This study reports on the drug use outcomes in an efficacy trial of a culturally grounded, school-based, substance abuse prevention curriculum in rural Hawai‘i. The curriculum (Ho‘ouna Pono) was developed through a series of preprevention and pilot/feasibility studies funded by the National Institute on Drug Abuse, and focuses on culturally relevant drug resistance skills training. The present study used a dynamic wait-listed control group design (Brown, Wyman, Guo, & Peña, 2006), in which cohorts of middle/intermediate public schools on Hawai‘i Island were exposed to the curriculum at different time periods over a 2-year time frame. A total of 486 youth participated in the study. Approximately 90% of these youth were 11 or 12 years of age at the start of the trial. Growth curve modeling over 6 waves of data was conducted for alcohol, marijuana, cigarettes/e-cigarettes, crystal methamphetamine, and other hard drugs. The findings for alcohol use were contrary to the hypothesized effects of the intervention, but may have been a reflection of a lack equivalence among the cohorts in risk factors that were unaccounted for in the study. Despite this issue, the findings also indicated small, statistically significant changes in the intended direction for cigarette/e-cigarette and hard drug use. The present study complements prior pilot research on the curriculum, and has implications for addressing Native Hawaiian and Pacific Islander health disparities.

This article describes the process of infusing implementation strategies in the development of a school-based drug prevention curriculum for rural Native Hawaiian youth. The curriculum (Ho'ouna Pono) is a video-enhanced, teacher-implemented curriculum developed using a culturally grounded and community-based participatory research approach. Throughout the development of the curriculum, strategies reflective of the domains of the Consolidated Framework for Implementation Research (CFIR) were integrated into the teacher training manual, to promote the implementation, adoption, and sustainability of the curriculum in rural Hawai'i. These strategies were validated through qualitative data across two interrelated studies with community stakeholders in rural Hawai'i. Implications for prevention, community, and educational practices are described in this article.

The way in which behavioral health interventions are designed, implemented, and evaluated must be responsive to the ethnocultural characteristics of the targeted youth and their families, schools, and communities. The goal of this article is to examine the relationship between ethnocultural identity measures and substance use among Native Hawaiian compared with non-Hawaiian youth. A crosssectional analysis was conducted from baseline data drawn from an efficacy trial of a culturally grounded drug prevention curriculum, Ho'ouna Pono. The sample (N ϭ 486) included youth from 13 rural, public middle schools who identified as Native Hawaiian, as well as other Pacific Islander, Asian, and other ethnicities. Ethnocultural identity measures used to explore the relationship between 30-day substance use included items from the Hawaiian Culture Scale (Hishinuma et al., 2000) and from Phinney's (1992) Multigroup Ethnic Identity Measure. Among the total sample, prevalence rates indicated that 11.2% of participants reported having been offered substances, and 9.7% reported having used one or more substances in the past month. For Hawaiian youth relative to the non-Hawaiian group, higher levels of Native Hawaiian ethnocultural independent variables were moderately associated with fewer offers to use substances and less gateway drug use. Mixed results were obtained for the relationship between ethnocultural variables and substance use. The present study found that selected ethnocultural variables were moderately associated with fewer drug offers and lower levels of gateway drug use for Hawaiian versus non-Hawaiian youth. What is the public significance of this article?Results from this cross-sectional analysis indicate that ethnoculture appears to be moderately protective for the Native Hawaiian students and less so for non-Hawaiian students (primarily of Asian and Pacific ancestry). There is a need for more robust measures to reflect ethnocultural connections and cultural continuity with respect to substance use prevention. Given the persistent lack of culturally relevant options in drug prevention for minority youth, such as for Native Hawaiian, Asian, and Pacific Islander adolescents, it can be argued that public investments must be prioritized if gains are to be made in the development and evaluation of culturally focused prevention interventions.

Background Despite their potential to ameliorate health disparities and address youth substance use, prevention programs have been poorly disseminated and implemented across Hawai‘i, which begs the question: Why are effective prevention programs not being used in communities most in need of them? Implementing and sustaining culturally grounded prevention programs is critical to address equitable healthcare and minimize health disparities in communities. The field of implementation science provides frameworks, theories, and methods to examine factors associated with community adoption of these programs. Method Our project applies concept mapping methods to a culturally grounded youth drug prevention program with state level educational leadership in rural Hawai‘i schools. The goal is to integrate barrier and facilitator salience collected through teacher and school staff surveys and specific implementation strategies to regionally tailored implementation plans on Hawai‘i island. This protocol paper describes the concept mapping steps and how they will be applied in public and public-charter schools. Discussion Improving prevention program implementation in rural schools can result in sustained support for populations that need it most. The project will integrate implementation science and culturally grounded methods in rural Hawai‘i, where most youth are of Native Hawaiian and Pacific Islander descent. This project addresses health disparities among Native Hawaiian and Pacific Islander youth and provides actionable plans for rural Hawai‘i communities to implement effective prevention programming.