Ethnic Differences in Substance Use Among Pacific Islander Adolescents: A Mediational Analysis

Introduction: About two‑thirds of the population of the state of Hawaii are of Asian, Native Hawaiian or other Pacific Islander ancestry. Public health statistics indicate that Native Hawaiians currently have an elevated rate of mortality compared with other ethnic groups, and substance use is believed to contribute to the health differentials. However, there is little evidence about the basis for ethnic differences in substance use among Pacific Islander adolescents, and health disparities researchers have emphasized the need for detailed data on specific subgroups. Therefore, the purpose of this study is to examine ethnocultural differences in substance use among youth in Hawai‘i.

Methods: We conducted a school-based study in Honolulu, Hawai‘i, obtaining data on substance use (tobacco, alcohol, and marijuana) and psychosocial variables for 881 adolescents (M age = 13.5 years, 55% were female, and average parental education was high school graduate). Data were obtained through a self-report questionnaire administered in classrooms by trained research staff. The sample was 22% Asian-American, 26% Native Hawaiian/Pacific Islander, 35% Filipino, 9% Caucasian, and 8% other ethnicity.

Results: Prevalence results showed substance use was significantly elevated among Native Hawaiian adolescents and also among Filipinos, compared with Caucasians or Asian-Americans. Structural modeling analysis was conducted entering indices for ethnicity as the predictor together with covariates of family structure and parental education. Seven psychosocial variables were specified as mediators, and a latent construct for adolescent substance use was the criterion. Results showed the relationship of ethnicity and substance use occurred as indirect effects for both Native Hawaiians and Filipinos, with no direct effects to substance use. Pathways for Native Hawaiians involved elevated levels of poor regulation, negative life events, relatively favorable perceptions of substance users, and less parental disapproval of substance use. Pathways for Filipinos involved elevations in negative life events and favorable substance use prototypes plus higher perceived consensus for substance use. The mediators had some indirect effects to substance use, through promoting affiliation with peer users, as well as two direct effects to substance use (for parental attitudes and tolerance for deviance).

Conclusions: This study describes the multiple pathways from ethnicity to substance use. The mediation findings have implications for the development of ethnic-specific prevention interventions.