This article provides a literature review of recent programs to prevent alcohol and substance use in Hawaii and Pacific Islander youths. Five programs for alcohol and substance use prevention among Hawaii and Pacific Islander youths were found in peer-reviewed literature. Of these, two focused on Native Hawaiians and/or other Pacific Islanders and three focused on overall youths in Hawaii. The main themes of these programs were increasing cultural pride, character development through personal efficacy and integrity, connecting youth to family and community, and being school- or community-centered. Two studies showed a decrease in substance use, one showed a change in knowledge, and two did not published outcomes. This review highlights a lack of evidence-based culturally appropriate options for preventing substance use by Native Hawaiian and Pacific Islander youth. Dialogue about best practices is needed and should be supported through publication of program evaluations.