Susana Helm

The development and initial validation of the Hawaiian Youth Drug Offers Survey (HYDOS)

Objective. This study describes the development and preliminary validation of a survey focused on the most salient situations where drugs and/or alcohol are offered to Native Hawaiian youth in rural communities. Design. The study used a five-phase approach to test development and validation. In Phase 1 (item generation), survey items were created from a series of focus groups with middle school aged youth (n=47). In Phase 2 (item refinement and selection), items were edited and reduced to 62 drug-offer situations that were selected for inclusion in the survey. In Phase 3 (item reduction), items were administered to 249 youth from seven middle or intermediate schools in Hawai‘i. Results. Exploratory factor analysis of the Native Hawaiian subsample (n=194) indicated the presence of three factors accounting for 63% of the variance: peer pressure (23%); family offers and context (21%); and unanticipated drug offers (19%). The survey items differentiated between Hawaiian and non-Hawaiian youth respondents, supporting the validity of the questionnaire. The hypothesized relationship between cultural connectedness and drug offer exposure was not confirmed. Internal consistency of the measure was high. Conclusions. The survey helps to fill the gap in information related to drug use of Native Hawaiian youth and has implications for the development and assessment of culturally-specific drug prevention programs for these youth.

Community Risk and Resiliency Factors Related to Drug Use of Rural Native Hawaiian Youth: An Exploratory Study

This exploratory, qualitative study examined the community-based risk and resiliency factors related to the drug use of rural Native Hawaiian youth. Forty-seven youth from five middle schools participated in focus groups that examined the ecological context of drug use for rural Hawaiian youth. Findings indicated that youth in the study were part of large extended networks of families and that these networks became a defining characteristic of the rural communities in the study. These familial networks functioned as sources of risk and protection related to drug use for youth participants. Implications for community-based practice are discussed.

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

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.

Moving Toward Comprehensiveness and Sustainability in a Social Ecological Approach to Youth Violence Prevention: Lessons from the Asian/Pacific Islander Youth Violence Prevention Center

Youth violence is a serious public health problem affecting communities across the United States. The use of a social ecological approach has helped reduce its prevalence. However, those who have put the approach into practice often face challenges to effective implementation. Addressing social ecology in all its complexity presents one obstacle; the ability of private non-profit and public agencies to sustain such comprehensive efforts presents another. Here, we provide an example of our efforts to prevent youth violence. We worked with the Asian/Pacific Islander Youth Violence Prevention Center (APIYVPC) and two communities on O`ahu. We provide a case example from the Asian/Pacific Islander Youth Violence Prevention Center (APIYVPC) of our work, in collaboration with two communities on O`ahu, to develop and implement a youth violence prevention initiative that is becoming both comprehensive and sustainable. We illustrate the incremental nature of what it means to be comprehensive and we underscore the importance of reaching sustainability as the project unfolds.

Intimate Partner Violence and Substance Use Among Hawai'i Youth: An Analysis of Recent Data From the Hawai'i Youth Risk Behavior Survey

Objective: This study explored the relationship between adolescent substance use and intimate partner violence (IPV). Method: A secondary data analysis was conducted using the statewide Hawai‘i Youth Risk Behavior Survey data for the years 2005, 2007, and 2009. Public school students (n = 4,364) attending medium to large school districts in Hawai‘i participated. Prevalence estimates and regression models of covariates were calculated. Results: Results indicated that IPV victimization and substance use are prevalent among Hawai‘i youth. Odds ratio calculations indicated that substance use (specifically multiple drug use) is associated with an increased likelihood of reporting IPV victimization. Conclusions: Curricula and programming to prevent drug use among Hawai‘i youth must incorporate IPV prevention, and vice versa.

Gender differences in drug offers of rural Hawaiian youths: A mixed-methods analysis

This study examined the gender differences in drug-offer situations of Native Hawaiian youths in rural communities. Youths from seven middle or intermediate schools (N = 194) on the Big Island of Hawai‘i completed a survey that focused on the drug offers they had received. Multivariate and bivariate analyses indicated that the girls received significantly more drug offers than did the boys in the sample and found it more difficult to refuse drugs in such situations. Qualitative data gathered from communities in the survey’s sampling frame elucidated the quantitative findings. Limitations of the study and implications for prevention practice are discussed.

Getting In, Being In, Staying In, and Getting Out Adolescents’ Descriptions of Dating and Dating Violence

Dating is a highly desirable experience during adolescence and serves as an important developmental milestone. This study explored healthy and unhealthy dating as a step toward improving adolescent well-being. Six focus group interviews were conducted with high school–aged girls and boys (N = 35). Interviews were audio recorded, transcribed verbatim, and analyzed using a grounded theory approach. Youth were asked to describe what dating was like for teens in their age, including dating problems. Narrative analyses indicated the following four distinct stages of dating: getting in, being in, staying in, and getting out. Each stage is described in-depth, along with exemplary quotes. Practice implications for each stage of the dating experience emphasize developmentally timed universal health education starting in middle school. In particular, health programming is needed to improve adolescents’ skills for identifying unhealthy relationships to minimize “staying in,” and for “getting out” safely and respectfully.

Developing Empirically Based, Culturally Grounded Drug Prevention Interventions for Indigenous Youth Populations

This article describes the relevance of a culturally grounded approach toward drug prevention development for indigenous youth populations. This approach builds drug prevention from the “ground up” (i.e., from the values, beliefs, and worldviews of the youth that are the intended consumers of the program) and is contrasted with efforts that focus on adapting existing drug prevention interventions to fit the norms of different youth ethnocultural groups. The development of an empirically based drug prevention program focused on rural Native Hawaiian youth is described as a case example of culturally grounded drug prevention development for indigenous youth; the impact of this effort on the validity of the intervention and on community engagement and investment in the development of the program are discussed. Finally, implications of this approach for behavioral health services and the development of an indigenous prevention science are discussed.

The development of videos in culturally grounded drug prevention for rural native Hawaiian youth.

The purpose of this study was to adapt and validate narrative scripts to be used for the video components of a culturally grounded drug prevention program for rural Native Hawaiian youth. Scripts to be used to film short video vignettes of drug-related problem situations were developed based on a foundation of pre-prevention research funded by the National Institute on Drug Abuse. Seventy-four middle- and high-school-aged youth in 15 focus groups adapted and validated the details of the scripts to make them more realistic. Specifically, youth participants affirmed the situations described in the scripts and suggested changes to details of the scripts to make them more culturally specific. Suggested changes to the scripts also reflected preferred drug resistance strategies described in prior research, and varied based on the type of drug offerer described in each script (i.e., peer/friend, parent, or cousin/sibling). Implications for culturally grounded drug prevention are discussed.

‘A‘ole Drugs! Cultural Practices and Drug Resistance of Rural Hawai`ian Youths

This qualitative study examined how Native Hawai`ian youths from rural communities utilized cultural practices to promote drug resistance and/or abstinence. Forty-seven students from five different middle schools participated in gender-specific focus groups that focused on the cultural and environmental contexts of drug use for Native Hawai`ian youths. The findings described culturally specific activities that participants used in drug-related problem situations. The findings also suggested that those youths with higher levels of enculturation were able to resist drugs more effectively than those youths who were disconnected from their culture. The implications of these findings for social work practice are discussed.