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Marshall SM, Lau S. Native Hawaiian and Pacific Islander Youth Substance Use Prevention in Rural Hawai'i. HAWAI'I JOURNAL OF HEALTH & SOCIAL WELFARE 2024; 83:144-146. [PMID: 38716140 PMCID: PMC11070780 DOI: 10.62547/duas8087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2024]
Affiliation(s)
- Sarah Momilani Marshall
- Department of Social Work, Thompson School of Social Work & Public Health, University of Hawai'i at Mānoa, Honolulu, HI
| | - Sophia Lau
- Department of Social Work, Thompson School of Social Work & Public Health, University of Hawai'i at Mānoa, Honolulu, HI
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Okamura KH, Okamoto SK, Marshall SM, Chin SK, Garcia PM, Powell BJ, Stern KA, Becker SJ, Mandell DS. Ho'ouna Pono implementation: applying concept mapping to a culturally grounded substance use prevention curriculum in rural Hawai'i schools. Implement Sci Commun 2022; 3:111. [PMID: 36224628 PMCID: PMC9556135 DOI: 10.1186/s43058-022-00359-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 09/28/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Despite their potential to ameliorate health disparities and address youth substance use, prevention programs have been poorly disseminated and implemented across Hawai'i, which begs the question: Why are effective prevention programs not being used in communities most in need of them? Implementing and sustaining culturally grounded prevention programs is critical to address equitable healthcare and minimize health disparities in communities. The field of implementation science provides frameworks, theories, and methods to examine factors associated with community adoption of these programs. METHOD Our project applies concept mapping methods to a culturally grounded youth drug prevention program with state level educational leadership in rural Hawai'i schools. The goal is to integrate barrier and facilitator salience collected through teacher and school staff surveys and specific implementation strategies to regionally tailored implementation plans on Hawai'i island. This protocol paper describes the concept mapping steps and how they will be applied in public and public-charter schools. DISCUSSION Improving prevention program implementation in rural schools can result in sustained support for populations that need it most. The project will integrate implementation science and culturally grounded methods in rural Hawai'i, where most youth are of Native Hawaiian and Pacific Islander descent. This project addresses health disparities among Native Hawaiian and Pacific Islander youth and provides actionable plans for rural Hawai'i communities to implement effective prevention programming.
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Affiliation(s)
- Kelsie H Okamura
- The Baker Center for Children and Families/Harvard Medical School, 53 Parker Hill Ave, Boston, MA, 02120-3225, USA.
- Department of Psychology, University of Hawai'i at Mānoa, 2530 Dole Street, HI, 96826, Honolulu, USA.
| | - Scott K Okamoto
- Population Sciences in the Pacific Program, University of Hawai'i Cancer Center, 701 Ilalo Street, Honolulu, HI, 96813, USA
| | - Sarah Momilani Marshall
- Population Sciences in the Pacific Program, University of Hawai'i Cancer Center, 701 Ilalo Street, Honolulu, HI, 96813, USA
| | - Steven Keone Chin
- Population Sciences in the Pacific Program, University of Hawai'i Cancer Center, 701 Ilalo Street, Honolulu, HI, 96813, USA
| | - Pamela M Garcia
- Department of Psychology, Hawai'i Pacific University, 500 Ala Moana Blvd, Honolulu, HI, 96813, USA
| | - Byron J Powell
- Center for Mental Health Services Research, Brown School, Washington University in St. Louis, St. Louis, MO, USA
- Center for Dissemination and Implementation, Institute for Public Health, Washington University in St. Louis, St. Louis, MO, USA
- Division of Infectious Diseases, John T. Milliken Department of Medicine, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Kelly A Stern
- Hawai'i State Department of Education, West Hawai'i School Based Behavioral Health Services, 74-5000 Puohulihuli St, Kailua-Kona, HI, 96740, USA
| | - Sara J Becker
- Center for Dissemination and Implementation Science, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - David S Mandell
- Department of Psychiatry, University of Pennsylvania, 3535 Market Street, 3rd Fl, Philadelphia, PA, 19104, USA
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Scoppetta O, Avendaño Prieto BL, Cassiani Miranda C. Individual factors associated with the consumption of illicit substances: a review of reviews. REVISTA COLOMBIANA DE PSIQUIATRIA (ENGLISH ED.) 2022; 51:206-217. [PMID: 36085126 DOI: 10.1016/j.rcpeng.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 01/30/2020] [Indexed: 06/15/2023]
Abstract
INTRODUCTION According to national studies, the use of illicit drugs is growing in Colombia. With this, the prevalence of substance use disorders and the set of health effects related to this practice also increases. Knowledge of the factors associated with the use of illicit drugs is necessary to guide the comprehensive care of the phenomenon. METHODS This is a systematic review of reviews on factors associated with the consumption of illicit drugs with seven databases and evaluation of the quality of the manuscripts according to AMSTAR. RESULTS Information was extracted from 38 reviews on individual factors associated with the use of illicit drugs. Demographic factors are associated with consumption through other factors. There is evidence of the association between mental and behavioural disorders and personality disorders. CONCLUSIONS The likelihood of consumption of illicit substances and disorders due to their use is affected by a set of personal factors including sociodemographic characteristics, mental health conditions, sexual behaviour, legal drug use, age of onset and risk perception.
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Affiliation(s)
- Orlando Scoppetta
- Psicólogo, Magister en Estudios de Población, Universidad Católica de Colombia, Avenida Caracas No. 46-22, Bogotá, Colombia.
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Scoppetta O, Avendaño BL, Cassiani C. Factors Associated with the Consumption of Illicit Drugs: a Review of Reviews. Int J Ment Health Addict 2022. [DOI: 10.1007/s11469-020-00464-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Huang CY, Nishioka SA, Zane NW, Uchigakiuchi P. Examining risk and protective predictors of substance use among low-income Native Hawaiian and Pacific Islander adolescents. THE AMERICAN JOURNAL OF ORTHOPSYCHIATRY 2021; 92:18-24. [PMID: 34516146 PMCID: PMC8831443 DOI: 10.1037/ort0000582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
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).
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Affiliation(s)
- Cindy Y. Huang
- Department of Counseling and Clinical Psychology, Teachers College, Columbia University
| | - Silvia A. Nishioka
- Department of Counseling and Clinical Psychology, Teachers College, Columbia University
| | - Nolan W. Zane
- Department of Psychology, Asian American Center on Disparities Research, University of California, Davis
| | - Patrick Uchigakiuchi
- Social Science Research Institute, College of Social Sciences, University of Hawaii at Manoa
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Williams IL, Makini GK, Rezentes WC. Indigenous Hawaiian Psychoactive Drug Use: Before European Contact, and after 1778. J Psychoactive Drugs 2020; 53:111-126. [PMID: 33161891 DOI: 10.1080/02791072.2020.1833114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This article builds on an existing body of scholarship on historical and intergenerational cultural trauma to elucidate deliberate attempts to eliminate Native Hawaiian cultural practices related to psychoactive drug use and replace them with the foreign (Western) tradition of alcohol use. This action, to instill alcohol as a component of colonial domination, was one example of the resulting assault on cultural identity that has often been overlooked, particularly in relation to transgenerational trauma in the history of Hawai'i and the Hawaiian context. In this article, we argue for the use of the term historical trauma, introduced by Brave Heart, which allows for a more inclusive consideration of the many aspects of trauma. Drawing on literature related both to alcohol use in indigenous Hawaiian society and to the wider historical context of Hawai'i since the late eighteenth century, we endeavor to demonstrate the correlation between the historical trauma experienced by the population and the incidence of alcohol consumption and alcohol use disorder. The article is intended to augment the existing paradigm on cultural trauma as it specifically relates to Hawaiians, and potentially to widen the explanatory power of this paradigm with regard to present-day psychoactive drug use among Hawaiians as well as the implications for treatments.
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Affiliation(s)
| | - George K Makini
- Associate Professor of Psychiatry, University of Hawai'i John A. Burns School of Medicine, Honolulu, Hawai'i, USA
| | - William C Rezentes
- Clinical Psychologist, Private Practice/Independent Scholar, Kailua, Hawai'i, USA
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Deep-Structure Adaptations and Culturally Grounded Prevention Interventions for Native Hawaiians: a Systematic Review of the Literature. J Racial Ethn Health Disparities 2020; 8:570-578. [PMID: 32666508 DOI: 10.1007/s40615-020-00815-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/29/2020] [Accepted: 07/03/2020] [Indexed: 10/23/2022]
Abstract
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.
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Scoppetta O, Avendaño Prieto BL, Cassiani Miranda C. Individual Factors Associated with the Consumption of Illicit Substances: a Review of Reviews. REVISTA COLOMBIANA DE PSIQUIATRIA (ENGLISH ED.) 2020; 51:S0034-7450(20)30030-5. [PMID: 33735052 DOI: 10.1016/j.rcp.2020.01.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Revised: 12/11/2019] [Accepted: 01/30/2020] [Indexed: 12/20/2022]
Abstract
INTRODUCTION According to national studies, the use of illicit drugs is growing in Colombia. With this, the prevalence of substance use disorders and the set of health effects related to this practice also increases. Knowledge of the factors associated with the use of illicit drugs is necessary to guide the comprehensive care of the phenomenon. METHODS This is a systematic review of reviews on factors associated with the consumption of illicit drugs with seven databases and evaluation of the quality of the manuscripts according to AMSTAR. RESULTS Information was extracted from 38 reviews on individual factors associated with the use of illicit drugs. Demographic factors are associated with consumption through other factors. There is evidence of the association between mental and behavioural disorders and personality disorders. CONCLUSIONS The likelihood of consumption of illicit substances and disorders due to their use is affected by a set of personal factors including sociodemographic characteristics, mental health conditions, sexual behaviour, legal drug use, age of onset and risk perception.
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Affiliation(s)
- Orlando Scoppetta
- Psicólogo. Magister en Estudios de Población. Universidad Católica de Colombia. Avenida Caracas No. 46-22, Bogotá, Colombia.
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Williams IL, Laenui Hayden Burgess P, Makini GK, Rezentes WC. Native Hawaiian culturally based treatment: Considerations and clarifications. J Ethn Subst Abuse 2019; 20:559-593. [PMID: 31697192 DOI: 10.1080/15332640.2019.1679315] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The purpose of this article is two-fold. First, it aims to understand some of the earliest documented perspectives voiced by Native Hawaiian communities and their appeals for the concept of culturally based treatment. Second, it presents research, practice, and policy considerations with the goal of evolving the base of evidence supporting cultural treatment. Within the context of Hawai'i and Native Hawaiian history, this paper first contextualizes the emergence and conceptual orientation of culture-based addiction treatment. In discussing substance use disorder treatment in the Hawaiian context, insights and perspectives consider cultural-political trauma a key factor in developing a beneficial framework of practice. This historical background, however, reveals that contemporary culturally based design and service delivery is not aligned with the objective of specifically improving treatment for Native Hawaiians.
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Affiliation(s)
| | - Pōkā Laenui Hayden Burgess
- Institute for the Advancement of Hawaiian Affairs; Convenor, Hawaii National Transitional Authority, Waianae, Hawai'i
| | - George K Makini
- Associate Professor of Psychiatry at University of Hawai'i John A. Burns School of Medicine, Honolulu, Hawai'i
| | - William C Rezentes
- Clinical Psychologist, Private Practice/Independent Scholar, Kailua, Hawai'i
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Wills TA, Okamoto SK, Knight R, Pagano I. Parental Support, Parent-Adolescent Conflict, and Substance Use of Native Hawaiian and Other Pacific Islander Youth: Ethnic Differences in Stress-Buffering and Vulnerability Effects. ASIAN AMERICAN JOURNAL OF PSYCHOLOGY 2019; 10:218-226. [PMID: 31788156 PMCID: PMC6884318 DOI: 10.1037/aap0000139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
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.
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Affiliation(s)
- Thomas A Wills
- Professor and Director of the Cancer Prevention in the Pacific Program, University of Hawai'i Cancer Center
| | - Scott K Okamoto
- Professor and Research Faculty, School of Social Work, Hawai'i Pacific University, and an Adjunct Associate Researcher, Cancer Prevention in the Pacific Program, University of Hawai'i Cancer Center
| | - Rebecca Knight
- Community Health Educator, Polk County Public Health, Polk County, OR
| | - Ian Pagano
- Assistant Professor, Cancer Prevention in the Pacific Program, University of Hawai'i Cancer Center
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Helm S, Hishinuma E, Okamoto S, Chin SK, Silva A. The Relationship Between Ethnocultural Identity Measures and Youth Substance Use Among a School-Based Sample: A Focus on Native Hawaiian Youth. ASIAN AMERICAN JOURNAL OF PSYCHOLOGY 2019; 10:206-217. [PMID: 32983371 PMCID: PMC7517588 DOI: 10.1037/aap0000157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The way in which behavioral health interventions are designed, implemented, and evaluated must be responsive to the ethnocultural characteristics of the targeted youth and their families, schools, and communities. The goal of this paper is to examine the relationship between ethnocultural identity measures and substance use among Native Hawaiian compared to non-Hawaiian youth. A cross-sectional analysis was conducted from baseline data drawn from an efficacy trial of a culturally-grounded drug prevention curriculum, Hoòuna Pono. The sample (N=486) included youth from 13 rural, public middle schools who identified as Native Hawaiian, as well as other Pacific Islander, Asian, and other ethnicities. Ethnocultural identity measures used to explore the relationship between 30-day substance use included items from the Hawaiian Culture Scale (Hishinuma et al., 2000) and from Phinney's (1992) Multigroup Ethnic Identity Measure. Among the total sample, prevalence rates indicated that 11.2% of participants reported having been offered substances, and 9.7% reported having used one or more substances in the past month. For Hawaiian youth relative to the non-Hawaiian group, higher levels of Native Hawaiian ethnocultural independent variables were moderately associated with fewer offers to use substances and less gateway drug use. Other results were mixed regarding the relationship between ethnocultural variables and substance use. The present study found that selected ethnocultural variables were moderately associated with fewer drug offers and lower levels of gateway drug use for Hawaiian versus non-Hawaiian youth.
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Affiliation(s)
- Susana Helm
- Department of Psychiatry, John A. Burns School of Medicine, University of Hawai'i at Mānoa
| | - Earl Hishinuma
- Department of Psychiatry, John A. Burns School of Medicine, University of Hawai'i at Mānoa
| | - Scott Okamoto
- School of Social Work, Hawai'i Pacific University, and an Adjunct Professor, John A. Burns School of Medicine, University of Hawai'i at Mānoa
| | | | - Anjelica Silva
- Post-baccalaureate Research Assistant, John A. Burns School of Medicine, University of Hawai'i at Mānoa
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Okamoto SK, Kulis SS, Helm S, Chin SK, Hata J, Hata E, Lee A. 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. ASIAN AMERICAN JOURNAL OF PSYCHOLOGY 2019; 10:239-248. [PMID: 32395199 PMCID: PMC7213509 DOI: 10.1037/aap0000164] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
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.
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Helm S, Okamoto SK. Gendered Perceptions of Drugs, Aggression, and Violence. JOURNAL OF INTERPERSONAL VIOLENCE 2019; 34:2292-2312. [PMID: 27456534 PMCID: PMC5266725 DOI: 10.1177/0886260516660301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Drug use has been linked empirically with aggression and violence among youth in national and State of Hawai'i samples. In addition, aggression and violence appear to be gendered experiences perceived differently by girls and boys. This article explores the intersection of drug offers/drug refusals with aggression and violence with specific attention paid to gendered perceptions of drug use situations as a context for aggression and violence. A qualitative study, in which 14 sex-specific focus group discussions were held, focused on rural Native Hawaiian middle school students ( N = 64). Students were asked to discuss drug refusal strategies in a variety of drug offer contexts. Feminist theories and approaches were used to examine the role of aggression and violence in drug refusal as perceived by Native Hawaiian girls as compared with boys. Girls and boys differed in their perceptions of aggression and violence in drug offer situations, initially as evidenced by the extent to which the girl groups focused on the intersection of drugs and violence. Furthermore, qualitative analyses reflected gender norms and stereotypes about aggression and violence perpetration, and girls' apparently unique concerns about sexual violence victimization. Implications are discussed in terms of prevention research and practice, specifically in terms of school-based prevention curricula.
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Affiliation(s)
- Susana Helm
- 1 University of Hawai'i at Mānoa, Honolulu, HI, USA
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Okamoto SK, Helm S, Ostrowski LK, Flood L. The Validation of a School-Based, Culturally Grounded Drug Prevention Curriculum for Rural Hawaiian Youth. Health Promot Pract 2018; 19:369-376. [PMID: 28443350 PMCID: PMC5623612 DOI: 10.1177/1524839917704210] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
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.
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Affiliation(s)
| | - Susana Helm
- 2 University of Hawai'i at Mānoa, Honolulu, HI, USA
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Okamoto SK, Kulis S, Helm S, Lauricella M, Valdez JK. An Evaluation of the Ho'ouna Pono Curriculum: A Pilot Study of Culturally Grounded Substance Abuse Prevention for Rural Hawaiian Youth. J Health Care Poor Underserved 2018; 27:815-33. [PMID: 27180710 DOI: 10.1353/hpu.2016.0061] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
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.
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Schweitzer RJ, Wills TA, Tam E, Pagano I, Choi K. E-cigarette use and asthma in a multiethnic sample of adolescents. Prev Med 2017; 105:226-231. [PMID: 28964850 PMCID: PMC5653431 DOI: 10.1016/j.ypmed.2017.09.023] [Citation(s) in RCA: 102] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 09/11/2017] [Accepted: 09/24/2017] [Indexed: 10/18/2022]
Abstract
There is minimal evidence from epidemiological studies on how e-cigarette use is related to health indices in adolescence. We hypothesized that e-cigarette use would be associated with asthma, controlling for demographics and cigarette smoking. The hypothesis was tested with cross-sectional data from a statewide sample of school students. Surveys were administered in classrooms in 2015 to adolescents in 33 high schools throughout the State of Hawaii. The sample (N=6089) was 50% female and mean age was 15.8years. Data were obtained on demographics; ever use and current (past 30days) use of e-cigarettes, combustible cigarettes, and marijuana; ever being diagnosed with asthma; and currently having asthma. Multinomial regression examined the association between e-cigarette use and asthma controlling for cigarette smoking, marijuana use, and six demographic covariates. Current e-cigarette use was associated with currently having (vs. never having) asthma (adjusted odds ratio [aOR]=1.48, CI 1.26-1.74) and with previously having (vs. never having) asthma (aOR=1.22, CI 1.07-1.40). This was independent of cigarette smoking, marijuana use, and other covariates. Smoking and marijuana were nonsignificant in the multivariate analysis. Blacks, Native Hawaiians, other Pacific Islanders, and Filipinos had higher rates of asthma compared with Asian Americans and Caucasians. We conclude that e-cigarette use by adolescents is independently associated with asthma. This finding is consistent with recent laboratory research on pulmonary effects from e-cigarette vapor. Implications for public health should be considered.
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Affiliation(s)
- Rebecca J Schweitzer
- Office of Public Health Studies, University of Hawaii at Manoa, Honolulu, HI, USA.
| | - Thomas A Wills
- Cancer Prevention in the Pacific Program, University of Hawaii Cancer Center, Honolulu, HI, USA
| | - Elizabeth Tam
- Department of Medicine, John A. Burns School of Medicine, Honolulu, HI, USA
| | - Ian Pagano
- Cancer Prevention in the Pacific Program, University of Hawaii Cancer Center, Honolulu, HI, USA
| | - Kelvin Choi
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, MD, USA
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Bills K, Okamoto SK, Helm S. The Role of Relational Harmony in the Use of Drug-Refusal Strategies of Rural Native Hawaiian Youths. JOURNAL OF ETHNIC & CULTURAL DIVERSITY IN SOCIAL WORK 2016; 25:208-226. [PMID: 28133439 PMCID: PMC5267551 DOI: 10.1080/15313204.2016.1146190] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
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.
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Wills TA, Knight R, Sargent JD, Gibbons FX, Pagano I, Williams RJ. Longitudinal study of e-cigarette use and onset of cigarette smoking among high school students in Hawaii. Tob Control 2016; 26:34-39. [PMID: 26811353 DOI: 10.1136/tobaccocontrol-2015-052705] [Citation(s) in RCA: 232] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 11/25/2015] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Use of electronic cigarettes (e-cigarettes) is prevalent among adolescents, but there is little knowledge about the consequences of their use. We examined, longitudinally, how e-cigarette use among adolescents is related to subsequent smoking behaviour. METHODS Longitudinal school-based survey with a baseline sample of 2338 students (9th and 10th graders, mean age 14.7 years) in Hawaii surveyed in 2013 (time 1, T1) and followed up 1 year later (time 2, T2). We assessed e-cigarette use, tobacco cigarette use, and psychosocial covariates (demographics, parental support and monitoring, and sensation seeking and rebelliousness). Regression analyses including the covariates tested whether e-cigarette use was related to the onset of smoking among youth who had never smoked cigarettes, and to change in smoking frequency among youth who had previously smoked cigarettes. RESULTS Among T1 never-smokers, those who had used e-cigarettes at T1 were more likely to have smoked cigarettes at T2; for a complete-case analysis, adjusted OR=2.87, 95% CI 2.03 to 4.05, p<0.0001. Among ever-smokers at T1, using e-cigarettes was not related to significant change in their frequency of smoking at T2. Uptake of e-cigarette use among T1 never-users of either product was predicted by age, Caucasian or Native Hawaiian (vs Asian-American) ethnicity, lower parental education and parental support, higher rebelliousness, and perception of e-cigarettes as healthier. CONCLUSIONS Adolescents who use e-cigarettes are more likely to start smoking cigarettes. This result together with other findings suggests that policies restricting adolescents' access to e-cigarettes may have a rationale from a public health standpoint.
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Affiliation(s)
- Thomas A Wills
- Prevention and Control Program, University of Hawaii Cancer Center, Honolulu, Hawaii, USA
| | - Rebecca Knight
- Prevention and Control Program, University of Hawaii Cancer Center, Honolulu, Hawaii, USA
| | - James D Sargent
- Cancer Control Program, Norris Cotton Cancer Center, Lebanon, New Hampshire, USA
| | - Frederick X Gibbons
- Department of Psychology, University of Connecticut, Storrs, Connecticut, USA
| | - Ian Pagano
- Prevention and Control Program, University of Hawaii Cancer Center, Honolulu, Hawaii, USA
| | - Rebecca J Williams
- Office of Public Health Studies, University of Hawaii at Manoa, Honolulu, Hawaii, USA
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Durand Z, Cook A, Konishi M, Nigg C. Alcohol and substance use prevention programs for youth in Hawaii and Pacific Islands: A literature review. J Ethn Subst Abuse 2015; 15:240-251. [DOI: 10.1080/15332640.2015.1024811] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Wu LT, Swartz MS, Brady KT, Hoyle RH. Perceived cannabis use norms and cannabis use among adolescents in the United States. J Psychiatr Res 2015; 64:79-87. [PMID: 25795093 PMCID: PMC4404217 DOI: 10.1016/j.jpsychires.2015.02.022] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Revised: 02/10/2015] [Accepted: 02/26/2015] [Indexed: 11/29/2022]
Abstract
Due to changes in cannabis policies, concerns about cannabis use (CU) in adolescents have increased. The population of nonwhite groups is growing quickly in the United States. We examined perceived CU norms and their association with CU and CU disorder (CUD) for White, Black, Hispanic, Native-American, Asian-American, Native Hawaiian/Pacific Islander (NH/PI), and mixed-race adolescents. Data were from adolescents (12-17 years) in the 2004-2012 National Surveys on Drug Use and Health (N = 163,837). Substance use and CUD were assessed by computer-assisted, self-interviewing methods. Blacks, Hispanics, Native-Americans, and mixed-race adolescents had greater odds of past-year CU and CUD than Whites. Among past-year cannabis users (CUs), Hispanics and Native-Americans had greater odds of having a CUD than Whites. Asian-Americans had the highest prevalence of perceived parental or close friends' CU disapproval. Native-Americans and mixed-race adolescents had lower odds than Whites of perceiving CU disapproval from parents or close friends. In adjusted analyses, adolescent's disapproval of CU, as well as perceived disapproval by parents or close friends, were associated with a decreased odds of CU in each racial/ethnic group, except for NHs/PIs. Adolescent's disapproval of CU was associated with a decreased odds of CUD among CUs for Whites (personal, parental, and close friends' disapproval), Hispanics (personal, parental, and close friends' disapproval), and mixed-race adolescents (personal, close friends' disapproval). Racial/ethnic differences in adolescent CU prevalence were somewhat consistent with adolescents' reports of CU norm patterns. Longitudinal research on CU health effects should oversample nonwhite adolescents to assure an adequate sample for analysis and reporting.
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Affiliation(s)
- Li-Tzy Wu
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University Medical Center, Durham, NC, USA.
| | - Marvin S. Swartz
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Kathleen T. Brady
- South Carolina Clinical and Translational Research Institute, Medical University of South Carolina, Charleston, SC, USA
| | - Rick H. Hoyle
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
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Nakagawa K, Vento MA, Ing MM, Seto TB. Racial disparities in methamphetamine-associated intracerebral hemorrhage. Neurology 2015; 84:995-1001. [PMID: 25663228 DOI: 10.1212/wnl.0000000000001339] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To assess racial disparities in the prevalence of methamphetamine-associated intracerebral hemorrhage (Meth-ICH) among Native Hawaiians and other Pacific Islanders (NHOPI). METHODS Prospectively collected data from an ongoing, multiethnic, single-center cohort study were analyzed. The inclusion criteria for the cohort study required that patients be adult (age 18 years or older) residents of Hawaii with nontraumatic spontaneous intracerebral hemorrhage (ICH). Patients of race other than white, Asian, or NHOPI were excluded. Determination of Meth-ICH was made prospectively by positive urine toxicology result and lack of other clinically suspected ICH etiology. Prevalence of Meth-ICH among NHOPI was compared with that of white and Asian patients. RESULTS A total of 193 patients (white 16%, Asian 61%, NHOPI 23%) were analyzed. NHOPI were younger than white (54 ± 15 vs 68 ± 15 years, respectively, p = 0.0001) and Asian (vs 65 ± 16 years, p = 0.0001) patients. Overall, 25 (13%) Meth-ICHs (mean age: 49 ± 6 years, range: 33-56 years) were identified. NHOPI had higher prevalence of Meth-ICH compared with white (24% vs 0%, respectively, p = 0.003) and Asian (vs 12%, p = 0.046) patients. The observed age differences between the racial groups persisted even after excluding the Meth-ICH group (p < 0.01 for all comparison). CONCLUSIONS NHOPI have higher prevalence of Meth-ICH compared with white and Asian patients. However, the age disparity is not entirely driven by methamphetamine abuse.
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Affiliation(s)
- Kazuma Nakagawa
- From The Queen's Medical Center (K.N., M.A.V., M.M.I., T.B.S.), Honolulu, HI; and Department of Medicine (K.N., T.B.S.), John A. Burns School of Medicine, University of Hawaii, Honolulu.
| | - Megan A Vento
- From The Queen's Medical Center (K.N., M.A.V., M.M.I., T.B.S.), Honolulu, HI; and Department of Medicine (K.N., T.B.S.), John A. Burns School of Medicine, University of Hawaii, Honolulu
| | - Marissa M Ing
- From The Queen's Medical Center (K.N., M.A.V., M.M.I., T.B.S.), Honolulu, HI; and Department of Medicine (K.N., T.B.S.), John A. Burns School of Medicine, University of Hawaii, Honolulu
| | - Todd B Seto
- From The Queen's Medical Center (K.N., M.A.V., M.M.I., T.B.S.), Honolulu, HI; and Department of Medicine (K.N., T.B.S.), John A. Burns School of Medicine, University of Hawaii, Honolulu
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22
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Wu LT, Blazer DG. Substance use disorders and co-morbidities among Asian Americans and Native Hawaiians/Pacific Islanders. Psychol Med 2015; 45:481-494. [PMID: 25066115 PMCID: PMC4272661 DOI: 10.1017/s0033291714001330] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 05/12/2014] [Accepted: 05/16/2014] [Indexed: 12/16/2022]
Abstract
BACKGROUND Asian Americans (AAs) and Native Hawaiians/Pacific Islanders (NHs/PIs) are the fastest growing segments of the US population. However, their population sizes are small, and thus AAs and NHs/PIs are often aggregated into a single racial/ethnic group or omitted from research and health statistics. The groups' substance use disorders (SUDs) and treatment needs have been under-recognized. METHOD We examined recent epidemiological data on the extent of alcohol and drug use disorders and the use of treatment services by AAs and NHs/PIs. RESULTS NHs/PIs on average were less educated and had lower levels of household income than AAs. Considered as a single group, AAs and NHs/PIs showed a low prevalence of substance use and disorders. Analyses of survey data that compared AAs and NHs/PIs revealed higher prevalences of substance use (alcohol, drugs), depression and delinquency among NHs than among AAs. Among treatment-seeking patients in mental healthcare settings, NHs/PIs had higher prevalences of DSM-IV diagnoses than AAs (alcohol/drug, mood, adjustment, childhood-onset disruptive or impulse-control disorders), although co-morbidity was common in both groups. AAs and NHs/PIs with an SUD were unlikely to use treatment, especially treatment for alcohol problems, and treatment use tended to be related to involvement with the criminal justice system. CONCLUSIONS Although available data are limited by small sample sizes of AAs and NHs/PIs, they demonstrate the need to separate AAs and NHs/PIs in health statistics and increase research into substance use and treatment needs for these fast-growing but understudied population groups.
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Affiliation(s)
- L.-T. Wu
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University Medical Center, Durham, NC, USA
- Center for Child and Family Policy, Duke University, Durham, NC, USA
| | - D. G. Blazer
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University Medical Center, Durham, NC, USA
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Helm S, Lee W, Hanakahi V, Gleason K, McCarthy K, Haumana. Using Photovoice with youth to develop a drug prevention program in a rural Hawaiian community. AMERICAN INDIAN AND ALASKA NATIVE MENTAL HEALTH RESEARCH 2015; 22:1-26. [PMID: 25768388 PMCID: PMC4401743 DOI: 10.5820/aian.2201.2015.1] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Substance use represents a significant and persistent health disparity among Native Hawaiian youth and communities. A community-university participatory action research project was conducted to develop a Native Hawaiian model of drug prevention. METHODS Ten youth participated in eight Photovoice focus groups. Focus group transcripts and the youths' SHOWED (see, happening, our, why, empower, do) worksheets were analyzed. RESULTS Emergent analyses are described regarding focus group theme identification and the meaning of each theme. Youth-selected exemplary photographs and researcher-selected exemplary quotations are provided. IMPLICATIONS Native Hawaiian drug prevention will be place-based in culturally significant community locations, experiential, and guided by multigenerational teaching and learning.
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Wills TA, Knight R, Williams RJ, Pagano I, Sargent JD. Risk factors for exclusive e-cigarette use and dual e-cigarette use and tobacco use in adolescents. Pediatrics 2015; 135:e43-51. [PMID: 25511118 PMCID: PMC4279062 DOI: 10.1542/peds.2014-0760] [Citation(s) in RCA: 321] [Impact Index Per Article: 35.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To describe electronic cigarette (e-cigarette) use and cigarette use among adolescents and determine whether established risk factors for smoking discriminate user categories. METHODS School-based survey of 1941 high school students (mean age 14.6 years) in Hawaii; data collected in 2013. The survey assessed e-cigarette use and cigarette use, alcohol and marijuana use, and psychosocial risk and protective variables (eg, parental support, academic involvement, smoking expectancies, peer smoking, sensation seeking). Analysis of variance and multinomial regression examined variation in risk and protective variables across the following categories of ever-use: e-cigarette only, cigarette only, dual use (use of both products), and nonuser (never used either product). RESULTS Prevalence for the categories was 17% (e-cigarettes only), 12% (dual use), 3% (cigarettes only), and 68% (nonusers). Dual users and cigarette-only users were highest on risk status (elevated on risk factors and lower on protective factors) compared with other groups. E-cigarette only users were higher on risk status than nonusers but lower than dual users. E-cigarette only users and dual users more often perceived e-cigarettes as healthier than cigarettes compared with nonusers. CONCLUSIONS This study reports a US adolescent sample with one of the largest prevalence rates of e-cigarette only use in the existing literature. Dual use also had a substantial prevalence. The fact that e-cigarette only users were intermediate in risk status between nonusers and dual users raises the possibility that e-cigarettes are recruiting medium-risk adolescents, who otherwise would be less susceptible to tobacco product use.
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Affiliation(s)
| | | | | | - Ian Pagano
- University of Hawaii Cancer Center, Honolulu, Hawaii
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25
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Wu LT, Swartz MS, Brady KT, Blazer DG, Hoyle RH. Nonmedical stimulant use among young Asian-Americans, Native Hawaiians/Pacific Islanders, and mixed-race individuals aged 12-34 years in the United States. J Psychiatr Res 2014; 59:189-99. [PMID: 25263275 PMCID: PMC4253601 DOI: 10.1016/j.jpsychires.2014.09.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 08/28/2014] [Accepted: 09/04/2014] [Indexed: 10/24/2022]
Abstract
There are concerns over nonmedical use of prescription stimulants among youths, but little is known about the extent of use among young Asian-Americans, Native Hawaiians/Pacific Islanders (NHs/PIs), and mixed-race individuals-the fastest growing segments of the U.S. population. We examined prevalences and correlates of nonmedical stimulant use (NMSU) and disorder (StiUD) for these underrecognized groups. Whites were included as a comparison. Data were from young individuals aged 12-34 years in the 2005-2012 National Surveys on Drug Use and Health. We used logistic regression to estimate odds of past-year NMSU status. Significant yearly increases in lifetime NMSU prevalence were noted in Whites only. NHs/PIs (lifetime 7.33%, past-year 2.72%) and mixed-race individuals (10.20%, 2.82%) did not differ from Whites in NMSU prevalence (11.68%, 3.15%). Asian-Americans (lifetime 3.83%, past-year 0.90%) had lower prevalences than Whites. In each racial/ethnic group, "Methamphetamine/Desoxyn/Methedrine or Ritalin" was more commonly used than other stimulant groups; "got them from a friend/relative for free" and "bought them from a friends/relative" were among the most common sources. Females had greater odds than males of NMSU (among White, NH/PI, mixed-race individuals) and StiUD (among mixed-race individuals). Young adults (aged 18-25) had elevated odds of NMSU (White, NH/PI); adolescents had elevated odds of StiUD (White, mixed-race). Other substance use (especially marijuana, other prescription drugs) increased odds of NMSU and StiUD. NHs/PIs and mixed-race individuals were as likely as Whites to misuse stimulants. Research is needed to delineate health consequences of NMSU and inform prevention efforts for these understudied, rapidly-growing populations.
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Affiliation(s)
- Li-Tzy Wu
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University Medical Center, Durham, NC, USA.
| | - Marvin S. Swartz
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Kathleen T. Brady
- South Carolina Clinical and Translational Research Institute, Medical University of South Carolina, Charleston, SC, USA
| | - Dan G. Blazer
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Rick H. Hoyle
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
| | - NIDA AAPI Workgroup
- National Institute on Drug Abuse Asian American and Pacific Islander Researchers and Scholars Workgroup, Bethesda, MD, USA
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A continuum of approaches toward developing culturally focused prevention interventions: from adaptation to grounding. J Prim Prev 2014; 35:103-12. [PMID: 24322970 DOI: 10.1007/s10935-013-0334-z] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The purpose of this article is to describe a conceptual model of methods used to develop culturally focused interventions. We describe a continuum of approaches ranging from non-adapted/surface-structure adapted programs to culturally grounded programs, and present recent examples of interventions resulting from the application of each of these approaches. The model has implications for categorizing culturally focused prevention efforts more accurately, and for gauging the time, resources, and level of community engagement necessary to develop programs using each of the different methods. The model also has implications for funding decisions related to the development and evaluation of programs, and for planning of participatory research approaches with community members.
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Rowan M, Poole N, Shea B, Gone JP, Mykota D, Farag M, Hopkins C, Hall L, Mushquash C, Dell C. Cultural interventions to treat addictions in Indigenous populations: findings from a scoping study. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2014; 9:34. [PMID: 25179797 PMCID: PMC4158387 DOI: 10.1186/1747-597x-9-34] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2014] [Accepted: 08/26/2014] [Indexed: 01/06/2023]
Abstract
Background Cultural interventions offer the hope and promise of healing from addictions for Indigenous people.a However, there are few published studies specifically examining the type and impact of these interventions. Positioned within the Honouring Our Strengths: Culture as Intervention project, a scoping study was conducted to describe what is known about the characteristics of culture-based programs and to examine the outcomes collected and effects of these interventions on wellness. Methods This review followed established methods for scoping studies, including a final stage of consultation with stakeholders. The data search and extraction were also guided by the “PICO” (Patient/population, Intervention, Comparison, and Outcome) method, for which we defined each element, but did not require direct comparisons between treatment and control groups. Twelve databases from the scientific literature and 13 databases from the grey literature were searched up to October 26, 2012. Results The search strategy yielded 4,518 articles. Nineteen studies were included from the United States (58%) and Canada (42%), that involved residential programs (58%), and all (100%) integrated Western and culture-based treatment services. Seventeen types of cultural interventions were found, with sweat lodge ceremonies the most commonly (68%) enacted. Study samples ranged from 11 to 2,685 clients. Just over half of studies involved quasi-experimental designs (53%). Most articles (90%) measured physical wellness, with fewer (37%) examining spiritual health. Results show benefits in all areas of wellness, particularly by reducing or eliminating substance use problems in 74% of studies. Conclusions Evidence from this scoping study suggests that the culture-based interventions used in addictions treatment for Indigenous people are beneficial to help improve client functioning in all areas of wellness. There is a need for well-designed studies to address the question of best relational or contextual fit of cultural practices given a particular place, time, and population group. Addiction researchers and treatment providers are encouraged to work together to make further inroads into expanding the study of culture-based interventions from multiple perspectives and locations.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Colleen Dell
- Department of Sociology, University of Saskatchewan, 1109 - 9 Campus Drive, Saskatoon, SK S7N 5A5, Canada.
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Okamoto SK, Kulis S, Helm S, Edwards C, Giroux D. The Social Contexts of Drug Offers and Their Relationship to Drug Use of Rural Hawaiian Youth. JOURNAL OF CHILD & ADOLESCENT SUBSTANCE ABUSE 2014; 23:242-252. [PMID: 24860249 DOI: 10.1080/1067828x.2013.786937] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This paper examines the differences in drug offers and recent drug use between Hawaiian and non-Hawaiian youth residing in rural communities, and the relationship between drug offers and drug use of Hawaiian youth in these communities. Two hundred forty nine youth (194 Hawaiian youth) from 7 different middle or intermediate schools completed a survey focused on the social context of drug offers. Hawaiian youth in the study received significantly more offers from peers and family, and had significantly higher rates of recent alcohol and marijuana use, compared with non-Hawaiian youth. Logistic regression analysis indicated that the social context differentially influenced drug use of Hawaiian youth, with family drug offers and context influencing overall drug use and the use of the widest variety of substances. Implications for prevention practices are discussed.
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Affiliation(s)
| | - Stephen Kulis
- School of Social and Family Dynamics, Arizona State University
| | - Susana Helm
- Department of Psychiatry, University of Hawai'i at Mānoa
| | | | - Danielle Giroux
- Clinical-Community Psychology Program, University of Alaska Anchorage
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Wu LT, Brady KT, Mannelli P, Killeen TK. Cannabis use disorders are comparatively prevalent among nonwhite racial/ethnic groups and adolescents: a national study. J Psychiatr Res 2014; 50:26-35. [PMID: 24342767 PMCID: PMC3941308 DOI: 10.1016/j.jpsychires.2013.11.010] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Revised: 10/23/2013] [Accepted: 11/20/2013] [Indexed: 11/20/2022]
Abstract
The racial/ethnic composition of the US population is shifting, with the nonwhite population growing faster than whites. We examined cannabis use disorder (CUD) prevalences and correlates in seven racial/ethnic groups. We included cannabis use (CU) prevalence as a comparison. Data were from the 2005-2011 National Surveys on Drug Use and Health (N = 394,400). Substance use among respondents aged ≥12 years was assessed by computer-assisted, self-interviewing methods. The following were included as control variables: age, sex, family income, government assistance, county type, residential stability, major depressive episode history, arrest history, nicotine dependence, alcohol disorder, and survey year. Past-year CU prevalence increased significantly from 10.45% in 2005 to 11.41-11.54% during 2009-2011. Compared with whites, mixed-race individuals had higher odds of CU; Asian Americans and Hispanics had lower odds of CU. There were no significant yearly changes in CUD prevalence in the sample during 2005-2011 (1.58-1.73%). Compared with whites, individuals who were mixed-race, black, and Native American had higher odds of CUD; Asian Americans had lower odds. In aggregate, 15.35% of past-year cannabis users met criteria for a CUD in the 12-month period. Past-year cannabis users who were black, Native American, Hispanic, or Asian American had higher odds of CUD than white users. In each racial/ethnic group, adolescent cannabis users generally showed greater odds of CUD than adult users. Behavioral health indicators (major depressive episode, arrest history, nicotine dependence, alcohol disorder) were associated with CU and CUD. In conclusion, CUD disproportionally affects nonwhite groups and youth.
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Affiliation(s)
- Li-Tzy Wu
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University Medical Center, Durham, NC, USA.
| | - Kathleen T Brady
- South Carolina Clinical and Translational Research Institute, Medical University of South Carolina, Charleston, SC, USA
| | - Paolo Mannelli
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Therese K Killeen
- Department of Psychiatry and Behavioral Sciences, Clinical Neuroscience Division, Charleston, SC, USA
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Okamoto SK, Helm S, Pel S, McClain LL, Hill AP, Hayashida JKP. Developing empirically based, culturally grounded drug prevention interventions for indigenous youth populations. J Behav Health Serv Res 2014; 41:8-19. [PMID: 23188485 PMCID: PMC3595362 DOI: 10.1007/s11414-012-9304-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
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.
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Affiliation(s)
- Scott K. Okamoto
- School of Social Work, Hawai‘i Pacific University, 1188 Fort Street Mall, Suite 201C, Honolulu, Hawai‘i, 96813. Telephone: (808) 544-1160; Fax: (808) 544-1424
| | - Susana Helm
- Department of Psychiatry, John A. Burns School of Medicine, University of Hawai‘i at Mānoa, 1441 Kapi‘olani Blvd., Suite 1803, Honolulu, Hawai‘i, 96814. Telephone: (808) 945-1462; Fax: (808) 945-1522
| | - Suzanne Pel
- School of Social Work, Hawai‘i Pacific University, 1188 Fort Street Mall, Suite 201C, Honolulu, Hawai‘i, 96813. Telephone: (808) 544-1160; Fax: (808) 544-1424
| | - Latoya L. McClain
- School of Social Work, Hawai‘i Pacific University, 1188 Fort Street Mall, Suite 201C, Honolulu, Hawai‘i, 96813. Telephone: (808) 544-1160; Fax: (808) 544-1424
| | - Amber P. Hill
- School of Social Work, Hawai‘i Pacific University, 1188 Fort Street Mall, Suite 201C, Honolulu, Hawai‘i, 96813. Telephone: (808) 544-1160; Fax: (808) 544-1424
| | - Janai K. P. Hayashida
- School of Social Work, Hawai‘i Pacific University, 1188 Fort Street Mall, Suite 201C, Honolulu, Hawai‘i, 96813. Telephone: (808) 544-1160; Fax: (808) 544-1424
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Helm S, Okamoto S, Kaliades A, Giroux D. Drug offers as a context for violence perpetration and victimization. J Ethn Subst Abuse 2014; 13:39-57. [PMID: 24564559 PMCID: PMC4260524 DOI: 10.1080/15332640.2013.853015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
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.
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Affiliation(s)
- Susana Helm
- School of Social Work, Hawai`i Pacific University, Honolulu,
HI
| | - Scott Okamoto
- School of Social Work, Hawai`i Pacific University, Honolulu,
HI
| | - Alexis Kaliades
- School of Social Work, Hawai`i Pacific University, Honolulu, HI.
()
| | - Danielle Giroux
- Department of Psychology, University of Alaska—Anchorage,
Anchorage, Alaska. ()
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Wu LT, Blazer DG, Swartz MS, Burchett B, Brady KT. Illicit and nonmedical drug use among Asian Americans, Native Hawaiians/Pacific Islanders, and mixed-race individuals. Drug Alcohol Depend 2013; 133:360-7. [PMID: 23890491 PMCID: PMC3818295 DOI: 10.1016/j.drugalcdep.2013.06.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Revised: 06/15/2013] [Accepted: 06/15/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND The racial/ethnic composition of the United States is shifting rapidly, with non-Hispanic Asian-Americans, Native Hawaiians/Pacific Islanders (NHs/PIs), and mixed-race individuals the fastest growing segments of the population. We determined new drug use estimates for these rising groups. Prevalences among Whites were included as a comparison. METHODS Data were from the 2005-2011 National Surveys on Drug Use and Health. Substance use among respondents aged ≥ 12 years was assessed by computer-assisted self-interviewing methods. Respondents' self-reported race/ethnicity, age, gender, household income, government assistance, county type, residential stability, major depressive episode, history of being arrested, tobacco use, and alcohol use were examined as correlates. We stratified the analysis by race/ethnicity and used logistic regression to estimate odds of drug use. RESULTS Prevalence of past-year marijuana use among Whites increased from 10.7% in 2005 to 11.6-11.8% in 2009-2011 (P<0.05). There were no significant yearly changes in drug use prevalences among Asian-Americans, NHs/PIs, and mixed-race people; but use of any drug, especially marijuana, was prevalent among NHs/PIs and mixed-race people (21.2% and 23.3%, respectively, in 2011). Compared with Asian-Americans, NHs/PIs had higher odds of marijuana use, and mixed-race individuals had higher odds of using marijuana, cocaine, hallucinogens, stimulants, sedatives, and tranquilizers. Compared with Whites, mixed-race individuals had greater odds of any drug use, mainly marijuana, and NHs/PIs resembled Whites in odds of any drug use. CONCLUSIONS Findings reveal alarmingly prevalent drug use among NHs/PIs and mixed-race people. Research on drug use is needed in these rising populations to inform prevention and treatment efforts.
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Affiliation(s)
- Li-Tzy Wu
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, United States.
| | - Dan G. Blazer
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, United States
| | - Marvin S. Swartz
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, United States
| | - Bruce Burchett
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, United States
| | - Kathleen T. Brady
- Clinical Neurosciences Division, Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425, United States
| | - NIDA AAPI Workgroup
- National Institute on Drug Abuse Asian American and Pacific Islander Researchers and Scholars Workgroup, Bethesda, MD 20892, United States
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Wu LT, Blazer DG, Gersing KR, Burchett B, Swartz MS, Mannelli P. Comorbid substance use disorders with other Axis I and II mental disorders among treatment-seeking Asian Americans, Native Hawaiians/Pacific Islanders, and mixed-race people. J Psychiatr Res 2013; 47:1940-8. [PMID: 24060266 PMCID: PMC3846388 DOI: 10.1016/j.jpsychires.2013.08.022] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Revised: 08/29/2013] [Accepted: 08/29/2013] [Indexed: 02/06/2023]
Abstract
Little is known about behavioral healthcare needs of Asian Americans (AAs), Native Hawaiians/Pacific Islanders (NHs/PIs), and mixed-race people (MRs)-the fastest growing segments of the U.S. population. We examined substance use disorder (SUD) prevalences and comorbidities among AAs, NHs/PIs, and MRs (N = 4572) in a behavioral health electronic health record database. DSM-IV diagnoses among patients aged 1-90 years who accessed behavioral healthcare from 11 sites were systematically captured: SUD, anxiety, mood, personality, adjustment, childhood-onset, cognitive/dementia, dissociative, eating, factitious, impulse-control, psychotic/schizophrenic, sleep, and somatoform diagnoses. Of all patients, 15.0% had a SUD. Mood (60%), anxiety (31.2%), adjustment (30.9%), and disruptive (attention deficit-hyperactivity, conduct, oppositional defiant, disruptive behavior diagnosis, 22.7%) diagnoses were more common than others (psychotic 14.2%, personality 13.3%, other childhood-onset 11.4%, impulse-control 6.6%, cognitive 2.8%, eating 2.2%, somatoform 2.1%). Less than 1% of children aged <12 years had SUD. Cannabis diagnosis was the primary SUD affecting adolescents aged 12-17. MRs aged 35-49 years had the highest prevalence of cocaine diagnosis. Controlling for age at first visit, sex, treatment setting, length of treatment, and number of comorbid diagnoses, NHs/PIs and MRs were about two times more likely than AAs to have ≥ 2 SUDs. Regardless of race/ethnicity, personality diagnosis was comorbid with SUD. NHs/PIs with a mood diagnosis had elevated odds of having SUD. Findings present the most comprehensive patterns of mental diagnoses available for treatment-seeking AAs, NHs/PIs, and MRs in the real-world medical setting. In-depth research is needed to elucidate intraracial and interracial differences in treatment needs.
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Affiliation(s)
- Li-Tzy Wu
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University Medical Center, Durham, NC, USA.
| | - Dan G. Blazer
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Kenneth R. Gersing
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Bruce Burchett
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Marvin S. Swartz
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Paolo Mannelli
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University Medical Center, Durham, NC, USA
| | - NIDA AAPI Workgroup
- National Institute on Drug Abuse Asian American and Pacific Islander Researchers and Scholars Workgroup, Bethesda, MD, USA
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Abstract
Many indigenous cultures use storytelling as the foundation for the transmission of important cultural information. Stories passed down from generation to generation sometimes teach, record history, provide examples, or inform. One important function of storytelling is the transmission of stories about cultural resilience illustrating how a cultural group has kept strong in the face of adversity. This article shows how storytelling in the Hawaiian culture has been used for this purpose and how the Beamer family has served as the master storytellers of their culture, keeping the culture and traditions alive through their music, dance, and stories.
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Affiliation(s)
- Jeannette L Johnson
- 1National Institutes of Health/National Institute on Aging , Bethesda, Maryland , USA
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Thompson LM, Jarvis S, Sparacino P, Kuo D, Genz S. Perceptions of health equity and subjective social status among baccalaureate nursing students engaged in service-learning activities in Hawai'i. HAWAI'I JOURNAL OF MEDICINE & PUBLIC HEALTH : A JOURNAL OF ASIA PACIFIC MEDICINE & PUBLIC HEALTH 2013; 72:339-45. [PMID: 24167767 PMCID: PMC3796782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The purpose of this study was to measure undergraduate students' knowledge of social determinants of health, health equity, and subjective social status (SSS). A cross-sectional semi-structured survey was administered to 68 racially/ethnically diverse freshman students enrolled in a baccalaureate nursing program in O'ahu, Hawai'i. Students ranked the impact of 13 issues on Hawai'i residents' health and described how well the health care system addressed these issues. A 10-rung ladder was used to rank SSS; students marked an "X" on the ladder rung where they stand in society and explained what they would need to "move up or down" the ladder. The students identified three key issues that adversely impact health: substance abuse, diet/nutrition, and cancer. Sixty-nine percent of students stated that social determinants of health impact Hawai'i residents' health either "quite a bit" or "very much", while only 31% felt that the health care system adequately addressed these determinants. Students who ranked high on the ladder (rungs 6-10) cited family as the reason. The students who ranked low on the ladder (rungs 3-5) credited their position to lack of money. Students' perceptions of social determinants of health and health equity align with findings from public health studies in Hawai'i. These concepts were integrated into the 4-year nursing school curricula and findings inform future research and service-based learning activities conducted by the students. While findings presented here focus on nursing students in Hawai'i, this educational innovation could be replicated with students in other undergraduate health sciences programs.
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Affiliation(s)
- Lisa M Thompson
- Department of Family Health Care Nursing, University of California, San Francisco; San Francisco, CA (L.M.T., P.S.)
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Helm S, Okamoto SK. Developing the Ho'ouna Pono substance use prevention curriculum: collaborating with Hawaiian youth and communities. HAWAI'I JOURNAL OF MEDICINE & PUBLIC HEALTH : A JOURNAL OF ASIA PACIFIC MEDICINE & PUBLIC HEALTH 2013; 72:66-9. [PMID: 23463854 PMCID: PMC3585502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
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.
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Affiliation(s)
- Susana Helm
- Department of Psychiatry, John A. Burns School of Medicine, University of Hawai'i at Manoa, HI, USA.
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37
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Okamoto SK, Helm S, McClain LL, Dinson AL. The development of videos in culturally grounded drug prevention for rural native Hawaiian youth. J Prim Prev 2012; 33:259-69. [PMID: 23143071 DOI: 10.1007/s10935-012-0281-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
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.
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Affiliation(s)
- Scott K Okamoto
- School of Social Work, Hawai'i Pacific University, 1188 Fort St. Mall, Suite 201C, Honolulu, HI 96813, USA.
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Nakagawa K, Koenig MA, Seto TB, Asai SM, Chang CW. Racial disparities among Native Hawaiians and Pacific Islanders with intracerebral hemorrhage. Neurology 2012; 79:675-80. [PMID: 22815551 DOI: 10.1212/wnl.0b013e3182608c6f] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVES To evaluate disparities in stroke risk factors and outcome among the Native Hawaiians and other Pacific Islanders (NHPI) in Hawaii who are hospitalized with intracerebral hemorrhage (ICH). METHODS We performed a retrospective study on consecutive patients hospitalized for acute ICH at a single tertiary center on Oahu between 2004 and 2010. Clinical data were obtained from the Get With the Guidelines-Stroke database. Multivariable logistic regression was used to assess the predictors for young ICH (age <45). RESULTS A total of 562 patients hospitalized for acute ICH (Asian 63%, NHPI 18%, white 16%, other 3%) were studied. The NHPI were younger (mean ages, NHPI 55 ± 16 vs white 66 ± 16 years, p < 0.0001), and had higher prevalence of diabetes (NHPI 35% vs white 20%, p = 0.01) and history of hypertension (NHPI 77% vs white 64%, p = 0.04) compared to white patients. Independent predictors for young ICH were NHPI race (odds ratio [OR] 3.55; 95% confidence interval [CI] 1.33-9.45), being transferred from another hospital (OR 2.03; 95% CI 1.05-3.93), hypertension (OR 0.49; 95% CI 0.27-0.91), previous stroke or TIA (OR 0.21; 95% CI 0.05-0.91), and dyslipidemia (OR 0.15; 95% CI 0.05-0.50). CONCLUSIONS NHPI with ICH are younger and have higher burden of risk factors compared to white patients. Further studies controlling for socioeconomic modifiers are needed to determine factors contributing to the younger age at presentation in this racial group.
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Affiliation(s)
- Kazuma Nakagawa
- The Queen’s Medical Center, and Department of Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, USA.
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Abstract
This paper discusses the limitations of previous research on race, ethnicity, culture, and substance use. The study offers the following recommendations for future research in this area: (1) move beyond simple comparisons of mutually exclusive groups, (2) focus on the meaning of an ethnic label to the individual, (3) consider the complex interactions between an individual's cultural identity and the cultural context, (4) understand and acknowledge the researcher's inherent biases, and (5) translate research findings into practice and policy change.
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Affiliation(s)
- Jennifer B Unger
- Keck School of Medicine, University of Southern California, Los Angeles, California 90089, USA.
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Okamoto SK, Helm S, Delp JA, Stone K, Dinson AL, Stetkiewicz J. A community stakeholder analysis of drug resistance strategies of rural native Hawaiian youth. J Prim Prev 2012; 32:185-93. [PMID: 21809110 DOI: 10.1007/s10935-011-0247-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
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.
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Affiliation(s)
- Scott K Okamoto
- School of Social Work, Hawai'i Pacific University, 1188 Fort St. Mall, Suite 430, Honolulu, HI 96813, USA.
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Okamoto SK, Helm S, Giroux D, Kaliades A, Kawano KN, Kulis S. A typology and analysis of drug resistance strategies of rural Native Hawaiian youth. J Prim Prev 2011; 31:311-9. [PMID: 20640939 DOI: 10.1007/s10935-010-0222-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This study examines the drug resistance strategies described by Native Hawaiian youth residing in rural communities. Sixty-four youth from 7 middle and intermediate schools on the Island of Hawai'i participated in a series of gender-specific focus groups. Youth responded to 15 drug-related problem situations developed and validated from prior research. A total of 509 responses reflecting primary or secondary drug resistance strategies were identified by the youth, which were qualitatively collapsed into 16 different categories. Primary drug resistance strategies were those that participants listed as a single response, or the first part of a two-part response, while secondary drug resistance strategies were those that were used in tandem with primary drug resistance strategies. Over half of the responses reflecting primary drug resistance strategies fell into three different categories ("refuse," "explain," or "angry refusal"), whereas over half of the responses reflecting secondary drug resistance strategies represented one category ("explain"). Significant gender differences were found in the frequency of using different strategies as well as variations in the frequency of using different strategies based on the type of drug offerer (family versus friends/peers). Implications for prevention practice are discussed.
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Affiliation(s)
- Scott K Okamoto
- School of Social Work, Hawai'i Pacific University, 1188 Fort St. Mall, Honolulu, HI 96813, USA.
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OKAMOTO SCOTTK, HELM SUSANA, GIROUX DANIELLE, KALIADES ALEXIS. "I No Like Get Caught Using Drugs": Explanations for Refusal as a Drug Resistance Strategy for Rural Native Hawaiian Youth. JOURNAL OF ETHNIC & CULTURAL DIVERSITY IN SOCIAL WORK 2011; 20:150-166. [PMID: 21625339 PMCID: PMC3103076 DOI: 10.1080/15313204.2011.570131] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
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.
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Affiliation(s)
- SCOTT K. OKAMOTO
- School of Social Work, Hawai‘i Pacific University, 1188 Fort St. Mall, Suite 430, Honolulu, HI 96813,USA.
| | - SUSANA HELM
- Department of Psychiatry, John A. Burns School of Medicine, University of Hawai‘i at Mānoa, 1441 Kapi‘olani Blvd., Suite 1803, Honolulu, HI 96814, USA.
| | - DANIELLE GIROUX
- Clinical-Community Psychology Program, University of Alaska Anchorage, 3211 Providence Dr., SSB 303, Anchorage, AK 99508, USA.
| | - ALEXIS KALIADES
- Hawai‘i Speed and Quickness, 1750 Kalakaua Ave., Suite 1410, Honolulu, HI 96826. USA.
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Okamoto SK, Helm S, Po A-Kekuawela KO, Chin CIH, Nebre LRH. Exploring Culturally Specific Drug Resistance Strategies of Hawaiian Youth in Rural Communities. JOURNAL OF ALCOHOL AND DRUG EDUCATION 2010; 54:56-75. [PMID: 20730023 PMCID: PMC2922754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
This qualitative study examined the drug resistance strategies of Hawaiian youth residing in rural communities in Hawai`i. Forty seven youth participated in 14 focus groups which focused on the social and environmental context of drug use for these youth. The findings indicated that there were 47 references to resistance strategies used in drug offer situations. These strategies fell within two different categories: (1) overt/confrontational drug resistance strategies, and (2) non-confrontational drug resistance strategies. These strategies occurred within the community context of relational networks of ascribed and biological family members, and differed in frequency of use by gender. Implications for culturally grounded drug prevention programs for rural Hawaiian youth are discussed.
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