Culturally and community relevant physical activity (PA) is a promising area for health promotion from a strength-based perspective for many reasons. Promoting and supporting activities of known importance and value in communities, including the PA they prefer and in many cases already engage in, can improve individual health, reduce health risk, and increase collective well-being across a number of dimensions.
Health promotion that supports community assets, values, history, and strengths is an important way to build health equity.
Strengths-based approaches are vital for supporting health equity for Native Hawaiian and other Pacific Islander communities. We celebrate those who are doing this important work in research, practice, funding, infrastructure, and collaboration.
Surveillance
Culturally Relevant Physical Activity in the Behavioral Risk Factor Surveillance System in Hawai‘i
About the article
Introduction
Culturally relevant physical activity is a promising field for chronic disease prevention and management. Native Hawaiians and Other Pacific Islanders have higher rates of physical inactivity than other racial or ethnic groups and increased risk of chronic disease. The study objective was to provide population-level data from Hawai‘i on lifetime experiences in the Native Hawaiian Indigenous practices of hula and outrigger canoe paddling across demographic and health factors to identify opportunities for public health intervention, engagement, and surveillance.
Methods
Questions about hula and paddling were added to the Hawai‘i 2018 and 2019 Behavioral Risk Factor Surveillance System (N = 13,548). We considered level of engagement by demographic categories and health status indicators, accounting for the complex survey design.
Results
Overall, 24.5% of adults engaged in hula and 19.8% in paddling in their lifetime. Prevalence of engagement was higher among Native Hawaiians (48.8% hula, 41.5% paddling) and Other Pacific Islanders (35.3% hula, 31.1% paddling) than among other racial and ethnic groups. In adjusted rate ratios, experience in these activities was strong across age groups, education, sex, and income levels, particularly among Native Hawaiians and Other Pacific Islanders.
Conclusion
Throughout Hawaiʻi, hula and outrigger canoe paddling are important and popular cultural practices with high physical activity demands. Participation was notably high for Native Hawaiians and Other Pacific Islanders. Surveillance information around culturally relevant physical activities can benefit public health programming and research from a strength-based community perspective.
Paddling
Hula
Spearfishing
Activities
Public Health Resonance Project Event 2025
We were so grateful to spend time in the beautiful ʻāina of Papahana Kuaola on February 7 2025 for a Public Health Resonance Collaborative Knowledge Exchange. We drew much strength and solace from caring for the land and the connections, collaborations, and ideas that were nurtured in this amazing place. Mahalo nui loa to Esme Yokooji and Papahana Kuaola for this wonderful opportunity and for teaching us so much on this special day.
Learning Collaborative: Inclusion of Culturally and Regionally Relevant Physical Activity & Nutrition in Applied Public Health
We meet quarterly with public health professionals from Hawaiʻi and Alaska on best practices, wisdom, and innovation for culturally relevant physical activity & nutrition in public health surveillance, traditional practices in public health programming, and funding opportunities for applied public health. About the learning collaborative.
The HALE Project
Supporting increased connections to cultural resources/activities that support social determinants of health from an integrated perspective of social work and public health, including mental health, nutrition, ‘āina connected activities, culturally connected health/physical activities, etc. About the HALE Project.
Culturally and Regionally Relevant Physical Activity Across the Globe Webinar 2025
European Public Health Conference 2024
American Public Health Association 2024
Global Connections
For the public
Literature review data and protocols from this project will be shared in the Open Science Framework. OSF is a free, open platform to support research and enable collaboration. Coming soon: Heritage Physical Activity for Public Health Promotion: A Global Research Synthesis and Resource Library.
AccessMETs – Led by Dr. Simone Schmid
METs of Outrigger Canoe Paddling
Metabolic Equivalents of Outrigger Canoe Paddling for Health Equity: Planned Methods of an Inclusive AccessMETs Study
Spearfishing and Public Health
Spearfishing, a traditional practice deeply rooted in Hawaiian culture and many others across the globe, does more than provide food, it plays an important role in supporting health. This research effort is connecting benefits of this activity across physical, cultural, and other dimensions of health offering valuable insight into the practice and how it can be used to promote well-being for individuals, families, and communities.
This project is led by Lauryn Hansen, MPH, and Catherine Pirkle, PhD.
Spearfishing and public health promotion: A cross-sectional analysis of the Hawaiʻi Behavioral Risk Factor Surveillance System Survey
About the article
Authors
Lauryn Hansen, Yan Yan Wu, Tetine Lynn Sentell, Mika Thompson, Tonya Lowery St. John, Simone Schmid, Catherine McLean Pirkle
Abstract
Spearfishing, a culturally relevant practice in many locations globally, may foster physical activity and enhance well-being by promoting social cohesion, food security, and nature connectedness, but is understudied in public health promotion and surveillance. This study measured the population-level prevalence of lifetime spearfishing engagement in Hawaiʻi and identified associated factors for public health promotion. The Hawaiian Islands present an ideal setting for such activities due to its central Pacific location and a diverse population with cultural ties to spearfishing. In 2019 and 2020, lifetime spearfishing engagement was added to the Hawai’i Behavioral Risk Factor Surveillance System (N = 12,737). Prevalence ratios (PR) and 95% confidence intervals (95%CI) were estimated for spearfishing “sometimes,” “often,” or “very often” during one’s lifetime, considering sociodemographic, health behavior, and health status variables. A quarter of respondents statewide reported engagement, with higher rates amongst men (41%), Native Hawaiians (43%), other Pacific Islanders (36%), American Indian or Alaskan Native (32%), and rural island residents of Lānaʻi (51%) and Molokaʻi (43%). All age groups reported similar lifetime engagement. After statistical adjustment, those with a high school diploma or less were significantly more likely to have engaged in spearfishing than those with higher education. Spearfishing engagement was also associated with a higher likelihood of meeting physical activity guidelines (PR 1.45 95%CI 1.29-1.63). There is widespread lifelong engagement in spearfishing in Hawaiʻi, especially among Indigenous and rural populations. Supporting culturally relevant activities, such as spearfishing, is a strength-based approach to health promotion with global relevance, including encouraging physical activity.
Teamwork to Save Our Ocean: Benefits for Human Health and Well-Being
A side event at the United Nations Oceans Conference in Nice, France on June 10, 2025
About the event
Authors
Lauryn Hansen, Yan Yan Wu, Tetine Lynn Sentell, Mika Thompson, Tonya Lowery St. John, Simone Schmid, Catherine McLean Pirkle
About
The focus of this event, co-convened by a multi-continent coalition including academic, governmental, inter-governmental, and non-academic nongovernmental organizations, is to highlight and learn from successful efforts to support conservation and sustainable use of the oceans (SDG14) that have had demonstratable positive co-benefits for human health and wellbeing (SDG3) in addition to helping achieve other SDGs. This session will start with keynote presentations, followed by a broader panel discussion to consider the value, challenges, and facilitators of transdisciplinary science to help support SDG14 and SDG3.
Event Coordinating Partners
- Université Côte d’Azur
- International Atomic Energy Agency
- European Marine Board
- Centre Scientifique de Monaco
- UNESCO Chair for Sustainability of the Oceans at the University of São Paulo
- Institut de Ciències del Mar
- Institute of Marine Research (Havforskningsinstituttet)
- University of Plymouth
- University of the West Indies
- University of Hawai’i at Mānoa
- Woods Hole Oceanographic Institution
- Scripps Institution of Oceanography
- SINTEF Ocean AS; Stanford Center for Ocean Solutions
- Universiti Malaya; University of Edinburgh
- University of Alabama at Birmingham School of Public Health
- Sulubaai Environmental Foundation
- Mirpuri Foundation
- Fondation Prince Albert II de Monaco
Tahitian Dance
‘Ori Tahiti/Tahitian dance is a cultural practice with deep, strong foundations in place and worldwide popularity. While important literature exists related to the health benefits of hula, Tahitian dance is understudied from this perspective in Tahiti, the Pacific, and beyond.
The knowledge of the value of a traditional practice like Tahitian dance is found from lived experience as well as academic scholarship.
In collaboration with Taliilani Letuli-Goeas and N. Kuuleimomi Tolentino (a PH Resonance Steering Committee member) of Le ‘Ori Afi, Kāneʻohe, HI, Uliana Kostareva and others, the Public Health Resonance project is working on a braided evidence project to help fill this gap.
This includes narratives of lived experience as well as a scholarship review considering health and ‘Ori Tahiti in English and French from health scholarship databases (e.g., PubMed, CINAHL) and non-health specific scholarly databases (e.g., Web of Science and Open Alex). Outcomes include a short movie sharing history and stories of this practice, a scoping literature review, and a community feedback
The short movie is expected to premiere in August 2026. A community reportback discussion, and celebration for this project is also scheduled for August 2026. An evidence brief is scheduled to be completed in Fall 2026. An academic paper is expected to be published by 2027.
Albanian Dance
Folk dancing is a favored activity among Albanians, with great promise for physical activity and health promotion in Albania, South Eastern Europe, and around the globe. Albanians have a long history of emigration. Over a third of Albanians live outside of historical homelands. Despite this dispersal, Albanians maintain strong cultural traditions including through traditional costumes, language, and folk dance. Within the country, Albania’s population is growing more diverse, socially, demographically, and culturally with new political refugees and international migrant workers. Engagement in cultural dances is a way to support belongness and understanding across cultures.
In collaboration with Dr. Alban Ylli, Head of the Department of Public Health Performance and Non-Communicable Diseases at the Instituti i Shëndetit Publik/Institute of Public Health in Tirana Albania and a Public Health Resonance Steering Committee member, the PH Resonance Project is planning a research synthesis and an international collaborative conference in November 2026 about culturally and regionally relevant physical activity and public health promotion in Albania, South Eastern Europe, and beyond.
The conference will focus on the integration of traditional activities into public health agendas, a field where Albania is making significant progress. As the result of efforts under CURE-PA starting with the collaborative meeting in Vienna in 2022 and following from decades of global collaboration building from The International Mobility In Aging Study (IMIAS) and the Fulbright Program, Albania has included for the first time in its 2026 round of Health Behavior in School Children (HBSC) a module on physical activity and folk dance.
Fall 2026 events and projects will be in collaboration with the Academy of Sciences of Albania, the central scientific and research institution in Tirana, Albania; the Instituti i Shëndetit Publik/Institute of Public Health; and the Public Health Resonance Project. This event will also feature two experts from World Health Organization (WHO) Europe and will be followed by a short training on Behavior and Cultural Insight (BCI). Speakers will include international and local experts from Albania, South Eastern Europe, and beyond.
Resources
- Culturally and Regionally Relevant Physical Activity Workshop: Building Impactful Global Public Health Promotion Activities for Immigrant and Migrant Communities. Where folk dance and health were considered within and from Albania using the conceptual models described here and in context with other diaspora.
- Tetine Sentell will be sharing more about this at the International Society for Physical Activity and Health Congress in Mérida, México in Fall 2026: Look for: “We’d rather dance than jog!”: Albanian Folk Dance & Physical Activity Promotion for Health Equity.”
- Tetine Sentell, Alban Ylli, Alina Dorian, Leah Grout, Catherine Pirkle, 449 Culturally and regionally relevant physical activity workshop: building impactful global public health promotion activities for immigrant and migrant communities, European Journal of Public Health, Volume 35, Issue Supplement_6, December 2025, ckaf180.051, https://doi.org/10.1093/eurpub/ckaf180.051
Kalo
As part of a project collaboration with Ka ʻAha Lāhui O ʻOlekona Hawaiian Civic Club of Oregon and Southwest Washington (KALO) and Papa Ola Lōkahi (POL) the Native Hawaiian health board, to showcase the ways in which culturally and regionally relevant physical activities are nourishing land, community, and individuals across the Native Hawaiian Diaspora, including in the Pacific Northwest, we were so fortunate to visit the amazing AloHā Resource & Community Center and māla of KALO in Beaverton. We were honored to connect face-to-face with the community and organizational team as see examples of CURE-PA grounded in Native Hawaiian cultural traditions as practiced in the Pacific Northwest. More to come from this project in Fall 2026.
Resources
- Published work by KALO showcases the māla (garden) and projects:
- Ka’ula L, Cruz J, Dutro N, Ching D, Wong K, Jackson AM. Growing Kalo (Taro) in the Continental United States. Health Promot Pract. 2023 Nov;24(6):1083-1086. doi: 10.1177/15248399231190361. PMID: 37877644. https://pubmed.ncbi.nlm.nih.gov/37877644/
- Ka’ula L, Ellison NLK, James C, Oshiro A, Ideue K, Ka’ula K, Jackson AM. Growing kalo (taro) to promote culture and health in the Continental US. Front Public Health. 2025 Oct 10;13:1689052. doi: 10.3389/fpubh.2025.1689052. PMID: 41142747; PMCID: PMC12549674. https://pubmed.ncbi.nlm.nih.gov/41142747/
- And many resources on their comprehensive and informative website: https://www.kalohcc.org/, including: https://www.kalohcc.org/resources
- Papa Ola Lōkahi is connecting with the Native Hawaiian diaspora through the He Alo a He Alo ~ Listening Tour, a nationwide initiative that gathered insights from Native Hawaiians living across the United States. https://www.papaolalokahi.org/program/he-alo-a-he-alo-listening-tour
- More information about the Native Hawaiian diaspora: https://www.pbs.org/video/dear-aloha-4d82qw/
- A yearly event that celebrates Hawaiian arts, culture, and community in the Pacific Northwest: https://www.4daysofaloha.com/schedule
Call for Papers
Growing peer review research for our special journal theme on this topic in Hawai‘i and the Pacific
In collaboration with the University of Hawai’i Department of Public Health Sciences’ Hawai’i Health Data Warehouse Project, the Hawai’i State Department of Health Chronic Disease Prevention and Health Promotion Division, and others the Public Health Resonance Project had an open call for papers to continue to grow this area of scholarship and practice through the Hawaiʻi Journal of Health & Social Welfare.
The announcement can be found on the journal’s website and on LinkedIn. Yoko Kanemasu, PhD, Professor in Sociology in the School of Law and Social Sciences at the University of the South Pacific, Headquarters & Laucala Campus, Private Mail Bag, Suva, Republic of Fiji is a guest editor as well.
Thirteen articles from authors across the Pacific were submitted and will be developed into papers in the next year. The Public Health Resonance project will contribute to a collaborative, interdisciplinary editorial and other scholarship along with more than 10 other scholars to be published over the next year.
Abstracts are invited for consideration through September 1, 2026.
Selected References
Sentell TL, Pirkle CM, Grout L, Ylli A, Heil DP, Schmid SM, et al. Culturally and regionally relevant physical activity for public health promotion in a global context: nature of the evidence and definition development from a narrative review. BMJ Public Health. 2026;4:e002572. https://doi.org/10.1136/bmjph-2025-002572 https://bmjpublichealth.bmj.com/content/4/2/e002572
Engagement in Culturally and Regionally Relevant Physical Activity (Hula, Outrigger Paddling, Spearfishing, and Surfing) in the State of Hawai’i Over the Lifecourse: A Cross-Sectional Analysis. Pirkle CM, Thompson MD, Rodericks R, Schmid SM, Ching LK, Look MA, Wu YY, Phillips MM, Sentell TL. J Phys Act Health. 2026 May 27:1-13. doi: 10.1123/jpah.2025-0938. Online ahead of print. PMID: 42208608 https://journals.humankinetics.com/view/journals/jpah/aop/article-10.1123-jpah.2025-0938/article-10.1123-jpah.2025-0938.xml
Sentell T, Wu YY, Look M, Gellert K, Lowery St. John T, Ching L, et al. Culturally Relevant Physical Activity in the Behavioral Risk Factor Surveillance System in Hawai‘i. Prev Chronic Dis 2023;20:220412. DOI: http://dx.doi.org/10.5888/pcd20.220412 https://www.cdc.gov/pcd/issues/2023/22_0412.htm
Policy Brief: Sentell T et al. Outrigger Canoe Paddling on Maui. The Public Health Resonance Project. Policy Brief. Published June 9, 2024.
Pirkle C, Lowery St. John T, Wu YY, Look M, Ching, Chosy EJ, Dudla S, Rodericks R, Sentell T. Adding culturally relevant physical activity to the behavioral risk factor surveillance system in Hawai‘i: Lessons Learned. Oral presentation. BRFSS Conference. April 15-18 2024.
Look M, Sentell T, Pirkle C, Irvin L. Why Culturally Relevant Physical Activity is Important for Achieving Health Equity: A Case Study from Hawai‘i. CDC Division of Nutrition, Obesity, and Physical Activity, Workshop on Culturally Relevant PA. March 5, 2024.
Schmid S, Heil D., Yoshida A., Ching L, Sentell T. Metabolic equivalents of outrigger canoe paddling for health equity. Annual Pacific Rim International Conference on Disability and Diversity, organized by the Center on Disability Studies. O’ahu, Hawai’i, USA. February 2024
Sentell T, Thompson M, Rodericks R, Schmid S, Pirkle C, Ching L, Look M, Wu YY, Dudla S, Finn J, Phillips MM. Engagement in culturally-relevant physical activity (paddling, hula, surfing, and spearfishing) in the state of Hawai‘i over the lifecourse. American Public Health Association Conference. Atlanta, Georgia. November 2023.
Sentell T, Thompson M, Rodericks R, Schmid S, Pirkle C, Ching L, Look M, Wu YY, Finn J, Phillips MM. Culturally-Relevant Physical Activity over the lifecourse and association with chronic disease. European Public Health Conference. Dublin, Ireland. November 2023.
Sentell T, Thompson M, Philips M, Schmid S, Look M, Saiki K, Wu YY, Rodericks B, Soo Hoo C, Ching L, Yoshida A, Weldon R, Pirkle C. Surfing: A public health promotion opportunity. Poster. International Society for Physical Activity and Health Conference. Paris, France. October 28-31, 2024.
Hansen L, Pirkle C, Lowery St. John T, Ching L, Thompson M, Wu YY, Sentell T. Widespread engagement in spearfishing in Hawaiʻi – A culturally-relevant and accessible physical activity of global significance. Poster. International Society for Physical Activity and Health Conference. Paris, France. October 28-31, 2024.
Sentell T, Look M, Pirkle C, Ivin, Ylli A, Heil DP, Schmid S, Ching L, Rodericks B. Culturally relevant physical activity is important for achieving health equity: Case study from Hawai‘i. Oral presentation. Paris, France. October 28-31, 2024.
Schmid S, Soo Hoo C, Finn J, Thompson M, Phillips MM, Pirkle C, Rodericks R, Ching L, Sentell T. Culturally-relevant physical activities in comparison across levels of the social ecological model: Hula, surfing, paddling and spearfishing. American Public Health Association Conference. Minneapolis, Minnesota. (Fall 24)
Schmid S, Heil D, Yoshida A, Ching L, Funakoshi J, Kualau P, Sentell, T. Building the science for outrigger canoe paddling for paddlers with spinal cord injury as health promotion and for health equity. Oral presAccessMETs: An innovative project establishing metabolic equivalents of outrigger canoe paddling for health equity in real-life ocean conditions for those with and without spinal cord injuries. American Public Health Association Conference. Minneapolis, Minnesota. (Fall 24)
Mahalo
Thank you
This work has been partially supported by the Chin Sik & Hyun Sook Chung Endowed Chair in Public Health Studies and the Hawai‘i Department of Health, Chronic Disease Prevention and Health Promotion Division among others.