JMIR Publications

ABSTRACT

Background:

Today’s Native Hawaiians (NHs), American Indians (AIs), and Alaska Natives(ANs)are the contemporary descendants of the original Indigenous peoples who occupied lands before the arrival of European explorers and settlers and the establishment of the United States (US) of America. AIs and ANs are defined explicitly as citizens of sovereign federally recognized tribes and groups with Nation-to-Nation relationships with the US government. Indigenous peoples, before colonialization, were healthy. However, NHs, AIs, and ANs in the US today experience disproportionately higher rates of physical and mental health disparities and significantly higher rates of cigarette smoking, alcohol, and other substance use, suicide rates, and traumatic exposure than other ethnic groups in the US. In Hawaii, NHs are at significantly greater risk for adverse health outcomes and high-risk health behaviors as compared to other ethnic groups. Recent reports highlight high rates of substance use; 47% of NH adults report current alcohol and tobacco use, and 35% report lifetime substance use, including cannabis and opioids. Rates of alcohol use disorder, depression, and generalized anxiety disorder prevalence have been reported as 27%, 27%, and 19%, respectively. Lastly, approximately 30% of NH adults report past-year treatment needs for lifetime illicit substance abuse.6 Despite the high risk for alcohol and substance use, there is little known about the risk factors leading to alcohol use and misuse that are unique to NHs today.

Objective:

This study aimed to explore the lived experiences of colonization, historical trauma, and alcohol use among Native Hawaiians living in rural Hawaii. Most studies using Historical Trauma theory have focused on American Indian tribes, and at the time of this study, only one quantitative study existed that specifically focused on historical trauma and substance use among Native Hawaiian college students. Native Hawaiians and American Indians suffer from a startlingly high degree of physical and mental health disparities and alcohol and other substance misuse. Indigenous scholars posit that historical trauma is inter-generationally transmitted to subsequent generations and is the primary cause of today’s health and substance use disparities among these Indigenous populations.

Methods:

This qualitative study was guided by Husserl’s transcendental phenomenological design. The modified Stevick-Keen-Colaizzi method was used for data analysis. The Historical Trauma Conceptual framework and Story theory guided the study. The socio-psychological Explanatory Framework illustrated how intergenerational trauma transmission can occur through storytelling and can be passed down to subsequent generations.

Results:

The participants primarily identified as female, aged 50 to 59, were married or partnered, and were employed. The final qualitative themes that emerged from the analysis included: (1) Alcohol did not exist in Hawaii before European explorers arrived, (2) Alcohol helped expand colonialism in Hawaii, (3) Alcohol is used today as a coping strategy for feelings of grief and anger over losses (land, people, cultural traditions, and language), and (4) The Kupuna (elders) teach the younger generations to drink alcohol.

Conclusions:

Native Hawaiians, like American Indians, experienced Historical trauma, which is transmitted intergenerationally, resulting in mental and physical health disparities, substance misuse, and feelings of discrimination. Alcohol did not exist in Hawaii before European explorers arrived in Hawaii. Alcohol was introduced to NHs and is a component of Historical trauma. NHs use alcohol to self-medicate feelings of losses and is the foundation of problems with alcohol and other substances today.