriculum, which is a culturally grounded, school-based, drug prevention curriculum tailored to rural Native Hawaiian youth. The curriculum focuses on culturally relevant drug resistance skills training and is aligned with the State of Hawai'i academic standards. Six Hawai'i Island public middle/intermediate schools randomly assigned to intervention or treatment-as-usual comparison conditions (N = 213) were evaluated in this study. Paired sample t-tests separating intervention and comparison groups were conducted, as well as mixed models that adjusted for random effects (nesting) at the school level. Findings suggested that the curriculum was effective in maintaining youths' use of culturally relevant drug resistance skills, as well as decreasing girls' aggressive behaviors, at six-month follow-up. Unanticipated findings also suggested areas for curricular improvement, including more emphasis on normative drug education. Implications for future research and development of the curriculum are discussed.

The Role of Relational Harmony in the Use of Drug-Refusal Strategies of Rural Native Hawaiian Youths

This study examined the role of maintaining relational harmony among family members in the use of drug refusal strategies for rural Hawaiian youth. Youth focus groups were conducted to validate refusal strategies used in realistic, hypothetical drug-related problem situations. The findings suggested gender-specific motivations for maintaining relational harmony among family members when faced with drug offers from them. Specifically, boys described instrumental concerns when using refusal strategies (i.e., not wanting to get into trouble), while girls described holistic relational concerns (i.e., not wanting family members to be upset with each other). Implications for prevention and social work practice are discussed.

Annual Review of Asian American Psychology, 2014

This 2014 review of Asian American psychology is the sixth review in the series. It includes 316 articles that met the inclusion criteria established by the past five annual reviews. Featured articles were derived from three sources: 137 were generated via the search term "Asian American" in PyscINFO, 111 were generated via a search for specific Asian American ethnic groups, and 32 were generated via author searches of articles that met the inclusion criteria. The top primary topic was health and health-related behaviors, the most frequently employed study design was cross-sectional, and the most studied Asian American ethnic group was Chinese. This year's review includes information on the target population of the primary topic, the age range and developmental period of participants, and whether the study design was cross-sectional or longitudinal. It also identifies top authors and journals contributing to the 2014 annual review. These new features reveal that the most common target population of the primary topic was youths; studies most commonly included emerging adults ages 18-25; cross-sectional study design was employed more often than longitudinal design; the top contributor to the 2014 review was Stephen Chen, who authored the highest number of papers included; and the Asian American Journal of Psychology generated the highest number of publications for this review.

Developing empirically based, culturally grounded drug prevention interventions for indigenous youth populations

This article describes the relevance of a culturally grounded approach toward drug prevention development for indigenous youth populations. This approach builds drug prevention from the "ground up" (i.e., from the values, beliefs, and worldviews of the youth that are the intended consumers of the program) and is contrasted with efforts that focus on adapting existing drug prevention interventions to fit the norms of different youth ethnocultural groups. The development of an empirically based drug prevention program focused on rural Native Hawaiian youth is described as a case example of culturally grounded drug prevention development for indigenous youth; the impact of this effort on the validity of the intervention and on community engagement and investment in the development of the program are discussed. Finally, implications of this approach for behavioral health services and the development of an indigenous prevention science are discussed.

Drug offers as a context for violence perpetration and victimization

Drug use has been linked empirically with and aggression and violence among youth in national and State of Hawai'i samples. However, the nature of this link and its implications for prevention are unclear. Therefore, this article explores the intersection of drugs with aggression and violence by using the drug offer context as the unit of analysis. Native Hawaiian youth are sampled because substance use rates tend to be higher and onset tends to be earlier for them than for their non-Hawaiian peers. Fourteen sex-specific focus group discussions were held with rural Native Hawaiian middle school students (N = 64). Students discussed what they think they would do in terms of drug refusal strategies in a variety of drug offer contexts. Although aggression and violence were perceived to be socially inappropriate, students nonetheless felt drug use would be less socially competent. Narrative analyses indicated that aggression and violence were thought to function as potential drug refusal strategies. As proximal drug resistance, aggression and violence perpetration served as an immediate deterrent to the drug offerer and thus drug use. As distal drug resistance, victimization served as a rationale for avoiding drug using contexts. Implications are discussed in terms of prevention policy and practice, specifically in terms of a school-based prevention curriculum. Future research in Hawaiian epistemology and gendered approaches are warranted.

Gender differences in the use of drug resistance strategies: an analysis of rural Asian/Pacific Islander youth

This study examines gender differences in the use of drug resistance strategies for rural Asian/Pacific Islander youth. Multiethnic Asian/Pacific Islander youth (N = 213) from six middle/intermediate schools on the Island of Hawai'i participated in the study, and gender differences in their real-world use of specific strategies (e.g., refuse, explain, avoid, leave) were examined. Despite similar levels of exposure to situations where drugs and/or alcohol were offered, girls indicated significantly lower usage of most of the resistance strategies compared to boys, suggesting girls' increased risk in dealing with drug-related problem situations. Implications for gender-and culture-specific health promotion and drug prevention curricula are discussed.

Gender Differences in Preferred Drug Resistance Strategies of Rural Native Hawaiian Youth

This study examined the gender differences in preferred strategies used to resist drugs and alcohol for rural Native Hawaiian youth. Seventy-four youth (60% female) within eight different middle/intermediate or high schools participated in 15 different focus groups as part of a pilot/feasibility drug prevention study funded by the National Institute on Drug Abuse. Consistent with relational-cultural theory, qualitative findings indicated how female youth participants favored drug resistance strategies that maintained relational connectedness with the drug offerer, and how they considered the long-term relational consequences of different drug resistance strategies. Implications of these findings for indigenous- and gender-specific prevention are discussed.

Developing the Ho'ouna Pono substance use prevention curriculum: collaborating with Hawaiian youth and communities

This article briefly outlines a collaboration among communities on Hawai'i Island and a university-based research team to develop, implement, and evaluate a school-based substance use prevention curriculum called Ho'ouna Pono. In addition to providing a rationale for the project, the goal of this paper is fourfold. First, an overview of the Ho'ouna Pono research results to date (2007-2013) is provided. Second, within this overview, the ways in which selected results informed program development are highlighted. Third, the curriculum is briefly described, and finally, the role of the students and community in the video production is described.

The development of videos in culturally grounded drug prevention for rural native Hawaiian youth

The purpose of this study was to adapt and validate narrative scripts to be used for the video components of a culturally grounded drug prevention program for rural Native Hawaiian youth. Scripts to be used to film short video vignettes of drug-related problem situations were developed based on a foundation of pre-prevention research funded by the National Institute on Drug Abuse. Seventy-four middle- and high-school-aged youth in 15 focus groups adapted and validated the details of the scripts to make them more realistic. Specifically, youth participants affirmed the situations described in the scripts and suggested changes to details of the scripts to make them more culturally specific. Suggested changes to the scripts also reflected preferred drug resistance strategies described in prior research, and varied based on the type of drug offerer described in each script (i.e., peer/friend, parent, or cousin/sibling). Implications for culturally grounded drug prevention are discussed.

A community stakeholder analysis of drug resistance strategies of rural native Hawaiian youth

This study examines and validates the drug resistance strategies identified by rural Hawaiian youth from prior research with a sample of community stakeholders on the Island of Hawai'i. One hundred thirty-eight stakeholders with a vested interest in reducing youth substance use (i.e., teachers, principals, social service agency providers, and older youth) completed a web-based survey comprised of 15 drug-related problem situations and 413 responses developed by Hawaiian youth. The findings corroborated the youth-focused findings from prior research. Differences in the endorsement of different strategies were examined based on gender, ethnicity, and age of the stakeholders. Implications for culturally grounded drug prevention in rural Hawaiian communities are discussed.

"I No Like Get Caught Using Drugs": Explanations for Refusal as a Drug Resistance Strategy for Rural Native Hawaiian Youth

This exploratory study examined the use of explanations for refusal as a drug resistance strategy for rural Native Hawaiian youth. Fourteen gender-specific focus groups were conducted within seven middle or intermediate schools on the Island of Hawai'i (N = 64). Participants were asked to describe drug resistance strategies in response to 15 hypothetical culturally specific drug-related problem scenarios developed from earlier research. The findings indicate that variations in the types of explanations used for refusal were based on the type of drug offerer in the associated scenario (i.e., peer/friend, cousin, or parent). Participants also described the rationales for the use of different explanations with different drug offerers. The findings suggest that culturally grounded drug prevention programs for Hawaiian youth should incorporate the use of specific types of explanations for refusal, depending on the youths' relationship to the drug offerer.