The Healthy Hawaii Initiative: A social ecological approach promoting healthy communities

Purpose. The tobacco settlement has provided the opportunity for the state of Hawaii to implement the Healthy Hawaii Initiative (HHI), targeting smoking, poor nutrition and physical inactivity. The purpose of this paper is to describe and document preliminary findings. Methods. The social ecological model is translated into practice through school and community grants to create systems, environmental and policy changes, teacher training on health and physical education standards, continuing education for the medical community in behavioral health, and a public education campaign. A comprehensive evaluation provides ongoing feedback for program improvement and progress on the effects of psychosocial mediators, behaviors, and long-term chronic diseases. Results and Discussion. Preliminary process results presented here are promising. The components are thought to interact synergistically to bring about behavior changes state-wide. The HHI is one example of how to implement a multilevel initiative to target the three major behavioral determinants of chronic disease (tobacco use, physical inactivity, and poor nutrition) and build healthier communities.