Tonja R. Nansel

School bullying among adolescents in the United States: physical, verbal, relational, and cyber.

PURPOSE Four forms of school bullying behaviors among US adolescents and their association with sociodemographic characteristics, parental support, and friends were examined. METHODS Data were obtained from the Health Behavior in School-Aged Children (HBSC) 2005 Survey, a nationally representative sample of grades 6-10 (N = 7,182). The revised Olweus Bully/Victim Questionnaire was used to measure physical, verbal, and relational forms of bullying. Two items were added using the same format to measure cyber bullying. For each form, four categories were created: bully, victim, bully-victim, and not involved. Multinomial logistic regressions were applied, with sociodemographic variables, parental support, and number of friends as predictors. RESULTS Prevalence rates of having bullied others or having been bullied at school for at least once in the last 2 months were 20.8% physically, 53.6% verbally, 51.4% socially, or 13.6% electronically. Boys were more involved in physical or verbal bullying, whereas girls were more involved in relational bullying. Boys were more likely to be cyber bullies, whereas girls were more likely to be cyber victims. African-American adolescents were involved in more bullying (physical, verbal, or cyber) but less victimization (verbal or relational). Higher parental support was associated with less involvement across all forms and classifications of bullying. Having more friends was associated with more bullying and less victimization for physical, verbal, and relational forms but was not associated with cyber bullying. CONCLUSIONS Parental support may protect adolescents from all four forms of bullying. Friends associate differentially with traditional and cyber bullying. Results indicate that cyber bullying is a distinct nature from that of traditional bullying.

Bullies, Victims, and Bully/Victims: Distinct Groups of At-Risk Youth

Bullying and victimization are prevalent problems in the area of adolescent peer relationships. Middle school students (N = 4,263) in one Maryland school district completed surveys covering a range of problem behaviors and psychosocial variables. Overall,30.9% of the students reported being victimized three or more times in the past year and 7.4% reported bullying three or more times over the past year. More than one half of the bullies also reported being victimized. Those bully/victims were found to score less favorably than either bullies or victims on all the measured psychosocial and behavioral variables. Results of a discriminant function analysis demonstrated that a group of psychosocial and behavioral predictors—including problem behaviors, attitudes toward deviance, peer influences, depressive symptoms, school-related functioning, and parenting—formed a linear separation between the comparison group (never bullied or victimized), the victim group, the bully group, and the bully/victim group.

Cyber and traditional bullying: differential association with depression.

PURPOSE The study compared levels of depression among bullies, victims, and bully-victims of traditional (physical, verbal, and relational) and cyber bullying that is a relatively new form of bullying. The study also examined the association between depression and frequency of involvement in each form of bullying. METHODS A U.S. nationally representative sample of students in grades 6-10 (N = 7,313) completed the bullying and depression items in the Health Behavior in School-Aged Children 2005 Survey. RESULTS Depression was associated with each of the four forms of bullying. Cyber victims reported higher depression than bullies or bully-victims, a result not observed in other forms of bullying. For physical, verbal, and relational bullies, the frequently-involved group of victims and bully victims reported a significantly higher level of depression than the corresponding occasionally involved group. For cyber bullying, differences were found only between the occasional and frequent victims. CONCLUSION Results indicated the importance of further study of cyber bullying because its association with depression was distinct from traditional forms of bullying.

Co-occurrence of Victimization from Five Subtypes of Bullying: Physical, Verbal, Social Exclusion, Spreading Rumors, and Cyber

OBJECTIVE To examine co-occurrence of five subtypes of peer victimization. METHODS Data were obtained from a national sample of 7,475 US adolescents in grades 6 through 10 in the 2005/2006 Health Behavior in School-Aged Children (HBSC) study. Latent class analyses (LCA) were conducted on victimization by physical, verbal, social exclusion, spreading rumors, and cyber bullying. RESULTS Three latent classes were identified, including an all-types victims class (9.7% of males and 6.2% of females), a verbal/relational victims class (28.1% of males and 35.1% of females), and a nonvictim class (62.2% of males and 58.7% of females). Males were more likely to be all-type victims. There was a graded relationship between the three latent classes and level of depression, frequency of medically attended injuries, and medicine use, especially among females. CONCLUSIONS Increased co-occurrence of victimization types put adolescents at greater risks for poorer physical and psychological outcomes.

Self-efficacy, Outcome Expectations, and Diabetes Self-management in Adolescents with Type 1 Diabetes

ABSTRACT. The goal of this research was to develop and evaluate measures of adolescent diabetes management self-efficacy and outcome expectations that reflect developmentally relevant, situation-specific challenges to current diabetes regimens. Self-efficacy for diabetes management, expected outcomes of adherence, adherence to the diabetes regimen, and glycemic control were assessed in 168 adolescents (ages10-16 years) with type 1 diabetes. Factor analyses indicated a single scale for self-efficacy and two distinct factors representing positive and negative outcome expectations. Reliability and predictive validity of the new scales were supported. In regression analyses, self-efficacy and the interaction of self-efficacy with expectations of positive outcomes were significantly associated with diabetes self-management adherence and glycemic control in older adolescents. The effect of self-efficacy was greatest when adolescents had stronger beliefs in the beneficial outcomes of adherence. These brief measures can be used to identify youths at risk of poor diabetes self-management. Interventions targeting self-efficacy may lead to improved diabetes self-management.

Bacterial Vaginosis Assessed by Gram Stain and Diminished Colonization Resistance to Incident Gonococcal, Chlamydial, and Trichomonal Genital Infection

BACKGROUND We sought to assess the relationship between bacterial vaginosis (BV) assessed by Gram stain and incident trichomonal, gonococcal, and/or chlamydial genital infection. METHODS This longitudinal study included 3620 nonpregnant women aged 15-44 years who presented for routine care at 12 clinics in Birmingham, Alabama. Participants were assessed quarterly for 1 year. Vaginal smears were categorized by the Nugent Gram stain score (0-3, normal; 4-6, intermediate state; 7-10, BV). Pooled logistic regression was used to estimate the hazard ratios for the comparison of trichomonal, gonococcal, and chlamydial infection incidence in participants by Nugent score at the prior visit. Participants were censored at their first visit with a positive test result for trichomonal, gonococcal, and/or chlamydial infection. RESULTS Of the 10,606 eligible visits, 37.96% were classified by BV and 13.3% by positive detection of trichomonal, gonococcal, and/or chlamydial infection. An intermediate state or BV at the prior visit was associated with a 1.5-2-fold increased risk for incident trichomonal, gonococcal, and/or chlamydial infection (adjusted hazard ratio [AHR] for intermediate state, 1.41 [95% confidence interval {CI}, 1.12-1.76]; AHR for BV, 1.73 [95% CI, 1.42-2.11]; P= .058 for trend). Estimates were similar for trichomonal-only, gonococcal-only, and chlamydial-only infection outcomes. CONCLUSION BV microbiota as gauged by Gram stain is associated with a significantly elevated risk for acquisition of trichomonal, gonococcal, and/or chlamydial genital infection.

Vulvovaginal symptoms in women with bacterial vaginosis.

OBJECTIVE: A substantial, but highly variable, percentage of women with bacterial vaginosis are said to be asymptomatic. The purpose of this study was to estimate the prevalence of symptoms among women with bacterial vaginosis compared with women without bacterial vaginosis by direct, explicit, and detailed questioning of these women. METHODS: Women presenting for a routine health care visit at 12 health department clinics in Birmingham, Alabama, were recruited to participate in a longitudinal study of vaginal flora. At the first visit, they underwent a pelvic examination, lower genital tract microbiological evaluation, and an interview that included detailed questions regarding lower genital tract symptoms. The prevalence of symptoms among women with and without bacterial vaginosis (Gram stain score 7 or higher) was compared. RESULTS: Among 2,888 women without gonorrhea, Chlamydia, or trichomonas, 75% of women with and 82% of women without bacterial vaginosis never noted any vaginal odor in the past 6 months (P < .001). The corresponding values were 63% and 65% for never noting vaginal “wetness” (P = .02); 58% and 57% for vaginal discharge (P = .65); 91% and 86% for irritation (P = .004); 88% and 85% for itching (P = .64); and 96% and 94% for dysuria (P = .002), respectively. Cumulatively, 58% of women with bacterial vaginosis noted odor, discharge, and/or wetness in the past 6 months compared with 57% of women without bacterial vaginosis (P = .70). CONCLUSION: The 2 classic symptoms of bacterial vaginosis discharge and odor are each reported by a minority of women with bacterial vaginosis and are only slightly more prevalent than among women without bacterial vaginosis. LEVEL OF EVIDENCE: II-3

The Association of Bullying and Victimization with Middle School Adjustment

ABSTRACT Bullying others or being victimized during the transition to middle school may be an important risk factor for school adjustment problems; however, it has been minimally addressed in previous research. This study examined the relationship of bullying and being victimized during the first year of middle school with subsequent school adjustment. Self-report data were obtained from 930 youth at the beginning of 6th grade, the end of 6th grade, and the end of 7th grade. After controlling for baseline scores, youth who were classified as bullies, victims, or bully-victims during sixth grade showed poorer school adjustment than their non-involved peers. In addition, those who were victims or bully-victims during 6th grade reported a more negative perceived school climate than bullies or comparison youth. These differences persisted over time. Findings suggest that problematic peer interactions may hinder youths adaptation to the middle school environment.

A Longitudinal Study of Vaginal Douching and Bacterial Vaginosis—A Marginal Structural Modeling Analysis

The etiology of bacterial vaginosis is unknown, and there are no long-term therapies for preventing this frequently recurring condition. Vaginal douching has been reported to be associated with bacterial vaginosis in observational studies. However, this association may be due to confounding by indication--that is, confounding by women douching in response to vaginal symptoms associated with bacterial vaginosis. The authors used marginal structural modeling to estimate the causal effect of douching on bacterial vaginosis risk while controlling for this confounding effect. In 1999-2002, nonpregnant women (n = 3,620) were recruited into a prospective study when they visited one of 12 public health clinics in Birmingham, Alabama, for routine care. Participants were assessed quarterly for 1 year. Bacterial vaginosis was based on a Nugents Gram stain score of 7 or higher. Thirty-two percent of participants douched in every study interval, and 43.0% never douched. Of the 12,349 study visits, 40.2% were classified as involving bacterial vaginosis. The relative risk for regular douching as compared with no douching was 1.21 (95% confidence interval: 1.08, 1.38). These findings indicate that douching confers increased risk of disruption of vaginal flora. In the absence of a large randomized trial, these findings provide the best evidence to date for a risk of bacterial vaginosis associated with douching.

Efficacy and tolerability of CDB-2914 treatment for symptomatic uterine fibroids: a randomized, double-blind, placebo-controlled, phase IIb study

OBJECTIVE To evaluate the efficacy and tolerability of the P receptor modulator CDB-2914 (Ulipristal, CDB). DESIGN Randomized, placebo-controlled double-blind clinical trial. SETTING Clinical research center. PATIENT(S) Premenopausal women with symptomatic uterine fibroids. INTERVENTION(S) Once-daily oral CDB (10 or 20 mg) or placebo (PLC) for 12 weeks (treatment 1). A second 3-month treatment with CDB (treatment 2) was offered. A computer-generated blocked randomization was used. MAIN OUTCOME MEASURE(S) Magnetic resonance imaging (MRI)-determined total fibroid volume (TFV) change was the primary outcome; amenorrhea and quality of life (QOL) were secondary end points. RESULT(S) Treatment 1 TFV increased 7% in the PLC group, but decreased 17% and 24% in the CDB10 and CDB20 groups. The TFV decreased further in treatment 2 (-11%). Amenorrhea occurred in 20/26 women taking CDB and none on PLC. Ovulation resumed after CDB. Hemoglobin improved only with CDB (11.9 ± 1.5 to 12.9 ± 1.0 g/dL) as did the Fibroid QOL Questionnaire symptom severity, energy/mood, and concern subscores, and overall QOL scores. The CDB was well tolerated, with no serious adverse events. Adverse events were unchanged during treatments. CONCLUSION(S) Administration of CDB-2914 for 3-6 months controls bleeding, reduces fibroid size, and improves QOL.