Exploring culturally specific drug resistance strategies of Hawaiian youth in rural communities.

Exploring culturally specific drug resistance strategies of Hawaiian youth in rural communities. ABSTRACT This qualitative study examined the drug resistance strategies ofHawaiian youth residing in rural communities in Hawai'i. Fortyseven youth participated in 14 focus groups which focused on the socialand environmental context of drug use for these youth. The findingsindicated that there were 47 references to resistance strategies used indrug offer situations. These strategies fell within two differentcategories: (a) overt/confrontational drug resistance strategies, and(b) non-confrontational drug resistance strategies. These strategiesoccurred within the community context of relational networks of ascribedand biological family members and differed in frequency of use bygender. Implications for culturally grounded drug prevention programsfor rural Hawaiian youth are discussed. Keywords: Drug, resistance, Hawaiian, youth, prevention ********** Youth drug resistance skills have been researched extensively sincethe early 1990's and have been a core component of many substanceuse prevention programs (Tobler & Stratton, 1997). Overall, researchhas shown that prevention programs with a focus on drug resistanceskills or strategies are a promising approach in reducing youth druguse, particularly when used in combination with other preventiveapproaches (Johnson et al., 1990; Botvin, Baker, Dusenbury, Botvin,& Diaz, 1995). However, much of this research has focused onpredominantly Caucasian samples, and ethnocultural factors have not beenexamined in much depth. As a result, there is much to be learned aboutthe unique, culturally specific ways in which minority youth populationsresist drugs and alcohol. This information is important in order toaddress the growing problem of health disparities Main article: Race and healthHealth disparities (also called health inequalities in some countries) refer to gaps in the quality of health and health care across racial, ethnic, and socioeconomic groups. , including drug useand abuse (U.S. Department of Health and Human Services Noun 1. Department of Health and Human Services - the United States federal department that administers all federal programs dealing with health and welfare; created in 1979Health and Human Services, HHS , 2003) Guided by a resiliency The ability to recover from a failure. The term may be applied to hardware, software or data. framework (Waller, 2001), the purpose ofthis study was to examine the culturally specific drug resistancestrategies used by Hawaiian youth in rural communities in Hawai'i.Rural communities in Hawai'i were the focus of this study, becauserecent research has shown that these communities have beendisproportionately dis��pro��por��tion��ate?adj.Out of proportion, as in size, shape, or amount.dispro��por affected by drug use compared to their urban andsemi-urban counterparts (Affonso, Shibuya, & Frueh, 2007; Withy with��y?adj.1. Made of or as flexible as withes; tough.2. Wiry and agile.n. pl. with��ies1. A rope or band made of withes.2. a. ,Andaya, Mikami, & Yamada, 2007). The goal of this study was toidentify those skills that were most frequently accessed and accepted bythese youth. These findings have implications for the development ofdrug prevention programs that are grounded in the living conditions living conditionsnpl → condiciones fpl de vidaliving conditionsnpl → conditions fpl de vieliving conditionsliving inrural Hawai'i. Native Hawaiian Youth and Drug Use Similar to other indigenous youth populations, Native Hawaiianyouth have demonstrated high rates of substance use/abuse, withsignificant adverse effects (Edwards, Giroux, & Okamoto, 2010). Theyhave been found to report the highest lifetime and 30-day alcohol,tobacco and other drug (ATOD) use rates among various ethnic groups inHawai'i (Glanz, Maskarinec, & Carlin car��lineor car��lin ?n. ScotsA woman, especially an old one.[Middle English kerling, from Old Norse, from karl, man.] , 2005; Lai & Saka,2005; Mokuau, 2002; Wong, Klingle, & Price, 2004). Further,Ramisetty-Mikler, Caetano, Goebert, and Nishimura (2004) found that ahigher proportion of Native Hawaiian youth initiated drinking by age 12compared to Caucasian and other Asian Pacific Islander Pacific Islandern.1. A native or inhabitant of any of the Polynesian, Micronesian, or Melanesian islands of Oceania.2. A person of Polynesian, Micronesian, or Melanesian descent. See Usage Note at Asian. youths inHawai'i. In terms of substance use effects, Wong et al. found thatNative Hawaiian youth reported the highest need for drug and alcoholtreatment, while Ramisetty-Mikler et al. found that substance use ofNative Hawaiian youth was related to unsafe sexual practices. Clearly,there is a need for more culturally-focused empirical research Noun 1. empirical research - an empirical search for knowledgeinquiry, research, enquiry - a search for knowledge; "their pottery deserves more research than it has received" tounderstand these alarming statistics and to inform drug preventionpractices with rural Native Hawaiian youth. Culturally Specific Drug Resistance Skills Over the past two decades, there has been an increase in researchfocused on the drug resistance skills of minority youth populations(e.g., Hecht et al., 2003; Kulis, Marsiglia, Castillo, Becerra, &Nieri, 2008). Much of this research has been dedicated to thedevelopment and evaluation of culturally specific drug preventionprograms (Castro & Nieri, 2010). At the core of these programs istraining in specific drug resistance skills for minority youth. Forexample, a culturally focused version of Botvin's Life SkillsTraining program utilized Greek, Spanish, and African myths and storiesreflecting contemporary inner-city culture as the context for teachingcognitive and behavioral skills to middle school youth (Botvin, Schinke,Epstein, & Diaz, 1994; Botvin, Schinke, Epstein, Diaz, & Botvin,1995). More recently, a drug prevention program called keepin' itR.E.A.L. has been developed for Mexican/Mexican American youth (Hecht etal., 2003; Kulis et al., 2005). The primary focus of the program is onteaching drug resistance skills using four strategies--refuse, explain,avoid, and leave--within the unique cultural and regional contexts ofthe Southwest U.S. (Hecht et al., 2003). There has also been a specific body of research examining the drugresistance skills of indigenous youth populations. Most of these skillsare described in the context of drug prevention programs for theseyouth. Many of these programs focus on problem solving problem solvingProcess involved in finding a solution to a problem. Many animals routinely solve problems of locomotion, food finding, and shelter through trial and error. and communicationskills training (e.g., Gilchrist, Schinke, Trimble, & Cvetkovich,1987; Moran & Bussey, 2007; Schinke et al., 1988; Schinke,Schilling, & Gilchrist, 1986). Schinke et al. (1988), for example,tailored their program around skills of bicultural bi��cul��tur��al?adj.Of or relating to two distinct cultures in one nation or geographic region: bicultural education.bi��cul competence forAmerican Indian youth (i.e., communication, coping, and discriminationskills). Gilchrist et al. described a skills enhancement interventionfor American Indian youth focused on a culturally tailored problemsolving model (SODAS). Inherent in most of these programs is thetraining in a set of drug resistance skills within the context of anindigenous youth culture. Because much of the research on culturally specific resistanceskills exists within the development and evaluation of drug preventionprograms, the identification of many of these skills has evolvedpredominantly from experts in the field of drug prevention. Very fewstudies have examined the actual drug resistance skills used by minorityyouth populations in their own contexts (e.g., school, home, community).However, as part of a pre-prevention study, Okamoto, Hurdle, andMarsiglia (2001) examined the drug resistance strategies of AmericanIndian youth of the Southwest, and found that these youth preferrednon-confrontational strategies (e.g., redirecting the discussion awayfrom the topic of drugs, avoiding or leaving the situation) overconfrontational strategies (e.g., saying "no"). By using focusgroups with Native youth, drug resistance strategies identified in thestudy were "grounded" in the realities of these youth, therebyproviding a more relevant foundation for drug prevention programs thanthe use of theory alone. The present study examines the drug resistance strategies ofindigenous youth in rural Hawai'i. To date, there has been verylittle research focused specifically on drug resistance skills for theseyouth (Rehuher, Hiramatsu, & Helm, 2008). Rehuher et al. conductedan exhaustive literature search and found only one program based onrural Native Hawaiian culture, which is in its early stages ofdevelopment and evaluation (Kim, Withy, Jackson, & Sekaguchi, 2007).Nonetheless, research suggests that resistance skills training for theseyouth may prevent future drug use. Withy, Lee, and Renger (2007) usedstakeholder stakeholdern. a person having in his/her possession (holding) money or property in which he/she has no interest, right or title, awaiting the outcome of a dispute between two or more claimants to the money or property. interviews to link the causes of substance abuse within therural Hawaiian youth population to low self esteem, lack of selfidentity and life plan, and limited communication and conflictresolution skills. Consistent with this framework, the present studyexamines the way in which rural Hawaiian youth effectively managedconflict within drug related problem situations in order to resist drugoffers. As a result, this study has implications for the development ofculturally and regionally specific substance abuse prevention programswith Hawaiian youth. Future programs based on the perceptions of ruralHawaiian youth have the potential to provide essential resources forthem to negotiate environmental challenges related to drug and alcoholuse in their homes, schools and communities. METHOD Consistent with Okamoto et al.'s (2001) culturally groundedapproach to identifying drug resistance strategies, qualitative methodswere used in this study. Qualitative methods have recently been used insimilar studies in rural areas of Hawai'i, because they promotecommunity participation (Affonso et al., 2007) and investment (Withy etal., 2007). Data Collection and Participants Five rural middle schools participated in the study-four Big Islandschools plus one pilot study school from a different island. Communitieswithin the sample were included in recent research on health disparitiesin rural Hawai'i (Withy et al., 2007) and were considered rural bythe Hawai'i Rural Health Association. Consistent with models ofschool/university/community partnerships (e.g., Spoth, 2007), youth wererecruited in collaboration with school-based research liaisons. Thesewere designated school staff members such as counselors or healthteachers who assisted the university researchers in identifyingstudents, distributing and collecting consent forms, and securingfacilities in which to conduct the group interviews. The majority ofparticipants were selected from a statewide database of enrolledstudents, which designated those students who were Hawaiian or PartHawaiian in the participating schools. Fourteen focus "mini"groups (Morgan, 1997) with 2-5 Native Hawaiian middle school studentsper group were conducted (N = 47). Smaller (versus larger) groups wereselected, because of the sensitive nature of the research, and becausethey were more consistent with cultural norms of rural Hawaiiancommunities. In order to promote youths' comfort in disclosing drugrelated information, homogeneity HomogeneityThe degree to which items are similar. of group composition (Morgan, 1996;Zeller, 1993) was built into the research methodology. This was achievedin two ways. First, separate groups were held for girls (n = 26) andboys (n = 21), with group facilitators matching the gender of the youthparticipants. Second, efforts were made to create groups using naturallyformed social cliques. Participants were in grades 6 (9%), 7 (53%) and 8(38%). The average age of participating youth was 12.2 years. Allstudents self-identified as Native Hawaiian or with one or more Pacific,Asian American A��sian A��mer��i��canalso A��sian-A��mer��i��can ?n.A U.S. citizen or resident of Asian descent. See Usage Note at Amerasian.A , Euro-American, and American Indian ethnocultural groups. Interviews were held at school, either during lunch, recess, orafter school, and lasted from 40-60 minutes. The groups began with adiscussion "starter" question (Morgan, 1997) in which studentswere asked to imagine a scenario where someone important to them hadoffered them drugs or alcohol. This question led students to describereal situations in which drugs had been offered to them or someone theyknew, and to share their views on the extent of the drug problem intheir school or community and what could be done about it. Particularattention was given to the time, place, drug offerer, and drugs used inspecific situations described by the youth. Students were also askedabout the ways in which cultural values, practices, and beliefs helpmiddle school youth resist alcohol, marijuana marijuanaor marihuana,drug obtained from the flowering tops, stems, and leaves of the hemp plant, Cannabis sativa (see hemp) or C. indica; the latter species can withstand colder climates. , cigarettes, and otherdrugs. Participants were informed to keep confidential all youthdisclosures in the group setting. Because the interviews were audiotaped, participants were asked to use self-selected pseudonyms This article gives a list of pseudonyms, in various categories. Pseudonyms are similar to, but distinct from, secret identities. Artists, sculptors, architectsBalthus (Balthazar Klossowski de Rola) Bramantino (Bartolomeo Suardi) to referto one's self, others in the group discussion, and to individualsdescribed in their stories. Active parental consent and student assent An intentional approval of known facts that are offered by another for acceptance; agreement; consent.Express assent is manifest confirmation of a position for approval. were obtained for all participants in the study. All research procedureswere approved by the Institutional Review Boards at Hawai'i PacificUniversity, University of Hawai'i at Manoa, and the Hawai'iDepartment of Education. Data Analysis All interviews were audio recorded and transcribed verbatim ver��ba��tim?adj.Using exactly the same words; corresponding word for word: a verbatim report of the conversation.adv. by amember of the research team. Transcripts were then reviewed for accuracyby a different research team member. A comprehensive set of open codes(Strauss & Corbin, 1990) were identified by the Principal andCo-Principal Investigators, and were imported into a qualitativeresearch Qualitative researchTraditional analysis of firm-specific prospects for future earnings. It may be based on data collected by the analysts, there is no formal quantitative framework used to generate projections. data analysis program (N Vivo). N Vivo is one of severalcode-based theory-building programs that allows the researcher torepresent relationships among codes or build higher-orderclassifications (Weitzman, 2000). In order to establish interraterreliability and validity, all members of the research team collectivelycoded one transcript to clarify the definition and parameters of all ofthe codes. Then, all subsequent interview transcripts were separatelycoded by at least two different research team members. Narrativesegments that were not identically coded by the team members wereidentified, discussed, and justified for inclusion or exclusion in thedata set. Coding iterations continued until there was consensus by allmembers of the team coding each transcript. Upon establishing interraterreliability and validity, a content analysis of the resistancestrategies code was conducted, which examined each group'sresponses based on gender, grade, primary resistance strategy employedin each response, and secondary resistance strategies employed in eachresponse. RESULTS All 14 focus groups referenced resistance strategies in theirdiscussions, and the mean percentage of coverage for the code was 20.2(1). There were 47 references to real drug offers by participants in thestudy. The majority of the strategies used within these offers fellwithin two different categories: (a) overt/confrontational methods ofdrug resistance (22 references), and (b) non-confrontational methods ofdrug resistance (17 references). Seven of the references focused onseeking social support from friends or family members in drug relatedproblem situations, while one of the references focused on participatingin extracurricular activities as a method of drug resistance.Overt/confrontational methods of drug resistance included saying"no" to drug offers, verbal confrontations related to drugoffers (e.g., "How can you drink that?"), and aggressive actsof resistance (e.g., fighting). Non-confrontational methods of drugresistance included walking away from the drug offer situation, changingthe subject of a discussion away from the topic of alcohol or otherdrugs, and making excuses or lying to avoid using drugs. A genderdifference was evident in these two categories, with females describingthe use of overt/confrontational methods more often than maleparticipants (16 versus 6 references) and males describing the use ofnon-confrontational methods more often than female participants (11versus 6 references). Overt/Confrontational Drug Resistance Participants described several examples of overt or confrontationaldrug resistance strategies in the locus group discussions. Three primarytypes of these strategies were described by participants: (a) saying"no", (b) verbally confronting the offerer, and (c) usingaggression as drug resistance. One female participant described thechallenges of saying "no" to drug offers in the context ofclose relational networks in her community. Her fear of physicalconsequences related to drug use ultimately compelled her to say"no" to the drug offer. Facilitator (S.H.): So you were telling some of your story before,Jane. Did you want to give some more details? You said you were withanother eighth grade kid, was that a boy or a girl? Jane: Girl. S.H.: Uh-huh, and that was one of your friends? Jane: Well, yeah, kind of 'Cause her mom was my morn'sbest friend, so I met her [and] then we started being friends. S.H.: OK, how 'd that make you feel when she offered [youbeer]? Jane: Scared scare?v. scared, scar��ing, scaresv.tr.To strike with sudden fear; alarm. See Synonyms at frighten.v.intr.To become frightened: a child who scares easily. . I didn't really know what it was, and Ididn't know what was gonna gon��na?InformalContraction of going to: We're gonna win today.happen if I took it or something. So Ijust said, "No." Some participants described situations where youth would verballychallenge the drug using behavior of the offerer in an effort to helpthem to stop using drugs. S.H.: [What] about the kids who have chosen to not use marijuana?What do you think they tell to the other kids who are using? Mindy: Don't do it. Kari: Or, [they] just say, "You should quit, it's bad foryour health." Chrissy: And have fun living the rest of your short life. Finally, some participants described aggressive acts as a method ofdrug resistance. Some of them described taking the drugs or alcohol andthrowing it away or destroying it in front of the offerer. As an extremeexample of aggressive drug resistance, "Dana" describedslapping as a method for deterring drug use. S.H.: What do you do in those situations [when] you're hearingkids talk about [smoking marijuana], but they're not offering it? Dana: If it's [a] family [member] using, I walk up to them andl slap them. 'Cause then they don't really know what it means[when you smoke]. Then, I explain it to them and then they stop talkingabout it because they know they're not supposed to be talking aboutit. Even when participants described hypothetical ways of dealing withdrug offers, they often referenced aggressive behaviors. While it was not a common occurrence, in several cases youthreferred to violence as a method of drug resistance. S.O.: Are there ways in which you can avoid using drugs afteryou've been offered? How do you deal with that situation? Jason: You just walk away, tell an adult or something. Kenny: Say "no". S.O.: Say "no" or walk away? Jason: Lick lick1. a stroke with the tongue, normally used in cleaning the coat or ingesting a substance from a flat surface. See also licking.2. a mixture of salt plus other macro-elements, especially phosphorus, trace elements, vitamins and other feed additives, fed loosely in a box 'em li' that (2). Kenny: Yeah. Michael: Kill 'em, nah nah?interj. InformalNo.[Variant of no1.] . Non-Confrontational Drug Resistance Participants also described non-confrontational acts of drugresistance in the focus group discussions. Three primary types ofnon-confrontational drug resistance strategies were described byparticipants: (a) avoidance/walking away, (b) using proximity to aprotective family member for drug resistance, and (c) using Hawaiiancultural practices as drug resistance. As an example ofavoidance/walking away, a male participant described how he witnessedhis older brother becoming addicted ad��dict��edadj.1. Physiologically or psychologically dependent on a habit-forming substance.2. Compulsively or habitually involved in a practice or behavior, such as gambling. to drugs as his brother began tosocialize so��cial��ize?v. so��cial��ized, so��cial��iz��ing, so��cial��iz��esv.tr.1. To place under government or group ownership or control.2. To make fit for companionship with others; make sociable. with drug users in high school. He described the efforts ofhis family to deter his brother's drug use, and the effect hisbrother's addiction had on him and his family. This led to adiscussion of how he plans to resist drug use as he prepares totransition to high school. Facilitator (S.O.): Wow. So, that must be scary for you, thinkingabout [your brother] and what's happened to him. Then, you'regoing to be going to high school as well, so you're going to beexposed to that same kind of environment, right? Ross: Right S.O.: So you probably have thought of how to stay away from thoseguys, right? Ross: Yeah. S.O.: What are you going to try to do? Ross: I'm gonna try to stay away from them and make sure thatl do all my work in school. And, if anybody offers me [drugs], I'mjust gonna walk away and [not] say anything to them. S.O.: It sounds [like] the main strategy all [of] you guys'use is walking away from the situation, yeah? Why is it that that'sthe one you guys go to first? Why is that the best thing to do? Bo: 'Cause you want to stay out of it, and you don't wantany part of it. Just walk away. In several situations, drug offers were embedded Inserted into. See embedded system. in the socialcontext of the participants. There appeared to be a strong social demandfor drug use in these cases, and "walking away" seemed to bethe resistance strategy of choice for the participants. For example,"Honeygirl" described how she employed "walkingaway" from drug offers at a community event. We [were] getting together at [this community center]. [There was] a Friday night dance, and had all [these] guys smoking marijuana outside. And, then they was like, "Oh wassup Honeygirl, what, you like some?" I [was thinking] "Oh no, I not that stupid. " They started asking me all kinds [of] questions. I never [did anything], I walk[ed] away. "Lani" described the use of "walking away"during family parties where alcohol use is prevalent and unmonitored. Yeah, I've been at parties [with] all my cousins. They['re] not even of age yet, but my dad [and other adult family members], they just like [to] offer [drugs and alcohol], because they [are] stressed out. So, l just walk away. I walk away kind of frustrated, knowing that they [are] trying to get my cousins to drink and stuff. "Bo" also described how he tried to employ "walkingaway" from a drug related problem situation that involved his oldercousin. However, when this was not effective, he used another familymember to protect himself from pressure to use drugs. S.0.: So, Bo you said you had a real experience with drugs. Can youtell us what [happened]? Bo: Well, actually [it] was [with] one of my relatives. We all[were] at this party and then when I was walking, [my cousin] stop[ped]and asked me to try [and] take one drink of beer And I told him that Igotta got��ta?InformalContraction of got to: I gotta go home.go, but he kept following me and asking me to drink beer. S.O.: So, what did you do in that situation? Bo: I kept walking until I found one of my older cousins and Istaved by him. So, then my other cousin walked away. Similar to "Bo", many participants managed theirproximity around a protective individual in order to resist drug offers.Most often, protection was sought from a close family member."Skullz" described how he used his father as protection from adrug offer during a family gathering. S.O.: Have any of you been offered [drugs or alcohol]? Skullz: Nods head indicating "yes". S.O.: Skullz, you said you have? Skullz: By my auntie's boyfriend. [It] was on New Year'sEve last year, and he was drunk and I was sitting next to my morn. She[went to] the restroom, and then he offered me beer. I said no, and thenI walked away to go next to my dad, 'cause he was poppin'fireworks. "Tehani" described how she makes sure that she surroundsherself with supportive cousins when attending events where drugs oralcohol might be present, in order to protect herself from potentialdrug offers during these events. Tehani: I'm usually with my cousin when I go [to the communitydances]. I gotta make sure [my] cousin's there. S.H.: So, you have somebody who's watching out for you. Tehani: Yeah, I have three or four cousins there who watch over me.My cousin [who is female], she [is] the one [who] watches me the most.My other [male] cousin--he just goes out with his friends. He'sgoing to care if I get into [a] fight or something. Finally, in some of the more rural areas, Hawaiian culturalpractices were used as a form of non-confrontational drug resistance."Don" described his use of "throwing net" (anindigenous form of fishing in Hawai'i) when he and his friend wereoffered beer by an adult family member. S.O.: Can you tell me about your situation? Don: Well, [we were] at a beach, and my friends 'uncle wasdrunk and was offering all kinds of beer And, we said no. 'Cause weknow he was drunk and we didn't wanna follow anything, or elsesomebody [was] going to get hurt. S.O.: So, what did you do in that situation? Don: We said no, and [were] trying to get him off the subject.Like, we [went to] go "throw net" in that area, so he wouldget [beer] off of[his] mind and then try to focus on what to do. S.O.: How did that work? Don: It worked just fine. Once we caught fish, he forgot all aboutit. DISCUSSION Using qualitative methods, this study examined the drug resistancestrategies of Hawaiian youth in rural communities. The results revealedovert/confrontational and non-confrontational forms of drug resistanceused by the participants, which functioned within the unique culturalcontext of rural Hawai'i. Similar non-confrontational acts havealso been described as preferred drug resistance strategies of AmericanIndian youth (Okamoto et al., 2001). The strategies described by theparticipants highlighted several points. First, their strategies wereinfluenced by the close relational networks of biological and ascribedfamily members within their communities. For example, aggressive acts ofdrug resistance were used to protect themselves as well as other familymembers from drug use. Non-confrontational acts of drug resistance, suchas walking away, were used to preserve family relationships whileavoiding drug use. These findings are consistent with the familyoriented o��ri��ent?n.1. Orient The countries of Asia, especially of eastern Asia.2. a. The luster characteristic of a pearl of high quality.b. A pearl having exceptional luster.3. value system (i.e., 'ohana system) that is characteristicof the Native Hawaiian culture (Miike, 1996). It is also consistent withprior research which has shown how familial familial/fa��mil��i��al/ (fah-mil��e-il) occurring in more members of a family than would be expected by chance. fa��mil��ialadj. networks can intensify in��ten��si��fy?v. in��ten��si��fied, in��ten��si��fy��ing, in��ten��si��fiesv.tr.1. To make intense or more intense: bothrisk and protection related to drug use of American Indian (Waller,Okamoto, Miles, & Hurdle, 2003) and Native Hawaiian (Okamoto, Helm,Kekuawela, Chin, & Nebre, 2008) youth. Subsequently, the relativesuccess of the resistance strategies described in this study dependedupon the drug use acceptance levels of the familial networks in thecommunity. Youth with many drug abstinent family members were able tofind social support for their resistance strategies and were successfulin using them. Conversely con��verse?1?intr.v. con��versed, con��vers��ing, con��vers��es1. To engage in a spoken exchange of thoughts, ideas, or feelings; talk. See Synonyms at speak.2. , youth with many drug-using family members maynot receive support for their drug resistance efforts and may be athigher risk for drug use than peers with drug abstinent family members. The types of drug resistance strategies used by the youth in thisstudy varied by gender. Girls described the use of overt/confrontationalresistance strategies more often than boys, and boys described the useof non-confrontational strategies more often than girls. This differencemight be accounted for by the stronger verbal skills of Hawaiian girlswhich allowed them to articulate their negative feelings about drugsmore clearly and directly than boys. However, resistance strategiesfocused on non-confrontational communication patterns are consistentwith social norms of certain Indigenous youth (Green, 1999), suggestingthat these forms of drug resistance might become communicative com��mu��ni��ca��tive?adj.1. Inclined to communicate readily; talkative.2. Of or relating to communication.com��mu competencies that rural Hawaiian youth could use in specific situations(Okamoto et al., 2001). More research is necessary to understand thegender differences related to drug resistance of Native Hawaiian youth. Implications for Prevention This study has implications for the development of culturallygrounded prevention interventions with rural Hawaiian youth. Training indrug resistance skills or strategies for these youth should focus ontheir use within supportive social networks and, specifically, withinthe context of interconnected family relationships. For example, severalof the youth paired overt and non-confrontational forms of drugresistance with seeking social support from another family member (e.g.,"Bo"). In this way, the protective functions of familialrelationships are utilized alongside other resistance strategies.Focusing on non-confrontational forms of drug resistance is also aunique aspect of drug prevention for indigenous youth. This approachenables youth to manage their own behavior while preserving theirconnections with their peer group or family members (Okamoto et al.,2001). In this way, non-confrontational drug resistance may function asa valuable conflict management skill for Hawaiian youth in ruralcommunities. According to according toprep.1. As stated or indicated by; on the authority of: according to historians.2. In keeping with: according to instructions.3. practitioners and stakeholders StakeholdersAll parties that have an interest, financial or otherwise, in a firm-stockholders, creditors, bondholders, employees, customers, management, the community, and the government. interviewed forthe Withy et al. (2007) study, skills for conflict management areessential in order to prevent drug use of these youth. While preventionprograms employing non-confrontational drug resistance strategies maydiffer from the bulk of the programs that focus on overt refusal skills Refusal skills are a set of skills designed to help children avoid participating in high-risk behaviors. Programs designed to discourage drug use, violence, and/or sexual activity frequently include refusal skills in their curriculums to help students resist peer pressure while ,the findings suggest that the ability to avoid confrontation in drugresistance may be particularly important within the close knit ruralcommunities in Hawai'i. From a broader perspective, prevention programs built uponpragmatic drug resistance strategies of rural Hawaiian youth have thepotential to contribute to the growing movement towardnationally-recognized, evidence-based practices. Rehuher et al. (2008)found a lack of these practices designed by or for Native Hawaiians This is a list of notable Native Hawaiians: James Aiona, politician Daniel K. Akaka, politician Eddie Aikau, famous surfer Jesse Kuhaulua, sumo wrestler Akebono, sumo wrestler D. G. Anderson, politician S. .Further, Matsuoka (2007) argued that existing evidence-based practicesare "decontextualized," and therefore have limitedapplicability to the Hawaiian population. The present study is anattempt to infuse in��fusev.1. To steep or soak without boiling in order to extract soluble elements or active principles.2. To introduce a solution into the body through a vein for therapeutic purposes. Hawaiian culture and context into the "core"of drug prevention efforts, thereby enhancing both the fidelity and fitof these interventions (Castro, Becerra, & Martinez, 2004). Limitations of the Study There were several limitations of this study. A convenience samplewas utilized which may or may not have been representative of the viewsof the youth population in the sampled communities. Also, due to thesensitive nature of the topic, in depth interviews rather than focusgroups might have been a more appropriate approach in order to yieldricher, more valid data. However, in order to address thismethodological critique, group homogeneity and small group size wereincorporated to promote youths' active participation in the groups.Further, participants stated that the use of pseudonyms enhanced theanonymity of group members, increasing their engagement in the group.Finally, the findings of this study may lack transferability not only tothe general population of Hawaiian youth in Hawai'i but to thosewho reside m rural communities outside of the sampling frame. CONCLUSIONS Resistance skills have long been a staple 1. (language) STAPLE - A programming language written at Manchester (University?) and used at ICL in the early 1970s for writing the test suites. STAPLE was based on Algol 68 and had a very advanced optimising compiler.2. of drug preventionprograms for youth. However, there have been very few studies that havefocused on the actual resistance skills or strategies utilized by theseyouth. This study attempted to examine the resistance strategies used byrural Hawaiian youth, in order to inform future culturally groundedprevention interventions. Future prevention programs can translate thesestrategies into culturally relevant resistance skills for rural Hawaiianyouth, allowing these youth to more effectively negotiate environmentaldemands related to drug use. These programs should also involve familymembers as a part of their skill building programs. AUTHORS NOTE Scott K. Okamoto, Ph.D., is an Associate Professor, School ofSocial Work, Hawai'i Pacific University; Susana Helm, Ph.D., is anAssistant Professor, Department of Psychiatry psychiatry(səkī`ətrē, sī–), branch of medicine that concerns the diagnosis and treatment of mental, emotional, and behavioral disorders, including major depression, schizophrenia, and anxiety. , University ofHawai'i at Manoa; Ka'ohinani Po'a-Kekuawela, B.S.W., is aGraduate Research Assistant, School of Social Work, Hawai'i PacificUniversity; Coralee I. H. Chin, B.A., is a Graduate Research Assistant,School of Social Work, Hawai'i Pacific University; La Risa H.Nebre, B.S.W., is a Graduate Research Assistant, School of Social Work,Hawai'i Pacific University. This study was supported by funding from the National Institutes ofHealth/National Institute on Drug Abuse (K01 DA019884). All correspondence concerning this article should be mailed to:Scott K. 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(2) In Pidgin English Pidg��in Englishalso pidg��in English ?n.Any of several pidgins based on English and now spoken mostly on the Pacific islands and in West Africa. , which is the local slang of Hawai'i,this phrase translates into beating someone up.