Background: As recently as 1999, the Hawai'i DOH lacked the infrastructure to assist the general population in tobacco cessation. The need for tobacco cessation programs for the Native Hawaiian Health Care Systems (NHHCS), who collectively service medically uninsured and underinsured Hawaiians statewide, was critical because they have the highest smoking prevalence in the state. With training and resources the five NHHCS developed a standardized protocol for tobacco cessation across all 5 systems that included evidence-based best practices in smoking cessation and culturally appropriate methodologies.

Strategy: Our strategies include: 1) building on the strengths and resources within the community, 2) engaging a wide range of community stakeholders, 3) developing culturally appropriate processes and products, 4) promoting co-learning and knowledge transfer, and 5) providing tangible benefits to the community (facilitating cessation through assessment, intervention, and resources). Evaluation findings indicate: • A tobacco cessation protocol collaboratively developed and adopted by all 5 NHHCS • 5,000 Tobacco Quit Kits assembled and disseminated • 7 brief and intensive intervention trainings conducted • 89 NHHCS staff (90% Hawaiian) increased tobacco cessation skills set • 1,265 smokers received tobacco cessation services (Jan-Aug 2006)

Conclusion: This is the first tobacco cessation intervention for Hawaiians by Hawaiians, and the first tobacco cessation systems-wide change in Hawai`i. The process of this collaborative initiative has validated the importance of incorporating a participatory model to build capacity; developing culturally tailored resources; involving former (Hawaiian) smokers in the promotion of tobacco cessation; and building capacity to address high smoking rates that fosters support and measurable outcomes.