Occipital lobe glial and glioneuronal tumors: A systematic review of clinical presentation, surgical management, and outcomes.

Native Hawaiian and Pacific Islander (NHPI) communities face a disproportionate burden of health conditions, including elevated rates of cardiovascular disease, obesity, and diabetes (Boyd et al., 2022; ). These disparities are compounded by high mortality rates and are often attributed to the impacts of colonization and resulting historical trauma (McElfish et al., 2016; ; ). Historical trauma is a race-based form of trauma with significant psychological consequences, such as grief, anger, and social isolation (). Historical trauma can be transmitted intergenerationally, re-experienced through cultural narratives, family stories, or lived experiences of stigmatization, and affect indigenous populations through events such as colonization (; ). Colonization and occupation of NHPI island communities by Western powers played a central role in shaping their history of oppression, stigmatization, and prejudice (), impacting modern-day social determinants of health (SDoH) and health behaviors such as substance use (; ). SDoH include social and environmental factors, such as neighborhood characteristics and social networks, and affect health, functions, and quality of life (). SDoH are compounded by historical trauma and colonization in NHPI communities. Research has found that NHPI youth have an earlier initiation of substance use and higher probability of disordered use patterns. Pacific Islander and/or Native Hawaiian youth were more likely to initiate alcohol use by age 12 and have a probable substance use disorder compared to other ethnic youth groups (; ). While NHPI adolescent substance use is frequently underestimated because of data aggregation with Asian American youth populations (), their substance use behaviors are heavily influenced by their social contexts and cultural factors, making culturally grounded prevention approaches particularly salient (; Okamoto et al., 2014). Research on rural Indigenous populations suggests that rural settings may offer greater opportunities for youth involvement in cultural activities and stronger maintenance of cultural heritage than urban contexts (). These distinct cultural characteristics of rural communities underscore the importance of place-based, culturally grounded prevention. Existing school-based substance use prevention programs have typically been developed for youth populations in the continental United States (e.g., Mexican Americans; ). While these programs have addressed substance use disparities among the youth they were intended to serve, the cultural fit and community acceptability of these programs across ethnic youth populations are major issues (; Okamoto et al., 2014). For example, a culturally grounded, evidence-based prevention program (keepin’ It REAL) was found to have differential effects for Mexican American and American Indian youth in the Southwest U.S. (), highlighting the importance of cultural relevance and fit in prevention (Okamoto et al., 2014). Specifically, there is a growing need for effective prevention programs that incorporate NHPI-specific cultural and social contexts to promote positive health behaviors (). Born out of this need, the Ho‘ouna Pono (HP) substance use prevention program was developed. HP is an evidence- and classroom-based program developed over 15 years on Hawai’i Island using community-based participatory research (). The program consists of nine 45-to-60-minute lessons and eight videos that are aligned with Hawai’i state health standards and delivered by trained classroom teachers (). The videos depict Hawaiian youth in realistic drug-related problem situations specific to Hawai’i Island communities, and their culturally competent responses to those situations, such as overt refusals or redirecting conversations. Hawaiian cultural concepts are referenced throughout each HP lesson where students apply them to their drug refusal strategies. An efficacy trial of the program demonstrated Hawai’i Island youths reduction in cigarette, e-cigarette, and hard drug use (). Despite demonstrated efficacy, a critical gap remains in the literature regarding the adoption and implementation of culturally grounded programs (Jernigan et al., 2018; National Institute on Minority Health and Health Disparities, 2023). Past researchers noted the ongoing challenges in implementing sustainable substance use prevention programs in rural Hawai’i, such as staff development challenges, intervention-context fit, transportation and outreach barriers, and lack of training (; ). Further, cultural factors impact willingness to seek and accept care among NHPI populations and should be considered when implementing interventions with NHPI communities (). These include employing family-centered approaches that honor the extended family (‘ohana), using traditional cultural practices (e.g., storytelling), and recognizing the physical, spiritual, emotional, and mental well-being as parts of health ().