Hoʻouna Pono: a 20-year journey of designing, implementing, and sustaining prevention for rural, Indigenous communities

Abstract Background Numerous research studies indicate that Native Hawaiian and Pacific Islander (NHPI) youth report disproportionately higher substance use rates than other ethnic groups, as well as higher adverse effects associated with their use. Nonetheless, there has been a historical lack of evidence-based, culturally relevant interventions designed to prevent NHPI substance use. This article describes the trajectory of school-based, culturally grounded substance use prevention research for NHPI youth funded by the National Institute on Drug Abuse over the past two decades. Methods A review and synthesis of published research documenting the development, evaluation, implementation, and adaptation of the Hoʻouna Pono (HP) program is presented. The interconnectedness of separate funded research studies is highlighted. Results The HP program was developed and evaluated through 5 interconnected studies—a pre-prevention study, a pilot study, an efficacy trial, an implementation study, and an e-cigarette adaptation study. The program was also adapted to different regions through two complementary studies—a Guam adaptation (Fuestan Manhoben) and a Windward Oʻahu hybrid implementation trial (Mohala Na Pua). Conclusions The life course of the HP program may serve as a model for the development of culturally grounded prevention for under-researched and underserved youth populations. The program is a foundation for future substance use prevention adaptations across Hawaiʻi and the Pacific. Clinical trial Not applicable.