Native Hawaiians (NH) has higher rates of chronic diseases, such as cardiovascular disease (CVD), diabetes, and cancer. Hypertension (HTN), an important modifiable risk factor for CVD, is 70% higher in Native Hawaiians (NH) than in Whites. In fact, NH is 3-4 times more likely to develop CVD conditions, such as stroke and coronary heart disease, and at a younger age. In addition to prescribed medication, improvements in HTN can be achieved through increased physical activity (PA) and self-management education (e.g. stress management, reduces sodium intake, weight-loss, and smoking cessation). Yet, many commonly prescribed PA, such as jogging and use of treadmills, are difficult for NH to initiate and maintain because of socioeconomic barriers and lack of alignment with NH preferred modes of living and cultural values (i.e. familial interdependence, group-based PA, cultural PA). This proposed research uses hula, the traditional dance form of NH and hallmark of NH culture, as the PA basis for a culturally relevant and sustainable CVD prevention program targeting HTN management. Hula training is popular, not only Hawai'i, but across the U.S. through the 784 h lau hula (hula schools) found in most States. Using a community-based participatory research (CBPR) framework, a hula-based CVD health intervention was strongly endorsed by Kumu hula (hula experts and guardians of hula traditions), NH individuals, and communities. Further, hula training was determined to yield metabolic equivalent of energy expenditure as a moderate and vigorous intensity PA. Data from our pilot CBPR randomized control trial (RCT) study found that 60 minutes of hula training twice a week for 12 weeks reduced systolic blood pressure (BP) by 7.5 mmHg (SD=16.5) more than the control group, but the long-term effects were mixed and the study did not assess CVD risk. Interestingly, the pilot intervention also improved social functioning, reduced physical pain, and perceived racial discrimination, suggesting a possible psychosocial and socio-cultural mechanism by which the intervention affects BP. In this application we offer a CBPR guided RCT of 250 NH with physician-diagnosed HTN in Hawai'i and Washington State. We will compare the effects of a 6-month intervention that combines hula training and brief culturally-tailored HTN self- management education delivered by peer educators and Kumu hula to a wait-list control group in reducing systolic BP and CVD risk scores. We will also determine the mediating effects of health behaviors (e.g., smoking), self-regulation, psychosocial (e.g., social support), and socio-cultural factors (e.g., perceived racism) on blood pressure reduction. Our goal is to build on the existing widespread infrastructure of h lau hula and NH organizations to deliver a sustainable, culturally-preferred CVD prevention program.

Public Health Relevance

This project is a community-engaged, randomized control trial of hula, the indigenous dance form of Native Hawaiians (NH), among 250 NHs with hypertension living in Hawai`i and Washington State. We will compare the effects of a 6-month intervention, called the K?-HOLO Program, delivered by trained peer educators to a wait-list control condition on blood pressure and 10-year cardiovascular risk. The intervention will be comprised of hula plus hypertension self-care education program. We will also examine the mediating effects of health behaviors, self-regulation, psychosocial, and socio-cultural factors on blood pressure reduction. Our ultimate goal is to develop and test a culturally-appropriate, acceptable, and effective intervention that can be delivered and sustained in community settings.

National Institute of Health (NIH)
National Heart, Lung, and Blood Institute (NHLBI)
Research Project (R01)
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Special Emphasis Panel (ZRG1)
Program Officer
Pratt, Charlotte
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University of Hawaii
Internal Medicine/Medicine
Schools of Medicine
United States
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Kaholokula, Joseph Keawe'aimoku; Ing, Claire Townsend; Look, Mele A et al. (2018) Culturally responsive approaches to health promotion for Native Hawaiians and Pacific Islanders. Ann Hum Biol 45:249-263
Walters, Karina L; Johnson-Jennings, Michelle; Stroud, Sandra et al. (2018) Growing from Our Roots: Strategies for Developing Culturally Grounded Health Promotion Interventions in American Indian, Alaska Native, and Native Hawaiian Communities. Prev Sci :
Ing, Claire Townsend; Miyamoto, Robin E S; Fang, Rui et al. (2018) Comparing Weight Loss-Maintenance Outcomes of a Worksite-Based Lifestyle Program Delivered via DVD and Face-to-Face: A Randomized Trial. Health Educ Behav 45:569-580
Blue Bird Jernigan, Valarie; D'Amico, Elizabeth J; Keawe'aimoku Kaholokula, Joseph (2018) Prevention Research with Indigenous Communities to Expedite Dissemination and Implementation Efforts. Prev Sci :
Dickerson, Daniel; Baldwin, Julie A; Belcourt, Annie et al. (2018) Encompassing Cultural Contexts Within Scientific Research Methodologies in the Development of Health Promotion Interventions. Prev Sci :
Kaholokula, Joseph Keawe'aimoku; Look, Mele A; Wills, Thomas A et al. (2017) K?-HOLO Project: a protocol for a randomized controlled trial of a native cultural dance program for cardiovascular disease prevention in Native Hawaiians. BMC Public Health 17:321
Kaholokula, Joseph Keawe'aimoku; Look, Mele; Mabellos, Tricia et al. (2017) Cultural Dance Program Improves Hypertension Management for Native Hawaiians and Pacific Islanders: a Pilot Randomized Trial. J Racial Ethn Health Disparities 4:35-46
Stanley, Linda R; Swaim, Randall C; Kaholokula, Joseph Keawe'aimoku et al. (2017) The Imperative for Research to Promote Health Equity in Indigenous Communities. Prev Sci :