Adult Familial Influences on Rural Native Hawaiian and Pacific Islander Youths’ E-Cigarette Use

Résumé

Recent surveillance data has indicated that 18% of all middle school youth in the state of Hawai‘i currently use an electronic vapor product (e.g., e-cigarette), ranking first nationally among all states in the U.S. collecting data on middle school youth (CDC, 2020). However, research has lagged in terms of addressing drug prevention needs for Native Hawaiian and Pacific Islander (NHPI) youths, including tobacco product prevention needs for these youths. This study examines adult familial influences on rural NHPI youths’ decisions to engage in e-cigarette use, in order to inform the co-adaptation of a culturally grounded substance use prevention curriculum (Ho‘ouna Pono) to address tobacco product use. Students (N=69) from eight public schools in low-income, rural communities on Hawai‘i Island participated in 1 of 17 gender-aligned focus groups. A semi-structured interview schedule focused on NHPI youths’ social and cultural context of e-cigarette use guided the discussion. Two family-related themes emerged from the data—parental substance use permissiveness and family normalization of e-cigarette use. Two subthemes for parental substance use permissiveness were lack of parental monitoring and lack of parental support in health decision making. Focus group participants described how these themes contributed to their contemplation or use of e-cigarettes in their homes, schools, and communities. The findings have strong implications for co-adapting existing substance use prevention curricula in rural Hawai‘i with schools and communities to include family-specific content. Further, the findings suggest that family-focused interventions can complement school-based drug prevention efforts as part of a multi-level approach in rural Hawai‘i.