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

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

A Systematic Review of Racial and Ethnic Disparities in Maternal Health Outcomes among Asians/Pacific Islanders.

Efforts to improve women's health and to reduce maternal mortality worldwide have led to a notable reduction in the global maternal mortality ratio (MMR) over the past two decades. However, it is clear that maternal health outcomes are not equitable, especially when analyzing the scope of maternal health disparities across "developed" and "underdeveloped" nations. This study evaluates recent MMR scholarship with a particular focus on the racial and ethnic divisions that impact on maternal health outcomes. The study contributes to MMR research by analyzing the racial and ethnic disparities that exist in the US, especially among Asian and Pacific Islander (API) subgroups. The study applies exclusionary criteria to 710 articles and subsequently identified various maternal health issues that disproportionately affect API women living in the US. In applying PRISMA review guidelines, the study produced 22 peer-reviewed articles that met inclusionary and exclusionary criteria for this review. The data analysis identified several maternal health foci: obstetric outcomes, environmental exposure, obstetric care and quality measures, and pregnancy-related measures. Only eight of the 22 reviewed studies disaggregated API populations by focusing on specific subgroups of APIs, which signals a need to reconceptualize marginalized API communities' inclusion in health care systems, to promote their equitable access to care, and to dissolve health disparities among racial and ethnic divides. Several short- and long-term initiatives are recommended to develop and implement targeted health interventions for API groups, and thus provide the groundwork for future empirically driven research among specific API subgroups in the US.

The implementation of a culturally grounded, school-based, drug prevention curriculum in rural Hawai'i.

This article describes the process of infusing implementation strategies in the development of a school-based drug prevention curriculum for rural Native Hawaiian youth. The curriculum (Ho'ouna Pono) is a video-enhanced, teacher-implemented curriculum developed using a culturally grounded and community-based participatory research approach. Throughout the development of the curriculum, strategies reflective of the domains of the Consolidated Framework for Implementation Research (CFIR) were integrated into the teacher training manual, to promote the implementation, adoption, and sustainability of the curriculum in rural Hawai'i. These strategies were validated through qualitative data across two interrelated studies with community stakeholders in rural Hawai'i. Implications for prevention, community, and educational practices are described in this article.

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.