Association of common health symptoms with bullying in primary school children

Mobile phone addiction was the mediator and physical activity was the moderator between bullying victimization and sleep quality

BACKGROUND AND OBJECTIVES

Bullying victimization is strongly associated with sleep quality issues in primary school students, yet the underlying mechanisms among these variables require further exploration. This study investigates the mediating role of mobile phone addiction and the moderating role of physical activity in the relationship between bullying victimization and sleep quality among primary school students, contributing to a deeper understanding of these psychological processes.

METHODS

This study utilized a convenience sampling method to recruit 502 primary school students in 2023. The sample included 232 boys and 270 girls, with ages ranging from 10 to 12 years (mean age = 11.15 ± 0.62). Participants were recruited from specific region or school district to ensure a diverse representation of the target population. Ethical approval was obtained from the relevant institutional review board, and informed consent was obtained from both the students and their parents or guardians prior to data collection.

RESULTS

Bullying victimization was significantly positively correlated with both sleep quality issues and mobile phone addiction. Additionally, mobile phone addiction was significantly positively correlated with sleep quality issues. The analysis confirmed that mobile phone addiction mediates the relationship between bullying victimization and sleep quality. Furthermore, physical activity was found to moderate the relationship between bullying victimization and mobile phone addiction.

CONCLUSIONS

This study elucidates the psychological mechanisms underlying the relationship between bullying victimization and sleep quality among primary school students. Mobile phone addiction serves as a mediating factor, while physical activity acts as a moderating factor in the link between bullying victimization and mobile phone addiction. These findings underscore the importance of addressing mobile phone addiction and promoting physical activity as part of targeted interventions to improve sleep quality among primary school students.

The relationship between sports participation and bullying in elementary schools: the mediating role of mental toughness

Purpose

Previous research has shown a correlation between sports participation and bullying in schools. However, less attention has been paid to the factors influencing children's perpetrated bullying and victimized. Therefore, this study constructed a model of the role of influencing factors between sports participation, children's mental toughness, and school bullying to explore the link between sports participation and mental toughness on children's perpetrated bullying and victimized.

Methods

A sample of 861 students was randomly selected from five elementary schools in Shandong Province, China. After excluding invalid questionnaires with missing answers or consistent responses, 712 questionnaires were collected. The Physical Activity Rating Scale (PARS-3) was selected to assess sports participation, the Mental Toughness Scale to evaluate mental resilience, and the Chinese-adapted version of the Oweis Bullying Questionnaire (OBQ), which was revised by Chinese scholar Zhang Xinwen, to measure bullying experiences. All participants completed maturation scales on sports participation, mental toughness, and school bullying. Data were analyzed in SPSS 24.0, SPSSprocess 4.1, and AMOS 27.

Results

The results of this study are as follows: (1) According to the correlation test results, since p < 0.05 or p < 0.01, there is a correlation between sports participation and psychological resilience, bullying and being bullied. There is a correlation between mental resilience and bullying, being bullied. There is a correlation between bullying and being bullied. (2) Mental toughness plays a mediating role in the influence of sports participation on the perpetrated bullying and in the influence of sports participation on victimized. (3) In the pathways of sports participation, mental toughness, and school bullying, it suggested that mental toughness played a partial mediating role in this pathway. For the pathways of sports participation, mental toughness, and children's exposure to bullying. The mental toughness played a full mediating role in this pathway.

Conclusion

It is recommended that early intervention and support be given to promote children's physical mobility and increase their own levels of sports participation and mental toughness, thereby reducing the likelihood of children committing or experiencing bullying in schools and improving their physical and mental health.

Risk patterns of bullying perpetration and victimization among children

OBJECTIVES

This study uses the bioecological model of human development and person-centered methods to describe the underlying patterns of risk and their association with bullying perpetration and victimization among U.S. children.

METHODS

Using the National Survey of Children's Health, this study (n = 7319) explored the underlying patterns of risks across six domains (i.e., individual, family, school, neighborhood, economic, and socio-cultural) associated with bullying perpetration and victimization among U.S. elementary school children.

RESULTS

Latent Class Analysis uncovered four patterns of risks. The low risks group (72.4%) showed the lowest rates of bullying perpetration (24.6%) and victimization (57.2%). The individual and environmental risks group (15.3%) presented moderate levels of bullying perpetration (31.8%) and victimization (67.1%). The family risks group (8.3%) showed moderate levels of bullying perpetration (35.9%) and victimization (66.0%). High risks group (4.0%) presented exceptionally high rates of bullying perpetration (59.1%) and victimization (87.3%).

CONCLUSION

Results suggest rates of bullying perpetration and victimization differed across the four patterns of risks. Understanding the sources of risk may be critical to alleviate bullying perpetration and victimization among children.

IMPLICATION

Findings suggest that child bullying should be approached with customized treatment considering their pattern of risk exposure.

The burden and its determinants of mental health distress among adolescents dwelling in Africa: a systematic review and meta-analysis

BACKGROUND

Adolescent mental health issues are emerging as a significant public health concern across many low- and middle-income countries, particularly in Africa. This study aims to evaluate the aggregated prevalence and contributing risk factors of mental health distress among adolescents in Africa.

METHODOLOGY

A comprehensive search of PubMed, PsycINFO, Web of Science, Google Scholar, and HINARI databases was conducted to identify relevant articles on the prevalence and risk factors associated with mental health distress among African adolescents, published up to December 2023. The quality of the selected studies was assessed using the Newcastle-Ottawa Quality Assessment Scale. Heterogeneity among the studies was evaluated using the I² statistical test. Potential publication bias was assessed through a funnel plot and Egger's statistical test. This systematic review was registered with PROSPERO under reference number CRD42023494665.

RESULTS

Eighteen studies encompassing data from 37,016 adolescents were included in the analysis. The overall prevalence of mental health distress among adolescents in Africa was found to be 27.34% (95% CI: 23.18-31.50). The occurrence of mental health distress is observed in older adolescents at a prevalence of 29.44% (95% CI: 23.26-35.66) and in younger adolescents at 24.73% (95% CI: 11.96-37.51). Significant risk factors identified included bullying victimization, with an odds ratio (POR) of 1.30 (95% CI: 1.16, 1.46), and experiencing hunger, with an odds ratio (POR) of 2.10 (95% CI: 1.13, 3.91).

CONCLUSION

The findings indicate a high prevalence of mental health distress among adolescents in Africa, highlighting the widespread impact on this demographic. These results underscore the urgent need for targeted interventions to prevent and address mental health distress among adolescents. Further research on a global scale is essential to develop effective prevention and treatment strategies tailored to this age group.

Bullying Involvement and Physical Pain Between Ages 10 and 13 Years: Reported History and Quantitative Sensory Testing in a Population-Based Cohort

We aimed to quantify the prospective association between bullying and physical pain in a population-based cohort of adolescents. We assessed 4,049 participants of the 10 and 13 years waves of the Generation XXI birth cohort study in Portugal. Pain history was collected using the Luebeck pain screening questionnaire. A subsample of 1,727 adolescents underwent computerized cuff pressure algometry to estimate pain detection/tolerance thresholds, temporal pain summation and conditioned pain modulation. Participants completed the Bully Scale Survey and were classified as "victim only", "both victim and aggressor", "aggressor only", or "not involved". Associations were quantified using Poisson or linear regression, adjusted for sex and adverse childhood experiences. When compared to adolescents "not involved", participants classified as "victim only" or "both victim and aggressor" at age 10 had higher risk of pain with psychosocial triggers, pain that led to skipping leisure activities, multisite pain, pain of higher intensity, and pain of longer duration, with relative risks between 1.21 (95% confidence interval: .99, 1.49) and 2.17 (1.57, 3.01). "Victims only" at age 10 had lower average pain detection and tolerance thresholds at 13 years (linear regression coefficients: -1.81 [-3.29, -.33] and -2.73 [-5.17, -.29] kPa, respectively), as well as higher pain intensity ratings (.37 [.07, .68] and .39 [.06, .72] mm), when compared with adolescents not involved. No differences were seen for the remaining bullying profiles or sensory measures. Our findings suggest that bullying may have long-term influence on the risk of chronic musculoskeletal pain and may interfere with responses to painful stimuli. PERSPECTIVE: We found prospective evidence that bullying victimization in youth: 1) is more likely to lead to negative reported pain experiences than the reverse, 2) may have long-term influence on adverse pain experiences, and 3) may contribute to pain phenotypes partly by interfering with somatosensory responses to painful stimuli.

Normal Sleep in Children and Adolescence

Adequate sleep is essential for healthy development in childhood and adolescence. Healthy sleep contributes to good physical health, immune function, mental health, and academic performance. The regulation and architecture of sleep change greatly across childhood and adolescence, and the ability to obtain sufficient sleep is impacted by a range of factors that change with maturation. This article describes normal sleep across childhood and adolescence and discusses some of the most common barriers to adequate sleep, including early school start times, technology use, and changes to circadian rhythms, and sleep homeostasis across puberty.

Sleep-Related Urologic Dysfunction

This article reports on the epidemiology, prevalence, and physiopathology of sleep-related urinary dysfunction, a new syndromic category proposed by the recently revised ICSD-3-TR classification. Sleep enuresis, whether primary or secondary, monosymptomatic or plurisymptomatic, will be reviewed in terms of risk factors, comorbidity, and diagnostic and therapeutic indications. A definition of nocturia and its impact on patients' health, quality of life, and mortality will follow. Finally, the impact of urge incontinence on various medical and neurologic disorders will be discussed. Special emphasis will be placed on the possible association of this parasomnia with several sleep disorders and poor, fragmented sleep.

The genetics of incontinence: A scoping review

The genetic causes underlying incontinence in both children and adults have begun to be unravelled during the last decades. The aim of this scoping review is to synthesize current knowledge on the genetics of childhood and adult urinary and faecal incontinence, identify similarities between different incontinence subgroups, and identify knowledge gaps to aid future research. PRISMA-ScR was used, and 76 studies were included. Early epidemiological family and twin studies suggest high heritability of incontinence. Linkage studies provide evidence for the existence of rare genetic variants; however, these variants have not been identified. Later candidate gene association studies and recent genome-wide association studies provide the first preliminary evidence that common risk variants also play a role. The genetics of incontinence in children and adults has predominantly been studied separately, but this review identifies for the first time the endothelin system as a potential common pathophysiological pathway. Overall, these findings strengthen the hypothesis that genetic variants play a prominent role in the pathogenesis of incontinence. Future research should include hypothesis-free studies of rare and common variants in large well-characterized cohorts with incontinence. Studies should include different age groups and ethnicities and both sexes to fully reveal the genetics of incontinence.

Prevalence of bullying in orthodontic patients and its impact on the desire for orthodontic therapy, treatment motivation, and expectations of treatment

PURPOSE

This study aims at investigating the prevalence of bullying due to malocclusions in a sample of German orthodontic patients. Thereby, we analyzed the influence of self-reported bullying on initiation, desire and motivation, and expectations of orthodontic therapy.

PATIENTS AND METHODS

Patients completed questionnaires by themselves in three orthodontic practices (n = 1020, mean age 11.8 years). The sample was divided into three groups: (1) subjects bullied due to dentofacial features, (2) subjects bullied due to physical features, and (3) non-bullied control group. The effect of bullying on initiation, desire and motivation, and expectation from orthodontic treatment was assessed and compared between these groups.

RESULTS

Overall prevalence of bullying was 23.7% with male subjects revealing significantly higher values than females (p < 0.001). Subjects from the dentofacial features group (6.3%) initiated orthodontic therapy themselves significantly more often than subjects from the physical features (17.4%; p = 0.030) and control group (76.3%; p < 0.001). The dentofacial features group reported significantly more frequently that 'ugly teeth' were the major motivating factor to seek orthodontic treatment (40.4%). Within this group significantly higher mean scores for the expectation 'keep me from being bullied' were obtained compared with subjects in the physical features (p < 0.001) or control group (p < 0.001).

CONCLUSION

This analysis demonstrated that bullying due to malocclusion impacts attitude towards orthodontic treatment. Victims who experienced bullying due to malocclusion initiate orthodontic treatment more often themselves and expect therapy to prevent them from experiencing further bullying.

Neural signatures of bullying experience and social rejection in teenagers

Relational bullying in schools is one of the most frequent forms of violence and can have severe negative health impact, e.g. depression. Social exclusion is the most prominent form of relational bullying that can be operationalized experimentally. The present study used MR-based perfusion imaging (pCASL) to investigate the neural signatures of social exclusion and its relationship with individually different extent of previous bullying experience. Twenty-four teenagers reporting bullying experience at different extent were scanned during a virtual ball-tossing (Cyberball game). Our findings showed that social exclusion (relative to social inclusion) activated frontal brain areas: sub- and perigenual anterior cingulate cortex (sg/pgACC), left inferior frontal cortex (IFG), and dorsolateral prefrontal cortex. Positive relationship between exclusion-specific signal increase and individually different extents of prior bullying experience was for the first time observed in left IFG and sgACC. This suggests that more frequent prior experience has conditioned greater mentalizing and/or rumination, in order to cope with the situation. While this interpretation remains speculative, the present data show that the experience of being bullied partly sensitizes the neural substrate relevant for the processing of social exclusion.

Bullying Victimization Among Left-Behind Children in Rural China: Prevalence and Associated Risk Factors

Bullying victimization among Chinese school-aged children has recently been recognized as a serious problem. However, studies on the prevalence and correlates of bullying victimization among left-behind children-whose parents live and work in urban areas while they remain at home in a rural area-have fallen far behind. We conducted a study based on one representative sample of 742 left-behind children in Grades 6 to 10 from rural China in 2010. The results indicate that a total of 31.6% of the left-behind children report recurrent bullying victimization, which is higher than that of their rural counterparts who live with their parents. Furthermore, left-behind children who experience bullying victimization are more likely to report being drunk frequently, poorer peer and family relationships, and academic problems. Future bullying prevention and intervention programs should be designed to meet the special needs of left-behind children.

Recent advancements in tension-type headache: a narrative review

INTRODUCTION

Tension-type headache (TTH) is the most common primary headache disorder with a prevalence of up to 78% in general population and huge expenses in terms of health service. Despite its high incidence and impact on life's quality the knowledge on the pathophysiology and efficacious treatment of TTH was still limited.

AREAS COVERED

In recent years, a series of studies highlighted the heterogeneous nature of this pathology that seems to be determined by a complex interaction between genetic, environmental, and neuromuscular factors, which result in nociceptive system activation. In this setting, alongside the simple analgesic therapies used during the acute attack, a series of therapeutic options based on newly acquired experiences have taken hold.

EXPERT REVIEW

Not having a single substrate or a typical site of pathophysiology, TTH must be analyzed in a global and multidisciplinary way. Herein, we perform a narrative review of the most recent advancement stimulating the concept of this disease as the tip of the iceberg of a more complex individual malaise secondary to different alterations. Strategies based solely on symptomatic drugs should therefore be avoided by experienced personnel and treatment should aim at taking charge of the patient considering the processes behind this complex pathology.

Normal Sleep in Children and Adolescence

Adequate sleep is essential for healthy development in childhood and adolescence. Healthy sleep contributes to good physical health, immune function, mental health, and academic performance. The regulation and architecture of sleep change greatly across childhood and adolescence, and the ability to obtain sufficient sleep is impacted by a range of factors that change with maturation. This article describes normal sleep across childhood and adolescence and discusses some of the most common barriers to adequate sleep, including early school start times, technology use, and changes to circadian rhythms, and sleep homeostasis across puberty.

Persistent Short Sleep from Childhood to Adolescence: Child, Parent and Peer Predictors

PURPOSE

Many children have periods when they sleep too little, with widely recognized detrimental effects. Less is known about persistent short sleep during childhood. Therefore, the present study aimed to investigate the prevalence of persistent short sleep in school-aged children and identify a set of child, parent, and peer predictors thereof.

PARTICIPANTS AND METHODS

Objectively measured sleep duration (hip-held accelerometer) was biennially assessed in a community sample followed from 6 to 14 years (n=801). A latent profile analysis was applied to assess whether a subgroup of children slept consistently short across time and predictors of persistent short sleep were determined through regression analysis.

RESULTS

A subgroup of children (n=160; 20.2%) was identified as having persistent short sleep across time. Temperamental negative affectivity (β=0.08; 95% CI=0.01, 0.15; p=0.03) and low observer-assessed parental emotional availability (β=-.09; 95% CI=-.18, -.01; p=0.04) predicted membership to that group. Teacher ratings of victimization from bullying were not associated with persistent short sleep (β=0.01; 95% CI: -.10, 11; p=0.88).

CONCLUSION

High child temperamental negative affectivity and low parental emotional availability may be involved in the development of persistent short sleep through childhood.

Health effects of repeated victimization among school-aged adolescents in six major cities in China

BACKGROUND

Child victimization is a public health concern in China. Existing studies documented associations between victimization and negative health effects, while cumulative health effects of repeated victimization have attracted relatively little attention from scholars.

OBJECTIVE

To examine the health effects of various types of repeated victimization by using a large representative sample of school children in six major cities in China.

PARTICIPANTS AND SETTING

This study used data from a large representative sample of 18,452 Chinese adolescents aged 15-17 from six cities, Tianjin, Shenzhen, Shanghai, Xi'an, Wuhan, and Hong Kong.

METHODS

We carried out a two-stage data analysis in this study, including descriptive statistics to describe the prevalence of repeated victimization, and multiple analysis of variance (MANOVA) to examine the health consequences of repeated victimization.

RESULTS

27.54% of respondents experienced one-time victimization, and 44.26% suffered repeated victimizations, and those adolescents with repeated victimization reported significantly higher levels of depression and lower levels of self-esteem and overall health when compared to those with one-time victimization and those without victimization experience.

CONCLUSIONS

Experiences of repeated victimization can have much stronger associations with negative health outcomes when compared to experiences of one-time victimization. Promoting awareness of both the severity and repetition of victimization and designing integrative screening tool could be meaningful strategies to address the issue of child victimization in China.

Bullying experience of pupils in Nigerian primary schools

Childhood bullying leads to life-long scars and hinders adult development. Schoolchildren involved in bullying are at risk of developing behavioural difficulties, physical health problems and suicidal ideation. This research aimed to evaluate the bullying experience of pupils in Nigerian primary schools.The study is a cross-sectional analytic survey conducted from June to November 2019. A total of 1080 pupils in participated in the study. A self-report questionnaire containing 3 questions was used for collecting data. Analysis of the collected data was done using percentage and Chi-Squared at 0.05 probability level.Results indicate that 51.4% of the male pupils and 50.8% of females reported being victims of bullying. 51.8% of the males and 49.5% of females were found to be perpetrators of bullying. 39.6% of the males and 42.9% of the females were bystanders of bullying. 35.1% of the males and 34.1% of females have experienced any 2 of the categories while 11.2% of the males and 12.4% of the females have experienced all the categories of bullying. Results show a non-significant difference between male and female pupils on bullying victimization (χ = .036, P = .849), bullying perpetration (χ = .589, P = .443), and bullying bystander problem (χ = 1.194, P = .275).In conclusion, school bullying is an increasing problem among Nigerian schoolchildren. Initiatives must, therefore, be taken by the Nigerian government to further prevent and counter bullying problem in Nigerian primary schools. Interventions aimed at helping schools to develop effective policies to reduce bullying behaviour among pupils should be initiated.

GP views on their role in bullying disclosure by children and young people in the community: a cross-sectional qualitative study in English primary care

BACKGROUND

Bullying among children and young people (CYP) is a major public health concern that can lead to physical and mental health consequences. CYP may disclose bullying, and seek help from a GP. However, there is currently little research on GPs' views on and perceptions of their role in dealing with disclosures of bullying in primary care.

AIM

To explore GPs' views about their role in dealing with CYPs' disclosures of being bullied, especially factors that have an impact on GPs' roles.

DESIGN AND SETTING

In this cross-sectional qualitative study, semi-structured interviews were conducted with GPs in primary care in England from October to December 2017.

METHOD

Purposive sampling was used to achieve variation in GP age, professional status in practice, profile of the patients served by the practice, practice size and location, and whether the GPs considered themselves to be actively in research or teaching.

RESULTS

Data from 14 semi-structured interviews revealed three main themes: remaining clinically vigilant; impact of bullying in schools; and training and guidance on dealing with bullying and cyberbullying. GPs felt that dealing with disclosures of bullying and cyberbullying came down to their clinical experience rather than guideline recommendations, which do not currently exist, and that bullying was a precipitating factor in presentations of CYPs' mental health issues.

CONCLUSION

GPs feel they have a role to play in managing and supporting the health of CYP who disclose being bullied during consultations. However, they feel ill-equipped to deal with these disclosures because of lack of professional development opportunities, and guidance on treating and managing the health consequences of being bullied.

Bullying Behaviors and Psychosocial Adjustment Among School-Aged Children in China

Bullying behaviors have been studied extensively in Western countries; however, no national data exist regarding this issue in contemporary China. Using a sample of 14,536 children in Grades 6, 8, and 10 from public schools in 11 provinces or autonomous regions in rural and urban China, our study assesses the prevalence of bullying behaviors among school-aged children in China and examines the correlation between bullying and psychosocial adjustment. Results indicate that 6.3% of children reported having been bullied in the last 3 months, 2.5% of children admitted to bullying other students, and 2.2% said they were bullied and bullied others in that same time frame. More boys than girls reported bullying others and being victims of bullying. The frequency of bullying is higher in Grades 6 and 8 than in Grade 10. Rural children are more often involved in bullying than their urban counterparts. Perpetrating and being a victim of bullying are associated with poorer psychosocial adjustment, although different patterns are observed among bullies, those bullied, and those who bully others and have been bullied. Health care professionals should be sensitive to bullying behaviors when identifying students with psychosocial maladjustment. Moreover, programs designed to prevent and intervene in school bullying would benefit from a holistic approach.

The association between bullying victimization in childhood and fibromyalgia. Data from the nationwide Finnish health and social support (HeSSup) study based on a sample of 64,797 individuals

BACKGROUND

Fibromyalgia is a functional pain syndrome presenting with various psychological symptoms. Several studies have shown that adverse life events are associated with fibromyalgia. The aim of the current study is to explore the association between self-reported bullying victimization in childhood and self-reported fibromyalgia in adulthood.

METHODS

The basic study setting is cross-sectional - with focused use of retrospective data - derived from a large on-going postal follow up survey (sample N = 64,797) initiated in Finland in 1998. Only respondents having answered the questions on fibromyalgia in both follow ups in 2003 and 2012 were included (N = 11,924). Severity of bullying was divided into three groups starting from no bullying followed by minor and severe bullying. Covariates having shown statistically significant associations with fibromyalgia in cross tabulation using Pearson's chi-squared test were included in the final multiple logistic regression analyses.

RESULTS

In our study, 50.6% of the respondents reported victimization of minor and 19.6% of severe bullying in childhood. Participants reporting fibromyalgia in adulthood reported more bullying, and in females alone this association was statistically significant (p = .027). In multiple logistic regression analysis statistically significant associations between bullying victimization in childhood (reference: no bullying) and fibromyalgia were found: adjusted odds ratio (OR) for minor bullying was 1.35 (95% CI 1.09-1.67) and for severe bullying 1.58 (95% CI 1.21-2.06). However, in log-linear and logistic regression interaction models the association between bullying and fibromyalgia was not statistically significant when depression was included in the models.

CONCLUSIONS

Our results suggest that peer bullying victimization might be associated with fibromyalgia. However, in logistic log linear and logistic interaction models there was no statistically significant association when depression was included. As a result, there is need for further, preferably prospective cohort studies. The findings also emphasize the importance of actions to prevent childhood bullying.

Bullying involvement, psychological distress, and short sleep duration among adolescents

PURPOSE

Previous research has found links between involvement in bullying and sleep duration in adolescents. However, little is known about the factors that might mediate these relationships. This study examined the associations between cyberbullying victimization and school bullying involvement (bully, victim, bully-victim) with short sleep duration in a large sample of middle and high school students and tested whether psychological distress mediates these relationships.

METHODS

Data on 5061 students (49% females; mean age = 15.1 years) from the 2015 Ontario Student Drug Use and Health Survey were used. Participants self-reported their sleep duration and their levels of bullying involvement over the past year. Psychological distress was assessed using the Kessler 6 (K6) scale. Covariates in multiple linear regression analyses included age, sex, racial background, socioeconomic status, and substance use.

RESULTS

Being a victim of cyberbullying (β = - 1.179; 95% CI - 0.238; - 0.120) or school bullying (β = - 0.119; 95% CI - 0.190; - 0.049) was associated with short sleep duration. Mediation analyses suggested that psychological distress fully mediates the relationships between being cyberbullied, a school bullying victim or bully-victim with short sleep duration. There was a complementary mediation by psychological distress on the relationship between being a bully at school and short sleep duration.

CONCLUSIONS

These results suggest that higher levels of bullying involvement place adolescents at risk of developing higher psychological distress which, in turn, can lead to short sleep duration. Longitudinal research is necessary to confirm the mediating role of psychological distress on the relationship between bullying involvement and short sleep duration among adolescents.

A Modern Epidemic: Increasing Pediatric Emergency Department Visits and Admissions for Headache

OBJECTIVE

Headaches represent 0.9% to 2.6% of visits to a pediatric emergency department (PED). We noted a trend of increasing visits for headache in our tertiary care PED and sought to further characterize this trend.

METHODS

We identified PED visits with International Classification of Disease, Ninth Revision, Clinical Modification diagnoses for headache at 25 hospitals in Pediatric Health Information System between 2003 and 2013. To further characterize demographics and treatment trends over time we used the electronic health record in our emergency department to identify children ages four to 18 between January 2007 and December 2014 with International Classification of Disease, Ninth Revision codes for headache: a random sample of 50 visits per year were chosen for chart review.

RESULTS

Pediatric Health Information System visits for headache increased by 166% (18,041 in 2003 and 48,020 in 2013); by comparison, total PED visits increased by 57.6%. The percent admission increased by 300% (2020 admissions in 2003 and 8087 admissions in 2013). At our hospital, headache visits increased 111% from 896 visits in 2007 to 1887 visits in 2014; total PED visits increased 30.2%. The admission percentage for headache increased 187% with 156 admissions in 2007 and 448 in 2014. Management over time differed in the frequency of head computed tomography which decreased 3.7% per year (r = -0.93, 95% CI -0.99, -0.64) from 34% in 2007 to 18% in 2014.

CONCLUSION

Pediatric emergency department visits for headache are increasing and a growing proportion of these patients are admitted. This finding identifies a potential patient population to target for interventions to improve outpatient management and reduce pediatric emergency department utilization.

Bullying, mental health and friendship in Australian primary school children

BACKGROUND

Frequent bullying predicts adolescent mental health problems, particularly depression. This population-based study with young Australian primary school children aimed to determine the frequency and mental health correlates of bullying, and whether friendship could be protective.

METHOD

Participants were a population-based sample of 1221 children aged 8-9 years attending 43 primary schools in metropolitan Melbourne, Australia. Children were taking part in the Childhood to Adolescence Transition Study. Children completed online questionnaires at school to measure peer relations and emotional well-being. Parents reported on their child's mental health in questionnaires sent to the home.

RESULTS

One in three children (29.2%) reported experiencing frequent bullying, defined as at least once a week. This included physical bullying alone (13.8%), verbal bullying alone (22.7%) and the combination (7.4%). Children who reported being frequently bullied self-reported higher internalising symptoms compared with children who did not report frequent bullying (M (SD) 1.6 (0.9) vs. 1.1 (0.8), p < .001). This difference was confirmed by parents' reports of their child's internalising symptoms (M (SD) 2.4 (2.3) vs. 2.1 (2.0), p = .026, respectively). Amongst children who reported frequent bullying, those with a group of friends had better emotional well-being.

CONCLUSIONS

A substantial proportion of children report experiencing bullying on a weekly basis early in primary school. Given the prevalence of bullying in primary school and its relationship to children's mental health, we recommend effective school-wide antibullying programmes. Further research can explore whether intervention to foster a group of friends around bullied children can improve their emotional well-being.

Health-related quality of life associated with bullying and aggression: a cross-sectional study in English secondary schools

BACKGROUND

Associations between adolescent health-related quality of life (HRQoL), bullying, and aggression are not well understood. We used baseline data from a large-cluster randomized school trial to study the relationship between HRQoL, bullying experience, and other demographic factors.

METHODS

Cross-sectional self-reported questionnaires collected pre-randomization from the on-going INCLUSIVE trial. The questionnaires were completed in the classroom. The Gatehouse Bullying Scale measured bullying victimization and the Edinburgh Study of Youth Transitions and Crime school misbehavior subscale (ESYTC) measured aggressive behaviors. HRQoL was assessed using the Child Health Utility 9 Dimensions (CHU-9D) and general quality of life using the Pediatric Quality of Life Inventory (PedsQL). Participants were a cohort of year 7 students (age 11-12 years) from 40 state secondary schools in England. Descriptive statistics for the CHU-9D and PedsQL were calculated using standard methods with tests for differences in median scores by sex assessed using quantile regression. Correlation between HRQoL measures was conducted using Spearman's rank correlation coefficients. Predictors of HRQoL were identified using univariate and multiple regressions.

RESULTS

A total of 6667 students filled out the questionnaire. The CHU-9D was correlated with the PedsQL (0.63, p < 0.001). The multivariable regression results suggest that if students were bullied frequently and upset it resulted in a decrement in CHU-9D scores of (-0.108) and fall in PedsQL score of (-16.2). The impact of the antisocial/aggressive behavior on the ESYTC scale resulted in a utility decrement of -0.004 and fall of -.5 on the PedsQL.

CONCLUSIONS

Adolescents' involvement in bullying and aggression is a strong correlate of HRQoL. These data have important implications for the potential cost-effectiveness of reducing bullying and aggression in schools.

Talking About Cancer Among Adolescent and Young Adult Cancer Patients and Survivors: A Systematic Review

Communication plays an essential role in social relationships. Yet it is unclear how young cancer patients and survivors communicate with peers, and whether this contributes to increased rates of social difficulties. We aimed to analyze how childhood cancer patients and survivors communicate about their cancer with family and peers. We systematically searched Medline, Embase and PsycINFO for peer-reviewed studies on cancer-related communication among patients and survivors (any cancer, <25 years at diagnosis). We screened 309 articles, and included 6 qualitative studies. Studies were assessed using a standardized quality assessment tool. Participants were adolescents and young adults, 16-34 years of age at the time of study. Included studies related to different forms of cancer-related communication, benefits, and challenges. We found that cancer-related communication was an individual, complex process, addressing medical, existential, and emotional aspects of cancer. Communication occurred on a spectrum with variation in who information was shared with, as well as differences in the frequency at which information was shared, and the amount and type of information shared. Communication often occurred at uncertain or significant times for participants, or was initiated by others. Communicating about cancer yielded benefits as a coping strategy, prompted social support, and appeared central to significant relationships. Barriers to communication, including fear of stigma and poor peer reactions, hindered willingness to disclose. The number of studies analyzing this topic was limited. Communicating about cancer is a significant yet complex process for young patients and survivors. Further research is needed to complement the existing literature and to establish the evidence base for the development of future effective interventions promoting social and communication skills.

Mechanisms underlying the association between insomnia, anxiety, and depression in adolescence: Implications for behavioral sleep interventions

There is robust evidence of an association between insomnia, anxiety, and depression in adolescence. The aim of this review is to describe and synthesize potential mechanisms underlying this association and explore implications for the design of adolescent behavioral sleep interventions. Specifically, we examine whether insomnia symptoms are a mechanism for the development of internalizing symptoms in adolescence and whether sleep interventions are an effective treatment for both insomnia and internalizing symptoms in adolescence because they target the shared mechanisms underlying these disorders. Research using different methodologies points to the role of sequential, parallel, and interacting mechanisms. In this paper, we review a wide range of relevant biological (i.e., polymorphisms and dysregulation in serotonin, dopamine, and circadian clock genes; alterations in corticolimbic and mesolimbic brain circuits; cortisol reactivity to stress; inflammatory cytokine dysregulation; biased memory consolidation; changes in sleep architecture), psychological (i.e., cognitive inflexibility, interpretational biases, judgment biases, negative attribution styles, worry, rumination, biased attention to threat, dysfunctional beliefs and attitudes about sleep, misperception of sleep deficit), and social mechanisms (i.e., reduced and impaired social interactions, unhelpful parenting behaviors, family stress) and propose an integrative multilevel model of how these phenomena may interact to increase vulnerability to both insomnia and internalizing disorders. Several 'biopsychosocial' mechanisms hold promise as viable treatment targets for adolescent behavioral sleep interventions, which may reduce both insomnia and internalizing symptoms.

Victimization by Bullying and Physical Symptoms Among South Korean Schoolchildren

This study examined the relationship between victimization by bullying and physical symptoms among South Korean schoolchildren. Data were analyzed from a nationally representative sample of 2006 schoolchildren across South Korea aged 9-17 years. Multiple logistic regression analysis was used to estimate the associations between victimization by bullying and physical symptoms in the children. Schoolchildren bullied 4 or more times by peers in the previous year were approximately 3 times more likely to report recurrent stomachache or dizziness and twice as likely to report headache and sleep difficulties than students who were never victimized by peers. These risk estimates were calculated by controlling for confounding variables. School nurses, teachers, and school counselors or school social workers should consider frequent physical symptoms (headache, stomachache, dizziness, and sleep difficulties) as potential indicators of victimization through bullying and then provide prompt intervention and support using a multidisciplinary approach when harm is confirmed.

Sensitivity to Peer Evaluation and Its Genetic and Environmental Determinants: Findings from a Population-Based Twin Study

Adolescents and young adults are highly focused on peer evaluation, but little is known about sources of their differential sensitivity. We examined to what extent sensitivity to peer evaluation is influenced by interacting environmental and genetic factors. A sample of 354 healthy adolescent twin pairs (n = 708) took part in a structured, laboratory task in which they were exposed to peer evaluation. The proportion of the variance in sensitivity to peer evaluation due to genetic and environmental factors was estimated, as was the association with specific a priori environmental risk factors. Differences in sensitivity to peer evaluation between adolescents were explained mainly by non-shared environmental influences. The results on shared environmental influences were not conclusive. No impact of latent genetic factors or gene-environment interactions was found. Adolescents with lower self-rated positions on the social ladder or who reported to have been bullied more severely showed significantly stronger responses to peer evaluation. Not genes, but subjective social status and past experience of being bullied seem to impact sensitivity to peer evaluation. This suggests that altered response to peer evaluation is the outcome of cumulative sensitization to social interactions.

Systematic Review: Bullying Involvement of Children With and Without Chronic Physical Illness and/or Physical/Sensory Disability-a Meta-Analytic Comparison With Healthy/Nondisabled Peers

Objective

To compare levels of victimization and perpetration associated with bullying among children and adolescents with and without chronic physical illnesses and/or physical or sensory disabilities.

Methods

In total, 107 studies were identified using a systematic search in electronic databases and cross-referencing. A random-effects meta-analysis was computed.

Results

Children and adolescents with chronic physical illness or disability were more likely to be victims of bullying in general (odds ratio [OR] = 1.65), particularly physical bullying (OR = 1.47), relational bullying (OR = 1.47), verbal bullying (OR = 1.67), cyberbullying (OR = 1.39), and illness-specific teasing (OR = 5.29). They were also more likely to be bullies in general (OR = 1.28), as well physical (OR = 1.38) and relational bullies (OR = 1.13). The effect sizes varied across different illnesses and disabilities and, in part, by visibility of the disease, school type, and year of assessment.

Conclusions

Although most between-group differences tend to be small, some form of intervention is needed to reduce bullying among children and adolescents with chronic physical illnesses and/or physical or sensory disabilities, and illness-specific weight- and appearance-related teasing in particular.

Probiotics for management of functional abdominal pain disorders in children

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows:

The primary objectives are to evaluate the efficacy and safety of probiotics for the management of IBS, abdominal migraine and functional abdominal pain in children.

Bullying Behaviors among Macanese Adolescents-Association with Psychosocial Variables

Bullying is a widespread public health problem among school students. Using a large sample of Macanese school adolescents, the present study examines psychosocial conditions and demographic characteristics in discriminating the following four subgroups of students: victims; bullies; bully-victims; and a comparison group of adolescents. Participants included 2288 adolescents from 13 primary and secondary schools in Macau whose ages ranged from 10 to 20 years. Statistical results revealed significant differences among the groups and indicated that adolescents who are involved in school bullying experience worse psychosocial adjustment. Specifically, among the four subgroups of students, bully-victims reported the strongest feelings of anxiety, depression, and negative affectivity, and expressed the lowest satisfaction with life. Compared with students who were not involved in bullying and victimization, bullies experienced more anxiety and depression and victims had lower levels of satisfaction with life. In addition, boys were more likely to engage in bullying behaviors and younger students had a greater probability of being victimized by their peers at school. Implications for future research and practice on bullying perpetration and the prevention of peer victimization are discussed.

Dietary interventions for recurrent abdominal pain in childhood

BACKGROUND

This is an update of the original Cochrane review, last published in 2009 (Huertas-Ceballos 2009). Recurrent abdominal pain (RAP), including children with irritable bowel syndrome, is a common problem affecting between 4% and 25% of school-aged children. For the majority of such children, no organic cause for their pain can be found on physical examination or investigation. Many dietary inventions have been suggested to improve the symptoms of RAP. These may involve either excluding ingredients from the diet or adding supplements such as fibre or probiotics.

OBJECTIVES

To examine the effectiveness of dietary interventions in improving pain in children of school age with RAP.

SEARCH METHODS

We searched CENTRAL, Ovid MEDLINE, Embase, eight other databases, and two trials registers, together with reference checking, citation searching and contact with study authors, in June 2016.

SELECTION CRITERIA

Randomised controlled trials (RCTs) comparing dietary interventions with placebo or no treatment in children aged five to 18 years with RAP or an abdominal pain-related, functional gastrointestinal disorder, as defined by the Rome III criteria (Rasquin 2006).

DATA COLLECTION AND ANALYSIS

We used standard methodological procedures expected by Cochrane. We grouped dietary interventions together by category for analysis. We contacted study authors to ask for missing information and clarification, when needed. We assessed the quality of the evidence for each outcome using the GRADE approach.

MAIN RESULTS

We included 19 RCTs, reported in 27 papers with a total of 1453 participants. Fifteen of these studies were not included in the previous review. All 19 RCTs had follow-up ranging from one to five months. Participants were aged between four and 18 years from eight different countries and were recruited largely from paediatric gastroenterology clinics. The mean age at recruitment ranged from 6.3 years to 13.1 years. Girls outnumbered boys in most trials. Fourteen trials recruited children with a diagnosis under the broad umbrella of RAP or functional gastrointestinal disorders; five trials specifically recruited only children with irritable bowel syndrome. The studies fell into four categories: trials of probiotic-based interventions (13 studies), trials of fibre-based interventions (four studies), trials of low FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides and polyols) diets (one study), and trials of fructose-restricted diets (one study).We found that children treated with probiotics reported a greater reduction in pain frequency at zero to three months postintervention than those given placebo (standardised mean difference (SMD) -0.55, 95% confidence interval (CI) -0.98 to -0.12; 6 trials; 523 children). There was also a decrease in pain intensity in the intervention group at the same time point (SMD -0.50, 95% CI -0.85 to -0.15; 7 studies; 575 children). However, we judged the evidence for these outcomes to be of low quality using GRADE due to an unclear risk of bias from incomplete outcome data and significant heterogeneity.We found that children treated with probiotics were more likely to experience improvement in pain at zero to three months postintervention than those given placebo (odds ratio (OR) 1.63, 95% CI 1.07 to 2.47; 7 studies; 722 children). The estimated number needed to treat for an additional beneficial outcome (NNTB) was eight, meaning that eight children would need to receive probiotics for one to experience improvement in pain in this timescale. We judged the evidence for this outcome to be of moderate quality due to significant heterogeneity.Children with a symptom profile defined as irritable bowel syndrome treated with probiotics were more likely to experience improvement in pain at zero to three months postintervention than those given placebo (OR 3.01, 95% CI 1.77 to 5.13; 4 studies; 344 children). Children treated with probiotics were more likely to experience improvement in pain at three to six months postintervention compared to those receiving placebo (OR 1.94, 95% CI 1.10 to 3.43; 2 studies; 224 children). We judged the evidence for these two outcomes to be of moderate quality due to small numbers of participants included in the studies.We found that children treated with fibre-based interventions were not more likely to experience an improvement in pain at zero to three months postintervention than children given placebo (OR 1.83, 95% CI 0.92 to 3.65; 2 studies; 136 children). There was also no reduction in pain intensity compared to placebo at the same time point (SMD -1.24, 95% CI -3.41 to 0.94; 2 studies; 135 children). We judged the evidence for these outcomes to be of low quality due to an unclear risk of bias, imprecision, and significant heterogeneity.We found only one study of low FODMAP diets and only one trial of fructose-restricted diets, meaning no pooled analyses were possible.We were unable to perform any meta-analyses for the secondary outcomes of school performance, social or psychological functioning, or quality of daily life, as not enough studies included these outcomes or used comparable measures to assess them.With the exception of one study, all studies reported monitoring children for adverse events; no major adverse events were reported.

AUTHORS' CONCLUSIONS

Overall, we found moderate- to low-quality evidence suggesting that probiotics may be effective in improving pain in children with RAP. Clinicians may therefore consider probiotic interventions as part of a holistic management strategy. However, further trials are needed to examine longer-term outcomes and to improve confidence in estimating the size of the effect, as well as to determine the optimal strain and dosage. Future research should also explore the effectiveness of probiotics in children with different symptom profiles, such as those with irritable bowel syndrome.We found only a small number of trials of fibre-based interventions, with overall low-quality evidence for the outcomes. There was therefore no convincing evidence that fibre-based interventions improve pain in children with RAP. Further high-quality RCTs of fibre supplements involving larger numbers of participants are required. Future trials of low FODMAP diets and other dietary interventions are also required to facilitate evidence-based recommendations.

Pharmacological interventions for recurrent abdominal pain in childhood

BACKGROUND

Between 4% and 25% of school-aged children at some stage complain of recurrent abdominal pain (RAP) of sufficient severity to interfere with their daily lives. When no clear organic cause is found, the children are managed with reassurance and simple measures; a large range of pharmacological interventions have been recommended for use in these children.

OBJECTIVES

To determine the effectiveness of pharmacological interventions for RAP in children of school age.

SEARCH METHODS

We searched the Cochrane Central Register of Controlled Trials (CENTRAL), Ovid MEDLINE, Embase, and eight other electronic databases up to June 2016. We also searched two trials registers and contacted researchers of published studies.

SELECTION CRITERIA

Randomised controlled trials involving children aged five to 18 years old with RAP or an abdominal pain-related functional gastrointestinal disorder, as defined by the Rome III criteria (Rasquin 2006). The interventions were any pharmacological intervention compared to placebo, no treatment, waiting list, or standard care. The primary outcome measures were pain intensity, pain duration or pain frequency, and improvement in pain. The secondary outcome measures were school performance, social or psychological functioning, and quality of daily life.

DATA COLLECTION AND ANALYSIS

Two review authors independently screened titles, abstracts, and potentially relevant full-text reports for eligible studies. Two review authors extracted data and performed a 'Risk of bias' assessment. We used the GRADE approach to rate the overall quality of the evidence. We deemed a meta-analysis to be not appropriate as the studies were significantly heterogeneous. We have consequently provided a narrative summary of the results.

MAIN RESULTS

This review included 16 studies with a total of 1024 participants aged between five and 18 years, all of whom were recruited from paediatric outpatient clinics. Studies were conducted in seven countries: seven in the USA, four in Iran, and one each in the UK, Switzerland, Turkey, Sri Lanka, and India. Follow-up ranged from two weeks to four months. The studies examined the following interventions to treat RAP: tricyclic antidepressants, antibiotics, 5-HT4 receptor agonists, antispasmodics, antihistamines, H2 receptor antagonists, serotonin antagonists, selective serotonin re-uptake inhibitors, a dopamine receptor antagonist, and a hormone. Although some single studies reported that treatments were effective, all of these studies were either small or had key methodological weaknesses with a substantial risk of bias. None of these 'positive' results have been reproduced in subsequent studies. We judged the evidence of effectiveness to be of low quality. No adverse effects were reported in these studies.

AUTHORS' CONCLUSIONS

There is currently no convincing evidence to support the use of drugs to treat RAP in children. Well-conducted clinical trials are needed to evaluate any possible benefits and risks of pharmacological interventions. In practice, if a clinician chooses to use a drug as a 'therapeutic trial', they and the patient need to be aware that RAP is a fluctuating condition and any 'response' may reflect the natural history of the condition or a placebo effect, rather than drug efficacy.

Psychosocial interventions for recurrent abdominal pain in childhood

BACKGROUND

This review supersedes the original Cochrane review first published in 2008 (Huertas-Ceballos 2008).Between 4% and 25% of school-aged children complain of recurrent abdominal pain (RAP) severe enough to interfere with their daily activities. No organic cause for this pain can be found on physical examination or investigation for the majority of such children. Although many children are managed by reassurance and simple measures, a large range of psychosocial interventions involving cognitive and behavioural components have been recommended.

OBJECTIVES

To determine the effectiveness of psychosocial interventions for reducing pain in school-aged children with RAP.

SEARCH METHODS

In June 2016 we searched CENTRAL, MEDLINE, Embase, eight other databases, and two trials registers. We also searched the references of identified studies and relevant reviews.

SELECTION CRITERIA

Randomised controlled trials comparing psychosocial therapies with usual care, active control, or wait-list control for children and adolescents (aged 5 to 18 years) with RAP or an abdominal pain-related functional gastrointestinal disorder defined by the Rome III criteria were eligible for inclusion.

DATA COLLECTION AND ANALYSIS

We used standard methodological procedures expected by Cochrane. Five review authors independently selected studies, assessed them for risk of bias, and extracted relevant data. We also assessed the quality of the evidence using the GRADE approach.

MAIN RESULTS

This review includes 18 randomised controlled trials (14 new to this version), reported in 26 papers, involving 928 children and adolescents with RAP between the ages of 6 and 18 years. The interventions were classified into four types of psychosocial therapy: cognitive behavioural therapy (CBT), hypnotherapy (including guided imagery), yoga, and written self-disclosure. The studies were carried out in the USA, Australia, Canada, the Netherlands, Germany, and Brazil. The majority of the studies were small and short term; only two studies included more than 100 participants, and only five studies had follow-up assessments beyond six months. Small sample sizes and the degree of assessed risk of performance and detection bias in many studies led to the overall quality of the evidence being rated as low to very low for all outcomes.For CBT compared to control, we found evidence of treatment success postintervention (odds ratio (OR) 5.67, 95% confidence interval (CI) 1.18 to 27.32; Z = 2.16; P = 0.03; 4 studies; 175 children; very low-quality evidence), but no evidence of treatment success at medium-term follow-up (OR 3.08, 95% CI 0.93 to 10.16; Z = 1.85; P = 0.06; 3 studies; 139 children; low-quality evidence) or long-term follow-up (OR 1.29, 95% CI 0.50 to 3.33; Z = 0.53; P = 0.60; 2 studies; 120 children; low-quality evidence). We found no evidence of effects of intervention on pain intensity scores measured postintervention (standardised mean difference (SMD) -0.33, 95% CI -0.74 to 0.08; 7 studies; 405 children; low-quality evidence), or at medium-term follow-up (SMD -0.32, 95% CI -0.85 to 0.20; 4 studies; 301 children; low-quality evidence).For hypnotherapy (including studies of guided imagery) compared to control, we found evidence of greater treatment success postintervention (OR 6.78, 95% CI 2.41 to 19.07; Z = 3.63; P = 0.0003; 4 studies; 146 children; low-quality evidence) as well as reductions in pain intensity (SMD -1.01, 95% CI -1.41 to -0.61; Z = 4.97; P < 0.00001; 4 studies; 146 children; low-quality evidence) and pain frequency (SMD -1.28, 95% CI -1.84 to -0.72; Z = 4.48; P < 0.00001; 4 studies; 146 children; low-quality evidence). The only study of long-term effect reported continued benefit of hypnotherapy compared to usual care after five years, with 68% reporting treatment success compared to 20% of controls (P = 0.005).For yoga therapy compared to control, we found no evidence of effectiveness on pain intensity reduction postintervention (SMD -0.31, 95% CI -0.67 to 0.05; Z = 1.69; P = 0.09; 3 studies; 122 children; low-quality evidence).The single study of written self-disclosure therapy reported no benefit for pain.There was no evidence of effect from the pooled analyses for any type of intervention on the secondary outcomes of school performance, social or psychological functioning, and quality of daily life.There were no adverse effects for any of the interventions reported.

AUTHORS' CONCLUSIONS

The data from trials to date provide some evidence for beneficial effects of CBT and hypnotherapy in reducing pain in the short term in children and adolescents presenting with RAP. There was no evidence for the effectiveness of yoga therapy or written self-disclosure therapy. There were insufficient data to explore effects of treatment by RAP subtype.Higher-quality, longer-duration trials are needed to fully investigate the effectiveness of psychosocial interventions. Identifying the active components of the interventions and establishing whether benefits are sustained in the long term are areas of priority. Future research studies would benefit from employing active control groups to help minimise potential bias from wait-list control designs and to help account for therapist and intervention time.

Bullying among Greenlandic schoolchildren: Development since 1994 and relations to health and health behaviour

OBJECTIVES

The objective was to examine the development in the prevalence of bullying behaviours among Greenlandic schoolchildren and the association with health outcome and health behaviour.

STUDY DESIGN

The study was based on three school surveys among Greenlandic schoolchildren contributing to the Health Behaviour in School-aged Children (HBSC) survey, a WHO collaborative study. The surveys were carried out in Greenland in 1994, 1998 and 2002, with respective participations of 1322, 1648 and 891 pupils of 11, 13 and 15 years of age.

METHODS

The trends in bullying behaviours from 1994 to 2002 was analysed by means of descriptive statistics. The strengths of associations in the patterning of the bullying behaviours in their relation to health indicators (physical symptoms, psychological well-being and smoking and alcohol use) were analysed by means of logistic regression.

RESULTS

There has been an increase in the occurrence of bullying among Greenlandic schoolchildren since 1994, and significant changes have occurred in the different types of bullying behaviours. Consistent patterns were observed between types of bullying behaviours, and health behaviour, since pupils engaged in bullying were more likely to be smokers and to have been drunk several times. Strong associations were observed between disliking school and being engaged in bullying, whether this was as a victim, a bully, or both. There was no clear patterning of associations when it came to health indicators, except for significantly higher odds of stomach ache for the bullies, and sleeping difficulties and low self-rated health for pupils both being bullied and bullying others.

CONCLUSIONS

Being engaged in bullying is widespread among Greenlandic schoolchildren and is found to be associated with disliking school and detrimental health behaviours.

The View From the Bottom: Relative Deprivation and Bullying Victimization in Canadian Adolescents

We investigated the relation between relative deprivation (RD)-disparity in affluence between adolescents and their more affluent schoolmates-and involvement in bullying among 23,383 students (aged 9-19) in 413 schools that participated in the 2010 Canadian Health Behavior in School-Aged Children survey. Students reported family affluence and frequency of bullying victimization and perpetration during the previous 2 months. Using the Yitzhaki index of RD and multinomial logistic regression analysis, we found that RD positively related to three types of bullying victimization (physical, relational, and cyberbullying) and to two types of perpetration (relational and cyberbullying) after differences in absolute affluence were held constant. These findings suggest that RD uniquely contributes to risk of bullying involvement.

Identifying and Intervening in Relational Aggression

Chronic victimization by bullies has been associated with academic failure in adolescence, as well as adjustment difficulties, depression, and suicidal ideation. Relational aggression is a form of bullying that is a problem for adolescent girls. It often takes the form of damaging peer relationships and includes verbal assaults such as teasing or name calling, as well as psychological attacks such as gossip, social exclusion, and strategic friendship manipulations. A girl’s ability to identify these indirect attacks may be imperative for her to enact an effective defense. Because many students do not recognize relational aggression as a form of bullying, their experiences often go unreported to parents or teachers. School nurses may be the front line of defense. With this in mind, school nurses must be informed about bullying behaviors, equipped to identify these behaviors, and prepared to intervene with victims as well as perpetrators of bullying.

Bibliotherapy: A Strategy to Help Students With Bullying

Use of bibliotherapy to address childhood teasing and bullying is an innovative approach school nurses should consider as they work to promote a healthy school environment. Children’s books serve as a unique conduit of exchange between parents, teachers, and children. Bibliotherapy, using books to help people solve problems, involves three stages: identification, catharsis, and insight. These stages lend themselves well to coping with the sensitivities related to teasing and bullying. Salient research findings pertinent to teasing and bullying have made their way into the children’s literature and have been well received by children and their families over the course of the Child Adolescent Teasing in Schools (CATS) book review project and web site development. After exposure to a fictional story about teasing and bullying, children have shared their own nonfictional account of this often devastating experience and have come to develop successful coping strategies for dealing with the teasing and bullying that takes place in schools nationwide.

Legal requirements and nationally circulated materials against school bullying in European countries

School bullying has become the focus of attention in many countries in the last 20 years, in part as a result of systematic academic research on the problem, and sometimes extensive media publicity. One of the outcomes of this attention has been an effort on the part of governments and educational authorities in many countries to tackle the problem through various initiatives, including the setting up of anti-bullying legal guidelines that schools must observe. In this article we discuss definitional issues and summarize recent research on school bullying; and then present information on the legal guidelines/requirements against bullying produced by Ministries of Education or equivalent government departments in all EU member states and four associated or candidate states. In addition, we summarize information on anti-bullying materials distributed to schools on a large (national/regional) scale. Our findings show that only a few European countries have specific legal requirements against bullying, although more have requirements on the more general problem of violence at schools. Many countries have produced and distributed anti-bullying materials to schools, although the content and format of these vary considerably. A few European countries still have no anti-bullying actions at a national level. We discuss the policy implications of these findings.

Young people who are being bullied - do they want general practice support?

Background

Childhood bullying is a major risk factor for health, education and social relationships, with effects persisting into adulthood. It affects half of all children at some point, with 10–14 % experiencing bullying that lasts for years. With the advent of cyberbullying, it can happen at all times and places. There have been calls for GPs to take a more active role in identifying and supporting young people who are being bullied. This paper explores young people’s and parents’ opinions about whether general practice should be involved in identifying and supporting young people who are being bullied.

Methods

Two hundred six young people (85.9 % female, mean ± sd age 16.2 ± 3.2 years) and 44 parents were recruited through established bullying charity websites and their social media channels to complete an online questionnaire comprising multiple-choice questions and unlimited narrative responses. Questionnaire responses were analysed by age and gender using descriptive statistics. A descriptive analysis of the narrative responses was undertaken and key themes identified.

Results

Young people (90.8 %) and parents (88.7 %) thought it was important for GPs to be better able to recognise and help young people who are being bullied. Most recognised the link between bullying and health. The doctor’s independence was seen as advantageous. Young people preferred completing a screening questionnaire to disclose experience of being bullied than being asked directly. They expressed concerns about how questions would be asked and whether information would be shared with parents/guardians. Parents were supportive of the use of a screening questionnaire, and most expected their child’s disclosure to be shared with them.

Conclusion

Young people and parents recruited through anti-bullying websites and social media would welcome greater GP involvement in identifying and supporting young people who are being bullied and their families, provided it is offered in a caring, compassionate and confidential manner.

A Study of Violence Among Hong Kong Young Adults and Associated Substance Use, Risky Sexual Behaviors, and Pregnancy

This study aimed to estimate the self-reported prevalence of violence perpetration and victimization among Hong Kong youths and the associated health risk behaviors using a representative sample of 1,126 young adults aged 18-27 years. Perpetrating physical and emotional violence was common in Hong Kong, with prevalences ranging from 20.8% to 38.3% in males and from 6.4% to 21.3% in females. Victimization of physical and emotional violence was also common for both sexes, with prevalences ranging from 16.4% to 36.3% in males and from 6.6% to 19.2% in females. Perpetration of sexual harassment and sexual violence was less prevalent, whereas victimization of sexual harassment and sexual violence ranged from 0.6% to 3.6% in males and from 2.3% to 13.2% in females. Both violence perpetration and victimization among youths were significantly associated with substance use, risky sexual behaviors, and pregnancy. The implications of this study for violence prevention programs are discussed.

Principals’ Perceptions and Practices of School Bullying Prevention Activities

The purpose of this study was to examine principals’ perceptions and practices regarding bullying prevention. A survey instrument was developed to assess principals’ stages of change and perceived barriers regarding selected bullying prevention activities as well as the effectiveness of bullying prevention activities. Of a national random sample of 700 principalsto which the survey was mailed, 55% responded. None of the school-based bullying prevention activities were being done by more than one in five schools even though principals perceived there to be no barriers regarding these activities. Characteristics that affected the offering of these activities included number of perceived barriers to implementing the activity, whether the principal had received violence/bullying prevention training, perceptions regarding the extent of bullying, and the number of bullying problems reported to them. The findings suggest that preprofessional training and continuing education are needed to educate principals regarding this area.

Middle School Students’ Preferences for Anti-Bullying Interventions

In this study, 285 middle school students in the United States were surveyed to obtain their preferences regarding anti-bullying intervention strategies. Participants rated their preferences for 15 common anti-bullying intervention strategies involving teachers, students, and non-teaching staff. The strategies were generated based on a review of the literature. Overall, students rated seven of the 15 strategies as being ‘sometimes’ or ‘almost always’ helpful. Participants tended to prefer intervention strategies in which teachers effectively managed their classrooms, thereby deterring bullying, as well as providing direct assistance to students. The results were also suggestive of students desiring teachers to be proactive in helping them solve bully-victim conflicts. Students tended not to prefer strategies that involved non-teaching staff.