Bullying in the school environment: an injury risk factor?

Injuries among adolescents in Greenland: behavioural and socio-economic correlates among a nationally representative sample

Background

Injuries are among the most important threats to adolescent health, making examination of the patterns and risk factors a critical area of research. There exists a paucity of information on the health and injury experience of school-attending adolescents in Greenland. Consenting Greenlandic schoolchildren (n = 2,254) aged 9-19 years were included in the Health Behavior in School-Aged Children study 2005/2006. The aim of this study was to examine the socio-economic and behavioural correlates that were associated with injury occurrence among school-attending Greenlandic adolescents.

Methods

This study made use of two multinomial regression models to examine injury occurrence regarding potential influencing factors such as physical activity, risk behaviours, bullying and family socio-economic status (SES).

Results

Those self-reporting 1-2 injuries within the recall period were more likely to be male (OR = 1.70; CI [1.39-2.09]), involved in physical fighting (OR = 1.82; CI [1.33-2.47]), bullied (OR = 1.81; CI [1.47-2.24]) and participated in bullying others (OR = 1.53; CI [1.25-1.89]). Those reporting three or more injuries were again mostly male (OR = 2.13; CI [1.44-3.14]), involved in physical fighting at higher rates (OR = 4.47; CI [2.86-7.01]), bullied more often (OR = 2.43; CI [1.65-3.57]) and were more likely to bully others (OR = 1.67; CI [1.13-2.45]). Living without a mother proved to be significantly correlated with suffering 3 or more injuries during the recall period (OR = 1.63; CI [1.05-2.52]). The study results support the idea that factors that were found to be associated with injury occurrence, such as bullying and aggressive behaviour, should be taken into account when conducting future research on the nature of injuries among Greenlandic adolescents. More research on this topic is needed to identify factors that might modify the associations between injuries and adolescent behaviour and SES.

On the Association Between Repeat Bully Victimizations and Carrying a Firearm: Evidence in a National Sample

Bullying is a significant public concern. The purpose of the present study is to investigate whether being repeatedly victimized by a bully during childhood and adolescence is associated with gun carrying in adolescence and adulthood. Using data from the National Longitudinal Survey of Youth 1997, we found that just over one fourth of the respondents reported carrying a gun at some point in their lifetime. Respondents experiencing repeat bully victimizations reported higher rates of gun carrying during the last 12 months and the last 30 days. No support was found for the association of repeat bully victimizations and carrying a gun to school. Individuals victimized during childhood (before the age of 12) and during adolescence were found to be at risk of carrying a gun later in the life course. Repeat bully victimizations should be considered a marker for gun-carrying behaviors in adolescence and adulthood.

Understanding clusters of risk factors across different environmental and social contexts for the prediction of injuries among Canadian youth

BACKGROUND

Among Canadian youth, injury is the most common reason for presentation to the emergency department. Youth who commonly engage in multiple risk-taking behaviours are at greater risk for injury, but is it unknown if this phenomenon is more pronounced in different contexts. We aimed to study relationships between risk-taking behaviours and injury, and variations in such relationships between different environmental and social contexts, among youth in Canada.

METHODS

Risk-taking behaviour and injury outcome data were collected from grade 9 to 10 students using the 2009-2010 (Cycle 6) of the Health Behaviour in School-Aged Children Survey (n=10,429). Principal components analysis was used to identify clusters of risk-taking behaviours. Within each identified cluster, the degree of risk-taking was categorized into quartiles from lowest to highest engagement in the behaviours. Risk ratios with 95% confidence intervals were calculated to determine the association between the risk of any injury and the degree of risk-taking behaviour specific to the cluster. Clusters were then examined across home, school, neighbourhood and sport contexts.

RESULTS

Four clusters of risk-taking behaviour were identified which were labelled as "gateway substance use", "hard drugs and weapons", "overt risk-taking", and "physical activity". Each cluster was related to injury occurrence in a graded fashion. Clusters of risk behaviour were most strongly associated with injuries sustained in neighbourhood settings, and expectedly, increasing physical activity behaviours were associated with increased risk of sport injuries and injuries occurring at school.

CONCLUSIONS

This study furthers understanding of clustered risk-taking phenomena that put youth at increasing levels of injury risk. Higher risks for injury and associated gradients were observed in less structured contexts such as neighbourhoods. In contrast, clustered physical activity behaviours were most related to school injury or sport injury and were more likely to be sustained in a supervised context. Understanding the clustered and cumulative nature of risk-behaviours, and how these vary by environmental and social context, helps to explain potential mechanisms of injury as well as modifiable factors that may be important avenues for intervention.

The Global Implications of Bullying and Other Forms of Maltreatment, in the Context of Migratory Trends and Psychiatric Resources

This article identifies countries with the highest prevalence of bullying and other forms of maltreatment and examines the significance of these epidemiologic findings in the context of migration and availability of mental health resources. The relevance of higher prevalence of bullying and other forms of maltreatment in certain parts of the world has significant public health bearing not only on the nations affected by them but worldwide, because migrants carry with them the effects of victimization. The significant risk of abuse and violence affecting immigrants may be compounded by the effects of polyvictimization.

Working towards a detection of bullying related morbidity

BACKGROUND

Physicians are being confronted with the responsibility of detecting bullying related health and safety risks in different clinical settings.

METHODS

Recommendations are being made on the basis of research evidence of a significant link of bullying with a wide array of health and safety problems; the author's clinical routine practice of ascertaining patients' participation in bullying and a recommended role for clinical detection of bullying within a whole-community base strategy for its prevention.

RECOMMENDATIONS

There is a need to develop a standardized strategy for detection of bullying related morbidity which could be utilized in all clinical settings with sensitivity to developmental and cultural differences in the understanding of what is meant by bullying. Such an approach should ascertain the exposure of different types of bullying across social settings and its symptomatic repercussions. Its results should be used for clinical decisions to procure intervention and treatment, within a three-tier bullying prevention strategy.

CONCLUSIONS

The present paper is the result of a work-in-progress which will contribute to efforts to develop a clinical practice guideline providing a standardized strategy for the detection and intervention of bullying related health and safety problems, within a primary or specialty pediatric setting. Bullying is at the intersection of many health and safety risks and health practitioners are challenged with the critical public health responsibility of their detection, prevention, and intervention. It would be expected that the recommendations contained in this article should facilitate the development of strategies to fulfill such a responsibility.

Is there a syndrome of bullying?

OBJECTIVE

We investigated the existence of a psychosomatic disorder associated with bullying by delineating its health and safety and correlates, and defining the demographic characteristics of the USA adolescents affected by this condition.

METHODS

This study was based on an analysis of USA data from the 1996 World Health Organization Health Behavior in School-aged Children survey. The survey provides nationally-representative, cross-sectional survey information on 9938 USA students in Grades 6-10. We examined those students who were involved in bullying as a victim and/or as a bully, with or without a self-reported cluster of depression, "bad mood", "feeling low", "feeling nervous" and sleeping difficulties, and one or more physical symptoms (headaches, stomach aches, back aches, dizziness).

RESULTS

A cluster of physical and emotional symptoms linked to their participation in bullying as bullies and/or victims was reported by 9.5% of adolescents, with a higher frequency of 8th Grade students and a predominance of females. These students were 8.14 times more likely to hurt themselves on purpose and 4.20 times more likely to hurt others purposely than their peers who were not involved in bullying and did not suffer from a cluster of physical and emotional symptoms.

CONCLUSIONS

This study may elicit further examination and debate about the existence of a nosological entity linked to bullying. Pending further research, the present results should support the need to ascertain participation in bullying, as a bully and/or as a victim, in all pediatric visits. Furthermore, there is a need to enquire about symptoms and risks related to this form of abuse.

Prevalence and socio-demographic correlates for serious injury among adolescents participating in the Djibouti 2007 Global School-based Health Survey

Background

Mental health and injury are neglected public health issues especially in low-income nations. The objective of the study was to determine the prevalence and socio-demographic correlates for serious injury in the last 12 months.

Findings

The study used data of the 2007 Djibouti Global School-based Health Survey. Logistic regression analysis was used to establish associations. Of the 1, 777 respondents, 61.1% (63.2% males and 57.8% females) reported having sustained serious injury (SSI). Compared to participants who were not bullied, those who reported being bullied 3-9 days per month were more likely to have sustained serious injury in the last 12 months (AOR = 1.27; 95% CI [1.06, 1.52] for 3-5 days of bullying victimization per month, and AOR = 3.19; 95% CI [2.28, 4.47] for 6-9 days per month. Adolescents who were engaged in physical fighting were 47% (AOR = 1.47, 95% CI [1.40, 1.55] more likely to have sustained serious injury compared to those who were not engaged in the fighting. Meanwhile, adolescents who used substances (cigarettes, other forms of tobacco or drugs) were 30% (AOR = 1.30, 95% CI [1.19, 1.42]) more likely to have sustained serious injury compared to those who did not use substances.

Conclusions

Serious injury is common among adolescents in Djibouti, and we suggest that health workers attending to injured adolescents explore the patients' psycho-social environment. Further, we suggest longitudinal studies where reduction of substance use and bullying may be assessed if they have an impact in reducing serious injury among adolescents.

Gender differences in the relative impact of physical and relational bullying on adolescent injury and weapon carrying

Using structural equation modeling, concurrent associations were assessed among physical bullying, relational bullying, physical victimization, relational victimization, injury and weapon carrying using data from the population of 1300 adolescent girls and 1362 adolescent boys in grades 7-12 in a Colorado school district. For both genders, being a relational bully was a significantly stronger predictor of weapon carrying than being a physical bully, and both bullying types were significant predictors of more weapon carrying. For both genders, being a victim of physical bullying, a victim of relational bullying, or being a relational bully significantly predicted more injury. In latent means comparisons, adolescent girls reported more relational victimization and adolescent boys reported more physical bullying and victimization, more weapon carrying, and more injury. The relative strength of relational bullying on weapon carrying, and the health-related consequences of bullying on interpersonal violence and injury support concerted efforts in schools to mitigate these behaviors. Attention to differences related to age and gender also is indicated in the design of bullying mitigation programs.

Public health, safety and educational risks associated with bullying behaviors in American adolescents

Based on a national representative sample of United States (US) middle and high school students, we studied the association between different health, safety, and educational risk factors and involvement in a variety of bullying behaviors.

DESIGN

Based on an analysis of US data of the 1996 World Health Organization Health Behavior in School-aged Children survey, with cross-sectional survey information on 9,938 students in grades 6 through 10.

RESULTS

Thirty-nine per cent of the students were involved in bullying others and/or were victims of bullies at least three times in the preceding 12 months. Bullies, victims, and those who are both, are at a significantly higher risk of suffering from self-inflicted, accidental, and perpetrated injuries, abusing-over-the counter medications, hurting animals and people on purpose, using a weapon that could seriously hurt someone, and being frequently absent from school, as compared with their peers who are not involved in bullying or rarely participated in it. Those students who are both bullies and victims experience a wide array of associated risk behaviors with odd ratios stretching from 1.54 to 14.17.

CONCLUSIONS

The present study confirmed that participation in bullying behaviors, as a bully or as a victim, is associated with multiple health, safety, and educational hazards. Students who are bullies and/or victims are at a high risk of dying from self-inflicted, accidental, or perpetrated injuries.

Peer victimization and intentional injuries: quantitative and qualitative accounts of injurious physical interactions between students

Studies have shown that peer victimization engenders physical injuries both indirectly (i.e. as a trigger of injurious events) and directly (i.e. through intentional physical harm). How those injuries occur has not been much researched.

OBJECTIVE

To highlight the various circumstances in which injuries are sustained by young teenagers when physically interacting with other students, and to characterize more specifically the context surrounding those injuries sustained resulting from violent actions.

METHOD

Data were extracted from information already available from structured interviews conducted during two consecutive school years with children aged 10-15 years who had been hospitalized due to injury and who were residing in Stockholm County (Sweden) (n = 634). The current study considers those injuries resulting from physical interactions between students and pays attention to the gender and age distribution of the victims. The free text descriptions of the "interaction" injuries resulting from violent actions were re-read and examined by means of content analysis.

RESULTS

Of the injuries reported, 23.5% resulted from physical interactions between students. The most frequent context of their occurrence was sports and play. Other injuries resulted either from assaults where the victim was in a clear imbalance of power (n = 24) or from violent incidents in which the victim was not powerless (n = 27). The two latter situations were much more common among boys.

CONCLUSION

Peer victimization has an impact on children's safety both within and outside the school arena. Students are injured by their peers not only from deliberate violence targeting them but also from violent physical interactions in which they play an active role. These injurious events have a clear gender and age component.

Deaths linked to bullying and hazing

The purpose of this study was to determine the extent of news reports of deaths associated with bullying and hazing among young people over a period of 57 years. This study was based on a survey of death events linked to bullying or hazing reported in English newspapers from January 1, 1950 through December 31, 2007. The search was based on the review of major United States and world publications, written in English, using the terms "bullying, hazing, ragging, and death." In the last 57 years, at least 250 reported cases of deaths were linked to bullying, hazing, or ragging, reported in English language newspapers from around the world. Of these news stories (n = 121), 76% contained an alleged history that the victim was bullied. Twenty-two per cent (n = 55) of these reports were associated with suspected hazing or ragging. In only four cases (2%), those who died had a history of bullying others. The majority of the reports of bullying related deaths (62.3%) originated in Europe, with most of them (93%) occurring in the United Kingdom. Sixty-seven percent of bullying-related deaths were reported during the last 10 years.

CONCLUSIONS

The significant increment in news reports concerning deaths associated with bullying may be the result of a rise in public awareness about the lethal aspects of this type of maltreatment. An urgent global public health need exists to ascertain the regional mortality prevalence related to bullying and hazing, along the lifespan.

Antibullying legislation: a public health perspective

PURPOSE

To determine the extent to which aspects of public health policy have been incorporated into the antibullying statutes enacted in the United States.

METHODS

We reviewed all the state laws dealing with school bullying, harassment, and/or intimidation enacted in the United States as of June 2007. These laws were evaluated using an Antibullying Public Health Policy Criteria Index, designed for the purpose of this study. The criteria included presence of a bullying definition, a prohibition of bullying, a statutory recognition of bullying as a public health threat, and a call for prevention programs. As part of that evaluation, laws were examined to ascertain whether they evidenced essential elements of public health concerns and also the extent to which the U.S. school age population was protected by these laws.

RESULTS

As of June 2007, 35 states have enacted antibullying legislation that aims to protect the safety of 77% of U.S. students enrolled in public schools. However, only 16 of those states have enacted statutes that incorporate comprehensive basic public health antibullying principles.

CONCLUSIONS

There is an urgent need for implementation of school bullying prevention laws. Such laws should clearly define the problem of bullying in schools and its associated health risks, prohibit bullying, require implementation of prevention programs, provide funding for prevention activities, and confer adequate and appropriate jurisdiction.

Do episodes of peer victimization trigger physical injury? A case-crossover study of Swedish school children

AIMS

The aim of this study was to investigate how long the effect of peer victimization on the occurrence of physical injury lasts and whether the effect varies according to how frequently an injured child is victimized.

METHODS

A case-crossover design was employed. Children aged 10-15 years residing in Stockholm County during two consecutive school years were eligible as cases. Further inclusion criteria were that the children had been hospitalized or called back for a medical check-up due to a physical injury. Information on children's exposure to peer victimization at school was gathered in interviews, and on their social characteristics through a questionnaire filled in by parents. A total of 575 children were included.

RESULTS

Our analyses show that there is an increase in risk of unintentional injury after an episode of peer victimization shortly after the end of exposure to victimization (RR = 5.5) but not thereafter. The risk is substantially higher among children seldom victimized (RR = 49.9) than among those victimized on a more regular basis (RR = 2.5). The extent to which family social circumstances modify the risk is difficult to establish from the material at hand.

CONCLUSION

Peer victimization may trigger the occurrence of unintentional injuries in childhood and the effect is short lasting. The results need to be replicated and special attention should be given to separating lesson time from break time to avoid confounding by time of day.

Is perceived failure in school performance a trigger of physical injury? A case-crossover study of children in Stockholm County

OBJECTIVES

To investigate whether perceived failure in school performance increases the potential for children to be physically injured.

SUBJECTS

Children aged 10-15 years residing in the Stockholm County and hospitalised or called back for a medical check up because of a physical injury during the school years 2000-2001 and 2001-2002 (n = 592).

METHODS

A case-crossover design was used and information on potential injury triggers was gathered by interview. Information about family socioeconomic circumstances was gathered by a questionnaire filled in by parents during the child interview (response rate 87%).

RESULTS

Perceived failure in school performance has the potential to trigger injury within up to 10 hours subsequent to exposure (relative risk = 2.70; 95% confidence intervals = 1.2 to 5.8). The risk is significantly higher among pre-adolescents and among children from families at a higher education level.

CONCLUSIONS

Experiencing feelings of failure may affect children's physical safety, in particular among pre-adolescents. Possible mechanisms are perceptual deficits and response changes occasioned by the stress experienced after exposure.