Culture As Intervention: Developing Evidence-Based Drug Prevention with a Native Hawaiian Community

Introduction: Substance use is a serious public health concern across the United States, and represents a health disparity among Native Hawaiians. Hawaiian youth have reported earlier onset and higher use rates, which are linked to comorbid health outcomes into adulthood (cardiovascular and metabolic diseases, cancer). In an effort to prevent substance use, some Hawaiian communities have initiated collaborations with universities to engage in community based participatory action research (CB/PAR). This paper focuses on the Puni Ke Ola project which uses a “culture as intervention” stance in developing an evidence based drug prevention program.

Methods: This presentation focuses on a photovoice project in which youth leaders were loaned cameras so that they may take pictures representing “What are the Hawaiian values, beliefs, practices, & ways of knowing that we know and use, and that would be important to include in a model of Native Hawaiian drug prevention.” Ten girls and boys, aged 12 to 18 participated in the 6 month photovoice project, which also included a series of 8 focus group discussions. Interviews were facilitated by the lead authors, audio recorded, transcribed, and then verified for accuracy and de-identified. We used a grounded theory approach to the narrative analyses, which were verified through a series of community presentations and talk story sessions.

Results: The university based research team identified over 60 themes through narrative analyses, which were subsequently resorted to about 30 main themes.  Furthermore, these themes were organized into 3 overarching categories: 1) Native Hawaiian specific, 2) pan-indigenous, and 3) culturally relevant among broader community. Finally, with respect to developing a prevention framework, a problem-solution dynamic emerged. The problem of historical cultural trauma and ongoing cultural loss may be solved through culture as intervention approach. For this community, culture as intervention means adhering to a model of health that harkens pre-colonial traditions, with an emphasis on the lokahi triangle. The lokahi triangle model of health means striving to balance interconnecting relationships across spirituality, the natural environment, and humanity.

Conclusion: With the culture as intervention approach to healing historical cultural trauma and ongoing cultural loss by seeking balance in the lokahi triangle, a framework for community-based substance use prevention for youth has been established. Aspects of this framework will be shared as part of the symposium. Future prevention research will focus on curriculum development and outcome evaluation, also using CB/PAR and photovoice with youth, adults, and elders in the community.