Our 2020 needs assessment was designed to focus on the health priority areas at the performance measure level, which has enabled us to shift our approach to serving adolescents from a more “whole health” perspective going forward. Therefore, while teenage pregnancy and the other health concerns will remain important to our mission, our goal for the future is to approach the important issues facing adolescents with a focus on increasing healthy lifestyles and promoting the development of social and emotional wellness.

The State Systems Development Initiative (SSDI) Coordinator will participates in Guam’s State Epidemiological Outcomes Workgroup (SEOW). The SEOW was initiated in 2006 by the Guam Department of Behavioral Health and Wellness. The mission of the Guam SEOW is to identify, analyze, and communicate key substance abuse and related behavioral health data to guide programs, policies, and practices. The SEOW relies on a systematic and unbiased approach to data collection, analysis, and interpretation. The SEOW goal is to use data to inform and enhance state and community decisions regarding behavioral health programs, practices, and policies, as well as promote positive behavioral and mental health over the lifespan. 

In the past, our focus has been on unintentional injuries of children and youth. While this will remain an important focus for us, we intend to shift our approach slightly to addressing a different area of injury prevention by working on the impact and injury caused by the bullied children and who bully others. Historically, bullying awareness and prevention have been the responsibility of the Department of Education; however we now understand that bullying is quickly becoming a public health issue for children of Guam, especially for those students who have resulting mental health issues.

The MCH priority in this area is to focus on bullying among middle and high school-age children by focusing on reducing the mental health impacts of bullying on children. MCH also understands that bullying behavior can be triggered at much earlier ages than in middle school. Our Early Childhood, Comprehensive Services program focuses on the ACEs study and is working with our community partners to understand further childhood and adolescent behaviors associated with adverse childhood experiences that may have contributed to their negative behavior issues. Students who are bullied in middle and high school are most likely to suffer from low self-esteem, depression, substance abuse, and have poor education outcomes. This holds for not only the children who are being bullied but also for those who bully others. Studies are also beginning to show that students involved in bullying (either receiving or bullying others) are likely to have issues that impact their ability to function as healthy adults fully.

The Youth Risk Behavior Survey (YRBS) will continue to collect self-reported information for grades 9-12 on the following: in school and electronic bullying; well visits in the past 12 months and dental visits; physical activity level by a number of days in the past week; physical inactivity (screen time, TV, and electronics); height and weight to calculate BMI, obesity, and overweight; sleep on an average school night; suicide ideation, and self-rated health status.

The Youth Risk Behavior Survey will continue to collect parent-reported child health information (ages0-17) on the following: information on the dental visit, dental decay, and dental sealants for ages 0-17; physical inactivity (screen time, TV and electronics); and self-reported height and weight to calculate BMI, obesity, and overweight for ages 0-17.

Adolescents in Guam face a multitude of challenges, including engaging in high-risk behaviors that result in substance abuse, STI transmission, pregnancy, and exposure to injuries and violence. Exposure to violence, such as bullying, increases a child's risk of suffering from behavioral health disorders (i.e., anxiety and depression), having impaired ability to learn, impaired social interactions, and development of high-risk behaviors (sexual activity, binge drinking, suicide attempts, and physical fights). According to the 2019 Youth Risk Behavior Survey (YRBS), over 14 percent of high school students and 40 percent of middle school students reported being bullied at school in the previous school year. Strategies to improve students' physical, social, emotional, and behavioral health, as well as minimize the effects of poverty and other adverse childhood experiences, will help Guam youth achieve optimal health, educational, and life outcomes.

Our plans for the upcoming year include partnering with our Department of Education (DOE) to gather data collected regarding bullying and learn about their bullying prevention efforts. Our data-gathering efforts will consist of evaluating bullying and mental health-related questions included in the latest YRBS survey. Lastly, we will develop a workforce development plan to strengthen MCH's internal capacity to address bullying as a public health issue by providing professional development on bullying and strategies to promote social and emotional wellness.