Marci Feldman Hertz

Bullying and Suicide: A Public Health Approach

Several recent studies have found an association between bullying and depression [1] or bullying and suicide-related behaviors [2], and one study found evidence consistent with a causal link, at least for girls [3,4]. These studies, in conjunction with extensive media coverage of the deaths by suicide of several young people who were victims of bullying, led the Centers for Disease Control and Prevention (CDC) to convene an expert panel focusing on the relationship between bullying involvement and suicide-related behaviors. The purpose of the panel, held in September 2010, was to synthesize the latest research about the relationship between youth involvement in bullying (youth who bully, youth who are bullied, and those who bully and are bullied) and suicide-related behaviors (attempts, fatalities, and risk factors associated with suicide, such as depression). Experts on the topics of bullying and suicide presented their research about the relationship between these two behaviors; their work is contained in this supplement. The panel and this special issue provide clarity around the complicated issues of bullying and suicide among youth. Three key themes emerged: (1) bullying among youth is a significant public health problem; it is prevalent and frequently has detrimental effects; (2) there is a strong association between bullying and suicide-related behaviors, but this relationship is often mediated by other factors, including depression and delinquency; and (3) there are public health strategies that can be applied to the prevention of bullying and suicide.

Impacts of Metal Detector Use in Schools: Insights From 15 Years of Research ∗

BACKGROUND Multiple approaches exist, both in theory and in practice, to reduce young peoples risk of violent victimization when they are in school. Among these approaches, a growing number of school districts are choosing to install metal detectors. We sought to review the literature available on the impacts of metal detectors on school violence and perceptions about school violence. METHODS We conducted an extensive literature search, including databases for the medical, public health, sociology, and political science literature. Of 128 papers that met our search criteria, 7 studies met inclusion criteria for the literature review. RESULTS Each of the papers reviewed utilized data that originated from self-report surveys. Four of the studies consisted of secondary analyses of national databases, with the other 3 utilizing local surveys. The studies varied as to the outcome, ranging from student/staff perceptions of safety at school to student self-reports of weapon carrying and/or victimization, and showed mixed results. Several studies suggested potential detrimental effects of metal detectors on student perceptions of safety. One study showed a significant beneficial effect, linking metal detector use to a decrease in the likelihood that students reported carrying a weapon while in school (7.8% vs 13.8%), without a change in weapon carrying in other settings or a decline in participation in physical fights. CONCLUSION There is insufficient data in the literature to determine whether the presence of metal detectors in schools reduces the risk of violent behavior among students, and some research suggests that the presence of metal detectors may detrimentally impact student perceptions of safety.

Association between Bullying Victimization and Health Risk Behaviors among High School Students in the United States.

BACKGROUND Childhood exposure to adverse experiences has been associated with adult asthma, smoking, sexually transmitted disease, obesity, substance use, depression, and sleep disturbances. Conceptualizing bullying as an adverse childhood experience, 2011 Youth Risk Behavior Survey (YRBS) data were used to examine the relationship between in-person and electronic bullying victimization among US high school students and health risk behaviors and conditions related to violence, substance use, sexual risk, overweight and physical activity, sleep, and asthma. METHODS Data were from the 2011 national YRBS among students who answered questions about in-person and electronic bullying (N = 13,846). The YRBS is a biennial, nationally representative survey of students in grades 9-12 (overall response rate = 71%). Logistic regression analyses, stratified by sex and controlling for race/ethnicity and grade, examined the association between bullying victimization and health risk behaviors or conditions. RESULTS Rates of victimization varied; 9.4% of students reported being bullied in-person and electronically, 10.8% only bullied in-person, 6.8% only electronically bullied, and 73.0% uninvolved. Bullying was associated with nearly all health risk behaviors and conditions studied. CONCLUSION Assessing the broad functioning and behaviors of victims of bullying could enable educators and health practitioners to intervene early and promote the long-term health of youth.

Media Violence Exposure and Physical Aggression in Fifth-Grade Children

OBJECTIVE To examine the association of media violence exposure and physical aggression in fifth graders across 3 media types. METHODS We analyzed data from a population-based, cross-sectional survey of 5,147 fifth graders and their parents in 3 US metropolitan areas. We used multivariable linear regression and report partial correlation coefficients to examine associations between childrens exposure to violence in television/film, video games, and music (reported time spent consuming media and reported frequency of violent content: physical fighting, hurting, shooting, or killing) and the Problem Behavior Frequency Scale. RESULTS Child-reported media violence exposure was associated with physical aggression after multivariable adjustment for sociodemographics, family and community violence, and child mental health symptoms (partial correlation coefficients: TV, 0.17; video games, 0.15; music, 0.14). This association was significant and independent for television, video games, and music violence exposure in a model including all 3 media types (partial correlation coefficients: TV, 0.11; video games, 0.09; music, 0.09). There was a significant positive interaction between media time and media violence for video games and music but not for television. Effect sizes for the association of media violence exposure and physical aggression were greater in magnitude than for most of the other examined variables. CONCLUSIONS The association between physical aggression and media violence exposure is robust and persistent; the strength of this association of media violence may be at least as important as that of other factors with physical aggression in children, such as neighborhood violence, home violence, child mental health, and male gender.

Associations of School Violence With Physical Activity Among U.S. High School Students

BACKGROUND This study investigated associations of violence-related behaviors with physical activity (PA)-related behaviors among U.S. high school students. METHODS Data from the 2009 national Youth Risk Behavior Survey, a cross-sectional survey of a nationally representative sample of 9th-12th grade students, were analyzed. Sex-stratified, adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were estimated for associations between violence-related behaviors and being physically active for ≥60 minutes daily, sports participation, TV watching for ≥3 hours/day, and video game/computer use for ≥3 hours/day. RESULTS Among male students, at-school bullying victimization was negatively associated with daily PA (aOR: 0.72; 95% CI: 0.58-0.87) and sports participation; skipping school because of safety concerns was positively associated with video game/computer use (1.42; 1.01-2.00); and physical fighting was positively associated with daily PA. Among female students, at-school bullying victimization and skipping school because of safety concerns were both positively associated with video game/computer use (1.46; 1.19-1.79 and 1.60; 1.09-2.34, respectively), and physical fighting at school was negatively associated with sports participation and positively associated with TV watching. CONCLUSIONS Bullying victimization emerged as a potentially important risk factor for insufficient PA. Schools should consider the role of violence in initiatives designed to promote PA.

Connecting the Dots: State Health Department Approaches to Addressing Shared Risk and Protective Factors Across Multiple Forms of Violence

Violence takes many forms, including intimate partner violence, sexual violence, child abuse and neglect, bullying, suicidal behavior, and elder abuse and neglect. These forms of violence are interconnected and often share the same root causes. They can also co-occur together in families and communities and can happen at the same time or at different stages of life. Often, due to a variety of factors, separate, “siloed” approaches are used to address each form of violence. However, understanding and implementing approaches that prevent and address the overlapping root causes of violence (risk factors) and promote factors that increase the resilience of people and communities (protective factors) can help practitioners more effectively and efficiently use limited resources to prevent multiple forms of violence and save lives. This article presents approaches used by 2 state health departments, the Maryland Department of Health and Mental Hygiene and the Colorado Department of Public Health and Environment, to integrate a shared risk and protective factor approach into their violence prevention work and identifies key lessons learned that may serve to inform crosscutting violence prevention efforts in other states.

Healthy people 2010 objectives for unintentional injury and violence among adolescents trends from the national youth risk behavior survey, 1999-2009

BACKGROUND In 2000, the USDHHS released Healthy People 2010 (HP2010), a series of disease prevention and health promotion objectives for the nation. Thirty-nine of these objectives were dedicated to injury prevention and six of these objectives related to adolescents, who were tracked through CDCs National Youth Risk Behavior Survey (YRBS). PURPOSE This paper uses national YRBS data from 1999 to 2009 to analyze overall and subgroup trends and determine progress toward targets for the following HP2010 objectives: seatbelt use (HP2010 objective 15-19); motorcycle helmet use (15-21); riding with a driver who had been drinking alcohol (26-6); physical fighting (15-38); weapon carrying on school property (15-39); and suicide attempts requiring medical attention (18-2). METHODS The CDC conducted the national YRBS biennially from 1999 to 2009 and used similar three-stage cluster-sample designs to obtain representative samples of high school students in the U.S. This study was conducted in 2010 and used linear and quadratic time variables simultaneously in logistic regression models while controlling for gender, race/ethnicity, and grade to test for secular trends over time. RESULTS Only two objectives met their HP2010 targets: riding with a driver who had been drinking alcohol (26-6) and physical fighting (15-38). Progress was seen for four additional objectives and within some subgroups. CONCLUSIONS Substantial policy and practice changes must occur if the recently released Healthy People 2020 targets are to be met. School-, community-, and state-level policies and programs may be effective tools to prevent injuries and victimizations.

Partnerships for Preventing Violence A Locally-Led Satellite Training Model

Local face-to-face provider training has the benefit of enabling participants to network with people in their communities who are working on similar issues, to engage in interactive discussions, and to learn from local experts and local program examples. However, face-to-face training has considerable costs (labor and expense) and provides limited exposure to national experts. In recent years, technology has allowed training methods to expand to include distance learning methods (satellite and web-based). The newer methods can decrease per-person training costs, provide exposure to national experts, and result in wide dissemination of information. Yet these distance learning methods often limit the ability of participants to interact and network with each other and substantially reduce opportunities to apply the learning objectives to local circumstances. To maximize the benefits of both models, the Harvard School of Public Health, the Prevention Institute, and the Education Development Center developed, implemented, and evaluated Partnerships for Preventing Violence (PPV), an innovative six-part satellite training series on the public health approach to preventing youth violence. Using a unique hybrid methodology that combines satellite training with local, face-to-face facilitation by trained experts, PPV trained over 13,000 people, generated youth violence prevention activities across the country, and created a national cadre of youth violence prevention leaders.

Online Aggression: A Reflection of In-Person Victimization or a Unique Phenomenon?

m h t p c d v a a f G t a l a Bullying is an age-old phenomenon. In 1904, Stanley G. Hall, he first president of the American Psychological Association, escribedbullying behaviors in his book chapter, “Juvenile faults, mmoralities, and crimes [1].” In 1945, 50% of sixth-grade boys in ose Zeligs’ study cited bullying as “an annoying social factor 2].” Times have changed and, although bullying remains, its haracter has changed as well. Young people today live as much n the virtual world as in the “real world.” Aggression experinced remotely may be just as upsetting as aggression experinced in person, especially because the victimization may be witnessed” by hundreds of peers. The analysis by Mitchell et al 3] in this issue of the Journal of Adolescent Health contributes to a rowing body of research that seeks to understand the differnces and similarities between in-person and virtual aggression. The work by Mitchell et al highlights the overlap between n-person and online victimization, raising the following quesions: Is online aggression a unique and discrete phenomenon hat requires new prevention and intervention strategies? Or, is nline aggression a manifestation of in-person aggression? The imilarity in intent of the perpetrator (to embarrass, humiliate, r threaten), the co-occurrence of in-person and online victimzation, and shared risk and protective factors suggest the latter. he online environment simply provides amore efficientway for oung people to aggress. Thus, violence prevention strategies ith evidence of effectiveness in reducing in-person aggression ay also be effective when applied to online aggression. Although there are a few differences in risk and protective actors associated with in-person and online victimization and erpetration (e.g., online victims may be more likely to experince depression [4]), there aremanymore similarities. Similar to n-person aggression, three distinct groups are involved in online ggression: victims only, perpetrators only, and those who are oth victims and perpetrators [5,6]. In addition, similar to inerson victims, online victims are frequently more likely to have roblems at school, feel unsafe at school, and experience psychoogical distress [7–9]. Both online and in-person perpetrators are ikely to be school peers [5–7], to approve of bullying morally 10], exhibit symptoms of depression [4], have school problems