Original article| Volume 64, ISSUE 5, P664-670, May 2019

Download started.


Mechanisms and Frequency of Violent Injuries Among Victims and Perpetrators of Bullying



      This article aims to (1) evaluate whether bullying typology predicts violent injury; (2) longitudinally examine whether violent injury trajectories differ across bullying typology as children age; and (3) longitudinally determine whether children who consistently reported perpetration or victimization (i.e., reported bullying at fifth, seventh, and 10th grade) were different from children who inconsistently reported perpetration or victimization.


      Longitudinal data were obtained from 4,297 children at three waves (fifth, seventh, and 10th grade) in three United States communities. Children were categorized into four mutually exclusive bullying typologies: neither victim nor perpetrator; victim only; perpetrator only; victim-perpetrator. Children self-reported mechanisms of violent injuries that needed medical attention in the past year. Regression models were used to evaluate the relationship between bullying group and the likelihood of violent injury over time.


      Seventeen percent (n=857) of children in fifth grade reported a violent injury. Prevalence of overall violent injuries, and specifically firearm and knife injuries, increased over time. Children who reported perpetration in the absence of victimization were at increased odds for violent injury (adjusted odds ratio = 1.41, 95% confidence interval: 1.24, 1.60) compared with children who reported neither victimization nor perpetration, while children who reported victimization in the absence of perpetration were at decreased odds (adjusted odds ratio=.84, 95% confidence interval: .73, .97). A significant linear dose-response relationship was observed between duration of bullying perpetration and violent injury.


      The relationship between bullying perpetration and violent injury over time was strong. Future research should investigate potential mediating behaviors, such as weapon access, which might explain the observed relationship.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Adolescent Health
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • National Academy of Science, Engineering, and Medicine
        Preventing Bullying: Through science, policy, and practice.
        The National Academies Press, Washington, D.C.2016
        • Bradshaw C.P.
        • Sawyer A.L.
        • O'Brennan L.M.
        Bullying and peer victimization at school: Perceptual differences between students and school staff.
        Sch Psychol Rev. 2007; 36: 361-382
        • Bond L.
        • Carlin J.B.
        • Thomas L.
        • et al.
        Does bullying cause emotional problems? A prospective study of young teenagers.
        Br Med J. 2001; 323: 480-484
        • Gini G.
        • Pozzoli T.
        Association between bullying and psychosomatic problems: A meta-analysis.
        Pediatrics. 2009; 123: 1059-1065
        • Schuster M.A.
        • Bogart L.M.
        Did the ugly duckling have PTSD? Bullying, its effects, and the role of pediatricians.
        Pediatrics. 2013; 131: e288-e291
        • Klomek A.
        • Marrocco F.
        • Kleinman M.
        • et al.
        Bullying, depression, and suicidality in adolescents.
        J Am Acad Child Psychol. 2007; 46: 40-49
        • Kaltiala-Heino R.
        • Rimpela M.
        • Marttunen M.
        • et al.
        Bullying, depression, and suicidal ideation in Finnish adolescents: School survey.
        Br J Med. 1999; 319: 348-351
        • Bogart L.M.
        • Elliott M.N.
        • Klein D.J.
        • et al.
        Peer victimization in fifth grade and health in tenth grade.
        Pediatrics. 2014; 133: 440-447
        • Earnshaw V.A.
        • Elliott M.N.
        • Reisner S.L.
        • et al.
        Peer victimization, depressive Symptoms, and substance Use: A longitudinal analysis.
        Pediatrics. 2017; 139: e20163426
        • Beran T.N.
        • Hughes G.
        • Lupart J.
        A model of achievement and bullying: Analyses of the Canadian national longitudinal survey of children and youth data.
        Educ Res. 2008; 50: 25-39
        • Schuster M.A.
        • Bogart L.M.
        • Elliott M.N.
        • et al.
        A longitudinal study of bullying of sexual-minority youth.
        N Engl J Med. 2015; 372: 1872-1874
        • Shaikh M.A.
        • Kayani A.
        • Shaikh I.A.
        Bullying and injury profile of female intermediate and bachelor programme students–perspective from Islamabad.
        J Pak Med Assoc. 2013; 63: 411-412
        • Muula A.S.
        • Siziya S.
        • Rudatsikira E.
        Prevalence and socio-demographic correlates for serious injury among adolescents participating in the Djibouti 2007 Global School-based Health Survey.
        BMC Res Notes. 2011; 4: 372
        • Dukes R.L.
        • Stein J.A.
        • Zane J.I.
        Gender differences in the relative impact of physical and relational bullying on adolescent injury and weapon carrying.
        J Sch Psychol. 2010; 48: 511-532
        • Sullivan T.
        • Farrell A.
        • Kliewer W.
        Peer victimization in early adolescence: Association between physical and relational victimization and drug use, aggression, and delinquent behaviors among urban middle school students.
        Dev Psychopathol. 2006; 18: 119-137
        • Huang F.L.
        • Cornell D.G.
        The impact of definition and question order on the prevalence of bullying victimization using student self-reports.
        Psychol Assess. 2015; 27: 1484-1493
        • Haynie D.L.
        • Nansel T.
        • Eitel P.
        • et al.
        Bullies, victims, and bully-victims: Distinct groups of at-risk youth.
        J Early Adolescence. 2001; 21: 29-49
        • Nansel T.
        • Craig W.
        • Overpeck M.
        The health behavior in school-aged children bullying analysis working group. Cross-national consistency in the relationship between bullying behaviors and psychosocial adjustment.
        Arch Pediatr Adolesc Med. 2004; 158: 730-736
        • Veenstra R.
        • Lindenberg S.
        • Oldehinkel A.J.
        • et al.
        Bullying and victimization in elementary schools: A comparison of bullies, victims, bully/victims, and uninvolved preadolescents.
        Dev Psychol. 2005; 41: 672-682
        • Windle M.
        • Grunbaum J.
        • Elliott M.
        • et al.
        Healthy Passages: A multilevel, multimethod longitudinal study of adolescent health.
        Am J Prev Med. 2004; 27: 164-172
        • Schuster M.A.
        • Eilliott M.N.
        • Kanouse D.E.
        • et al.
        Racial and ethnic health disparities among fifth-graders in three cities.
        N Engl J Med. 2012; 367: 735-745
        • Vernberg E.M.
        • Jacobs A.K.
        • Hershberger S.L.
        Peer victimization and Attitudes about violence during early adolescence.
        J Clin Child Psychol. 1999; 28: 386-395
        • Gladden R.M.
        • Vivolo-Kantor A.M.
        • Hamburger M.E.
        • et al.
        Bullying Surveillance among youths: Uniform Definitions for public health and Recommended data Elements, Version 1.0.
        National Center for Injury Prevention and Control, Centers for Disease Control and Prevention and U.S. Department of Education, Atlanta, GA2014
        • Bogart L.M.
        • Elliot M.N.
        • Kanouse D.E.
        • et al.
        Association between percieved discrimination and racial/ethnic disparities in problem behaviors among preadolescent youth.
        Am J Public Health. 2013; 103: 1074-1081
        • Farrell A.D.
        • Kung E.M.
        • White K.S.
        The structure of self-reported aggression, drug use, and delinquent behaviors during early adolescence.
        J Clin Child Psychol. 2000; 29: 282-292
        • Christoffel K.K.
        • Scheidt P.C.
        • Agran P.F.
        • et al.
        Standard definitions for childhood injury research: Excerpts of a conference report.
        Pediatrics. 1992; 89: 1027-1034
        • SAS Institute Inc
        SAS 9.4.
        SAS Institute Inc., Cary, NC2014
        • Jetelina K.K.
        • Reingle Gonzalez J.M.
        • Cuccaro P.M.
        • et al.
        The association between Familial Homelessness, aggression, and victimization among a cohort of children.
        J Adolesc Health. 2016; 59: 688-695
        • Webster D.W.
        • Gainer P.S.
        • Champion H.R.
        Weapon carrying among inner-city junior high school students: Defensive behavior vs aggressive delinquency.
        Am J Public Health. 1993; 83: 1604-1608
        • Jennings W.G.
        • Piquero A.R.
        • Reingle J.M.
        On the overlap between victimization and offending: A review of the literature.
        Aggression Violent Behav. 2011; 17: 16-26
        • Carlyle K.
        • Steinman K.
        Demographic differences in the prevalence, co-occurrence, and correlates of adolescent bullying at school.
        J Sch Health. 2007; 77: 623-629
        • Holmes S.R.
        • Brandenburg-Ayres S.J.
        Bullying behavior in school: A predictor of later gang involvement.
        J Gang Res. 1998; 5: 1-6
        • Nansel T.R.
        • Overpeck M.D.
        • Haynie D.L.
        • et al.
        Relationships between bullying and violence among US youth.
        JAMA Pediatr. 2003; 157: 348-353
        • Newman J.C.
        • Des Jarlais D.C.
        • Turner C.F.
        • et al.
        The differential effects of face-to-face and computer interview modes.
        Am J Public Health. 2001; 92: 294-297
        • Robers S.
        • Kemp J.
        • Rathbun A.
        • et al.
        Indicators of school crime and safety: 2013.
        U.S. Department of Education, 2014
        • Lawless R.A.
        • Moore E.E.
        • Cohen M.J.
        • et al.
        Us national trends in violent and unintentional injuries, 2000 to 2016.
        JAMA Surg. 2018;
        • Solberg M.E.
        • Olweus D.
        Prevalence estimation of school bullying with the Olweus bully/victim Questionnaire.
        Aggressive Behav. 2003; 29: 239-268