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.

Introduction: Culturally and regionally relevant physical activities (CRRPA) show promise for disease prevention and strengths-based public health promotion. Understanding engagement across the lifecourse can support effective public health policy, research, and practice. This study examined: (1) factors associated with CRRPA participation, including gender, race/ethnicity, and chronic disease; (2) contexts of practice, as well as the frequency and duration of engagement; and, (3) lifetime participation in four CRRPA in Hawai'i (Hula, outrigger canoe paddling, spearfishing, and surfing). Methods: A cross-sectional analysis was conducted among 1044 English-speaking adults in Hawai'i, recruited through an online panel or by random-digit dialing to complete a survey examining CRRPA engagement in the state. Native Hawaiians and residents of rural islands (excluding O'ahu) were oversampled for representation. Lifetime participation in each CRRPA was self-reported and dichotomized. Engagement was characterized by sociodemographic and health-related variables. Frequency, context, and duration were summarized for the total sample and for Native Hawaiians (n = 425). Engagement patterns over the lifecourse are also presented. Results: Overall, 69.3% of respondents reported lifetime participation in at least one CRRPA. In the full sample, 44.9% engaged in Hula, 41.4% in surfing, 34.9% in spearfishing, and 33.9% in outrigger canoe paddling. Among those reporting having engaged in at least one CRRPA (n = 724), percentages were 64.8% (hula), 59.7% (surfing), 49.7% (spearfishing), and 48.9% (paddling). Most participated in multiple CRRPA, and 12.4% engaged in all four at some point in their lives. Among Native Hawaiians, family-based participation was common, especially for spearfishing and surfing. The average session duration for all activities was two hours or more, with more frequent engagement reported among Native Hawaiians. Engagement was highest during earlier life stages and declined with age. Trends varied notably by generation, with younger generations engaging more than older ones. Lifetime patterns corresponded with important historical events that popularized activities such as Hula and surfing. Conclusions: Engagement in CRRPA is widespread across Hawai'i. Trends varied by demographic and generational factors, underscoring opportunities to advance strengths-based public health promotion, planning, and policy for health equity.