Childhood Bullying

A Quality Improvement Initiative to Screen for Bullying in Pediatric Orthopedic Outpatient Clinics

Bullying annually affects 20%-25% of middle- and high-school children. Persistent bullying can lead to feelings of isolation, rejection, and despair and trigger depression and anxiety. In addition, pediatric patients have presented to outpatient orthopedic clinics with injuries consistent with physical bullying. Due to the high prevalence and negative ramifications of bullying, we developed a quality improvement (QI) initiative to screen for these behaviors. We aimed to increase the screening for bullying in pediatric orthopedic outpatient clinics from 0% to 60% by the end of 2020 and sustain these levels for 6 months.

Methods

Using the Institute for Healthcare Improvement Model for Improvement QI methodology, including Plan-Do-Study-Act cycles, we developed a four-question yes/no screening tool that asked patients (ages 5-18) and parents/guardians about bullying experiences in the preceding 3 months. To increase screening rates, we trained staff, integrated the screening form into the electronic medical record, initiated interscreener competitions, and shared unblinded data with screeners.

Results

The bullying screen rate of pediatric orthopedic patients increased from 0% to a process mean of 80%. In just over 1 year during the COVID-19 pandemic, clinics screened nearly 8,000 patients for bullying. Two percent of patients reported bullying in the prior 3 months. We offered patients who reported bullying literature and referrals to social work and/or behavioral health.

Conclusions

Implementing a QI initiative to provide universal bullying screening and increase bullying awareness in outpatient pediatric orthopedic clinics is feasible and sustainable.

The Silver Lining in the Dark Cloud of Social Status Insecurity: The Mediating Role of Popularity Goals in the Association Between Social Status Insecurity and Chinese Adolescents' Bullying Bystander Behaviors

Bullying bystander behavior has an important effect on bullying-both in stopping and facilitating it. Although bullying bystander behaviors have long been understood as a peer group process, existing research that focuses on the role of peer factors is still limited. Moreover, less is known about the social cognitive-related role of peer factors and its underlying mechanisms in adolescents' bullying bystander behaviors. Accordingly, using resource control theory, this study examines the mediating effects of popularity goals on the associations between social status insecurity and bullying bystander behaviors (active defending behaviors, passive bystanding behaviors) among 333 Chinese adolescents (181 males; M_age = 13.10; SD = .50). Analyses were conducted using SPSS 23 to conduct descriptive and correlation analyses. The hypothesized mediation model was tested using a structural equation modeling approach with bootstrapping techniques (bootstrap replications: 5,000) using AMOS 23. The results showed that popularity goals fully mediated the relationship between adolescents' social status insecurity and their active defending behaviors. No gender differences in these mediating effects were observed. The results also indicated that popularity goals did not mediate the relationship between social status insecurity and passive bystanding behaviors. These findings enrich our understanding of bullying bystander behaviors and highlight the positive role of social cognitive factors (e.g., popularity goals) in active defending behaviors. Our findings deepen our understanding of bullying bystanders through integrating proximate and ultimate approaches. Our findings have significant practical implications, which suggest that school anti-bullying interventions should value the positive roles of social status insecurity and popularity goals in promoting active defending behaviors.

Association between nutritional intake and aggressive behaviors in children and adolescents: The CASPIAN-IV study

OBJECTIVE: This study aims to explore the association of nutritional intake and aggression among a nationally representative sample of Iranian children and adolescents. METHODS: This nationwide cross-sectional study was conducted on a multi-stage sample of 14880 students, aged 6–18 years, living in 30 provinces in Iran. Parents were asked to report the dietary intake of their children as frequency of food groups and/or items. The validated questionnaire of the World Health Organization-Global School-based Health Survey (WHO-GSHS) was used to measure components related to aggression including physical fight, verbal aggression, and being bullied by other students. RESULTS: Participants consisted of 13486 students (90.6% participation rate) with mean age of 12.47 years (95% CI: 12.40, 12.54); 49.2% were girls, and 75.6% lived in urban areas. Physical fighting was more prevalent among urban boys[(48.63%), CI (46.75, 50.5)] while bulling was the most common aggressive behavior among boys [(29.7%), CI (28.03, 31.42)] and girls [(25.26%), CI (23.66, 26.93)] living in urban areas. Daily consumption of fast foods, sweets, soda, salty snacks and fried foods was higher among those participants who reported frequent experience of physical aggression and bullying. Bullying to others increased significantly with consumption of fast food (Odds ratio: 1.43, CI: 1.07, 1.92) and red meat (Odds ratio: 1.14, CI: 1.02, 1.28). Salty snack consumption showed a significant association with physical fighting (Odds ratio: 1.29, CI: 1.15, 1.44). CONCLUSION: The findings of this study suggest that some unhealthy foods might affect the mental health of children and adolescents. Improving dietary habits should be considered for prevention of violence in the vulnerable pediatric age group.

Bullying and Cyberbullying: Their Legal Status and Use in Psychological Assessment

Bullying and cyberbullying have severe psychological and legal consequences for those involved. However, it is unclear how or even if previous experience of bullying and cyberbullying is considered in mental health assessments. Furthermore, the relevance and effectiveness of current legal solutions has been debated extensively, resulting in a desire for a specific legislation. The purpose of this study is to investigate the psychological and legal components of bullying and cyberbullying. This is a qualitative research that includes interviews with five practitioner psychologists and four lawyers in the United Kingdom (UK). Thematic analysis revealed three main themes. One theme is related to the definition, characteristics, and impact of bullying and cyberbullying and the need for more discussion among the psychological and legal professions. Another theme is related to current professional procedures and the inclusion of questions about bullying and cyberbullying in psychological risk assessments. The third theme emphasised the importance of intervention through education. Two key messages were highlighted by the lawyers: ample yet problematic legislation exists, and knowledge will ensure legal success. The study recommends the necessity of performing revisions in the clinical psychological practices and assessments, and the legal policies regarding bullying and cyberbullying. In addition to improving legal success, this will reduce bullying prevalence rates, psychological distress, and psychopathology that can be comorbid or emerge as a result of this behaviour.

How Early do Social Determinants of Health Begin to Operate? Results From the Fragile Families and Child Wellbeing Study

PURPOSE

From a life course perspective, important insights about how social determinants of health operate can be gained by analyzing the various forms that social climate can take in different life periods. For children, a critical aspect of social climate is exposure to bullying. Bullying can serve as a proxy for power imbalance and social exclusion analogous to adult social climate of discrimination and racism.

DESIGN AND METHODS

We used the Year 9 follow-up data of the Fragile Families and Child Wellbeing Study (N=3301) that, for the first time included interviews with the children. We drew on a national sample of children and their families, which allowed us to account for broader contextual variables and represented a broad range of geographic areas and schools. Multinomial logistic regression was used to estimate the effects of exposure to bullying on self-rated health among primarily 9- to 10-year-old children while controlling for socio-demographic and diagnosed health-conditions.

RESULTS

Both frequency and forms of bullying were positively associated with lower odds of reporting excellent, very good or good health. The effect of forms of bullying on children's self-rated health fell on a gradient. Subgroup analysis indicated a significant effect on self-rated health for children who experienced peer rejection but not for those who experienced physical aggression.

CONCLUSIONS

The results of the study provide new evidence that the harmful health consequences of power imbalance and discriminatory practices may extend to children in early development. It also accentuates the need to study social determinants of health from both an ecological/contextual and a developmental angle.

PRACTICE IMPLICATIONS

Echoing a plethora of nursing literature on the critical role of psycho-social pediatric care, this study further encourages pediatric nurses to expand their assessment and intervention priorities beyond a familial and developmental perspective, and to consider the evident physical health consequence of a child's overall social climate determinants.

[Violence prevention in childhood and adolescence--a brief overview]

Aggressive and violent behaviour in children and adolescents can be associated with physical and psychological health effects continuing into adulthood. Early programs for violence prevention in childhood and adolescence are intended to prevent or reduce aggressive behaviour in order to decrease the risk for short- and long-term developmental impairments. In a literature review, research findings on prevalence, typical courses of development, and predictors of violent behavior in childhood are first summarized and compared with findings on the frequency, developmental course, and consequences of youth violence. International and German programs for violence prevention in children and adolescents are presented in the context of various settings (family, school, community), target groups (primary vs. secondary prevention) as well as target variables (universal vs. specific). Empirical findings on efficacy testing of violence prevention programs are described and discussed. The presented findings stress the relevance and potential of services for violence prevention for children and adolescents, but also demonstrate the challenges and gaps.

Vulnerable Bullies: Perpetration of Peer Harassment Among Youths Across Sexual Orientation, Weight, and Disability Status

OBJECTIVES

We examined perpetration of bullying among youths in vulnerable groups relative to youths in peer groups not categorized as vulnerable.

METHODS

Data were collected in 2013 from a large school-based survey of adolescents conducted in Minnesota (n = 122,180). We used the χ(2) test and logistic regression to compare measures of perpetration of physical and relational bullying, as well as experiences of victimization and perpetration (or both), across categories of sexual orientation, weight status, and disability status.

RESULTS

Rates of physical and relational bullying perpetration were significantly higher among youths in vulnerable groups than among those not in vulnerable groups. With respect to context of victimization experiences, young men and women from vulnerable groups were overrepresented in the group comprising both perpetrators and victims. For example, odds of being both a perpetrator and a victim were 1.41 to 3.22 times higher among gay, lesbian, and bisexual youths than among heterosexual youths.

CONCLUSIONS

Vulnerable youths, who are prone to peer harassment, may also act as perpetrators of bullying. Prevention strategies should address the particular needs of these populations; targeted programming may be appropriate.

Emotional Health of Lesbian, Gay, Bisexual and Questioning Bullies: Does It Differ from Straight Bullies?

Research demonstrates that young people involved in bullying are at greater risk for poor emotional health outcomes, but this association may not be consistent for youth of different sexual orientations. Understanding the unique needs of lesbian, gay, bisexual and questioning (LGBQ) youth may suggest important opportunities for intervention and prevention. This study, therefore, examines whether involvement with bullying is differentially associated with emotional well-being across sexual orientation. Survey data were collected from a large statewide sample of 9th and 11th grade students in 2013 (N = 79,039, 49.8% female, 74.6% white). Logistic regression tested associations between sexual orientation, physical or relational bullying perpetration and five measures of emotional health. In the full sample, those reporting bullying perpetration had significantly elevated odds of emotional health problems. However, interaction terms and stratified models indicated that in nine out of ten physical bullying models and two out of ten relational bullying models, perpetration was not as strongly associated with poor emotional health among LGBQ adolescents as it was among heterosexual youth. Possible explanations for this finding include unhealthy coping strategies or masking one's own vulnerable status as LGBQ. Continued efforts to prevent bullying are needed for all youth.

Adolescent interpersonal violence: implications for health care professionals

Violence involvement is a leading cause of morbidity and mortality among adolescents. This review provides a summary of the burden of adolescent violence and violence-related behavior, risk, and protective factors for violence outcomes. The importance of screening for violence involvement in the primary care setting and examples of online resources to support providers in advocating, assessing, and intervening on behalf of youth are also reviewed. The article draws attention to bullying and dating/relationship violence, not as new forms of violence-related behavior, but as behaviors with health outcomes that have recently received increased attention.