Adolescence is a time of incredible growth and is a crucial physical, psychological, and social developmental period. Learning to stay healthy and avoid risks during this period of life can have lifelong effects on health by assisting adolescents to adopt healthy habits, avoid risky behaviors, and prevent disease. Habits and behaviors frequently started during adolescence related to healthy weight management, exercise, sexual behavior, nicotine/tobacco/vaping, alcohol, and substance use can impact the risk of unfavorable health outcomes in the short and long term. Mental health disorders and related conditions often surface during adolescence and are best addressed early to enhance optimal health.

The Adolescent Health domain focuses on two priority needs. The first is "to improve and enhance adolescent strengths, skills, and support to improve adolescent health." This priority need includes National Performance Measure (NPM) # 9 – Percent of adolescents, ages 12 through 17, who are bullied or bully others."

Guam Title V also created two State Performance Measures (SPM) SPM #1 – “Guam youth suicide rate, ages 10-24 years” and SPM #2 – “Percent of LGBTQ high school students attempting suicide.”

The second priority was "Reduce the use of substances including alcohol, tobacco, marijuana, and opioids among youth." This priority need includes NPM #14.2 "Percent of children, ages 0 through 17, who live in households where someone smokes."

The Centers for Disease Control and Prevention (CDC) defines youth as ages 10-18 and young adults as ages 19-24. This section serves as the narrative for the Annual Report and Application. The narrative considers the adolescent domain as ages 10 to 24 years. In 2020, 35,903 youth and young adults were residing in Guam, approximately 4.28% of the population.

The Guam Youth Risk Behavior Surveillance Survey (YRBSS) is administered by the Guam Department of Education (GDOE). The YRBSS is a school-based surveillance system designed by the CDC. It collects substance use and abuse data, including alcohol, mental health, well-visits, sleep, physical activity and nutrition, obesity and overweight, violence and injury, sexual behaviors, and positive and protective factors. Due to the impact of COVID-19 in Guam on schools during the school year 2021-2022, the YRBSS was not administered during the spring of 2022.

Current cigarette smoking is defined as smoking cigarettes in the past 30 days among Guam students. In 2019, 11.9% of Guam students in high school (grades 9-12) stated that they were current smokers. This was a significant decrease from 2017 (9.8%). Cigarette smoking among Guam students has continuously declined since 2001, when 37.1%

The percentage of cigarette smoking differed significantly between males (15.6%) and females (7.7%). As grade levels increased, students were more likely to report smoking cigarettes. The cigarette smoking percentage for students in 9th grade (7.9%) was lower than the cigarette smoking percentages for students in 10th grade (13.3%) and 12th grade (13.6%).

The Guam Department of Education (GDOE) continues to see underage smoking as a significant issue on school campuses. GDOE has had to discipline students in middle and high schools. In SY 2021-2022, 402 students were disciplined for nicotine use/possession. There were 264 males (65.6%) and 138 females (34.3%).

Source: GDOE

During the same school year, 25 students violated the smoking policy and chose to participate in the tobacco intervention program. Meanwhile, there were 377 students suspended.

Vape products are battery-powered devices that heat liquids and turn them into aerosols inhaled by the user. These liquids usually contain nicotine and kid-friendly flavors like fruit, candy, or mint. Whether smoked, vaped, or chewed, nicotine interferes with adolescent brain development and affects cognitive abilities and mental health.

In 2019, 26.5% of Guam public high school students reported vaping products in the past 30 days. This was a 100% increase from the 2017 data. Guam students were likelier to report vape product use than all other nicotine products combined. Male students (36.7%) reported using vape products at a significantly higher percentage than female students. The use of vape products increased substantially with grade levels from 22.1% in grade 9 to 39.3% in grade 12.

Prescription drugs can be beneficial when prescribed by a doctor and used as directed. The misuse and abuse of prescription medications is a significant health concern in Guam and has led to deaths due to drug overdose.

In 2019, 15.5% of Guam students in grades 9 through 12 reported using prescription drugs not prescribed in the past 30 days. This was a significant increase from 2017. Female students (12.3%) reported a lower percentage than males (18.4%). Students in 9th grade (12.8%) reported a lower rate in 10th grade (18.2%) but lower than grade 12 (9.7%).

Guam youth surpasses the US—mainland youth in the use of marijuana and lifetime use of prescription pain medicine without a prescription. The prevalence rate of methamphetamine, cocaine, and inhalant use you are lower in Guam than in the US, but cocaine and methamphetamine use on the island has increased since 2011. Lifetime and current marijuana use among Guam's youth remain higher than among US 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

The University of Guam Cancer Research Center developed a new program for 6th to 8th-grade students in Guam. The Fuetsan Manhoben Youth Substance Use Prevention Program uses a curriculum of realistic videos showing scenarios where local students are exposed to drinking, smoking, and vaping at bus stops, family parties, and schools.

Fuetsan Manhoben, which means "the power within youth" in Chamorro and other cultures in Guam. The lessons guide students to draw on these values to remain drug-free and healthy. The team produced four videos that depict realistic situations in which substances are offered to middle students and culturally relevant strategies for kids to respond.

Maolek Na Lina'la or Life is Good, is a WestCare Pacific Islands Inc. program aimed to prevent and reduce alcohol and marijuana use in youth ages 11-17 in northern and central villages of Guam.

Funded by the US Department of Health and Human Services - Substance Abuse and Mental Health Services Administration (SAMHSA), Maolek Na Lina'la is committed to building prevention and intervention strategies in Guam through various programs and outreach events in the community using evidence-based programs such as Positive Action for the youth and Talk. They Hear You for parents/caregivers. The program also highlights Champions in the community who exemplify and promote a substance-free lifestyle.

Bullying is a learned behavior that often starts at home, known by older siblings, extended family, and parents, and then transferred to school behaviors. Youth who are bullied are at increased risk for substance use, academic problems, and violence to others later in life, and teens who are both bullies and victims of bullying suffer the most severe effects of bullying and are at greater risk for mental and behavioral problems than those who are only bullied and who are only bullies.

Bullying is a form of adolescent violence. Bullying is any unwanted, aggressive behavior(s) by another adolescent or group of adolescents who are not siblings or current dating partners that involves an observed or perceived power imbalance.

In 2019, 14.5% of Guam students in grades 9 through 12 reported that during the past 12 months, they were picked on or bullied by another student on school property. This was an 11% decrease from 2017. Females (16%) were significantly bullied than males (12.9%). Reported bullying decreased significantly as grade level increased. Students in grade 9 (14.5%) reported significantly more bullying than in grade 12 (11.8%).

An increasing number of adolescents are becoming victims of electronic bullying. Electronic bullying occurs over digital devices like cell phones, tablets, and computers. Electronic bullying includes sending, posting, or sharing content about someone else that is negative, harmful, false, or mean. It can include sharing personal or private information about someone else, causing embarrassment or humiliation.

In 2019, 12.4% of Guam students in grades 9 through 12 reported being threatened or harassed over the internet, by email, or by someone using a cell phone. This was a decrease from 2017’s 13.3%. Females (15.8%) were significantly more likely than males (9.4%) to be electronically bullied. Students in grade 12 (8.9%) reported a significantly lower percentage than students in grades 9(10.3%), grade 10 (16%), and grade 11 (14.1%).

The GDOE has an anti-bully policy, but schools have problems addressing cyberbullying. One of the most significant issues is that teachers and administrators must fully understand how social media platforms work. Students agree that cyber bullying has evolved. Cyberbullying is seen mainly on Instagram, where multiple "tea accounts" were established. Tea accounts (slang for gossip) are set up anonymously and used by students to spread rumors and word.

A safe environment is a prerequisite for productive learning. If students feel unsafe, it may lead to decreased academic performance and increased absences. In 2019, 11.1% of Guam students in grades 9 through 12 reported feeling unsafe at school. This was an increase from 2017's 10.9%. Both female (10.7%) and male (11.2%) students reported feeling unsafe on school grounds. Feeling unsafe at school decreased as grade level increased from grade 9 (9.8%) to grade 12 (7.5%).

Adolescents in Guam experience various health issues. Poor mental health has become a significant concern in recent years. As a result of the Covid 19 pandemic, mental health among adolescents has further declined due to uncertainty, social isolation, stress, disruption to daily life and loss of routine, and loss of family members or loved ones.

The closing of schools due to the pandemic had many adverse effects on Guam's school 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, as well as personal/family issues. Students were worried about their relatives getting sick. Students struggled with being unable to see friends, ending the school year early, and missing end-of-the-year activities, which caused isolation, loneliness, and suicidal ideation. Students lacked energy and motivation to engage in schoolwork, were frustrated, distracted, and developed behavioral issues related to distance learning. For some students, the lack of fluency in English, deficits in technology knowledge, and limited access to good internet connections made the process of distance learning frustrating for many students and parents.

The Island Wide Body of Governing Students has been discussing 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.

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 are more likely to complete a suicide attempt.

Source: DPHSS, OVS

In 2022, there were 28 completed suicides. Adolescent suicides made up 21.4%, and young adults made up 7.14% of the suicides that were completed.

There have been 33 suicide ideation cases noted by the Guam Department of Education, with 19 of those student cases referred to Guam Behavioral Health and Wellness Center. Based on the numbers provided, it appears that 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 that 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 to administer suicide risk assessments.

The Guam Behavioral Health Wellness Center (GBHWC) crisis helpline field a total of 8623 calls, of which 288 (3%) were suicide related.

Source: GBHWC Helpline

Lesbian, gay, bisexual, transgender, and questioning/queer (LGBTQ) youth are more than four times as likely to attempt suicide compared to their straight and cisgender peers. [1] Negative treatment by others, such as bullying, is a strong and consistent risk factor for youth suicide.

According to the 2019 YRBSS, 60% of LGBTQ high schools in Guam seriously considered suicide (survey participants were only asked about their sexual orientation). Compared with the percentages for heterosexual peers, these numbers are exceptionally high. The survey showed that 16.5% of straight teens had seriously considered suicide.

The 2019 Gay, Lesbian, and Straight Education Network (GLSEN) National School Climate Survey reports that LGBTQ youth regularly heard anti-LGBTQ remarks at school and had victimized at school. Schools remain hostile to LGBTQ students. The vast majority of LGBTQ+ students who attended school in-person at some point during the 2021-2022 academic year (83.1%) experienced in-person harassment or assault based on personal characteristics, including sexual orientation, gender expression, gender, religion, actual or perceived race and ethnicity, and real or perceived disability.

Source; 2019 YRBSS

Bullying and harassment go beyond the classroom. Students who were in online-only learning environments during the pandemic experienced higher rates of online harassment based on sexual orientation, gender, and gender expression than those who were in hybrid learning environments. School policies discriminate against LGBTQ students, especially transgender and nonbinary students. Most LGBTQ+ students (58.9%) experienced LGBTQ+-related discriminatory policies or practices at school. There has been an increase since 2019 in restrictions on students' use of names and pronouns and clothing based on gender norms.

Anti-LGBTQ harassment and hostile school environments directly harm mental health and academic performance. A hostile school climate affects students' academic success and mental health. Nearly one-third (32.2%) of LGBTQ+ students missed at least one school day last month due to feeling unsafe. LGBTQ+ students also reported having lower self-esteem and higher levels of depression due to the harassment.

Project Mangåffa' Peer Education Program is a Guam Alternative Lifestyles Association (GALA) core service that utilizes a cultural empowerment and social learning model, delivering health & social services to Guam's LGBTQ community.  Mangåffa' is the Chamorro word for family. In the Pacific, the family is the anchor and center of our social lives, playing a central role in influencing our identities. For those in the LGBTQ community, family is also slang, referring to those who identify as LGBTQ. She is "family," to mean she is lesbian or transgender. 

A unique aspect of Project Mangåffa’ is that services are delivered by those impacted by the health issues individuals seek to address, such as HIV/AIDS, substance abuse, and suicide; they are trained to help others overcome difficult situations and build and maintain healthy lives. Since its implementation four years ago, over 50 people have been trained to be peer educators. They are LGBTQ and straight allies, parents of LGBTQ children, high school and college students, and individuals seeking to make a difference in the lives of others. They range in age from 15 to over 40; they are Chamorro, Chuukese, Filipino, and other ethnicities. Peer educators are certified in Applied Suicide Intervention Skills Training (ASIST), safeTALK, Suicide Postvention, HIV Risk Reduction, Tobacco Cessation, Brief Tobacco Intervention (BTI), and Storytelling for Empowerment curriculum facilitation.

Gala offers free and confidential HIV rapid testing. Results are available in 15 minutes. GALA also provides free condoms and lubes to keep them safe. We have five risk reduction specialists from both the LGBTQ and straight-ally communities. Testing on an appointment basis. GALA's HIV Prevention and Testing Program is funded by a grant from the Office of Minority Health Resource Center (Maryland) and the Guam Department of Public Health and Social Services, STD Program.

GALA can help navigate the health and social service system in Guam. They are partnered with numerous social service agencies (government and non-profit) on the island to get you the care you need. In addition, they are proud members of the Non-Communicable Disease Consortium, the HIV Planning Group, the Guam Coalition against Family Violence and Sexual Assault, the PEACE Council, the State Epidemiological Operating Workgroup, and the Guam Coalition for Peace and Justice. Referral services include linkages to immunization services offered through the Guam Department of Public Health and Social Services; family violence and sexual assault survivor services; access to employment, housing, and legal services. Services offered through partner agencies may have eligibility requirements, conditions, and costs not covered by GALA.

Over the last five years, GALA has offered support groups to LGBTQI persons. Support groups are open and closed, co-facilitated by GALA staff or interns.  Support groups are topic-driven and help foster a sense of community, especially among those feeling isolated or wishing to feel connected with others. Support groups are open to LGBTQI persons over 18, who are asked to submit an intake form.

Creating LGBTQI-affirming environments and programs is a goal of GALA. GALA offers LGBTQI Sensitivity & Cultural Competence Training to government, private, and civil society organizations. Workshops can be tailored to fit the agency’s needs and can be done at their location.  Training is delivered by LGBTQI persons, sharing personal stories and best practices working with the LGBTQI community.

 LGBTQI Sensitivity Training is intended to help agencies better work with the LGBTQI community and help to transform social service systems and workplaces to be more LGBTQI-supportive and affirming.

“Dry Nights” is a powerful collection of poetry that explores the profound impacts of love, sensuality, loss, and longing that pervade the night with memories often left unspoken in the day. Dry Nights utilize a variety of poetic forms, distinctly tropical metaphors, musical references, and exquisite illustrations to capture the tender wounds of love. This hand-sized book belies its brevity in the breadth of experiences and stories conveyed in each poem, creating a haunting prosaic of what author Pep Borja describes as "reflections about what it's like to be close to someone." Borja navigates the complex spaces of intimacy, addiction, and suicide to show how dark emotions can be vibrant in the shadows. Coated with ambiguity, intrigue, and powerful imagery, Dry Nights does not hold your hand and gently lead you; instead, it demands you jump headfirst with eyes wide open into its soul. The University of Guam Press, in partnership with acclaimed film director Brian Muña, will release a short film titled “Dry Nights” with showings at UOG and the Guam Museum. The longest scene in the movie was the interpretation of Borja's poem "Billie," about a teenage girl who died of suicide. The Press worked with George Washington High School's drama class and other youth actors to capture Billie's story.  

The “Remembering Billie” Documentary will continue UOG Press's suicide prevention initiative by producing a professional documentary centering on the narratives of the mental health and suicide crisis in Guåhan. “Remembering Billie” will include dramatic flashbacks produced in partnership with Breaking Wave Theatre Company; and interviews with a range of mental health professionals, individuals, families, and organizations affected by suicide. 

Breaking Wave Theatre Company (BWTC) premiered Unspoken; A Mental Health Anthology - a collection of local works and an original musical that explored the topics of mental health and suicide prevention in Guam. The production made waves through the community for its use of creative and original content to bring to light the important issues of mental health, substance abuse, and suicide prevention. After the production's success and the growing mental health crisis that resulted from the COVID-19 pandemic, it was essential to continue the work that our 2019 production started. With this in mind, BWTC produced Unspoken; Volume II, Live from Home, a virtual production that continued the conversation by using original works from creatives in Guam and beyond.

Other Adolescent Issues

Teen childbirth is a strong risk factor for poor outcomes for both infants and their mothers and is expensive for society. Teen pregnancy is closely linked to critical social and public health issues, such as intergenerational poverty and low educational attainment. It significantly contributes to high school dropout rates among girls - only approximately 50 percent of teen moms receive a high school diploma by 22 years, compared to roughly 90 percent of women who are not teen moms. These teen mothers face many struggles to adequately support their child (ren), including being more likely to live in poverty, thus affecting their future economic capacity and lifelong income. Pregnant teens are also less likely to receive timely and consistent prenatal care (45.9%) than women who become pregnant at an older age.                  

Data Source: DPHSS Office of Vital Statistics 

Teen pregnancy is still a significant public health concern, and Guam has some striking disparities in teen pregnancy by poverty, race and ethnicity, and geography. Health is created through the interaction of individual, social, economic, and environmental factors; and in systems, policies, and processes encountered in everyday life. The growing economic inequities and the persistence of health disparities in Guam experienced by youth are neither random nor unpredictable. Many youths, particularly those of Micronesian ethnicity, experience social, economic, and environmental disadvantages resulting in poverty, homelessness, unemployment, dropping out of high school, discrimination, racism, violence, bullying, and incarceration. These structural inequities lead to disparities in unplanned and unintended teen pregnancies and sexually transmitted infections (STIs). Guam's relatively low rate of teen pregnancy and childbirth results from a dramatic decline in teen pregnancies among all racial and ethnic groups during the past 20 years.

Source: DPHSS OVS

Sexual violence is sexual activity when consent is not obtained or freely given. It is considered a serious public health problem in the United States that has a profound long-term impact on the victim's health, opportunity, and well-being. Sexual violence impacts every community and affects people of all age groups, gender, and sexual orientation. Anyone can experience or perpetrate sexual violence. The perpetrator of sexual violence is usually someone the survivor knows, such as a friend, current or former intimate partner, coworker, neighbor, or family member. Sexual violence can occur in many ways, such as in-person, online, or through technology, i.e., posting or sharing sexually explicit pictures of someone without consent or non-consensual sexting.

In 2020, Guam had the second-highest sexual assaults per capita nationwide. In 2022 the Domestic Assault Response Team under the Guam Police Department reported that 240 sexual assault victims/survivors received services. Of these, 198 were minors, or 82%.  This high percentage reflects that sexual assault against minors is more likely to be reported than sexual assault against adults. The Guam Healing Hearts Rape Crisis Center had 72 cases of sexual assault or rape in 2021. Of these, 62 were female, and six were male.  74% were minors. Chamorro’s were 69%, Filipinos were 10%, Asians were 14%, other Pacific Islanders were 5%, Caucasians were 7%, and the rest were Black 2%, Hispanic 2%, and unknown 1%. Perpetrators were 69% family members, 20% Acquaintances, and 11% strangers.

It is felt that many cases of sexual assault are not reported for reasons which include culturally based attitudes where victims are often discouraged from reporting sexual assault. Reporting sexual assault is often viewed as bringing shame and unwanted attention to the family. Silence was encouraged to retain the integrity of the family unit, and, as a result, victims were often denied justice. Marginalized groups such as the Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ) and the growing homeless population have also been identified as vulnerable segments of the community vulnerable to sexual assault.

Community partners provide new protection for victims, such as advocacy, empowerment, safety planning, and other services. However, there are still barriers to benefits, such as lack of transportation to some services, language barriers, lack of trust in interpreters from their ethnic communities, and lack of affordable, safe housing and shelters, often at total capacity. 

The Healing Hearts Crisis Center (HHCC) is Guam's only Rape Crisis Center. It intends to provide survivors of sexual assault with "discrete, immediate, and full medical attention. HHCC incorporates a holistic approach for the survivor of sexual assault or abuse. HHCC services include intake assessment and crisis intervention, forensic and multi-disciplinary team interviews, short-term case management, and linkage to other needed services such as individual and family therapy. It also provides medical services, including forensic examinations and collection of forensic evidence, and outreach and training to schools, service providers, and the community at large, regardless of when the assault occurred or the age, ethnicity, gender, or disability of the victim, Healing Hearts offers a supportive, healing atmosphere with caring people to assist them in regaining feelings of safety, control, trust, autonomy, and self-esteem.  

The Preventive Health and Health Services Block Grant (PHHSBG) staff will partner with Victim Advocates Reaching Out (VARO), a local non-profit agency, to provide support for victims of sexual assault, spreading awareness, educating the victims and their families and working to educate the community to eliminate sexual violence. By providing secondary supportive services to sexual assault victims, it will help to fill a need within the community. In addition, VARO will assist victims/survivors with emotional support and finding solutions when they are in hostile and vulnerable situations. VARO will provide emotional support, safety planning, transportation when requested to other agencies for assistance, a 24/7 hotline, case management when appropriate, and assistance in finding safe shelter or housing. The outcomes of these efforts will be reported in a proposed sexual assault prevention conference in Guam.

I Lina'la-Hu, which translates to "My Life," is a Sexual Risk Avoidance Education (SRAE) Program dedicated to educating middle-school-aged youth ages 11-14 on how to voluntarily refrain from non-marital sexual activity and prevent other youth risk behaviors. As one of WPI's newer grants, I Lina'la-Hu will focus education on preventing teen pregnancies, preventing and reducing sexually transmitted infections (STIs,) preventing intimate partner and dating violence and coercion, and will incorporate education and skill building in sexual risk avoidance, responsible decision making, and the identification of local resources.

Sexually transmitted diseases (STDs) are a serious health problem for adolescents, occurring in an estimated one-quarter of sexually active teenagers. Many health problems--including STDs--result from specific risk-taking behaviors. Determinants of STD risks among adolescents include behavioral, psychological, social, biological, and institutional factors. Education is an important component in STD control in adolescents. Education aims to increase adolescent self-efficacy in practicing STD prevention and risk reduction. A comprehensive approach including quality, theory-based education, accessible and effective health clinics, and improved social and economic conditions has the most promise of controlling adolescent STDs.

The recent rise in STIs has disproportionately impacted adolescents and adults in their early 20s. Young people in this age group acquire an estimated half of all new STIs annually, yet they comprise only one-quarter of the sexually active population. As stated in the Sexually Transmitted Disease Surveillance for 2021, rates of reported Chlamydia increased among both males and females in all regions of the United States, most age groups, and all race/Hispanic ethnicity groups. Rates of reported Chlamydia are highest among adolescents and young adults. In 2021, almost two-thirds (58%) of all reported chlamydia cases were among persons aged 15–24. For Guam, the rate of Chlamydia was 423 per 100,000 (Women 640/1000 and men 575/100,000).

Rates of reported Gonorrhea have increased by 118% since their historic low in 2009. From 2020 to 2021, the overall rate of reported Gonorrhea increased by 4.6%. From 2020 to 2021, rates increased among both males and females. For Guam, the rate of Gonorrhea was 117/100000 (Women 120/10000 and men 150/10000).

Many health problems – including STDs – result from specific risk-taking behaviors. Determinants of STD risks among adolescents include behavioral, psychological, social, biological, and institutional factors. Education is an important component in STD control in adolescents. Education aims to increase adolescent self-efficacy in practicing STD prevention and risk reduction. A comprehensive approach including quality, theory-based education, accessible and effective health clinics, and improved social and economic conditions has the most promise of controlling adolescent STDs.

Beginning in grade 9, students in Guam learn about "Family Life and Human Sexuality." The School Health Education Program of Guam addresses the "prevention of risk behaviors," including "sexual behaviors that contribute to unintended pregnancy, HIV infection, and other [STDs]." The program aims to "improve educational outcomes in Guam's schools." In the Guam Department of Education, K-12 Content Standards and Performance Indicators, pregnancy, sexually transmitted infections (STIs), and HIV are mentioned in Content Standard 1: Health Promotion and Disease Prevention.

Over the past few years, sex education advocates and health providers have worked hard to develop culturally relevant and responsive resources for the indigenous populations of Guam. In 2017, a new teaching resource entitled Navigating Personal Well-being & Sexuality: A Facilitator's Guide for Working with Chuukese and Chamoru Communities was published by health providers, professionals from the Office of Minority Health Resource Center, cultural advisers, and sex education researchers to serve as a guide for educators in providing culturally responsive sex education curriculum.

In 2019, the Centers for Disease Control and Prevention (CDC) released the School Health Profiles, measuring school health policies and practices and highlighting which health topics were taught nationwide. Since the data were collected from self-administered questionnaires completed by schools' principals and lead health education teachers, the CDC notes that one limitation of the School Health Profiles is biased toward reporting more positive policies and practices. In the School Health Profiles, the CDC identifies 20 sexual health education topics as critical for ensuring a young person’s sexual health. Below are key instruction highlights for secondary schools in Guam.

Guam secondary schools taught 42.9% of students how to access valid and reliable information, products, and services related to HIV, other STDs, and pregnancy in a required course in any of grades 6, 7, or 8. 100% of Guam secondary schools taught students how to access valid and reliable information, products, and services related to HIV, other STDs, and pregnancy in a required course in any of grades 9, 10, 11, or 12.

[1] Johns et al, 2019, Johns et al, 2020