AAP eBooks

Bullying and Victimization

By American Academy of Pediatrics

The articles included in this collection on bullying provide a wide lens through which to view this complexity.

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  2. Page 7
    Address correspondence to Tracy Evian Waasdorp, PhD, MEd, Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, 415 N. Washington St, Baltimore, MD 21231. E-mail: twaasdorp@jhu.edu

    BACKGROUND AND OBJECTIVES Bullying is a significant public health concern, and it has received considerable attention from the media and policymakers over the past decade, which has led some to believe that it is increasing. However, there are limited surveillance data on bullying to inform our understanding of such trends over the course of multiple years. The current study examined the prevalence of bullying and related behaviors between 2005 and 2014 and explored whether any such changes varied across schools or as a function of school-level covariates.

    METHODS Youth self-reports of 13 indicators of bullying and related behaviors were collected from 246 306 students in 109 Maryland schools across 10 years. The data were weighted to reflect the school populations and were analyzed by using longitudinal hierarchical linear modeling to examine changes over time.

    RESULTS The covariate-adjusted models indicated a significant improvement over bullying and related concerns in 10 out of 13 indicators (including a decrease in bullying and victimization) for in-person forms (ie, physical, verbal, relational) and cyberbullying. Results also showed an increase in the perceptions that adults do enough to stop bullying and students’ feelings of safety and belonging at school.

    CONCLUSIONS Prevalence of bullying and related behaviors generally decreased over this 10-year period with the most recent years showing the greatest improvements in school climate and reductions in bullying. Additional research is needed to identify factors that contributed to this declining trend.

  3. Page 15
    Address correspondence to Elizabeth Englander, PhD, Massachusetts Aggression Reduction Center, Bridgewater State University, Bridgewater, MA 02325. E-mail: eenglander@bridgew.edu

    Is cyberbullying essentially the same as bullying, or is it a qualitatively different activity? The lack of a consensual, nuanced definition has limited the field’s ability to examine these issues. Evidence suggests that being a perpetrator of one is related to being a perpetrator of the other; furthermore, strong relationships can also be noted between being a victim of either type of attack. It also seems that both types of social cruelty have a psychological impact, although the effects of being cyberbullied may be worse than those of being bullied in a traditional sense (evidence here is by no means definitive). A complicating factor is that the 3 characteristics that define bullying (intent, repetition, and power imbalance) do not always translate well into digital behaviors. Qualities specific to digital environments often render cyberbullying and bullying different in circumstances, motivations, and outcomes. To make significant progress in addressing cyberbullying, certain key research questions need to be addressed. These are as follows: How can we define, distinguish between, and understand the nature of cyberbullying and other forms of digital conflict and cruelty, including online harassment and sexual harassment? Once we have a functional taxonomy of the different types of digital cruelty, what are the short- and long-term effects of exposure to or participation in these social behaviors? What are the idiosyncratic characteristics of digital communication that users can be taught? Finally, how can we apply this information to develop and evaluate effective prevention programs?

  4. Page 20
    Address correspondence to Valerie A. Earnshaw, PhD, Division of General Pediatrics, Boston Children’s Hospital, 130 Enders Building, 300 Longwood Ave, Boston, MA 02115. E-mail: valerie.earnshaw@gmail.com

    Lesbian, gay, bisexual, transgender, and queer (LGBTQ) youth experience significant bullying that undermines their mental and physical health. National health organizations have called for the development of innovative strategies to address LGBTQ bullying. Pediatricians and other clinicians, medical and public health students, interdisciplinary researchers, government officials, school leaders, community members, parents, and youth from around the country came together at a national symposium entitled “LGBTQ Bullying: Translating Research to Action to Improve the Health of All Youth” in May 2016 to generate strategies to prevent LGBTQ bullying and meet the needs of LGBTQ youth experiencing bullying. This article describes key scientific findings on bullying, LGBTQ stigma, and LGBTQ bullying interventions that were shared at the symposium and provides recommendations for pediatricians to address LGBTQ bullying via clinical care, research, interventions, and policy. Symposium participants recommended that pediatricians engage in efforts to foster inclusive and affirming health care environments wherein LGBTQ youth feel comfortable discussing their identities and experiences, identify youth experiencing LGBTQ bullying, and prevent the negative health consequences of bullying among youth. Moreover, pediatricians can attend to how multiple identities (eg, sexual orientation, gender identity, race and/or ethnicity, disability, and others) shape youth experiences of bullying and expand intervention efforts to address LGBTQ bullying in health care settings. Pediatricians can further advocate for evidence-based, antibullying policies prohibiting bullying on the basis of sexual orientation and gender identity. Collaboration between pediatricians and diverse stakeholders can contribute to the development and implementation of lasting change in all forms of bullying, including LGBTQ bullying.

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    Education Gap It is imperative to understand the etiology and risk factors that contribute to aggressive behaviors. Equally important is effectively assessing and using targeted management strategies to reduce pathologic aggression.

    After completing this article, readers should be able to:

    1. Recognize the biological and psychosocial determinants of aggression.

    2. Use effective interviewing and screening measures to assess aggressive behaviors.

    3. Coordinate psychosocial and biologic interventions to reduce aggression.

  6. Page 42
    Address correspondence to Valerie A. Earnshaw, PhD, Boston Children’s hospital, General Pediatrics, BCh 3201, Boston, MA 02115. E-mail: valerie.earnshaw@gmail.com

    BACKGROUND Peer victimization is common among youth and associated with substance use. Yet, few studies have examined these associations longitudinally or the psychological processes whereby peer victimization leads to substance use. The current study examined whether peer victimization in early adolescence is associated with alcohol, marijuana, and tobacco use in mid- to late adolescence, as well as the role of depressive symptoms in these associations.

    METHODS Longitudinal data were collected between 2004 and 2011 from 4297 youth in Birmingham, Alabama; Houston, Texas; and Los Angeles County, California. Data were analyzed by using structural equation modeling.

    RESULTS The hypothesized model fit the data well (Root Mean Square Error of Approximation [RMSEA] = 0.02; Comparative Fit Index [CFI] = 0.95). More frequent experiences of peer victimization in the fifth grade were associated with greater depressive symptoms in the seventh grade (B[SE] = 0.03[0.01]; P < .001), which, in turn, were associated with a greater likelihood of alcohol use (B[SE] = 0.03[0.01]; P = .003), marijuana use (B[SE] = 0.05[0.01]; P < .001), and tobacco use (B[SE] = 0.05[0.01]; P < .001) in the tenth grade. Moreover, fifth-grade peer victimization was indirectly associated with tenth-grade substance use via the mediator of seventh-grade depressive symptoms, including alcohol use (B[SE] = 0.01[0.01]; P = .006), marijuana use (B[SE] = 0.01[0.01]; P < .001), and tobacco use (B[SE] = 0.02[0.01]; P < .001).

    CONCLUSIONS Youth who experienced more frequent peer victimization in the fifth grade were more likely to use substances in the tenth grade, showing that experiences of peer victimization in early adolescence may have a lasting impact by affecting substance use behaviors during mid- to late adolescence. Interventions are needed to reduce peer victimization among youth and to support youth who have experienced victimization.

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    Address correspondence to Melissa K. Holt, Boston University School of Education, 2 Silber Way, Boston, MA 02215. E-mail: holtm@bu.edu

    BACKGROUND AND OBJECTIVES Over the last decade there has been increased attention to the association between bullying involvement (as a victim, perpetrator, or bully-victim) and suicidal ideation/behaviors. We conducted a meta-analysis to estimate the association between bullying involvement and suicidal ideation and behaviors.

    METHODS We searched multiple online databases and reviewed reference sections of articles derived from searches to identify cross-sectional studies published through July 2013. Using search terms associated with bullying, suicide, and youth, 47 studies (38.3% from the United States, 61.7% in non-US samples) met inclusion criteria. Seven observers independently coded studies and met in pairs to reach consensus.

    RESULTS Six different meta-analyses were conducted by using 3 predictors (bullying victimization, bullying perpetration, and bully/victim status) and 2 outcomes (suicidal ideation and suicidal behaviors). A total of 280 effect sizes were extracted and multilevel, random effects meta-analyses were performed. Results indicated that each of the predictors were associated with risk for suicidal ideation and behavior (range, 2.12 [95% confidence interval (CI), 1.67–2.69] to 4.02 [95% CI, 2.39–6.76]). Significant heterogeneity remained across each analysis. The bullying perpetration and suicidal behavior effect sizes were moderated by the study’s country of origin; the bully/victim status and suicidal ideation results were moderated by bullying assessment method.

    CONCLUSIONS Findings demonstrated that involvement in bullying in any capacity is associated with suicidal ideation and behavior. Future research should address mental health implications of bullying involvement to prevent suicidal ideation/behavior.

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    Address correspondence to Andrew Adesman, MD, Division of Developmental and Behavioral Pediatrics, Steven and Alexandra Cohen Children’s Medical Center of New York, 1983 Marcus Ave, Suite 130, Lake Success, NY 11042. E-mail: aadesman@northwell.edu

    OBJECTIVES To examine, in a large, nationally representative sample of high school students, the association between bullying victimization and carrying weapons to school and to determine to what extent past experience of 1, 2, or 3 additional indicators of peer aggression increases the likelihood of weapon carrying by victims of bullying (VoBs).

    METHODS National data from the 2015 Youth Risk Behavior Survey were analyzed for grades 9 to 12 (N = 15624). VoB groups were determined by self-report of being bullied at school and additional adverse experiences: fighting at school, being threatened or injured at school, and skipping school out of fear for one’s safety. Weapon carrying was measured by a dichotomized (ie, ≥ 1 vs 0) report of carrying a gun, knife, or club on school property. VoB groups were compared with nonvictims with respect to weapon carrying by logistic regression adjusting for sex, grade, and race/ethnicity.

    RESULTS When surveyed, 20.2% of students reported being a VoB in the past year, and 4.1% reported carrying a weapon to school in the past month. VoBs experiencing 1, 2, or 3 additional risk factors were successively more likely to carry weapons to school. The subset of VoBs who experienced all 3 additional adverse experiences were more likely to carry weapons to school compared with nonvictims (46.4% vs 2.5%, P < .001).

    CONCLUSIONS Pediatricians should recognize that VoBs, especially those who have experienced 1 or more indicators of peer aggression in conjunction, are at substantially increased risk of weapon carrying.

  9. Page 79
    Address correspondence to Jodi Halpern, MD, PhD, Joint Medical Program, 570 University Hall, University of California-Berkeley, Berkeley, CA 94720. E-mail: jhalpern@berkeley.edu

    BACKGROUND Recent research shows that by age 5, children form rigid social hierarchies, with some children consistently subordinated, and then later, bullied. Further, several studies suggest that enduring mental and physical harm follow. It is time to analyze the health burdens posed by early social dominance and to consider the ethical implications of ongoing socially caused harms.

    METHODS First, we reviewed research demonstrating the health impact of early childhood subordination. Second, we used philosophical conceptions of children’s rights and social justice to consider whether children have a right to protection and who has an obligation to protect them from social harms.

    RESULTS Collectively, recent studies show that early subordination is instantiated biologically, increasing lifetime physical and mental health problems. The pervasive, and enduring nature of these harms leads us to argue that children have a right to be protected. Further, society has a role responsibility to protect children because society conscripts children into schools. Society’s promise to parents that schools will be fiduciaries entails an obligation to safeguard each child’s right to a reasonably open future. Importantly, this role responsibility holds independently of bearing any causal responsibility for the harm. This new argument based on protecting from harm is much stronger than previous equality of opportunity arguments, and applies broadly to other social determinants of health.

    CONCLUSIONS Social institutions have a role responsibility to protect children that is not dependent on playing a causal role in the harm. Children’s rights to protection from social harms can be as strong as their rights to protection from direct bodily harms. Pediatrics 2015;135:S24–S30

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    OBJECTIVE To investigate whether increasing risk and challenge in primary school playgrounds influences interactions between children.

    METHODS In a 2-year cluster-randomized controlled trial, 8 control schools were asked to not change their play environment, whereas 8 intervention schools increased opportunities for risk and challenge (eg, rough-and-tumble play), reduced rules, and added loose parts (eg, tires). Children (n = 840), parents (n = 635), and teachers (n = 90) completed bullying questionnaires at baseline, 1 (postintervention), and 2 (follow-up) years.

    RESULTS Intervention children reported higher odds of being happy at school (at 2 years, odds ratio [OR]: 1.64; 95% confidence interval [CI]: 1.20–2.25) and playing with more children (at 1 year, OR: 1.66; 95% CI: 1.29–2.15) than control children. Although intervention children indicated they were pushed/shoved more (OR: 1.33; 95% CI: 1.03–1.71), they were less likely to tell a teacher (OR: 0.69; 95% CI: 0.52–0.92) at 2 years. No significant group differences were observed in parents reporting whether children had “ever” been bullied at school (1 year: P = .23; 2 years: P = .07). Intervention school teachers noticed more bullying in break time at 1 year (difference in scores: 0.20; 95% CI: 0.06–0.34; P = .009), with no corresponding increase in children reporting bullying to teachers (both time points, P ≥ .26).

    CONCLUSIONS Few negative outcomes were reported by children or parents, except for greater pushing/shoving in intervention schools. Whether this indicates increased resilience as indicated by lower reporting of bullying to teachers may be an unanticipated benefit.

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