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. Author manuscript; available in PMC: 2011 Dec 1.
Published in final edited form as: J Prim Prev. 2010 Dec;31(5-6):311–319. doi: 10.1007/s10935-010-0222-8

A Typology and Analysis of Drug Resistance Strategies of Rural Native Hawaiian Youth

Scott K Okamoto 1,✉, Susana Helm 2, Danielle Giroux 3, Alexis Kaliades 4, Kaycee Nahe Kawano 5, Stephen Kulis 6
PMCID: PMC3005017  NIHMSID: NIHMS233456  PMID: 20640939

Abstract

This study examines the drug resistance strategies described by Native Hawaiian youth residing in rural communities. Sixty-four youth from 7 middle and intermediate schools on the Island of Hawai‘i participated in a series of gender-specific focus groups. Youth responded to 15 drug-related problem situations developed and validated from prior research. A total of 509 responses reflecting primary or secondary drug resistance strategies were identified by the youth, which were qualitatively collapsed into 16 different categories. Primary drug resistance strategies were those that participants listed as a single response, or the first part of a two-part response, while secondary drug resistance strategies were those that were used in tandem with primary drug resistance strategies. Over half of the responses reflecting primary drug resistance strategies fell into three different categories (“refuse,” “explain,” or “angry refusal”), whereas over half of the responses reflecting secondary drug resistance strategies represented one category (“explain”). Significant gender differences were found in the frequency of using different strategies as well as variations in the frequency of using different strategies based on the type of drug offerer (family versus friends/peers). Implications for prevention practice are discussed.

Keywords: Drug, Native Hawaiian, Culture, Prevention, Youth

Introduction

The health and health disparities of Native Hawaiian and other Pacific Islander (NHOPIs) populations have been gaining increased attention in recent years. The National Institutes of Health have recently prioritized indigenous health disparities, including those of Native Hawaiians, in recent funds released through the American Recovery and Reinvestment Act (National Institute on Drug Abuse 2009), and a United States President’s advisory commission on the health and welfare of Asian Americans and Pacific Islanders has recently been established through an Executive Order (Obama 2009). As a part of these initiatives, research focused on the drug use of NHOPI populations is central in the effort to reduce drug abuse and drug-related health disparities of these populations.

More specifically, drug use of NHOPI youth populations has been recognized as a major health concern over the past 20 years (Edwards et al. in press); however, there are very few studies that have been published on these populations (Mokuau et al. 2008). Particularly absent from the literature is research on drug prevention for these youth (Edwards et al. in press; Rehuher et al. 2008), including studies that have cultural and social relevance for the development of prevention programs for these youth. To help fill this gap in the literature, this study examines the drug resistance strategies used by Native Hawaiian youth residing in rural communities. Participants in this study described strategies they would employ in drug-related problem situations selected from a recently developed and validated survey (the Hawaiian Youth Drug Offers Survey [HYDOS]; Okamoto et al. 2010). In the Okamoto et al. (2010) study, culturally- and contextually-specific drug related problem scenarios were developed through focus groups with rural Hawaiian youth and were evaluated based on their frequency of exposure to each scenario and difficulty in refusing drugs in each scenario. The present study evaluates the responses to a subset of these scenarios using a series of small group activities.

The Prevalence and Risk of Drug Use among Native Hawaiian Youth

Historically, Native Hawaiian youth have been collapsed with other Asian American and Pacific Islander populations in epidemiological drug use research, often leading to misleading results (Mokuau et al. 2008). However, more recent studies have analyzed Native Hawaiians separately from Asian American populations and have found that they have some of the highest rates of alcohol, tobacco, and other drug (ATOD) use. Research specific to Native Hawaiian youth has found that these youth have an earlier initiation into ATOD use (Lai and Saka 2005), and higher ATOD use rates (Wong et al. 2004) when compared with other ethnocultural groups. Further, Mayeda et al. (2006) found that Native Hawaiian girls used marijuana and alcohol at significantly higher rates than their male counterparts, suggesting different levels of substance use risk based on gender for these youth. Drug use has been described as a robust correlate to school infractions, suspensions, and poorer academic achievement for Native Hawaiian youth (Hishinuma et al. 2006) and has been related to other health and mental health issues for them such as unsafe sexual practices (Ramisetty-Mikler et al. 2004) and suicidal behavior (Else et al. 2007; Yuen et al. 2000).

Several recent qualitative and quantitative studies have also pointed to the higher social and environmental risk for drug use of Native Hawaiian youth compared with other youth populations. Compared with other ethnocultural groups, Native Hawaiian youth were exposed significantly more to drug offers from peers and family members in their social environment (Okamoto et al. 2010). Although many of these offers were overt and direct, an equal amount of them were more complex and incorporated a situational demand or expectation to use drugs (Helm et al. 2008). Risk and protection related to drug use for Native Hawaiian youth have also been described in the context of interrelated familial networks (Okamoto et al. 2009). Using qualitative methods, Okamoto et al. (2009) described how immediate and extended family members provided exposure to or protection from illicit substances in the home, school, and community. In fact, research has suggested that family factors play a significant role in the substance use and resistance to substances of Native Hawaiian youth (Makini et al. 2001; Goebert et al. 2000). Compared to their non-Hawaiian counterparts, Hawaiian adolescents interacted significantly more with their family members (Goebert et al. 2000) and received more family support (Goebert et al. 2004), suggesting that family plays an important and influential role in the lives of Native Hawaiian youth. In particular, respect for elder family members (kūpuna) as sources of wisdom and carriers of the culture is an important characteristic within Native Hawaiian communities and has been shown to be an integral part of drug abuse rehabilitation (Morelli and Fong 2000; Morelli et al. 2001). These findings are indicative of the family-oriented value system (i.e., ‘ohana system) that is pervasive within the Native Hawaiian culture (Miike 1996). Therefore, though drug use of Native Hawaiian youth may be influenced by multiple factors, family members seem to play a key role in the drug use and resistance for these youth.

Drug Resistance Strategies of Native Youth Populations

Drug resistance skills and strategies have long been a staple of effective drug prevention programs, including those for minority and indigenous youth populations (Hecht et al. 2003; Tobler and Stratton 1997). For example, Schinke et al. (1988) described a drug prevention program focused on skills for bicultural competence of Native American youth, incorporating communication and coping skills specific to the worldviews of these youth. Okamoto et al. (2001) examined the drug resistance strategies of Native American youth of the Southwest U.S. and found a preference for non-confrontational drug resistance strategies (e.g., avoiding a drug related problem situation, redirecting the topic away from drug use). A more recent analysis found a variety of different non-confrontational strategies employed by these youth including avoiding or evading a drug-related problem situation, distancing oneself from drug offerers or users, or leaving the drug-related situation altogether (Kulis et al. in press). One explanation for these findings might be that non-confrontational strategies toward drug resistance allow Native youth to preserve important relationships with peers and family members, allowing them to maintain harmony within interconnected social networks. To date, however, there have been no published accounts of drug resistance strategies of Native Hawaiian youth. This knowledge gap has had negative implications for the development of effective prevention programs for these youth. Specifically, there are very few evaluated drug prevention programs targeted for these youth, and most of those that are described in the literature have incorporated weak research designs (Edwards et al. in press; Rehuher et al. 2008). More research is needed on drug resistance strategies for Native Hawaiian youth in order to create a foundation for evidence-based drug prevention practices for them. The present study addresses this need through the systematic evaluation of the drug resistance strategies described by Native Hawaiian youth residing in rural communities.

Method

Sampling and Participants

The schools participating in the study were geographically focused within two of the three public school complex areas on the Island of Hawai‘i, and comprised 88% of all middle and intermediate public schools within the sampling frame. Compared with the State, schools within these areas had a higher percentage of families receiving public assistance and a higher percentage of families with children living in poverty (Accountability Resource Center Hawai’i 2008). Consistent with school–university–community partnerships in youth research (e.g., Spoth 2007), students were recruited in collaboration with School Based Research Liaisons, who were staff members (e.g., school counselors, health teachers) working within the schools in our sampling frame. Liaisons functioned as the coordinators between the university researchers and public schools within our sampling frame. Their responsibilities were to recruit Native Hawaiian students for the study, to distribute and collect parental consent forms for these students, and to arrange for space within their respective schools for data collection procedures.

Sixty-six parental consent forms were collected by School Based Research Liaisons; however, two of these forms did not grant permission for the youth to participate in the study. Thus, 64 youth from 7 middle and intermediate schools on the Island of Hawai‘i participated in this study. Approximately 11% of these youth were in the 6th grade, 42% were in the 7th grade, and 47% were in the 8th grade. Fifty percent of these youth were female, and their mean age was 12.58 (SD = 0.612). In terms of ethnicity, approximately 95% of the youth identified as Hawaiian or part Hawaiian. The majority of these youth also identified with additional ethnocultural groups, such as Chinese (53%), Filipino (52%), Portuguese (50%), and White (41%).

Procedures

All research procedures were approved by the Institutional Review Boards at Hawai‘i Pacific University, the University of Hawai‘i at Mānoa, and the State of Hawai‘i Department of Education. Youth participated within 14 gender-specific focus groups (one male and one female group per school), and the gender of the group facilitators matched that of the participants. The group process lasted approximately 90 min and consisted of three parts: (a) an elicitation activity, in which youth were asked to generate as many potential or viable responses as possible to selected drug related problem scenarios (see Table 1 for a list of these scenarios), (b) a rank ordering activity, in which youth were asked to rank order their responses to each selected scenario by their perceived level of competence, and (c) a focus group discussion, in which youth were asked to describe and/or justify their decisions for their rank order. The present study focused primarily on the first two parts of the group process (i.e., elicitation and rank ordering), although initial impressions of the youths’ narratives from the data collection process were used to broadly interpret some of the findings. The 15 scenarios used in this study were selected from a larger group of 62 drug-related problem scenarios (see Okamoto et al. 2010). Specifically, these scenarios were developed from the narratives of rural Hawaiian youth and were subjected to a series of test development and validation procedures. Selected scenarios were those that were found to be the most frequently experienced by middle or intermediate school aged youth as well as the most difficult for them to deal with in their homes, schools, and/or communities, based on prior research (Okamoto et al. 2010).

Table 1.

Drug related problem scenarios

Item Scenario Offerer Drug
1. One of your classmates always hangs around with this group of older kids and they smoke weed every day. One day, your classmate asks you if you’d like to eat lunch with them. Peer/friend Marijuana
2. A big, bulky boy in school is known to be the leader of a group of “tough kids,” who fight and do drugs. He approaches you one day at recess and asks you if you’d like to hang out with his group. Peer/friend Drugs
3. You’re at a party with your ‘ohana (family), and one of your older cousins offers you to take a sip of beer. You tell him you gotta go, but he keeps following you and asking you to drink some. Cousin Alcohol
4. You’re at a New Year’s Eve Party with your ‘ohana, and your auntie’s boyfriend offers you some of his beer. Uncle Alcohol
5. Your friends bring Bacardi to school and mix it with juice. They are drinking it on campus during recess. They offer you some. Peer/friend Alcohol
6. You are at a family party where the adults have coolers full of beer. They are getting drunk, so you and your cousins can take a beer without the adults noticing. One of your cousins says to you, “Let’s grab one.” Cousin Alcohol
7. You see some of your friends at the fair, so you go cruise with them for the night. Your friend has weed with her and wants to smoke. She offers you some. Peer/friend Marijuana
8. Your best friend offers you marijuana. You don’t know what might happen to your friendship if you said “no.” Peer/friend Marijuana
9. Your dad, uncles, papa, and dad’s friends are making pulehu (barbecue) in the yard, and you are with them. Your mom is inside the house. They are drinking a lot of beer, probably already drunk. Your dad offers you a beer. Parent Alcohol
10. Your older brother enters your bedroom, closes the door, and asks you if you’d like to smoke some weed. Sibling Marijuana
11. On the nights that there is a full moon lots of the older kids like to go out at night because they can kanikapila (play music) and smoke marijuana and drink beer outside. Your older cousin invites you to come along. Cousin Drugs
12. You are at school, and some of your friends want to skip class so that they can smoke pakalolo (marijuana). They ask you to join them. Peer/friend Marijuana
13. You are with a girl/boy you like and some other friends. They are all hiding in the bushes and smoking weed. They ask you if you want to try some. After you say no, they say, “Just try this once, it’s cool.” Peer/friend Marijuana
14. You are at home having dinner with your family. Your parents are drinking beer with dinner, and your mom offers you some. Parent Alcohol
15. Your older cousin is walking with you to the mall. He takes out some marijuana and says, “Don’t tell my parents. You like some?” Cousin Marijuana
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For the elicitation activity, group members were separated into 2–3 smaller groups based on grade level and were asked to come up with as many responses as they could to each selected scenario. In order to control for a response set, scenarios were assigned to each gender-specific group randomly, and efforts were made to minimize the duplication of the same scenario within male and female groups in the same school. The mean number of scenarios examined per gender-specific group was 3.57 (SD = 0.65). Because this activity resembled the process of “brainstorming,” participants were encouraged not to edit or filter any of their responses. When youth participants became “stuck” in the elicitation process, facilitators prompted them by asking them if they could think of any additional responses or by asking them to envision themselves within each scenario and how they might react in each situation if it were real. After the elicitation activity, the members within each gender-specific group were asked to come together and collectively rank order the responses to each scenario that were generated in the smaller grade-specific groups based on their perceived efficacy for drug refusal. For this activity, youth were asked questions such as, “which one of these responses is the best response to the situation in terms of preventing you from using drugs and/or alcohol”; “which one is the second (third, fourth, etc.) best response to the situation”; and “which one of these responses is the worst one, which might result in your use of drugs and/or alcohol in the situation.” As a means toward establishing an overall ranking for each scenario, the youth would typically identify a top, middle, and bottom tier of responses for each scenario. In these cases, facilitators prompted the youth to collaboratively rank order the 2–3 responses within each tier in order to complete the overall rank ordering for each scenario. The mean number of scenarios that were ranked per gender-specific group was 2.93 (SD = 1.00).

Data Analysis

Responses to each scenario were transcribed verbatim and systematically coded based on content or theme of the resistance strategy (see Table 2 for a description of each code). In some cases, responses incorporated more than one strategy. In these situations, a primary resistance strategy was coded, which was the first resistance strategy described in the response, as well as a secondary resistance strategy, which was the second strategy described in the response. Each response was also coded by the gender of the group participants that created the response as well as by the offerer (i.e., peers/friends versus family) and the type of drug (i.e., alcohol, marijuana, or multiple drugs) described in its associated scenario. Relationships between the primary drug resistance strategies and gender, drug offerer, and type of drug were explored using chi-square analyses. These analyses were adjusted to eliminate cells with counts less than 5. Patterns related to high- and low-ranked primary drug resistance strategies were also examined. Because secondary drug resistance strategies were not included in every response to each scenario, they were not ranked separately from the primary drug resistance strategies.

Table 2.

Frequency of primary and secondary drug resistance strategies

Category Definition and/or example(s) PDRS (N = 420) SDRS (N = 89)
Refuse Saying “no” to a drug offer 88 (21.0%) 6 (6.7%)
Explain Providing an explanation for drug refusal 76 (18.1%) 49 (55.1%)
Leave Walking away from the drug offer situation 26 (6.2%) 16 (18.0%)
Angry refusal Refusal with an angry tone, often laced with profanity (e.g., “Get the hell away from me!”) 70 (16.7%) N/A
Aggressive refusal Refusal that incorporates the threat or act of physical violence (e.g., “Get the hell away from me, or I’ll punch you in the face.”) 19 (4.5%) 3 (3.4%)
Involve Others Incorporating another person as part of drug refusal (e.g., “I would tell my mom that he offered me drugs.”) 32 (7.6%) 6 (6.7%)
Question Responding to a drug offer with a question (e.g., “Why are you offering me drugs?) 14 (3.3%) N/A
Divert Changing the topic of discussion away from drugs (e.g., “Let’s go play with my X Box 360.”) 7 (1.7%) 1 (1.1%)
Destroy Destroying the drugs being offered in the situation 4 (1.0%) 6 (6.7%)
Ignore Ignoring the offer of drugs in the situation 10 (2.4%) N/A
Accepta Accepting drugs in the situation, with the intent on using them 24 (5.7%) N/A
Intervene Providing a response to the drug offer which expresses caring or concern for the offerer (e.g., “I’m worried about you.”) 26 (6.2%) 1 (1.1%)
Take Taking the drugs away from the offerer, without the intent on using them 16 (3.8%) N/A
Don’t take Not taking the drugs from the offerer, with the absence of overt refusal 2 (0.5%) N/A
Sarcasm Providing a sarcastic comment in response to the drug offer (e.g., “Sure, I’ll take it. NOT.”) 3 (0.7%) 1 (1.1%)
Other Random responses that may not reflect drug resistance 3 (0.7%) N/A
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PDRS primary drug resistance strategy, SDRS secondary drug resistance strategy

a

Accept was included as a drug resistance strategy because multiple youth participants described how they would use “a little” to avoid further pressure to use more alcohol or drugs

Results

A total of 420 individual responses reflecting primary drug resistance strategies were identified by focus group participants, with 204 and 216 responses evolving from male and female focus groups, respectively. Participants rank ordered approximately 88% of these responses within the 90-min time frame. The mean number of rank-ordered responses per scenario developed by each focus group was 8.02 (SD = 1.77). Of these responses, 89 of them (21.2%) also incorporated a secondary drug resistance strategy (47 and 42 from male and female focus groups, respectively). The overall frequency of responses reflecting primary and secondary drug resistance strategies are listed in Table 2. Over half (56%) of the primary drug resistance strategies identified by the youth participants fell into one of three categories: “refuse,” “explain,” or “angry refusal.” Further, over half (55%) of the responses reflecting secondary drug resistance strategies fell into the “explain” category. Of these latter responses, 44 (90%) of them were paired with “refuse” as the primary drug resistance strategy.

Table 3 examines the primary drug resistance strategies ranked first (i.e., the “best”) and eighth or below (i.e., the “worst”) by the youth participants. “Refuse” was ranked first the most frequently whereas “angry refusal” was ranked eighth or below the most frequently. Further, while accepting drugs was identified 24 times by youth participants as a primary response to a drug offer situation (see Table 2), this response was ranked eighth or below in 20 of these occasions (see Table 3).

Table 3.

Frequency of high- and low-ranked primary drug resistance strategies

Category PDRS ranked first (N = 43) PDRS ranked eighth or below (N = 143)
Refuse 17 (39.5%) 18 (12.6%)
Explain 7 (16.3%) 16 (11.2%)
Leave 4 (9.3%) 6 (4.2%)
Angry refusal 2 (4.7%) 32 (22.4%)
Aggressive refusal 2 (4.7%) 10 (7.0%)
Involve others 6 (14.0%) 10 (7.0%)
Question 1 (2.3%) 5 (3.5%)
Divert 1 (2.3%) 3 (2.1%)
Destroy N/A 2 (1.4%)
Ignore N/A 1 (0.7%)
Accept 1 (2.3%) 20 (14.0%)
Intervene 2 (4.7%) 10 (7.0%)
Take N/A 6 (4.3%)
Don’t take N/A N/A
Sarcasm N/A 2 (1.4%)
Other N/A 2 (1.4%)
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PDRS primary drug resistance strategy

Gender, Drug Offerer, and Type of Drug

Analyses were conducted to examine the relationship between primary drug resistance strategies with the gender of the group participants that created each response as well as the drug offerer and type of drug described in each scenario. In terms of gender, male participants referenced “refuse” and “explain” significantly more than female participants whereas female participants referenced “angry refusal” and “aggressive refusal” significantly more than males, χ2 (3, N = 253) = 16.18, p < 0.01. In terms of drug offerer, “angry refusal” was referenced significantly more in situations involving family members compared with those involving peers/friends, χ2 (3, N = 253) = 10.00, p < 0.05. Finally, in terms of type of drug, “refuse” was referenced significantly more in marijuana situations, while “angry refuse” was referenced more in alcohol situations, χ2 (3, N = 226) = 9.14, p < 0.05. However, after controlling for drug offerer in this analysis, these findings failed to reach significance, χ[peer/friend]2=(1,N=57)=2.89, p > 0.05; χ[family]2(2,N=120)=1.76, p > 0.05.

Discussion

The purpose of this study was to enumerate, categorize, and analyze the drug resistance strategies described by Native Hawaiian youth residing in rural communities on the Island of Hawai‘i. Overall, youth participants identified 509 individual responses reflecting either primary or secondary resistance strategies that they would use in their homes, schools, and/or communities. Unlike prior research (e.g., Okamoto et al. 2001), Hawaiian youth in this study did not appear to favor non-confrontational drug resistance strategies to the extent of other Native youth populations. However, consistent with past research on youth drug resistance strategies (e.g., Hecht et al. 2003), participants in this study described overt drug refusal (e.g., saying “no”) and explanations related to drug refusal as predominant ways to resist drugs. Overt drug refusal was the strategy most frequently ranked first by youth participants, suggesting its overall real-world utility related to drug resistance. The combination of overt drug refusal and explanations for refusal has been described in research on the drug resistance of other Native youth populations (Kulis et al. in press), pointing to Native-specific preferences in approaches to drug resistance strategies. Explanations, in particular, were frequently described as both a primary and secondary resistance strategy in this study. Based on initial impressions of the narratives from the data collection process, some youth in the study suggested that explanations for drug refusal were implicitly expected in drug-related problem situations, particularly when drug offerers were adult family members. In order to preserve the interconnected familial relationships characteristic of rural Hawaiian communities (Okamoto et al. 2009), as well as to demonstrate respect for elder family members (Morelli and Fong 2000; Morelli et al. 2001), some youth may have felt it was more respectful to adult family members to provide them with an explanation for drug refusal rather than just providing them with an abrupt negative response. However, with same-generation family members (e.g., cousins, siblings), “angry” refusal strategies might have been utilized more readily because they may have been more permissible within the kinship structure of the culture. Nonetheless, an examination of the drug resistance strategies ranked eighth or below suggests that angry drug refusals, as well as acceptance of drugs, are used as a last resort. After all else fails, youth may feel that they either need to angrily assert their refusal or just accept the drug offer in order to alleviate the social pressure to use drugs.

The relationship of primary resistance strategies with gender, drug offerer, and type of drug demonstrated interesting findings. In terms of gender, Hawaiian boys referenced “refuse” and “explain” more often than girls whereas Hawaiian girls referenced “angry refusal” and “aggressive refusal” strategies more often. One interpretation of this finding might be that girls’ simple requests for drug abstinence may not be as respected or taken as seriously as those of boys, thus requiring girls to use more forceful means of drug resistance in order for them to abstain from drug use. In other words, angry or aggressive refusal strategies may be a means by which Hawaiian girls assert their needs within a context which attempts to marginalize or control them. Alternatively, Hawaiian boys might not use “angry” or “aggressive” refusal strategies as often because of greater fear that these types of strategies could bring them physical harm (e.g., fighting) and/or the belief that they could be perceived more negatively by male peers/cousins with this type of response. In terms of drug offerers, youth participants referenced angry refusal strategies more frequently with family members than with peers or friends. These findings may have been accounted for through the use of these strategies with same-generation family members (e.g., cousins, siblings). Some youth participants indicated that these strategies accomplished two goals. They communicated shock and dismay at the family member for exposing them to illicit substances, and simultaneously, they expressed concern for the well-being of the family member. Finally, though analyses indicated a relationship between primary drug resistance strategies and type of drug described in the scenario, these findings failed to reach significance when controlling for the type of drug offerer in the scenario. The majority of alcohol scenarios used in the elicitation activity included family members as offerers whereas the majority of marijuana scenarios included peers or friends as offerers. Future research might include a greater number of scenarios with a wider variety of substances and drug offerers in order to explore the relative influence of type of drug and/or offerers in the resistance strategies of Native Hawaiian youth.

Limitations of the Study

This study had several limitations. First, the responses from the focus groups came from a convenience sample of Native Hawaiian youth from one island. The responses from these youth might not represent those of Native Hawaiian youth from rural communities on other islands or from Hawaiian youth residing in urban or suburban areas. Second, despite efforts to recruit only Hawaiian or part-Hawaiian youth, three youth in this study (5%) indicated that they were not Hawaiian, which may have influenced the findings. Third, the resistance strategies described by the youth were elicited through a list of realistic, albeit hypothetical, drug related problem situations. Though participating youth were asked to envision these situations as real, it is unclear as to whether these youth would have actually responded to the situations as they described in the group sessions if they were actually confronted with them. Future research might examine the drug resistance strategies of youth in higher risk environments or perhaps even older youth (i.e., in high school) in order to increase the probability of youth participants that have been exposed to drug offer situations. Finally, though the focus group data were broadly used to elucidate the quantitative findings in the Discussion section, they were not systemically analyzed as part of the methodology of this study. In-depth qualitative analyses will be conducted in the future in order to further validate the reasons behind the quantitative findings described in the present study.

Conclusions

This study provided an initial description of the typology of drug resistance strategies used by Native Hawaiian youth in rural communities. As such, it provided a necessary foundation for the development of culturally-grounded drug prevention programs for these youth. Similar to prevention programs focused on non-Hawaiian youth, this study indicated that drug prevention for Hawaiian youth should entail strategies such as overt drug refusal and explanations for refusal. In particular, this study strongly suggested that explanations for drug refusal are a key component of effective drug resistance for Hawaiian youth, perhaps allowing them to achieve the goal of drug resistance while simultaneously preserving their relationships with family. Further, the findings also suggested gender-specific avenues for drug prevention with these youth. Methods for assertive drug refusal are particularly essential for Hawaiian girls and should be integrated into prevention efforts. Finally, the findings suggested that prevention efforts might need to be tailored to specific types of drug offerers (e.g., adult or same-generation family members or peers/friends). This might entail ways to communicate drug resistance while preserving relationships with family and peers in the home, school, and community.

Acknowledgments

This study was supported by funding from the National Institutes of Health/National Institute on Drug Abuse (K01 DA019884), with supplemental funding from the Trustees’ Scholarly Endeavors Program, Hawai‘i Pacific University. Data analysis for this study was supported in part by the National Institutes of Health/National Center on Minority Health and Health Disparities (P20 MD002316). The authors wish to acknowledge the support of Mr. Christopher Edwards and Mr. Anthony Spratford in the data collection for this study.

Contributor Information

Scott K. Okamoto, Email: sokamoto@hpu.edu, School of Social Work, Hawai‘i Pacific University, 1188 Fort St. Mall, Suite 430, Honolulu, HI 96813, USA

Susana Helm, Department of Psychiatry, University of Hawai‘i at Mānoa, 1441 Kapiolani Blvd., Suite 1803, Honolulu, HI 96814, USA.

Danielle Giroux, Department of Psychology, University of Alaska, Anchorage, 3211 Providence Drive, SSB214, Anchorage, AK 99508, USA.

Alexis Kaliades, School of Social Work, Hawai‘i Pacific University, 1188 Fort St. Mall, Suite 430, Honolulu, HI 96813, USA.

Kaycee Nahe Kawano, Department of Psychology, University of Hawai‘i at Hilo, 200 West Kawili Street, Hilo, HI 96720, USA.

Stephen Kulis, School of Social and Family Dynamics, Arizona State University, P.O. BOX 873701, Tempe, AZ 85287, USA.

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