Method: This study used an embedded mixed methods design, in which quantitative methods were used primarily to answer the research question, and qualitative methods were embedded within the quantitative design in order to explain the results (Creswell & Clark, 2006). Respondents completed a recently developed and validated survey of drug offers for rural Hawaiian youth (the Hawaiian Youth Drug Offers Survey; Okamoto, Helm, Giroux, Edwards, & Kulis, 2009). The survey consists of 62 drug related problem situations, evaluated by their frequency of exposure to each situation and perceived difficulty in dealing with them. One hundred ninety four Native Hawaiian youth from 7 different middle or intermediate schools on the Big Island of Hawai‘i completed the survey. Ordinary least squares multiple regression models were developed in order to examine the potential gender differences in frequency of exposure to drug offers by types of offerer (e.g., peers, cousins), and the perceived difficulty of refusing drugs from these individuals in offer situations. A content analysis of drug offers described in a series of focus groups of Native Hawaiian youth (N = 47) was conducted to elucidate the quantitative findings. Youth from the focus groups were different from those completing the survey, but were sampled from the same communities as the survey youth.
Results: Overall, the mean frequency and difficulty scores were low (between 0 and 1 on scales ranging from 0 to 4), indicating low exposure to drug offers and relative ease in refusing them. However, after controlling for age, grade level, free or reduced cost lunch participation, and family structure in the regression analyses, female Hawaiian youth received significantly more drug offers from parents, cousins, peers, friends, and in dating situations compared to their male counterparts (all ps < .05). Further, aside from offers from siblings, female Hawaiian youth found it significantly more difficult to refuse drugs from all offerer sources (all ps < .01, except for parent offers, p < .05). The focus group findings indicated that female youth were initiated into drug use at an early age (i.e., 4th-5th grade), were exposed to drug offers indirectly through complex social situations, and felt strong pressure toward peer conformity and acceptance.
Conclusions: Compared with their male counterparts, Hawaiian girls received substantially more offers from peers and family members and had more difficulty refusing drugs from them. Focus group data suggested reasons behind these quantitative findings. Implications of the findings for prevention practice include gender- and culture-specific resistance skills training, including skills to deal with indirect drug offers, and pressure toward peer conformity and acceptance.