ADOLESCENT HEALTH        

The MCH Program continues to utilize partnerships to be able to expand its reach within the adolescent population group. In 2019, partnerships for addressing adolescent teen health priorities and emerging needs included the Public School System Personal Responsibility and Education Program (PREP), the Garret Lee Smith (GLS) Suicide Prevention Program, and the Pride Marianas Youth. 

National Performance Measure 9: Percent of adolescent ages 12 through 17 years who are bullied or who bully others

The CNMI utilizes the bi-annual Youth Risk Behavior Survey (YRBS) to report on this measure. The most recent YRBS completed was in 2017. Therefore, the CNMI is reporting on this measure utilizing the 2017 YRBS results, which is the most recent federally available data on bullying. Of the 3,240 children ages 12 through 17 years in the CNMI enrolled in public schools 29.4 percent (953) reported to have been bullied.

Strategy: Expand the use of bullying prevention programs in public schools.

Many of the challenges for engaging schools in 2019 were a direct result of the disaster caused by super typhoon Yutu at the start of the year. Schools were closed for a couple of months as they were used as shelters for families who were displaced by the disaster.

Many school campuses were severely damaged leaving school officials with the substantial task of strategizing on ways to ensure that learning continued. Several school campuses on the island of Saipan had a large proportion of their campus building damaged resulting in schools moving to half day sessions for students to share class space in order to accommodate learning for all students. One of the largest middle schools on the island of Saipan, Hopwood Middle School, had damage to the majority of its campus, which resulted in a temporary relocation of its campus into another village utilizing tents donated by FEMA as classrooms.

As a result of these, our school officials and administrators focused the greater part of the 2019 year prioritizing strategies for ensuring that students were able to access the amount of necessary amount of instructional hours and that all students were accommodated on campuses where space and capacity were severely diminished as a result of the super typhoon.

While the MCH program was not able to work individually with each school administration on activities to implement or strengthen bullying prevention work, the Program did partner with the Public School System in coordinating a Youth Conference, which included conference sessions on bullying prevention and mental health topics. Conference attendees included students from each middle and high school from the islands of Saipan, Tinian, and Rota (a total of 10 campuses) who represent their respective Youth Advisory Panel (YAP). Among conference sessions, included were presenters from the Hawaii Youth Services Network who conducted sessions focused on bullying prevention. Other conference topics included mental health and non-communicable disease prevention. The conference concluded with YAP members developing work plans that included activities to be implemented on their campuses that addressed the conference session topics. 

Strategy: Increase parent engagement in bullying prevention.

Plans for engaging parents in bullying prevention in 2019 included partnering with individual Parent Teacher Organization (PTO) groups from each school campus. However, the activities were adjusted in response to the resulting disaster from super typhoon Yutu. As part of parent engagement, the MCH program partnered with the Public School System on the 2019 Youth Conference, which included a day of training/conference sessions for parents of students in Middle and High School on the islands of Saipan, Tinian, and Rota. Parents were able to participate in sessions that included topics on Bullying Prevention, Mental Health, and Non-Communicable Disease prevention. Sessions were focused on promoting parental awareness regarding these topics as it relates to our CNMI teens as well as providing information on strategies for preventing the adverse impacts of these issues.

Evidence Based Measure 9.1: Percent of schools that have implemented evidence based programs to address bullying in schools.

In 2018, MCH program conducted an assessment to determine the types of evidence based curriculums being utilized by public schools to address bullying. There are a total of 20 public school campuses across all school levels throughout the CNMI. Results from the assessment concluded that 9 (45 %) of the 20 schools reported utilizing an evidence based curriculum to address bullying prevention. For 2018, 8 of the 20 schools reported to be currently utilizing an evidence based curriculum to address bullying prevention. Of the 20 schools that were surveyed, 8 (40%) reported that they were currently utilizing an evidence based curriculum, 9 (45%) reported that they were not currently utilizing an evidence based curriculum, and 3 (15%) schools did not respond. Two of the 9 that reported no current use of a curriculum stated that they had just placed an order for the Second Step curriculum and will be working towards implementing that program in the next coming school year. Additionally, 3 of the 9 who reported no current use indicated interest in implementing a curriculum to support bullying prevention efforts. Three of the schools were unresponsive to the survey.

CNMI Youth Risk Behavior Survey Results on the percentage of Middle and High School Students who reported being bullied on school property, years 2009 - 2019.

                     Data Source: CDC Youth Online, Northern Mariana Islands

A review of CNMI YRBS results beginning in the year 2009 through 2017 illustrates a gradual increase on the percentage of high school aged teens reporting being bullied, increasing from 19.7 percent in 2009 up to 23.2 percent in 2017. For middle school students, the percentages are more than double what is being reported by high school students. In 2009, 48.8 percent of middle school aged children reported being bullied. In 2013 this number rose to 63.7 percent of middle school children reporting being bullied with a slight decrease in the subsequent 2015 and 2017 reporting years to 58.5 and 59.0 percent respectively. The 2019 YRBS results were just being released as of the time of this report and indicators included in the graph above. The 2019 YRBS indicates decreases in both the middle and high school population’s reporting of bullying, with 48.8 percent and 18.4 percent respectively responding to being bullied. This data indicates a decreases in bullying of 10.2 percent in middle schools and a 4.8 percent decrease in the high school population.

State Performance Measure 4: Percent of high school student that report thoughts of suicide.

The CNMI utilizes the bi-annual Youth Risk Behavior Survey (YRBS) to report on this measure. Information available via the CDC’s Youth Online website indicates results of the 2019 YRBS conducted in the CNMI. Data from the report illustrates that 28.5 percent of high school students reported thoughts of suicide, this is a 3.5 increase from the previous YRBS conducted in 2017.

Strategy: Increase teen access to mental/behavioral health supports and education.

In addition to the Youth Conference that was conducted in 2019 through a collaboration with PSS, the MCH Program also coordinated training on LGBTQ through a facilitator from the Hawaii Youth Services Network. Through the HRSA MCHB technical assistance form, the MCH program coordinated training to be provided to the staff of the Commonwealth Healthcare Corporation (clinical and public health) and partner agencies (Public School System and the Marianas Pride Youth) on the following topics: 1) The LGBT: Understanding Sexual Orientation and Identity; and 2) Creating LGBT Inclusive Environments. The goals of the TA were to: 1) To increase knowledge and capacity to create safe and inclusive environments within organizations for LGBT groups; and 2) To increase knowledge and understanding of sexual orientation and the many sexual identities across the spectrum. Objectives included: 1) To increase knowledge and understanding among healthcare, public health, and partner agency staff on sexual orientation and the many sexual identities across the spectrum; 2) To increase knowledge and understanding of words that are used with the LGBT community and how to use terminologies in positive communication settings; 3) Increase in knowledge on guidelines and tools needed to create and maintain more affirming and inclusive environments; and 4) Understanding LGBT individuals and their health needs.

This training aimed to build capacity among MCH staff, Public Health Workers, and Partner Agency employees to be able to utilize affirming/positive communication techniques to deliver effective messaging and other health information to the LGBT population/youth in the CNMI. Additionally, the training was intended to build agency capacity to support policies and environments that are more affirming and inclusive ultimately impacting or facilitating improvements in measures related to youth suicide ideation (state performance measure) and bullying (national performance measure).

State Performance Measure 5: Teen birth rate among 15 to 17 year olds

There are substantial social and economic costs related to teen births as indicated through long term impacts on teens and their children[i]. Teen pregnancy significantly contributes to high school drop-out rates and lower educational attainment among teen mothers. The CNMI MCH Program has worked diligently to engage partners such as the Family Planning program and the Public School System in efforts towards teen pregnancy prevention and reduction in teen births among CNMI youth. In 2016, the rate of teen births was 15.03 per 1,000 females ages 15 through 17 years. This rate decreased to 8.48 per 1,000 in 2017. The CNMI experienced a slight increase in 2018 with a rate of 11.58 per 1,000 females ages 15 through 17 years and is maintained in 2019 with a teen birth rate of 11.9. The data reported for this measure was obtained through birth records from the CNMI Health & Vital Statistics Office (HVSO).

Strategy: Increase access to confidential adolescent health services.

Through partnership with the Public School System, the MCH and Family Planning program continue to work on activities that focus on increasing access to confidential teen health services available through the CHCC, including HIV/STD testing and treatment and Family Planning services. In 2019, classroom presentations were conducted by the HIV/STD Prevention and Family Planning programs. The presentations provided education to students on HIV/STD and teen pregnancy prevention. Also included was information on how to access confidential teen services available through the CHCC. Presenters provided information and answered questions on student concerns around confidentiality and payment for services. Family Planning and STD testing and treatment services for teens are confidential and are at no cost to teens in the CNMI.

[i] Centers for Disease Control and Prevention 9CDC). (2017). About Teen Pregnancy. Retrieved on June 30, 2018 from https://www.cdc.gov/teenpregnancy/about/index.htm