Abstract
Today, the Hawaiian community faces high rates of health disparities, as well as loss of land, language, and culture due to colonization. However, Hawaiians continue to keep their culture alive, and cultural reclamation theory argues that Indigenous Peoples are healthier when they have opportunities to engage with their cultural practices. This theory points to culture as a possible intervention. We analyze data from the 2019 Native Hawaiian Survey, which examines Hawaiian identity through a sample of over 1,000 participants across Hawai‘i who are 18 years or older and have Hawaiian ancestry. Drawing upon what it means to identify as Hawaiian, we expect a positive relationship between activities that increase connection to Hawaiian culture and life satisfaction. We find statistical significance in consideration of sacred spaces, pride in being Hawaiian, and sense of belonging to America and discuss implications for Hawaiian well-being based on these findings.
Keywords: cultural identity, cultural reclamation, Hawaiian, Indigenous, Native Hawaiian, well-being
Introduction
Hawaiians face adversities similar to other Indigenous Peoples who have been impacted by colonization, including high levels of health disparities at disproportionate rates (Andrade et al., 2006; Evans-Campbell, 2008; Hawai‘i Health Data Warehouse, 2014). However, drawing upon the Hawaiian framework ka wa ‘ōiwi wale (pre-contact Hawai‘i) may provide insight into these current health disparities (Cook, 2018). Ka wa ‘ōiwi wale (Young, 2014) describes a process of facing the past and using cultural values, practices, and knowledge to guide the shaping of the future for the Hawaiian community (Cook, 2018). In a study that explored Hawaiian conceptualizations of health (McMullin, 2005), one participant drew upon the past to describe a healthy Hawaiian community as “a time of easy access to the land and ocean from which he or she could obtain healthy food and little disease” (p. 814).
Although contemporary society has shifted away from the image due to the continual impacts of colonization, many Hawaiians continue to draw from their cultural values, practices, and knowledge to support their health and well-being on both individual and communal levels (McCubbin & Marsella, 2009; Mokuau, 2011). A recent comprehensive example of this is the 2019 Thirty Meter Telescope (TMT) protests on Mauna Kea, in which kia‘i (protectors, protector) fought against the desecration of sacred land. Rooted in kapu aloha (a way of life that is rooted in dignity and humanity for others), these protests made a global impact, resulting in activists, allies, and community members from all over the world joining the movement (Medeiros, 2021). In addition, cultural practitioners, artists, scholars, and community leaders were invited to an open learning space on the Mauna, Pu‘uhonua o Pu‘uhuluhulu, to speak on a variety of subjects, such as cultural arts, technology, and demilitarization (Manuel-Sagon, 2020). These expressions of cultural values and learning through protest and open accessibility of shared knowledge sparked a conversation surrounding what it means to be Hawaiian in contemporary Hawai‘i (Medeiros, 2021). Furthermore, this case of the TMT protests poses the question of how culture may counteract the adversities the Hawaiian community faces.
This study explores cultural identity as an intervention for the health disparities within the Hawaiian community, as previous research identifies cultural identity as a protective factor for Indigenous Peoples (Kana’iaupuni, 2006; Mokuau et al., 2012; Ramirez & Hammack, 2014; Wexler, 2014). Aligned with ka wa ‘ōiwi wale, this study uses cultural reclamation theory, which argues that Indigenous Peoples are healthier when they have opportunities to draw upon their cultural knowledge and practices (Gone, 2013; Gonzalez et al., 2022; Leonard, 2008; Paglinawan et al., 2020). Due to the limited research on the Hawaiian community, this study draws upon research across different Indigenous communities, and “Indigenous” is used in a broad context to refer to “the original inhabitants of the land” (Schachter & Funk, 2012, p. 400). Hawaiian is used to refer to individuals who identify with having Hawaiian ancestry, although we acknowledge that this term may not represent all individuals of Hawaiian descent. In addition, this study builds upon previous research on Hawaiian resilience (Antonio et al., 2020) to support the healthy society Hawaiians currently work toward and envision for the future (Kana’iaupuni, 2005). We attempt to measure different themes of cultural reclamation theory using data from the 2019 Native Hawaiian Survey, the largest known survey on Hawaiian identity and community concerns. Specifically, data from the life satisfaction and cultural identity questions are analyzed to explore the relationship between cultural identity and Hawaiian well-being. Moreover, the purpose of this research is to understand identity and its relationship with well-being for Hawaiians. This article outlines previous research on the impacts of colonization on Hawaiian health, Hawaiian conceptualizations of well-being, and the identification process through cultural reclamation, followed by results from multivariate regressions of the survey data and future implications of these findings.
Hawaiian health in the context of colonization
Although Hawaiians currently comprise 23.3% of the population in Hawai‘i (Hawai‘i Health Data Warehouse, 2014), research shows that they are disproportionately affected by chronic health conditions, such as heart disease, cancer, and diabetes (Kaholokula, Okamoto, & Yee, 2019; Look et al., 2013), and display high rates of psychological distress (Andrade et al., 2006; Hawai‘i Health Data Warehouse, 2014). In addition, Hawaiians have one of the lowest life expectancy rates compared to other major ethnic groups in Hawai‘i (Kaholokula, Okamoto, & Yee, 2019; Look et al., 2013). These statistics pose the question: how are Hawaiians experiencing such high rates of health disparities on their own ancestral land despite once being a healthy, robust population (Beaglehole, 2017)? Insight into these statistics can be found within the context of colonialism in Hawai‘i.
Upon the first arrival of foreign settlers to Hawai‘i in the late 1700s, Hawaiians were exposed to several infectious diseases brought by these settlers, such as measles, smallpox, dysentery, and influenza (Bushnell, 1993). Introduction of these diseases resulted in the deaths of over 90% of the Hawaiian population from 1778 to 1876, a period that is often referred to as a cultural genocide or holocaust (Stannard, 1989). Along with a rapid population decline, traditional ways of life were threatened by advancements of Euro-colonial powers, resulting in displacement and marginalization of Hawaiians on their own ancestral lands (Kaholokula, Hermosura, & Antonio, 2019). Eventually, continual attempts to exert foreign political and economic control over Hawai‘i led to the illegal overthrow of the Hawaiian Kingdom government with the aid of the US Marines in 1893 (Trask, 1999). Although the overthrow occurred over 130 years ago, Hawaiians continue to suffer from the loss of their land, language, culture, similarly to other colonized groups (Pokhrel & Herzog, 2014; Ramirez & Hammack, 2014; Wexler, 2014).
Understanding the health of Indigenous Peoples within the context of colonization is important to prevent overgeneralization and misrepresentation of their communities (Gone, 2013; McKivett et al., 2018). Research on Hawaiian health often operates from a deficits-based approach, which contributes to the false narrative that Indigenous Peoples fail to succeed in Euro-colonial societies (Kana’iaupuni, 2005). Deficit-based research often overlooks what Hawaiians are currently doing to support their health and well-being, despite the adversities they face, prompting a call toward strengths-based research (Kūkulu Kumuhana Planning Committee, 2017; Pulla, 2012; Zimmerman, 2013). Utilizing a strengths-based approach, or ka‘akālai kū kanaka from a Hawaiian lens (Kana’iaupuni, 2005), may empower Hawaiians through visibility of their cultural ways of knowing and being (Endo Inouye & Estrella, 2014; Kana’iaupuni, 2005), as well as the diversity that exists within the community (Kana’iaupuni, 2005; McKivett et al., 2018). In addition, strengths-based research shifts the blame often put on the individual or overall community and, instead, holds the sources of oppression accountable (Tuck, 2009). Revisiting the ways in which Indigenous Peoples continually draw upon their culture and keep it alive amid adversity may contribute to this shift and disrupt the negative impacts of colonization (Kana’iaupuni, 2005; Thomas et al., 2016).
Hawaiian framework of well-being
Numerous Hawaiian scholars who have studied Hawaiian health point to culture as an intervention, especially since Indigenous Peoples have always been the experts of their traditional knowledge (Bang et al., 2018; Wendt & Gone, 2012). According to Blaisdell & Mokuau (1991), cultural and ancestral knowledge must be prioritized to establish health equity for Hawaiians. Thus, exploration of how Hawaiians conceptualize well-being is imperative in restoring the health of the Hawaiian community. A Hawaiian conceptualization of health holds a cosmographic holistic view, which accounts for the greater systems of the universe in relation to the individual and extends beyond biological health (Mokuau, 2011). On an individual level, health encompasses the physical, spiritual, mental, emotional, and social domains (Kamaka et al., 2017; Look et al., 2014). In addition, physical health refers to both an individual’s body and connection to ‘āina (land) (McCubbin & Marsella, 2009). On a community level, health is linked to the cultural values, lōkahi (harmony) and pono (equity, balanced in righteousness), and the role of these values in the relationships between kānaka (humankind), ‘āina, and akua (god, gods, spirits) (Kamaka et al., 2017). Moreover, both individual and community well-being are dependent on each other and are considered healthiest when lōkahi and pono between the physical, spiritual, mental, emotional, and social domains, as well relationships between kānaka, ‘āina, and akua are sustained (Mau et al., 2010; McCubbin & Marsella, 2009; Mokuau, 2011).
A foundational pillar for both individual and community health is connection to ‘āina, or connection to place. Not only does ‘āina hold cultural significance as the ancestral homeland for Hawaiians, ‘āina is also the source of all life and is not confined to land identified by geographical markers (Kana’iaupuni, 2006). All other aspects of Hawaiian well-being rely on ‘āina, including connection to ancestors from the past, present, and future through the transmission of cultural knowledge, language, and practices (Kana’iaupuni, 2006). In one study that interviewed 13 Native Hawaiians from the Wai‘anae coast of O‘ahu about sense of place, participants discussed the positive contributions of their claimed ‘āina on their identity; interactions with others; and physical, mental, and spiritual health (Oneha, 2000). Furthermore, they stated that they could not exist without their ‘āina and vice versa. In another study that interviewed Hawaiians from Maui and Hawai‘i Island about what it means to be a “healthy Hawaiian,” 69% of Native Hawaiian participants described an image of a Hawaiian who lived in “a time of easy access to the land and ocean from which he or she could obtain healthy food and little disease” (McMullin, 2005, p. 814). ‘Āina also intersects with another foundational value, aloha, which has many different definitions, including love, compassion, kindness, and grace (Mokuau, 2011). According to Meyer (2003), aloha is “a sacred idea that connects us to spiritual traditions” (p. ix). Such traditions include aloha ‘āina or mālama ‘āina (caring for the land), in which kānaka are stewards of the land. These traditions contrast Euro-colonial practices of land ownership that we currently see in Hawai‘i (Trask, 2010), often creating barriers for relationship to ‘āina.
Along with the relationship to ‘āina, specific emphasis is placed on spiritual and social well-being. These two positively impact overall well-being for Hawaiians, even with the limitations caused by chronic diseases (Ka‘opua, 2008). In one study that examined the differences between White adults and Hawaiian adults with diabetes, results showed that social and emotional support were greater indicators of overall health for the Hawaiians participants versus the White participants (Shahan, 2009). This difference may be linked to the Euro-colonial value of individualism, which often clashes with the Hawaiian value of collectivism (Kana’iaupuni, 2006). In another study, family support for Hawaiian students reduced the risk for internalized symptoms of family adversity and other major life events (Goebert et al., 2000). Overall, Hawaiian health and well-being is rooted in cultural values of relationships and identity. Further exploration into these identification processes may provide more insight into culture as an intervention for Hawaiians.
Culture as treatment: identification processes in contemporary society
While Indigenous Peoples often experience uncertainty and difficulty in navigating identity in contemporary society due to the loss of land, language, and culture (Gone, 2009), research on “culture as treatment” (Brady, 1995, p. 1495) and cultural identity as a protective factor (Kana’iaupuni, 2006; Mokuau et al., 2012; Ramirez & Hammack, 2014; Wexler, 2014) poses a remedy to this loss. Cultural or Indigenous resilience is used to describe the ways Indigenous communities have thrived and maintained their cultural identities amid adversity (Kana’iaupuni, 2005; Thomas et al., 2016). Learning and practicing traditional cultural ways (Gone, 2009, 2010; Leonard, 2012) has been linked to positive self-image and healing for Indigenous Peoples (Paglinawan et al., 2020). Positive relationships between reclamation of cultural identity and health have been linked to pride in one’s identity (Gone, 2009), empowerment (Leonard, 2012) and autonomy over vision for the future (Gone, 2009), sense of belonging, and sense of purpose (Gone, 2013). In addition, culture has been effectively used as an intervention for addiction (Gone, 2010) and mental illness (Gone, 2013). In alignment with a strengths-approach, Leonard (2008) argues that these reclamation processes are acts toward decolonization by allowing Indigenous Peoples to identify and resist Euro-colonial values that subjugate Indigenous knowledge and practices. Moreover, reclaiming cultural identity may counteract the harm imposed by colonization by empowering Indigenous Peoples to reject colonial misrepresentations of self and pursue pathways to relearn who they really are (Kana‘iaupuni, 2005).
However, complete rejection of dominant Euro-colonial values and practices in the pursuit of cultural identity does not always lead to healthy outcomes for Indigenous Peoples. For example, some individuals feel more aligned with dominant Euro-colonial values and practices, in which reclamation of cultural identity would contradict their sense of self (Leonard, 2012). In addition, there may be negative ramifications of reclaiming cultural identity with the barriers posed by colonialism, such as systemic discrimination (Bombay et al., 2010). Identifying as Hawaiian has become politicized through Euro-colonial concepts such as blood quantum, which is a government strategy of tracing and fractionating Hawaiian ancestry, or blood, for the purpose of limiting access to land and resources (Kauanui, 2008). According to Kauanui (2008), blood quantum creates exclusion within the Hawaiian community and makes some Hawaiians feel like they are not Hawaiian enough. Building upon the relationship with land and ‘āina as a foundational pillar for connection to Hawaiian identity, land may be a safe harbor for Hawaiians while also acting as a reminder of historical loss, economic disadvantage, and loss of culture (Whitbeck et al., 2009). Considering the processes of reclaiming identity as nuanced and complex, Bombay et al. (2010) argues identity should be understood as a spectrum, rather than a binary concept.
Cultural reclamation theory
Building upon “culture as treatment” (Brady, 1995, p. 1495), and cultural identity as a multi-dimensional construct (Bombay et al., 2010), we derive the following themes of cultural reclamation theory from previous research on cultural identity and well-being: (1) finding one’s purpose as an Indigenous person (Gone, 2009, 2010, 2013; Paglinawan et al., 2020); (2) sense of belonging (Gone, 2010; Gonzalez et al., 2022); and (3) engagement with cultural learning and practices (Gone, 2013; Gonzalez et al., 2022; Leonard, 2012; Paglinawan et al., 2020). By centering culture at the core of well-being for Indigenous Peoples (Bombay et al., 2010; Paglinawan et al., 2020), cultural reclamation theory aligns with a Hawaiian perspective of self (Mau et al., 2010), while also accounting for the complexities of healing and identification processes in contemporary society (Gonzalez et al., 2022). It also recognizes the impacts of historical trauma for Indigenous Peoples as ongoing (Brave Heart, 1998; Whitbeck et al., 2009). Cultural reclamation has been previously measured through confidence in ability to learn cultural ways, community engagement, social support, opportunities to engage with culture (Gonzalez et al., 2022), and critical engagement of empirical observations within cultural treatment centers (Gone, 2010). This study further contributes to cultural reclamation theory by attempting to measure its themes through analysis of empirical survey data. Furthermore, we test cultural reclamation as a facilitator of connection to cultural identity.
Research design and methodology
Data collection background
We analyze data from the 2019 Native Hawaiian Survey, which has the largest known sample of Hawaiians in Hawai‘i to date. The use of Native Hawaiian in this study’s name was intended to refer to individuals with Hawaiian ancestry. However, after receiving community feedback, the use of Native Hawaiian was minimized in the survey itself as the term may not represent all individuals of Hawaiian descent and may be inaccurate, controversial, and political. IRB approval was obtained for this study by Hawai‘i Pacific University on June 9, 2019 prior data collection. During data collection, a total of 1,023 responses—191 paper surveys and 832 online surveys—from individuals who self-identified as having Hawaiian ancestry, were 18+ years old, and resided in Hawai‘i were collected. Convenience and snowball sampling aided recruitment for this survey, which occurred between August 1, 2019 and December 21, 2019 on O‘ahu, Maui, Kaua‘i, Lāna‘i, and Hawai‘i islands.
Identities of the participants remained anonymous with encrypted technologies for the online survey and numerical codes for paper surveys. IP addresses for online surveys were not collected, and there were no personal identifiers linked to any responses. Participants were required to read and sign a consent form prior to participation, and participation was voluntary and could be stopped at any point. No compensation was provided to participants. Hawai‘i Pacific University provided funding through two small grants, totaling US$5,400, and all other costs were paid out of pocket by the survey team. The survey was not attached to any government or civic organizations. This survey utilizes methodology that draws upon cultural values and provides unique insight into what it means to be Hawaiian and the issues that are important within the community.
Principal investigator positionality and participatory methods
The principal investigator of the 2019 Native Hawaiian Survey began this project by exercising her kuleana (responsibility) to learn more about the people on whose lands she is a settler. To this end, she connected with kūpuna (elders) through her home institution and consulted with them to discuss using her survey skills to support Hawaiian sovereignty. This approach offered members of the Lāhui (Hawaiian community) opportunities to provide feedback on survey design, and to propose a broader range of ethnoracial self-identifications in the survey.
Participatory methods were also used in the data collection process. Given the long history of surveys used as tools of Indigenous dispossession, many Hawaiians are rightfully suspicious of surveys. With the vouching of kūpuna and the labor of Hawaiian undergraduate research assistants distributing surveys in selected public spaces, the research team was able to build trust and legitimacy within Hawaiian communities, such that Hawaiians would be willing to participate in the survey. These research assistants were recognized as intellectual partners, with their labor valued through compensation, travel and lodging funding, co-authorship and mentorship opportunities.
Finally, participatory methods were incorporated into the data analysis and dissemination process. Continued transparency and open engagement with kūpuna and undergraduate research assistants were established as ongoing opportunities to provide feedback on the study, and periodic updates on analysis and publications. The tight-knit, grassroots character of the project helped to cultivate a culture of openness and trust within the research team and to ensure that everything was pono within the research team, thereby providing some accountability to the Lāhui.
Measures
We derive our variables from questions from the 2019 Native Hawaiian Survey (Table 1; Supplemental Material 1; nhsurvey.org). This survey was not designed to focus specifically on health or well-being, nor was it created for the purpose of this analysis. However, this survey’s focus on Hawaiian identity, cultural values and practices, and community concerns are relevant to Hawaiian conceptualizations of well-being. In addition, this survey contributes to research that increases distinct visibility of Hawaiian ways of knowing, as Hawaiians are often grouped with other ethnic groups (Endo Inouye & Estrella, 2014; Kaholokula, Hermosura, & Antonio, 2019).
Table 1.
Variable names, questions, and coding from the 2019 Native Hawaiian Survey that we used for our analysis.
| Variable type | Variable name | Variable question | Variable coding |
|---|---|---|---|
|
| |||
| DV | Life Satisfaction | Q25. All things considered, how satisfied are you with life as a whole nowadays? | Very Satisfied (5) Satisfied (4) Neither satisfied or dissatisfied (3) Dissatisfied (2) Very dissatisfied (1) |
| IV | Language | Q8. Thinking back to elementary, middle, or high school, were you offered Hawaiian language courses? | Yes (1) No (0) |
| Occupied | Q9. Do you consider Hawai‘i occupied by the USA? | Yes (1) No (0) |
|
| Sacred | Q11. Are there places in Hawai‘i that you consider sacred? | Yes (1) No (0) |
|
| Protect Access | Q12. How important is it to you that sacred places are accessible and protected? | Extremely important (5) Very important (4) Somewhat important (3) Not so important (2) Not at all important (1) |
|
| Learn History | Q14a. I have spent time trying to find out more about Hawaiian history, traditions, and culture. | Strongly agree (5) Agree (4) Neither agree or disagree (3) Disagree (2) Strongly disagree (1) |
|
| Cultural Activeness | Q14b. I am active in Hawaiian organizations, social events, or cultural activities. | Strongly agree (5) Agree (4) Neither agree or disagree (3) Disagree (2) Strongly disagree (1) |
|
| Feel Good | Q14c. I feel good about my Hawaiian identity. | Strongly agree (5) Agree (4) Neither agree or disagree (3) Disagree (2) Strongly disagree (1) |
|
| Belonging Hawaiian | Q14d. I have a deep sense of belonging to my Hawaiian group | Strongly agree (5) Agree (4) Neither agree or disagree (3) Disagree (2) Strongly disagree (1) |
|
| Belonging America | Q14e. I have a deep sense of belonging to America. | Strongly agree (5) Agree (4) Neither agree or disagree (3) Disagree (2) Strongly disagree (1) |
|
DV = Dependent Variable; IV = Independent Variable Q = Question.
For our analysis, Hawaiian well-being is our dependent variable and cultural identity is our independent variable. The life satisfaction variable is used as a proxy for well-being. This variable aligns with the World Health Organization’s (2001) definition of well-being, which extends beyond the presence of physical or mental ailments to encompass perception of one’s life. Moreover, this study recognizes the excess research on health statistics within the Hawaiian community and is interested in understanding how Hawaiians feel about their overall well-being. Cultural identity variables are used to measure cultural identity. These variables capture cultural values and engagement processes with Hawaiian culture. We use these variables to test the following themes of cultural reclamation theory: (1) finding’s one’s purpose as an Indigenous person (Gone, 2009, 2010, 2013; Paglinawan et al., 2020); (2) sense of belonging (Gone, 2010; Gonzalez et al., 2022); and (3) engagement with Indigenous learning and practices (Gone, 2013; Gonzalez et al., 2022; Leonard, 2012; Paglinawan et al., 2020).
For the first theme of cultural reclamation theory—finding one’s purpose as an Indigenous person—we analyze the following variables: “Occupied,” “Sacred,” “Protect Access,” and “Feel Good.” These variables ask about the cultural significance of ‘āina to Hawaiian well-being and positive emotions associated with Hawaiian identity. In addition, the occupation variable is included to account for identification processes within contemporary context. Furthermore, this variable highlights the nuances of finding one’s purpose as an Indigenous in the specific context of military occupation in Hawai‘i. For the second theme of cultural reclamation theory—sense of belonging—we analyze the following variables: Hawaiian Belonging & America Belonging. These variables explicitly ask about belonging to the Hawaiian community and America. Neither variable was given a specific classification of government, land, or society, allowing for interpretation of what belonging to either means. In addition, America is used to refer to the USA in this survey, but we acknowledge that it may not be exclusive to other communities in the Americas. For the third theme of cultural reclamation theory—engagement with Indigenous learning and practices—we analyze the following variables: “Language,” “Learn History,” and “Cultural Activeness.” These variables ask about levels of engagement with culture through learning language and cultural history, and activeness in cultural organizations, social events, and cultural activities. We hypothesize that life satisfaction among Hawaiians increases as opportunities to pursue cultural reclamation increase.
Statistical analyses and sample demographics
We analyze our survey data using multivariate regressions and statistical software, STATA™. We chose multivariate regressions as the best statistical test for our data because we have one ordinal dependent variable and multiple interval and normal independent variables (OARC Stats, 2021). Each variable was run as a separate variable since no variables were highly correlated with one another. In addition, demographic controls were constructed from the demographic variables and included in the regression: gender, education, employment status, children, and age. We use these controls since research refers to these demographics as social determinants of health (Kaholokula, 2013), or factors that may impact health outcomes. Any response that did not meet all three inclusion criteria were excluded from analyses. “Missing” and “don’t know” responses were also removed from the final analyses since they made up less than two percent of responses. In addition, these excluded responses made no statistical differences. Observation numbers vary for each variable because not every participant answered every question.
Gender, education, employment, and having children were constructed into binary variables. For the gender control, “Female” was coded as 1 and “Male” was coded as 0. “Transgender,” “Māhū,” and “Gender Queer/Non-Binary” responses were removed from the gender variable since less than five percent of participants indicated these identities. For the education control, responses that indicated the “completion of some higher education” were coded as 1, which included “Some college but no degree,” “Associate Degree,” “Bachelor’s Degree,” and “Graduate Degree.” Responses that indicated “no higher education” were coded as 0, which included “Less than high school” and “High School degree or GED” responses. For the “employment” control, “Yes, part-time” and “Yes, full-time” responses were coded as 1, and “No” and “Retired or Disabled” were coded as 0. For the “children” control, “Yes, all over 18” and “Yes, one or more under 18” responses were coded at 1, and “No” was coded as 0. “Age” was run as is, with “18–24” coded as 1, “25–34” coded as 2, “35–44” coded as 3, “45–54” coded as 4, “55–64” coded as 5, “65–74” coded as 6, and “75+” coded as 7.
The majority of participants identified as female (68%), received some form of higher education (75%), were employed (71%), had children (67%), and were 45 to 54 years old (17%).
Results
We present the descriptive statistics of our variables (Table 2) followed by findings from the regressions (Table 3). For the life satisfaction variable, the majority of participants answered “satisfied” with their lives as a whole (x = 3.79; SD = 0.94). For the cultural identity variables, the majority of participants did not receive language courses in school (x = 0.47; SD = 0.50); consider places in Hawai‘i sacred (x = 0.99; SD = 0.05); find high importance in protecting and accessing sacred spaces (x = 4.82; SD = 0.51); spend time learning about Hawaiian history, traditions, and culture (x = 4.57; SD = 0.71); are active in Hawaiian organizations, social events, or cultural activities (x = 4.04; SD= 1.00); feel good about their Hawaiian identity (x = 4.62; SD = 0.68); have high levels of belonging to their Hawaiian group (x = 4.44; SD = 0.84); and have low levels of belonging to America (x = 2.31; SD = 1.28).
Table 2.
Rounded descriptive statistics of variables.
| Variable | N | Mean | SD |
|---|---|---|---|
|
| |||
| Life satisfaction | 759 | 3.79 | 0.94 |
| Language | 809 | 0.47 | 0.50 |
| Sacred* | 804 | 0.99 | 0.05 |
| Protect access | 815 | 4.83 | 0.51 |
| Learn history | 784 | 4.57 | 0.71 |
| Cultural activeness | 782 | 4.04 | 1.00 |
| Feel good | 781 | 4.62 | 0.68 |
| Hawaiian belonging | 783 | 4.44 | 0.84 |
| America belonging | 774 | 2.31 | 1.28 |
N = Number of observations; SD = Standard Deviation
= The original mean for “Sacred” was 0.998.
Table 3.
Multivariate logistic regression outcomes between the life satisfaction variable and each cultural identity variable.
| Life satisfaction | |
|---|---|
|
|
|
| Finding one’s purpose as an Indigenous person | Co-efficient (Std. error) |
|
| |
| Feel good | 0.32* (0.07) |
| Occupied | 0.08 (0.13) |
| Sacred | 3.49* (0.91) |
| Protect access | –0.07 (0.10) |
| Sense of Belonging Hawaiian belonging | −0.03 (0.06) |
| America belonging | 0.19* (0.03) |
| Engagement with Indigenous learning and practices Language | 0.13 (0.08) |
| Learn history | −0.05 (0.07) |
| Culture activeness | −0.02 (0.05) |
| Demographics Female | 0.05 (0.08) |
| Higher education | –0.02 (0.09) |
| Employed | 0.04 (0.09) |
| Children | 0.04 (0.09) |
| Age | −0.02 (0.03) |
| Constant | −0.97 (1.07) |
| N | 608 |
| F(15, 586) | 5.88 |
| Prob > F | 0.00 |
| R-Squared | 0.13 |
| Adjusted R-Squared | 0.11 |
| Root MSE | 0.90 |
N = Number of observations; F = F-Value; Prob = Probability; R = Correlation coefficient; MSE = Mean square error
= p = −0.00.
Cultural identity variables are categorized by the themes of cultural reclamation theory. We also ran a Variance Inflation Factor (VIF) and found low correlation between the independent variables in our regression analysis (Supplementary Material 2).
There were statistically significant relationships found between three cultural identity variables and the life satisfaction variable: (1) feeling good about one’s Native Hawaiian identity—“Feel Good”; (2) considering places in Hawai‘i sacred—“Sacred”; and (3) having a sense of belonging to America—“America Belonging.” These variables have positive relationships with the life satisfaction variable.
No statistical significance was found for importance of protecting and accessing sacred places —“Protect Access”; belonging to the Hawaiian community—“Hawaiian Belonging”; receiving language courses in school—“Language”; learning about Hawaiian history, traditions, and culture—“Learn History”; and activeness in Hawaiian organization, events, and activities—“Cultural Activeness.” In addition, no demographic variable was statistically significant.
Discussion
Life satisfaction variable
Starting with our dependent variable, high levels of life satisfaction supports the argument that strengths already exist within Indigenous communities (Kana’iaupuni, 2005; McKivett et al., 2018). Variation in responses may be due to this question’s presentation of life satisfaction as a subjective concept. Moreover, there may have been variation in how life satisfaction was interpreted and defined among participants, and exploring these differences or dimensions of life satisfaction may be valuable in adding to existing models of Hawaiian well-being. In addition, exploring factors that contribute to these current levels of life satisfaction may provide more in-depth insight into how participants responded to this question. Furthermore, additional insight may be found in the four cultural identity variables that were statistically significant in relation to life satisfaction.
Cultural identity variables
Feeling good about one’s Hawaiian identity, considering places in Hawai‘i sacred, and having a sense of belonging to America were positively related to life satisfaction. Moreover, responses that reflected these themes were linked to higher levels of life satisfaction and had the same level of statistical significance. Referring to the themes of cultural reclamation theory as facilitator for connection to cultural identity—finding one’s purpose as an Indigenous person, sense of belonging, and engagement with Indigenous learning and practices—we find two statistically significant variables for the first theme, one statistically significant variable for the second theme, and no statistically significant variables for the third theme.
First, feeling good about one’s Hawaiian identity and considering places in Hawai‘i sacred were statistically significant variables for finding one’s purpose as an Indigenous person. Along with the high statistical significance of feeling good about one’s Hawaiian identity in relation to high life satisfaction, this cultural identity variable also yielded the highest mean out of all the Likert-type cultural identity variables after perceived importance of accessing and protecting sacred spaces. Moreover, an overwhelming majority of participants indicated that they feel good about their Hawaiian identity. Considering the challenges colonization poses on identification processes in contemporary society (Bombay et al., 2010; Leonard, 2012), further exploration into the factors that contribute to these positive emotions may provide insight into how they may act as a buffer to the health disparities and adversities Hawaiians face. In addition, these factors may provide insight into the possible nuances of what feeling good about being Hawaiian means. Next, considering places in Hawai‘i sacred was statistically significant to high life satisfaction and yielded a high mean. This variable also yielded the lowest variability in responses out of all the cultural identity variables, meaning the majority of participants said “Yes” to considering places in Hawai‘i as sacred. Along with statistical significance to life satisfaction, sacrality may also be important to understanding the processes that facilitate finding one’s purpose as a Hawaiian. Moreover, sacred spaces and interaction with these spaces may provide healing for some Hawaiians despite the health disparities and adversities they face (Whitbeck et al., 2009). No statistical significance was found in considering Hawai‘i occupied by the USA and importance of protecting and accessing sacred spaces. Lack of statistical significance for these variables may be linked to the realities of land loss in contemporary society and negative ramifications of continually fighting against the desecration of sacred land (Trask, 2010; Whitbeck et al., 2009).
Second, having a sense of belonging to America was the statistically significant variable for the sense of belonging theme. Although this variable had high statistical significance in relation to high life satisfaction, there was also high variability in responses. Similarly to the life satisfaction variable, this variability may be related to the presentation of belonging to America as a subjective concept. Further exploration into what belonging to America means may be valuable in understanding its relation to high life satisfaction, especially since the majority of participants indicated high opposition to belonging to America. No statistical significance was found in belonging to one’s Hawaiian group. Explanations for these variables may be linked to complexities of reclaiming identity. Furthermore, those who resist dominant powers in pursuit of one’s Indigenous identity or group may result in difficulty navigating current Euro-colonial systems compared to those who assimilate (Trask, 2010). Findings from both of these variables may pose the need for further exploration into the processes that facilitate belonging within the Hawaiian community through the lens of cultural identity as a multi-dimensional construct (Bombay et al., 2010).
Last, no variables were statistically significant for engagement with Indigenous learning and practices. For receiving language courses in school, the majority of participants said they did not receive language courses in school. However, the majority of participants also indicated high levels of learning Hawaiian history, traditions, and culture and activeness in Hawaiians organizations, events, and activities. Lack of statistical significance for these variables may be linked to barriers to accessibility, as well as the deficits-based narratives informed by colonization. Although language is an important part of Indigenous cultures and reclamation of identity (Leonard, 2008), our results show that the majority of participants did not have the opportunity to learn Hawaiian language in school. In addition, because the Hawaiian community is often overgeneralized in studies that take a deficit-based approach, learning through the lens of this narrative may contribute to a negative sense of self (Kūkulu Kumuhana Planning Committee, 2017). Furthermore, some who speak to the history of US colonization and historical trauma neglect to tell the full story, which includes high levels of resilience among Hawaiians in the midst of multiple adversities (Kana’iaupuni, 2005; Thomas et al., 2016).
The levels of resilience found in this study further reinforces the need for more strengths-based research that looks at what Hawaiians are already doing to support their health and well-being. When considering engagement with cultural activities, it also may be insightful to explore additional alternative pathways to cultural connection that extend beyond practicing traditions or remaining active in cultural organizations, to take account of the diversity that exists within the Hawaiian community (Kana’iaupuni, 2005; McKivett et al., 2018). In addition, Gonzalez et al. (2022) argues the importance of looking beyond cultural engagement to cultural efficacy, which is one’s “personal preferences and confidence engaging with Indigenous culture,” (p. 193) as an indicator of Indigenous Peoples. Overall, variables for this theme may capture differences in accessibility to specific cultural practices, such as learning language. Thus, treating “culture as treatment” should consider barriers that may prevent people from engaging with culture in meaningful ways.
Based on these findings, the following implications are important to consider when measuring Hawaiian well-being through cultural reclamation in contemporary society: (1) the constant fight for access, protection, and autonomy with regard to ‘āina, (2) the barriers to sense of belonging within the Hawaiian community due to the politicization of Hawaiian identity, (3) the impact of a deficits-based data approach on sense of self and confidence engaging with cultural practices, and (4) limited recognition of cultural diversity. Further exploration in these four areas may provide a more holistic understanding of Hawaiian well-being and identity that can be used to inform more effective culturally-based interventions.
Limitations
While this study has the largest known sample of people who self-identify with having Hawaiian ancestry across multiple islands, results are not generalizable to the entire Hawaiian community. In addition, this study is limited in its measurement of subjective well-being through self-reported life satisfaction. Because the life satisfaction question was the last question in the survey, life satisfaction results may also have been influenced by the interaction with previous survey questions, resulting in potential bias. Analysis of open-ended survey questions on conceptualizations and expressions of Hawaiian identity may provide a more holistic analysis of well-being. Despite these limitations, this study also contributes unique, extensive insight into Hawaiian identity that may be relevant to future Hawaiian well-being measurements.
Conclusion
This study explores cultural identity as an intervention for the health disparities within the Hawaiian community, as previous research identifies cultural identity as a protective factor for Indigenous Peoples (Kana’iaupuni, 2006; Mokuau et al., 2012; Ramirez & Hammack, 2014; Wexler, 2014). Using cultural reclamation theory, which argues that Indigenous Peoples are healthier when they have opportunities to draw upon their cultural knowledge and practices (Gone, 2013; Gonzalez et al., 2022; Leonard, 2012; Paglinawan et al., 2020), we build upon previous research on Hawaiian resilience (Antonio et al., 2020) and measure following themes of cultural reclamation theory using data from the 2019 Native Hawaiian Survey: finding one’s purpose as an Indigenous person; sense of belonging; and engagement with cultural learning and practices.
Utilizing the life satisfaction question as a proxy for well-being and the cultural identity questions, we find high levels of overall life satisfaction and cultural engagement. Statistical significance is found between high levels of life satisfaction and feeling good about one’s Hawaiian identity; considering places in Hawai‘i sacred; and a sense of belonging to America. These variables support the first two themes of cultural reclamation theory—finding one’s purpose as an Indigenous person; and having a sense of belonging. Findings from this study prompt further exploration into the dimensions of cultural reclamation as a facilitator for connection to culture, particularly engagement with cultural learning and practices and cultural efficacy. Moreover, barriers to Hawaiians’ ability and confidence to connect the ‘āina, Hawaiian culture, and Hawaiian community should be considered when understanding cultural identity as a multi-dimensional construct and protective factor for health disparities.
Supplementary Material
Supplemental material for this article is available online.
Acknowledgements
The authors extend their gratitude to all of the participants who trusted the Native Hawaiian Survey team with their knowledge and wisdom. They also thank the various organizations and individuals who extended their support on this project. They specifically thank Emilia Kandagawa, La‘akea Dedrick, Leilani De Lude, and Lynette Cruz, PhD. They also thank the many others working to build the Lāhui.
Funding
The authors disclosed receipt of the following financial support for the research, authorship, and publication of this article: A portion of this project was supported in part by Hawai’i Pacific University’s: (1) College of Liberal Creative Scholar Endeavor Program (US$2,900); and (2) The National Endowment of the Humanities Faculty Development (US$2,500).
Glossary
- ‘āina
land
- aloha
love, compassion, kindness, and grace; a sacred idea that connects us to spiritual traditions
- aloha ‘āina
caring for the land
- akua
god, gods, spirits
- ka wā ‘ōiwi wale
pre-contact Hawai‘i
- ka‘akālai kū kanaka
Hawaiian conceptualization of strengths-based approach
- kānaka
humankind
- kapu aloha
a way of life that is rooted in dignity and humanity for others
- kia‘i
protectors, protector
- kuleana
responsibility
- kūpuna
elders
- Lāhui
Hawaiian community
- lōkahi
harmony
- mālama ‘āina
caring for the land
- pono
equity; balanced in righteousness
Authors’ note
Catherine Jara (BSW) is a Kanaka Maoli scholar from the island of O‘ahu. She received her Bachelor of Social Work from Hawai‘i Pacific University in Spring 2022. She is interested in exploring Kānaka identity, health, and well-being from a Kānaka lens. She is committed to using research as a tool to uplift the voices and stories within her community in alignment with the movement toward sovereignty.
Ngoc T Phan (PhD) is a Vietnamese-American scholar who resides in Hawai‘i and considers herself a settler-ally to the Kānaka Maoli people. She is an Associate Professor of Political Science at Hawai‘i Pacific University in the department of History, Humanities, and International Studies. Her research agenda focuses on decolonization and implementing anticolonial science. Her scholarship is grounded in her relationship with, responsibility to, and community building among Indigenous scholars.
Footnotes
Declaration of conflicting interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and publication of this article.
References
- Andrade NN, Hishinuma ES, McDermott JF, Johnson RC, Goebert DA, Makini GK, Nahulu LB, Yuen NYC, McArdle JJ, Bell CK, Carlton BS, Miyamoto RH, Nishimura ST, Else IRN, Guerrero APS, Darmal A, Yates A, & Waldron JA (2006). The National Center on Indigenous Hawaiian Behavioral Health Study of prevalence of psychiatric disorders in Native Hawaiian adolescents. Journal of the American Academy of Child & Adolescent Psychiatry, 45(1), 26–36. 10.1097/01.chi.0000184933.71917.f4 [DOI] [PubMed] [Google Scholar]
- Antonio MCK, Hishinuma ES, Ing CT, Hamagami F, Dillard A, Kekauoha BP, Solatorio C, Cassel K, Braun KL, & Kaholokula JK (2020). A resilience model of adult Native Hawaiian health utilizing a newly multi-dimensional scale. Behavioral Medicine, 46(3–4), 258–277. 10.1080/08964289.2020.1758610 [DOI] [PMC free article] [PubMed] [Google Scholar]
- Bang M, Marin A, & Medin D. (2018). If Indigenous peoples stand with the sciences, will scientists stand with us? Daedalus, 147(2), 148–159. https://doi-org.hpusidm.oclc.org/10.1162/DAED_a_00498 [Google Scholar]
- Beaglehole JC (2017). The journals of Captain James Cook on his voyages of discovery: Volume II: The voyage of the resolution and adventure 1772–1775. Routledge. [Google Scholar]
- Blaisdell K, & Mokuau N. (1991). Kanaka Maoli: Indigenous Hawaiians. In Mokuau N. (Ed.), Handbook of social services for Asian and Pacific Islanders (pp. 131–154). Greenwood. [Google Scholar]
- Bombay A, Matheson K, & Anisman H. (2010). Decomposing identity: Differential relationships between several aspects of ethnic identity and the negative effects of perceived discrimination among first nations adults in canada. Cultural Diversity & Ethnic Minority Psychology, 16(4), 507–516. 10.1037/a0021373 [DOI] [PubMed] [Google Scholar]
- Brady M. (1995). Culture in treatment, culture as treatment. A critical appraisal of developments in addictions programs for Indigenous North Americans and Australians. Social Science & Medicine (1982), 41(11), 1487–1498. 10.1016/0277-9536(95)00055-c [DOI] [PubMed] [Google Scholar]
- Brave Heart MY (1998). The return to the sacred path: Healing the historical trauma and historical unresolved grief response among the Lakota through a psychoeducational group intervention. Smith College Studies in Social Work, 68(3), 287–305. 10.1080/00377319809517532 [DOI] [Google Scholar]
- Bushnell OA (1993). The gifts of civilization: Germs and genocide in Hawaii. University of Hawaii Press. [Google Scholar]
- Cook K. (2018). Mai Kahiki Mai: Out from Kahiki. In Cook K. (Ed.), Return to Kahiki: Native Hawaiians in Oceania (Studies in North American Indian History, pp. 1–31). Cambridge University Press. 10.1017/9781108164436.001 [DOI] [Google Scholar]
- Endo Inouye T, & Estrella R. (2014). Toward health equity for Asian American, Native Hawaiian, and Pacific Islanders: The health through action model. The Foundation Review, 6(1), 10–24. 10.9707/1944-5660.1188 [DOI] [Google Scholar]
- Evans-Campbell T. (2008). Historical trauma in American Indian/NativeAlaska communities. Journalof Interpersonal Violence, 23(3), 316–338. 10.1177/0886260507312290 [DOI] [PubMed] [Google Scholar]
- Goebert D, Nahulu L, Hishinuma E, Bell C, Yuen N, Carlton B, Andrade NN, Miyamoto R, & Johnson R. (2000). Cumulative effect of family environment on psychiatric symptomatology among multiethnic adolescents. Journal of Adolescent Health, 27(1), 34–42. 10.1016/S1054-139X(00)00108-7 [DOI] [PubMed] [Google Scholar]
- Gone JP (2009). A community-based treatment for Native American historical trauma: Prospects for evidence-based practice. Journal of Consulting and Clinical Psychology, 77(4), 751–762. 10.1037/a0015390 [DOI] [PubMed] [Google Scholar]
- Gone JP (2010) The Red Road to wellness: Cultural reclamation in a Native First Nations community treatment center. American Journal of Community Psychology, 47(1–2), 187–202. 10.1007/s106464-010-9373-2 [DOI] [PubMed] [Google Scholar]
- Gone JP (2013). Redressing First Nations historical trauma: Theorizing mechanisms for Indigenous culture as mental health treatment. Transcultural Psychiatry, 50(5), 683–706. 10.1177/1363461513487669 [DOI] [PubMed] [Google Scholar]
- Gonzalez MB, Sittner KJ, & Walls ML (2022). Cultural efficacy as a novel component of understanding linkages between culture and mental health in Indigenous communities. American Journal of Community Psychology, 70(1–2), 191–201. 10.1002/ajcp.12594 [DOI] [PMC free article] [PubMed] [Google Scholar]
- Hawai‘i Health Data Warehouse. (2014). Depressive disorder, for the State of Hawaii, for the aggregated years-2011–2013, 2012–2014. http://hhdw.org/wp-content/uploads/BRFSS_Depression_AGG3_00002_2011.pdf
- Kaholokula JKA (2013). Social determinants of health and health disparities social determinants of health and health disparities in Native Hawaiians in Native Hawaiians. National Institute on Minority Health and Health Disparities Translational Health Disparities Course. [Google Scholar]
- Kaholokula JKA, Hermosura AH, & Antonio MC (2019). Physical wellbeing of Native Hawaiians, the Indigenous people of Hawai’i. In Fleming C. & Manning M. (Eds.), Routledge handbook of Indigenous wellbeing (pp. 44–57). Routledge. [Google Scholar]
- Kaholokula JKA, Okamoto SK, & Yee BW (2019). Special issue introduction: Advancing Native Hawaiian and Other Pacific Islander health. Asian American Journal of Psychology, 10(3), 197–205. 10.1037/aap0000167 [DOI] [Google Scholar]
- Kamaka MK, Wong VS, Carpenter D, Kaulukukui CM, Markarinec GG, Mesiona WK, & Look MA (2017). Kākou: Collaborative cultural competency. In Lee WKM & Look MA (Eds.), Ho‘i hou ka mauli ola: Pathways to Native Hawaiian health (pp. 53–71). University of Hawai‘i Press. [Google Scholar]
- Kana’iaupuni SM (2005). Ka’akālai Kū Kanaka: A call for strengths-based approaches from a Native Hawaiian perspective. Educational Researcher, 34(5), 32–38. 10.3102/0013189X034005032 [DOI] [Google Scholar]
- Kana’iaupuni SM (Ed.). (2006). Hūlili: Multidisciplinary research on Hawaiian well-being (Vol. 3). Kamehameha Schools. [Google Scholar]
- Ka‘opua LS (2008). Developing a culturally responsive breast cancer screening promotion with Native Hawaiian women in churches. Health & Social Work, 33(3), 169–177. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Kauanui JK (2008). Hawaiian blood: Colonialism and the politics of sovereignty and indigeneity. Duke University Press. [Google Scholar]
- Kūkulu Kumuhana Planning Committee. (2017). Creating radical and new knowledge to improve Native Hawaiian wellbeing. Lili’uokalani Trust. [Google Scholar]
- Leonard WY (2008). When is an “extinct” language not extinct? Miami, a formerly sleeping language. In King KA, Schilling-Estes N, Fogle L, Lou JJ, & Soukup B. (Eds.), Sustaining linguistic diversity: Endangered and minority languages and language varieties (pp. 23–33). Georgetown University Press. [Google Scholar]
- Leonard WY (2012). Reframing language reclamation programmes for Everybody’s Empowerment. Gender and Language, 6(2), 339–367. 10.1558/genl.v6i2.339 [DOI] [Google Scholar]
- Look MA, Maskarinec GG, de Silva M, Seto T, Mau ML, & Kaholokula JK (2014). Kumu hula perspectives on health. Hawai’i Journal of Medicine & Public Health a Journal of Asia Pacific Medicine & Public Health, 73(12 Suppl. 3), 21–25. [PMC free article] [PubMed] [Google Scholar]
- Look MA, Trask-Batti M, Agres R, Mau ML, & Kaholokula JK (2013). Assessment and priorities for health & well-being in Native Hawaiians and other Pacific peoples. Center for Native and Pacific Health Disparities Research, University of Hawai‘i. [Google Scholar]
- Manuel-Sagon K. (2020). An awakening of the Hawaiian way of life: Framing Kapu Aloha and the Mauna Kea Controversy. PURE Insights, 9, Article 5. https://digitalcommons.wou.edu/pure/vol9/iss1/5 [Google Scholar]
- Mau M, Blanchette P, Carpenter D, Kamaka M, & Saito E. (2010). Lōkahi triangle. Health and health care of Native Hawaiian and Other Pacific Islander older adults eCampus-Geriatrics. https://geriatrics.stanford.edu/wp-content/uploads/downloads/ethnomed/hawaiian_pacific_islander/downloads/hawaiian_american.pdf [Google Scholar]
- McCubbin LD, & Marsella A. (2009). Native Hawaiians and psychology: The cultural and historical context of Indigenous ways of knowing. Cultural Diversity and Ethnic Minority Psychology, 15(4), 374–387. 10.1037/a0016774 [DOI] [PubMed] [Google Scholar]
- McKivett A, Paul D, & Hudson N. (2018). Healing conversations: Developing a practical framework for clinical communication between Aboriginal communities and Healthcare Practitioners. Journal of Immigrant and Minority Health, 21(3), 596–605. 10.1007/s10903-018-0793-7 [DOI] [PubMed] [Google Scholar]
- McMullin J. (2005). The call to life: Revitalizing a healthy Hawaiian identity. Social Science & Medicine, 61(4), 809–820. 10.1016/j.socscimed.2004.08.051 [DOI] [PubMed] [Google Scholar]
- Medeiros W. (2021). How the 2019 Mauna Kea Protest Movement sparked a Hawaiian Cultural Renaissance: A mini ethnography. SUURJ: Seattle University Undergraduate Research Journal, 5, Article 17. https://scholarworks.seattleu.edu/suurj/vol5/iss1/17 [Google Scholar]
- Meyer M. (2003). Ho’oulu our time of becoming: Hawaiian epistemology and early writings. Native Books. [Google Scholar]
- Mokuau N. (2011). Culturally based solutions to preserve the health of Native Hawaiians. Journal of Ethnic and Cultural Diversity in Social Work, 20(2), 98–113. 10.1080/15313204.2011.570119 [DOI] [Google Scholar]
- Mokuau N, Braun KL, & Daniggelis E. (2012). Building family capacity for Native Hawaiian women with breast cancer. Health & Social Work, 37(4), 216–224. https://doi-org.hpu.idm.oclc.org/10.1093/hsw/hls033 [DOI] [PMC free article] [PubMed] [Google Scholar]
- OARC Stats. (2021). https://stats.oarc.ucla.edu/other/mult-pkg/whatstat/
- Oneha MFM (2000). Ka mauli o ka `āina a he mauli Kānaka (The life of the land is the life of the people): An ethnographic study from a Hawaiian sense of place [Unpublished doctoral dissertation]. University of Colorado. [Google Scholar]
- Paglinawan L, Paglinawan R, Kauahi D, & Kanuha VK (2020). Nānā i ke kumu: Helu Ekolu look to the Source (Vol. III). Lili‘uokalani Trust. [Google Scholar]
- Pokhrel P, & Herzog TA (2014). Historical trauma and substance use among Native Hawaiian College students. American Journal of Health Behavior, 38(3), 420–429. 10.5993/ajhb.38.3.11 [DOI] [PMC free article] [PubMed] [Google Scholar]
- Pulla V. (2012). What are strengths based practices all about? In Pulla V, Chenoweth L, Francis A, & Bakaj S. (Eds.), Papers in strengths based practice (1st ed., pp. 51–68). Allied Publishers Private Limited. [Google Scholar]
- Ramirez LC, & Hammack PL (2014). Surviving colonization and the quest for healing: Narrative and resilience among California Indian tribal leaders. Transcultural Psychiatry, 51(1), 112–133. 10.1177/1363461513520096 [DOI] [PubMed] [Google Scholar]
- Schachter J, & Funk A. (2012). Sovereignty, indigeneity, identities: Perspectives from Hawai’i. Social Identities, 18(4), 399–416. 10.1080/13504630.2012.673869 [DOI] [Google Scholar]
- Shahan KM (2009). Health disparity in Native Hawaiians diagnosed with diabetes [Unpublished doctoral dissertation]. Arizona State University. [Google Scholar]
- Stannard DE (1989). Before the horror: The population of Hawaii on the eve of western contact. Honolulu, HI: University of Hawaii Press. [Google Scholar]
- Thomas D, Mitchell T, & Arseneau C. (2016). Re-evaluating resilience: From individual vulnerabilities to the strength of cultures and collectivities among Indigenous communities. Resilience, 4, 116–129. 10.1080/21693293.2015.109417 [DOI] [Google Scholar]
- Trask HK (1999). From a Native daughter: Colonialism and sovereignty in Hawai‘i (Revised ed.). University of Hawai‘i Press. [Google Scholar]
- Trask HK (2010, April 2). The struggle for Hawaiian Sovereignty–Introduction. Cultural Survival. https://www.culturalsurvival.org/publications/cultural-survival-quarterly/struggle-hawaiian-sovereignty-introduction [Google Scholar]
- Tuck E. (2009). Re-visioning action: Participatory action research and Indigenous theories of change. The Urban Review, 41, 47–65. [Google Scholar]
- Wendt DC, & Gone JP (2012). Rethinking cultural competence: Insights from Indigenous community treatment settings. Transcultural Psychiatry, 49(2), 206–222. 10.1177/1363461511425622 [DOI] [PubMed] [Google Scholar]
- Wexler L. (2014). Looking across three generations of Alaska Natives to explore how culture fosters Indigenous resilience. Transcultural Psychiatry, 51(1), 73–92. 10.1177/1363461513497417 [DOI] [PubMed] [Google Scholar]
- Whitbeck LB, Walls ML, Johnson KD, Morrisseau AD, & McDougall CM (2009). Depressed affect and historical loss among North American Indigenous adolescents. American Indian and Alaska Native Mental Health Research (Online), 16(3), 16. [DOI] [PMC free article] [PubMed] [Google Scholar]
- World Health Organization. (2001). The world health report 2001: Mental health: New understanding, new hope. [Google Scholar]
- Young KGT (2014). Rethinking the Native Hawaiian past. Routledge. 10.4324/9781315805153 [DOI] [Google Scholar]
- Zimmerman MA (2013). Resiliency theory: A strengths-based approach to research and practice for adolescent health. Health Education & Behavior, 40(4), 381–383. 10.1177/1090198113493782 [DOI] [PMC free article] [PubMed] [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
