A researcher at the University of Hawaii Cancer Center has received a $2.8 million grant to develop a school-based, culturally-grounded e-cigarette prevention program specifically for Hawaii’s rural youth.

UH-Manoa on Wednesday announced the grant award to researcher Scott Okamoto from the National Institute on Drug Abuse.

“To our knowledge, this is the first study to develop and test an e-cigarette prevention intervention tailored to rural Hawaiian youth,” said Okamoto in a news release. “Our proposed intervention will educate youth on the risks of e-cigarette use, while also reflecting the cultural and relational values of rural Hawaiian youth and communities.”

The project will build on Hoʻouna Pono, a drug prevention curriculum designed for rural Hawaiian adolescents. Ho‘ouna Pono means “to send with righteousness,” according to a previous article about the pilot program in the “Journal of Health Care for the Poor and Underserved.”

With the grant, Okamoto will update the curriculum and introduce new e-cigarette and vaping prevention content, including a social and print media campaign across middle and multi-level public and charter schools on Hawaii island.

More than 500 students are anticipated to enroll in the study over five years.

In Hawaii, 18% of all middle school youth currently vape, ranking the state first nationally among 14 states collecting data on the demographic, according to the U.S. Centers for Disease Control and Prevention.

The highest percentage of e-cigarette users among these youth, 30%, are of Native Hawaiian or Pacific Islander ancestry, higher than other major ethnic groups in Hawaii.

Health advocates say e-cigarette use among adolescents and young adults has been associated with adverse respiratory symptoms, including symptoms of asthma and bronchitis.

CDC says most e-cigarettes contain nicotine, which is known to be highly addictive, and that nicotine exposure can harm adolescent brain development, which continues into the early to mid-20s.

Research has found ever-users of e-cigarettes were five times more likely to be diagnosed with COVID-19, UH said.

Additionally, e-cigarette consumption increases the risk for using combustible, tobacco cigarettes, which is directly linked with lung cancer.