Examining implementation determinants of a culturally grounded, school-based prevention curriculum in rural Hawai'i: A test development and validation study.

Background: This study examined the implementation determinants of a culturally grounded, school-based drug prevention curriculum in rural Hawai'i. Test development and validation procedures were used to examine the impact of implementation barriers and facilitators of the curriculum in public or charter middle/intermediate schools on Hawai'i Island. Method: A five-phase, mixed-methods approach toward test development and validation was used. These phases included item generation (Phase 1), item refinement and selection (Phase 2), item reduction (Phase 3), reliability testing (Phase 4), and validity testing (Phase 5). Educational administrators, teachers, and staff employed by the Hawai'i State Department of Education (HIDOE) participated in the study. Results: Phases 1 and 2 yielded 50 implementation barriers and 27 implementation facilitators that were evaluated by 204 HIDOE administrators, teachers, and staff. Factor analysis of the barrier items indicated a four-factor solution: (1) Innovation Barriers, (2) HIDOE State-Level Barriers, (3) Teacher-Level Barriers, and (4) Administrator-Level Barriers. Mean comparisons indicated that several barrier and facilitator items differentiated teachers from administrators in the sample. Conclusions: This study contributes to the implementation measurement literature, specifically in the areas of mental health and substance use. It also highlights the importance of addressing multiple contextual levels in the implementation of culturally focused prevention interventions. Plain Language Summary Title: Examining Implementation Barriers and Facilitators for School-Based Prevention in Hawai'i. Plain Language Summary Compared with other major ethnic groups, Native Hawaiian and Pacific Islander (NHPI) youth have substantially higher rates of substance use and higher adverse mental and physical health effects related to their use. Despite these disparities, educational and community-based practitioners have long struggled with implementing and sustaining promising substance use interventions for NHPI youth. This study contributes to our understanding of measuring implementation barriers and facilitators for substance use prevention for NHPI youth in rural school settings. It contributes to the field of health disparities and health equity promotion, by addressing calls for research to understand factors affecting successful implementation of prevention programs. This is critical toward achieving health equity for underrepresented and vulnerable populations, such as NHPI and rural youth.

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.

Ho'ouna Pono implementation: applying concept mapping to a culturally grounded substance use prevention curriculum in rural Hawai'i schools.

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.

The Relationship Between Ethnocultural Identity Measures and Youth Substance Use Among a School-Based Sample: A Focus on Native Hawaiian Youth.

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.

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.