Adolescent Health

Priority Need – To improve and enhance adolescent strengths, skills, and support to improve adolescent health.

National Performance Measure # 9- Percent of adolescents, ages 12 through 17, who are bullied or bully others.

ESM 9.1 – The percent of BFHNS staff receiving lesbian, gay, bisexual, transgender, and questioning (LGBTQ) cultural competency training.

The health status of adolescents is a key determinant for adult health productivity and longevity. Adolescence, the transition from childhood to early adulthood between 10 and 19, is critical in human development. While youth may appear relatively healthy, health patterns, behaviors, and lifestyle choices made in adolescence have essential long-term implications. Habits and behaviors frequently sated during adolescence related to healthy weight management, exercise, sexual behavior, nicotine/tobacco/vaping, alcohol, and substance abuse can affect the risk of unfavorable health outcomes in the short and –long-term.

Bullying is a significant public health problem that may contribute to depression, antisocial behaviors, suicidal thoughts, and poor school performance, among other adverse outcomes. Adolescence is a unique developmental period that encompasses puberty's biological changes and other psychological, cognitive, and behavioral changes. Adolescents only require medical care for illness and injury but family planning services, substance abuse treatment, mental health services, and various informational and educational activities oriented toward developing positive health outcomes. Bullying is repeated exposure over time to deliberate, negative actions on the part of one person or more than one person that is unprovoked, resulting in a physical and/or psychological power imbalance. In school, bullying generally occurs in the "hot spots" where adult supervision is usually minimal – playgrounds, bathrooms, hallways, buses, and locker rooms.

In 2019, 14.5% of students in Guam high schools reported being bullied by another student on school property. Female students reported being bullied more than male students (16% vs. 12.9%). Students in Grade 11 (16.5%) reported significantly more bullying than in Grade 9 (14.5%). In 2019, 41% of Middle School students in Guam reported being bullied by a student on school property. 6th-grade students reported being bullied more often than students in 8th Grade (42.4% vs. 41.4%).

Schools should be safe places for everyone. Bullying experienced during childhood and adolescence has far-reaching effects, undermining bullied youth's mental and physical health. Lesbian, gay, bisexual, transgender, and queer (LGBTQ) youth, in particular, experience significant verbal bullying, physical bullying, and cyberbullying leading to bodily injury, psychological distress, and even suicide. The prevalence and consequences of bullying among LGBTQ youth are increasingly well understood, yet successful efforts to address LGBTQ bullying are lagging.

Keeping hallways and classrooms free of homophobic, sexist, racist, and other discriminatory language is one aspect of creating a positive school climate for all students. In 2019, 10.6% of Guam high school students had incidents of name-calling or teasing because someone thought they were gay, lesbian, or bisexual. Male students (11.9%) were more likely to be bullied or called names than female students (9.2%). Students in Grades 9 (13.9%) and Grade 11 (11.5%) were more likely to tease or call names than in Grades 10 and 12.

Bullying also occurs via electronic means – cell phone/texting and social media platforms. This is known as "cyberbullying" and can be challenging to control as this form of bullying is most often done away from school.

According to the Superintendent, cyberbullying has increased in Guam public schools over the past two years. He stated that school administrators have been dealing with more cases based on disciplinary reports that track infractions than in the past. The Guam Department of Education has an anti-bullying policy, but schools have problems addressing cyberbullying.

Additionally, students who are part of the LGBTQ community have difficulty finding safe spaces online, with students being more vocal online. A dangerous new trend emerged in early 2021. The "super straight" trend explicitly mocks members of the LGBTQ community and has seen widespread adaption on social media.

In 2019, 12.4% of Guam students in high school reported being threatened or harassed over the internet, by email, or by someone using a cell phone. This was a decrease of 7% from 2017. Female (15.8%) high school students were significantly more likely to be electronically bullied than males (9.4%). A higher prevalence of LGBTQ students was electronically bullied in 2019. Among LGTBQ students, 13.9% had been electronically bullied, and among students who were unsure of their sexual identity, 16.4% had been bullied.

The Island Wide Body of Governing Students has discussed the merits of the Anti-Bullying policy to include specific protections for LGBTQ students. Furthermore, training is needed to help teachers and administrators determine when cyberbullying occurs. In addition to addressing bullying, GDOE policy prohibits cyberbullying, sexting, and sexual harassment in the classroom, on buses and bus stops, and at school-sponsored activities.

The closing of schools due to the pandemic had many adverse effects on Guam's students. Many reported symptoms of depression, anxiety, and loneliness due to the uncertainty of the pandemic. Students experienced anxiety and stress around managing online learning and navigating the online learning world and personal/family issues. Students worried about their relatives getting sick. Students struggled with not being able to see friends, ending the school year early, and missing end-of-the-year activities, which caused isolation, loneliness, and some suicidal ideation. Students lacked the energy and motivation to engage in schoolwork. They were frustrated, distracted, and developed behavioral issues related to distance learning. For some students, the lack of fluency in English, deficits in technical knowledge, and limited access to good internet connections made the process of distance learning frustrating for many students and parents.

Suicide is one of the leading causes of death among adolescents and young adults. Suicide is not experienced equally across genders and sexual orientations. In Guam, the suicide rate for males (45.5 per 100,000) is six times the suicide rate for females (7.4 per 100,000). There is a well-studied gender paradox in the method used for suicide attempts, with men of age selecting more lethal methods and, therefore, more likely to complete a suicide attempt.

From 2017 through 2021, 178 competed for suicide among the Guam population (all ages). Adolescent suicides made up 7.3% of the completed suicide and whereas young adults made up 17.9% of the suicides.

Source: OVS, DPHSS

In 2021, there were 33 suicide ideation cases noted by the Guam Department of Education, with 19 of those student cases referred to the Guam Behavioral Health and Wellness Center. Based on the numbers provided, up to 14 students were not referred to support outside of school following initial contact with a school guidance counselor. As it stands, school counselors conduct screenings of students who have suicide ideation. Using a suicide risk screener, the student's risk level is gauged, and the scale ranges from high and moderate to low. Students who rate high to moderate are referred; however, the standard operating procedure does not call for referrals of students identified through the risk screener as low risk. Another compounding factor is that GDOE only has four district school psychologists who can administer suicide risk assessments.

Guam Public Law 35-40 was passed to establish a pilot program for youth mental health first aid training for the Guam Department of Education and Guam Academy Charter School Personnel. Youth mental health first aid training is designed to teach adults how to help youth ages 12 through 18 who may be experiencing a mental health or substance abuse challenge or crisis. Unfortunately, the creation of the training curriculum was postponed due to the pandemic.

Priority Need – Reduce the use of substances, including alcohol, tobacco, marijuana, and opioids.

National Performance Measure # 14.2- Percent of children, ages 0 through 17, live in households where someone smokes.

ESM 14.2.1 – Percent of clients enrolled prenatally in the home visitation program who reported reduced or stopped smoking by delivery.

Substance experimentation (alcohol, tobacco, marijuana, and drugs) is widespread. Unfortunately, teenagers often do not see the link between their actions today and the consequences of tomorrow. They also tend to feel indestructible and immune to the problems that others experience.

Tobacco is the leading cause of preventable and premature death in the U.S. An estimated 88% of adult tobacco users started using tobacco before they turned 18. The younger someone starts smoking, the more likely they become regular smokers.

Smoking prevalence and smokeless tobacco use remain higher in Guam than in the U.S. for adults and youth. Youth smoking has surpassed the Healthy People 2020 target; however, adult smoking, youth, and adult smokeless tobacco use, and quit attempts have not met the Healthy People 2020 target. Over time, adult and youth smoking and youth smokeless tobacco use have declined in Guam.

Guam started seeing a decline in smoking prevalence in 2007, one year after implementing the Natasha Act (Guam's smoke-free public place law). In 2019, the Natasha Act was amended to include electronic smoking devices. The Guam "Youth Protection Act of 2017" increased the minimum age for legal access to tobacco products and e-cigarettes to age 21.

Tobacco Use Indicators, Guam vs USA, 2017-2019

Source: Guam BRFSS and YRBSS

The Guam Department of Education continues to see underage smoking as a significant issue on school campuses. GDOE has had to discipline students in elementary school for the infraction. It was stated that nicotine use had become one of the top five behavioral issues across the school district over the past several years.

Based on the current data, 402 students were disciplined for nicotine use/possession. Students caught with nicotine products or e-cigarettes are disciplined in line with Board Policy 430, which is first offense – three days suspension; second offense – six days suspension; third offense- nine days suspension and fourth offense – ten days suspension.

Source: GDOE

However, there are instances when students can participate in the Brief Tobacco Intervention program instead of suspension. The department cannot compel parents to require students to participate. Twenty-five students who violated the Board Policy chose to participate in the tobacco intervention program during the school year, and 377 students were suspended.

In general, binge drinking among youth is lower in Guam than in the U.S. In 2005, the binge-drinking rate decreased for the first time since 1995, following the legislated increase in taxes on alcohol products. In 2011, Guam's high school binge-drinking rate dropped further after the law raising the minimum legal age for alcohol consumption from 18 years to 21 years was passed in 2010. It has continued to trend downwards.

Guam youth surpass U.S. mainland youth in using marijuana and lifetime use of prescription pain medicine without a prescription. The prevalence rate of methamphetamine, cocaine and inhalant use in Guam is lower than in the U.S., but cocaine and methamphetamine use on the island has increased since 2011. Conclusion: Guam's youth's lifetime and current marijuana use remain higher than among U.S. youth. Nearly half of all high school students had tried marijuana, and roughly one-fourth had used marijuana within 30 days of the survey. There is no apparent sex difference noted.

Drug Use Indicators, Guam Youth Current and Baseline

Source: Guam BRFSS and YRBSS

Betel (areca) nut is an addictive substance chewed with or without tobacco and is widely used in Asia and the Pacific. Research suggests that most betel nut initiation occurs in adolescence. However, very little is currently known about the etiology of adolescent betel nut use.

A study, "Adolescent Betel Nut Use in Guam – Belief, Attitudes, and Social Norms."[1] it was found that betel nut use appears to be highly prevalent in adolescents' social environment: parents and/or other adults' use of betel nut seems common among cousins, siblings, and friends. Furthermore, the youth found betel nut to be easily accessible. In addition, for some island groups such as Yapese and Saipanese, betel nut use appears to be a part of cultural tradition and possibly a symbol of cultural identity.

[1] www.ncbi.nim.nih.gov