The Development of Videos in Culturally Grounded Drug Prevention for Rural Hawaiian Youth

Introduction: The lack of prevention research on indigenous populations, including Native Hawaiians, coupled with their disproportionately high substance use rates has led to the recent federal emphasis on the development of science-based approaches to drug prevention for these populations. Consistent with federal scientific priorities, 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. The validated and adapted scripts in this study form the core of an emerging, innovative drug prevention program for rural Hawaiian youth.

Methods: Seventy-four youth within eight middle/intermediate or high schools on Hawai‘i Island participated in this study. Youth participated in 15 gender-specific focus groups (2-10 youth per group; M = 4.63, SD= 2.33). Participants within each group were given a copy of one of seven narrative scripts, all of which were developed from prior NIDA-funded, pre-prevention research. Group facilitators asked the participants questions related to the realism of each script. Focus group discussions were transcribed verbatim, and grounded theory coding procedures were conducted to examine patterns in suggested changes to each narrative script.

Results: Participants in all 15 focus groups affirmed the overall validity of the narrative scripts. Although overall agreement with the situations described in each of the scripts was evident, youth offered suggestions to increase the realism of the scripts, which reflected two primary themes—changes in the settings within the scripts, and changes in the behaviors of the actors in the scripts. Regarding settings, youth suggested the addition of references to local foods (e.g., laulau) or specific rural locations. Regarding behaviors, youth suggested changes in responses to drug offers based on the relationship of the protagonist to the offerer in the script. For drug offers from peers/friends and parents, youth suggested changes to the scripts that made responses to the drug offers more non-confrontational or indirect. For drug offers from cousins, youth suggested changes that made responses to the drug offers more overt and confrontational.

Conclusions: The findings from this study validated prior research findings on drug resistance strategies of rural Hawaiian youth, and highlighted the culture- and context-specific decision making processes that these youth use in drug refusal. Videos based on these scripts are being used as core components of culturally specific drug resistance skills training in ongoing NIDA-funded intervention research in rural Hawai‘i.