Strategies for Pacific Empowerment and Alcohol Reduction for Native Hawaiian/Pacific Islander Young Adults: Study Protocol for a Community Randomized Controlled Trial

Abstract Background Native Hawaiian/Pacific Islander (NH/PI) young adults endure severe disparities in alcohol use disorder (AUD) and alcohol-related harms, yet NH/PI are almost entirely absent from alcohol trials research. SPEAR (Strategies for Pacific Empowerment and Alcohol Reduction) is a culturally grounded, five-session group intervention designed to reduce these disparities by targeting five empirically-identified risk and protective mechanisms for NH/PI young adult AUDs: alcohol knowledge and attitudes, cultural drinking norms, alcohol refusal skills, stress coping, and distress communication. Methods/Design This protocol describes a two-arm randomized controlled trial evaluating SPEAR versus an active control matched on format, setting, attention, and peer contact without alcohol content. The trial will recruit 200 NH/PI young adults (100 per arm) aged 18 to 30 years with elevated AUD risk. Eligibility criteria include self-reported NH/PI heritage, past-month alcohol use, and screened AUD risk. The primary outcome is frequency of heavy episodic drinking days (Daily Drinking Questionnaire) assessed at pretest, immediate posttest, and 3- and 6-month follow-up. Analyses will follow intention-to-treat principles using generalized linear mixed models for repeated measures. Eligibility criteria include self-reported NH/PI heritage, past-month alcohol use, and screened AUD risk. Discussion This trial will provide the first efficacy evidence for a culturally grounded AUD prevention intervention for NH/PI young adults. If efficacious, SPEAR could address a substantial gap in health disparities and prevention science by providing a scalable AUD prevention approach for at-risk NH/PI communities. Trial Registration ClinicalTrials.gov Identifier: NCT06337721; Registered 03-29-2024