Family and 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 (e.g., 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 presentation focuses on the Puni Ke Ola project which uses a “culture as intervention” stance in developing an evidence based drug prevention program. We highlight a single module of Puni Ke Ola pilot project conducted in 2015-2016.

Methods: This paper focuses on a photovoice project in which youth leaders were loaned cameras so that they may take pictures representing Hawaiian values, beliefs, practices, and ways of knowing that are essential for Native Hawaiian drug prevention. Haumana (youth/students) participated in the photovoice project, which included a set of focus group discussions paired with community-based cultural immersion activities. The 2015-2016 module focused on loko i‘a (fishpond aquaculture). Interviews were facilitated by the lead authors, audio recorded, and then transcribed for the purpose of in vivo and narrative analyses. Youth participants selected photos from their collective portfolio to emphasize the family and culture theme presented here.

Results: Family and culture is the broad theme to be highlighted in the presentation. Specifically, quotes and photos are used to depict the interdependence of family with other cornerstones of Hawaiian culture – spirituality, ‘âina and the physical environment; and relationships (including family) in the social environment. Together these are referred to as the lokahi triangle. 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.

Conclusion: Findings and implications will highlight the project’s dual aims of documenting the community-based implementation process used in this pilot phase, as well as for the purpose of developing outcome measures for future interventions. Future prevention research will focus on intervention development and outcome evaluation, also using CB/PAR and photovoice with youth, adults, and elders in the community.