The Role of Relational Harmony in the Use of Drug Refusal Strategies of Rural Native Hawaiian Youth

Introduction: Recently, there has been a national emphasis on the health and well-being of Native Hawaiians and other Pacific Islanders (NHOPIs), yet, research has lagged in terms of identifying the social and environmental contributors to health disparities of these populations, and the interventions necessary to address them. To fill this scientific gap, this pre-prevention study focused on how maintaining relational harmony among family members influenced both the selection and use of drug resistance strategies 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). The intent of the groups was to focus on the adaptation and validation of narrative scripts to be used to film culturally grounded videos for rural Hawaiian youth. Focus group discussions of family-based scripts were transcribed verbatim, and grounded theory coding procedures were conducted to examine patterns in suggested changes to each family-based script.

Results: Both boys and girls groups emphasized the importance of maintaining relational harmony among family members; however, these findings differed by gender. Instrumental motives were emphasized in the discussion of scripts within boys’ groups. Boys in the study expressed concerns about maintaining harmony between the youth protagonist in the script and various family members (e.g., youth not getting in trouble), but did not appear to be as concerned about maintaining relational harmony between other family members. In contrast, holistic concerns were emphasized in the discussion of scripts within girls’ groups. Girls primarily defined relational harmony as ensuring that family members were not mad at each other, and rarely mentioned a fear of "getting in trouble" in discussions of the scripts.

Conclusions: This is consistent with the ‘ohana structure in Native Hawaiian culture, and the emphasis on relational interconnectedness within the family (McCubbin & Marsella, 2009; Mokuau, 2011). Findings suggest the importance of addressing gender-specific considerations and motivations that Hawaiian youth may have when using drug refusal strategies, and reflecting these considerations and motivations in culturally specific drug prevention programs. Specifically, discussions and/or activities in prevention programs might be tailored to address more holistic relational goals within the family (i.e., having all family members getting along with each other) for girls, and more instrumental relational goals (i.e., having the adults not being mad at the youth) for boys.