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Position papers of the Society for Adolescent Medicine| Volume 36, ISSUE 1, P88-91, January 2005

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Bullying and peer victimization: Position paper of the Society for Adolescent Medicine

      Definition

      The scientific literature on aggressive peer relations makes use of several different terms, including bullying, harassment and victimization. Although there may be subtle differences between these terms, they are all used to refer to behavior that is 1) aggressive or intended to harm; 2) carried out repeatedly and over time; and 3) occurs in an interpersonal relationship where a power imbalance exists [
      • Olweus D.
      • Sweden
      ]. A distinction is also made between direct and indirect behaviors. Direct bullying includes physical and verbal attacks or aggression (kicking, pushing, name-calling) while indirect bullying involves behaviors such as ignoring and gossiping which often rely on a third party [
      • Van der Wall M.F.
      • De Wit C.A.M.
      • Hirasing R.A.
      Psychosocial health among young victims and offenders of direct and indirect bullying.
      ]. Indirect bullying is also referred to as relational bullying, in that it is “aggression directed at damaging a social relationship” [
      • Espelage D.L.
      • Swearer S.M.
      Research on school bullying and victimization What have we learned and where do we go from here?.
      ]. Throughout this paper, we will use the term “bullying” to refer to behaviors meeting the three criteria above, and “victim” or “victimization” to refer to the person or the experience of being bullied.

      Scope of the problem

      It is estimated that up to three-quarters of young adolescents experience some types of bullying (such as rumors, name calling or public ridicule) and up to one-third report more extreme experiences of coercion or inappropriate touching [
      • Juvonen J.
      • Nishina A.
      • Graham S.
      Peer harassment, psychological adjustment, and school functioning in early adolescence.
      ]. In a large study of children in grades 6 through 10, 30% reported moderate or frequent involvement as a victim and/or perpetrator of bullying [
      • Nansel T.R.
      • Overpeck M.
      • Pilla R.S.
      • Ruan W.J.
      • Simons-Morton B.G.
      Bullying behavior among the U.S. youth Prevalence and association with psychological adjustment.
      ]. Direct bullying is more common among males, and indirect is more common among females [
      • Borg M.G.
      The extent and nature of bullying among primary and secondary school children.
      ]. Black youth report being bullied significantly less frequently than white or Hispanic youth [
      • Nansel T.R.
      • Overpeck M.
      • Pilla R.S.
      • Ruan W.J.
      • Simons-Morton B.G.
      Bullying behavior among the U.S. youth Prevalence and association with psychological adjustment.
      ,
      • Borg M.G.
      The extent and nature of bullying among primary and secondary school children.
      ,
      • Junger - Tas J.
      • Van Kesteren J.
      ]. Bullying behavior tends to peak in early adolescence and to decrease in frequency as adolescence progresses.

      Individual characteristics of victims

      Youth who are victimized tend to be perceived as physically weaker and have fewer friends than those who are not victimized [
      • Olweus D.
      ,
      • Pellegrini A.D.
      The rough play of adolescent boys of differing sociometric status.
      ,
      • Perry D.G.
      • Kusel S.J.
      • Perry L.C.
      Victims of peer aggression.
      ]. Gay, lesbian or bisexual adolescents are more likely to be victimized than their heterosexual peers [
      • Garofalo R.
      • Wolf R.C.
      • Kessel S.
      • Palfrey S.J.
      • DuRant R.H.
      The association between health risk behaviors and sexual orientation among a school-based sample of adolescents.
      ], and overweight and obese adolescents suffer more harassment than normal weight teens, particularly among girls [
      • Janssen I.
      • Craig W.M.
      • Boyce W.F.
      • Pickett W.
      Associations Between Overweight and Obesity With Bullying Behaviors in School-Aged Children.
      ].

      Consequences for victims

      An Australian study found that victimization in middle adolescence predicted poorer physical health in later adolescence, controlling for baseline health status [
      • Rigby K.
      Peer victimization at school and the health of secondary school students.
      ]. The psychosocial consequences of bullying are also significant: victims of bullying have reported increased rates of depression, suicidal ideation and loneliness [
      • Van der Wall M.F.
      • De Wit C.A.M.
      • Hirasing R.A.
      Psychosocial health among young victims and offenders of direct and indirect bullying.
      ,
      • Nansel T.R.
      • Overpeck M.
      • Pilla R.S.
      • Ruan W.J.
      • Simons-Morton B.G.
      Bullying behavior among the U.S. youth Prevalence and association with psychological adjustment.
      ]. One study in particular showed that young people who had been bullied repeatedly throughout middle adolescence had lower self-esteem and higher depressive symptoms as young adults, compared to those who had not been bullied, controlling for emotional health at baseline and victim status as young adults [
      • Olweus D.
      Victimization by peers Antecedents and long term outcomes.
      ]. Victimization has implications for academic success as well. Experiencing peer harassment has been associated with lower grades, disliking school and absenteeism [
      • Juvonen J.
      • Nishina A.
      • Graham S.
      Peer harassment, psychological adjustment, and school functioning in early adolescence.
      ,
      • Eisenberg M.E.
      • Neumark-Sztainer D.
      • Perry C.
      Peer harassment, school connectedness and school success.
      ]. In addition, youth who were victimized as children or adolescents also have increased rates of violence-related behaviors compared to those not involved in bullying at all [
      • Nansel T.R.
      • Overpeck M.D.
      • Haynie D.L.
      • Ruan W.J.
      • Scheidt P.C.
      Relationships between bullying and violence among US youth.
      ].

      Individual characteristics of perpetrators

      Young people who engage in bullying behaviors tend to have higher levels of overall conduct problems [
      • Junger - Tas J.
      • Van Kesteren J.
      ], and are more likely to be involved in violence-related behaviors, such as weapon carrying and frequent fighting. These associations appear to persist into adulthood. For example, Olweus studied former bullies and found a 4-fold increase in criminal behavior at age 24 [
      • Olweus D.
      Bullying among school children Intervention and prevention.
      ]. Sixty percent of the bullies had one conviction and 35 to 40% had 3 or more convictions.
      It is important to note that perpetrators of bullying behavior also have significantly poorer psychosocial outcomes than non-bullies, including depression [
      • Junger - Tas J.
      • Van Kesteren J.
      ]. The poorest psychosocial functioning may be evidenced by youth who both bully and are bullied by others [
      • Austin S.
      • Joseph S.
      Assessment of bully/victim problems in 8 to 11 year-olds.
      ,
      • Juvonen J.
      • Graham S.
      • Schuster M.A.
      Bullying Among Adolescents The Strong, the Weak and the Troubled.
      ].
      The associations described above (i.e. poor emotional adjustment, school adjustment, and high-risk health behaviors among those involved with bullying) are remarkably consistent in international comparisons. A large cross-national study by the Health Behaviour in School-aged Children Bullying Analysis Working Group [
      • Nansel T.R.
      • Craig W.
      • Overpeck M.D.
      • Saluja G.
      • Ruan J.
      Bullying and psychosocial adjustment cross-national comparisons.
      ] demonstrated that the adverse relationship between bullying involvement - as a victim, bully, or bully-victim - and psychosocial adjustment is similar across youth in 25 countries.

      Environmental factors associated with bullying behavior

      A variety of socio-environmental factors have been associated with the development of aggressive behavior in adolescence. General family characteristics, such as low involvement with parents, low parental warmth, low family cohesion and single-parent family structure have been found to be related to greater bullying among young people [
      • Olweus D.
      ,
      • Berdondini L.
      • Smith P.K.
      Cohesion and power in the families of children involved in bully/victim problems at school An Italian replication.
      ,
      • Bowers L.
      • Smith P.K.
      • Binney V.
      Cohesion and power in the families of children involved in bully/victim problems at school.
      ,
      • Flouri E.
      • Buchanan A.
      The role of mother involvement and father involvement in adolescent bullying behavior.
      ,
      • Rigby K.
      School children’s perceptions of their families and parents as a function of peer relations.
      ,
      • Rigby K.
      Psychosocial functioning in families of Australian adolescent schoolchildren involved in bully/victim problems.
      ]. Childhood experiences more germane to aggression, such as spanking and other physical discipline, inconsistent punishment, family violence, bullying and/or victimization by siblings, and father’s history of bullying have also been positively related to bullying behavior [
      • Duncan R.D.
      Peer and sibling aggression An investigation of intra- and extra-familial bullying.
      ,
      • Espelage D.L.
      • Bosworth K.
      • Simon T.R.
      Examining the social context of bullying behaviors in early adolescence.
      ,
      • Farrington D.
      Understanding and preventing bullying.
      ,
      • Strassberg Z.
      • Dodge K.A.
      • Pettit G.S.
      • Bates J.E.
      Spanking in the home and children’s subsequent aggression towards kindergarten peers.
      ].
      Studies examining peer influences on bullying behavior have concluded that increased aggressive behavior within peer networks is associated with increased bullying behavior [
      • Espelage D.L.
      • Bosworth K.
      • Simon T.R.
      Examining the social context of bullying behaviors in early adolescence.
      ,
      • Pellegrini A.D.
      • Bartini M.
      • Brooks F.
      School bullies, victims and aggressive victims factors relating to group affiliation and victimization in early adolescence.
      ]. One multi-level longitudinal study determined that after controlling for baseline levels of aggressive behavior, bullying and fighting within friendship groups was significantly predictive of these behaviors for both males and females over time. [
      • Espelage D.L.
      • Holt M.K.
      • Henkel R.R.
      Examination of peer-group contextual effects on aggression during early adolescence.
      ]. At a broader peer level, students in elementary school classrooms where aggression was normative tended to become more aggressive in future years [
      • Rodkin P.C.
      • Hodges E.V.E.
      Bullies and victims in the peer ecology Four questions for psychologists and school professionals.
      ].
      Additional characteristics of the social context of young people may also contribute to bullying behavior. For example, neighborhood safety concerns were positively associated with increased bullying behavior, while having positive adult role models was associated with less bullying behavior [
      • Espelage D.L.
      • Bosworth K.
      • Simon T.R.
      Examining the social context of bullying behaviors in early adolescence.
      ].

      Interventions to reduce bullying behavior

      Comprehensive school-based interventions aimed at reducing bullying behavior attempt to reduce opportunities and rewards for bullying by publicizing school-wide rules; training teachers to recognize and halt bullying; holding classroom discussions; implementing curricular activities; and meeting individually with bullies, victims and their parents. Evaluations of these programs have shown mixed results [
      • Smith P.K.
      • Ananiadou K.
      • Cowie H.
      Interventions to reduce school bullying.
      ]. The Olweus Bullying Prevention Program, developed in Norway by one of the leading researchers on youth bullying, has shown a 30%–70% reduction in student reports of being bullied and bullying others, significant reductions in student reports of general antisocial behavior, improvements in classroom order and discipline, and more positive attitude towards schoolwork and school [
      U.S. Department of Health and Human Services
      Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Prevention.
      ]. It is considered a “model program” by the U.S. Department of Health and Human Services’ Substance Abuse and Mental Health Services Administration. Another study assessed the impact of a comprehensive bullying prevention program in an elementary school, developed locally by a team of school personnel and parents; this study demonstrated significant reduction of peer victimization [
      • Orpinas P.
      • Horne A.M.
      • Staniszewski D.
      School bullying Changing the problem by changing the school.
      ]. However, in one of the largest trials in the U.S., conducted in 39 rural South Carolina schools, no significant differences were found between intervention and control schools in victimization rates, bullying rates, general antisocial behavior or attitudes towards bullying at the completion of the two-year intervention [
      • Smith P.K.
      • Ananiadou K.
      • Cowie H.
      Interventions to reduce school bullying.
      ]. Mixed findings reflect differences in program length, school investment, student age, and concurrence with community-wide campaigns to reduce bullying. Although several states have taken legislative action to address bullying among school children, the effectiveness of such legislation remains unknown [
      • Limber S.P.
      • Small M.A.
      State laws and policies to address bullying in schools.
      ].

      Positions

      The Society for Adolescent Medicine (SAM) supports the following positions:
      • Bullying among peers, although common, is not acceptable social behavior among youth. Adults and adolescents are encouraged to prevent bullying behavior and to change the perception that such behavior is normative.
      • Health care providers should be familiar with the characteristics of youth that may be involved in bullying, either as aggressors or victims. They need to be sensitive to signs and symptoms of bullying, victimization, their influences and their sequelae. Health care providers are encouraged to intervene early when either bullying or victimization behaviors are noted. Discussing possible interventions with the adolescent and parent is appropriate. Additionally, referral for co-occurring mental health disorders (e.g. conduct disorder, depression, anxiety) is recommended. Lastly, health care providers and school personnel can provide leadership and education to community organizations on these issues.
      • Community organizations that serve youth and their families should incorporate anti-bullying messages, address victimization and promote non-violent discipline.
      • SAM supports the goals of the National Bullying Prevention Campaign of the Health Resources and Services Administration’s Maternal and Child Health Bureau. The campaign goals are to:
        • raise awareness about bullying
        • prevent and reduce bullying behaviors
        • identify appropriate interventions for pre-teens (i.e. 9–12 year olds)
        • foster links between education, public health and other partners
      • Future research on bullying and victimization is needed. Large longitudinal studies are needed to determine if the many adverse conditions associated with victimization are long-lasting. Additional research aimed at understanding the biopsychosocial characteristics of bullies and the social circumstances of bullying might lead to better prevention programs. Further rigorous research is also needed to identify specific characteristics or aspects of school-based interventions and prevention programs that are effective in reducing bullying behaviors, and for which types of communities, schools and individuals. Research soundly rooted in theory (e.g. social and peer dynamics of bullying behavior [
        • Farmer T.W.
        • Estell D.B.
        • Bishop J.L.
        • O’Neal K.K.
        • Cairns B.D.
        Rejected bullies or popular leaders? The social relations of aggressive subtypes of rural African American early adolescents.
        ], social learning models of peer victimization [
        • Schwartz D.
        • Proctor L.J.
        Community violence exposure and children’s social adjustment in the school peer group The mediating roles of emotion regulation and social cognition.
        ]) will allow those involved in prevention and intervention efforts to focus their programs more effectively.

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