Community-driven drug prevention implementation strategies for Native Hawaiian and Pacific Islander youth in rural Hawai'i

PROJECT SUMMARY/ABSTRACT I am an implementation scientist, youth substance use and mental health services researcher, clinical psychologist, and descendant of Okinawan-Japanese immigrants to Hawaiʻi. I propose to use a community- based participatory research approach to study the implementation of a culturally grounded substance use

prevention curriculum, Ho`ouna Pono. The intervention has been created, evaluated, and spread through several NIDA-funded grants to address the high rates of substance use in Native Hawaiian and Pacific Islander youth, especially in rural areas. Our work has revealed that many implementation barriers intersect at the

youth, family, and teacher levels, indicating a pressing need for community-led implementation efforts. In this Racial Equity Initiative Visionary Award, I propose an innovative combination of implementation science and participatory methods to spread and sustain Ho`ouna Pono in the Windward District of the Hawaiʻi State

Department of Education. I hypothesize that Ho`ouna Pono adoption and sustainability will increase by using community-led innovation tournaments, which actively promote engagement and ownership in the implementation process. I also hypothesize that real-time assessments of implementation through ecological

momentary assessment will enable rapid and accurate implementation and intervention adaptation. These two innovative approaches have never been tested for Native Hawaiian and Pacific Islander youth living in geographically remote and rural areas, making this a novel high-risk, high-reward study. Moreover, this is the

first study to use ecological momentary assessment to facilitate implementation of youth substance use prevention. I intend to challenge the existing research paradigm through this Racial Equity Initiative Visionary Award through redistributing power to community to lead the research effort. Traditionally, implementation

science and research has privileged the researchers' voice, often leading to highly controlled, community-based studies that create mistrust in the scientific process and produce unsustainable interventions with limited community acceptability. These concerns are even more pronounced in populations that have systematically

been the focus of increased scientific inquiry, like indigenous and rural populations. The impact of this paradigm-shifting project has the potential to change how implementation research is conducted by putting community in the leadership role. Furthermore, it will build scientific skills and expertise directly into the

community to foster ongoing implementation and generalizability toward future implementation efforts. It is imperative that studies with the potential for reshaping institutional structures and systems be conducted to further advance racial equity, especially for Native Hawaiian and Pacific Islander youth. The proposed study

addresses this imperative.