Abstract

This article aims to identify the association of sociodemographic factors and lifestyle behaviours with bullying perpetration and victimization among high school students. The adolescents (n=852) answered a questionnaire about bullying (victims and perpetrators), sociodemographic factors (sex, age, maternal education, and participant’s work status), tobacco use, alcohol use, illicit drug experimentation, physical activity, screen time, and sleep duration. Multilevel logistic regression models were performed. Older adolescents were less likely to be victims of bullying. Females were less likely to be perpetrators or victims of bullying. Adolescents who were working were more likely to be involved in bullying in both forms. Participation in non-sport activities and alcohol consumption were associated with higher odds of bullying victimization. We have identified specific populational subgroups that are more susceptible to being victims and/or perpetrators of bullying, which could support tailor-specific interventions to prevent bullying.

Key words:
Bullying; Adolescent Health; Schools; Lifestyle behaviours; Social behaviour

Resumo

O objetivo deste artigo é identificar a associação de fatores sociodemográficos e comportamentos de estilo de vida com a perpetração do bullying e da vitimização entre os alunos do ensino médio. Os adolescentes (n=852) responderam a um questionário sobre bullying (vítimas e perpetradores), fatores sociodemográficos (sexo, idade, educação materna e status profissional dos participantes), uso de tabaco, uso de álcool, experimentação de drogas ilícitas, atividade física, tempo de tela e duração do sono. Modelos de regressão logística multinível foram realizados. Os adolescentes mais velhos eram menos propensos a serem vítimas de bullying. As mulheres tinham menos probabilidade de serem perpetradoras ou vítimas de bullying. Os adolescentes que estavam trabalhando tinham maior probabilidade de estarem envolvidos em bullying em ambas as formas. A participação em atividades não esportivas e o consumo de álcool estavam associados a maiores probabilidades de vitimização por bullying. Identificamos subgrupos populacionais específicos que são mais suscetíveis a serem vítimas e/ou perpetradores de bullying, o que poderia apoiar intervenções específicas sob medida para evitar o bullying.

Palavras-chave:
Bullying; Saúde do Adolescente; Escolas; Comportamentos de estilo de vida; Comportamento social

Introduction

In recent years, bullying has been internationally recognized as a public health problem among young populations that may increase the risk of health, social, and educational problems during childhood and adolescence¹1 Currie C, Zanotti C, Morgan A, Currie D, Looze M, Roberts C, Samdal O, Smith ORF, Barnekow V. Social determinants of health and well-being among young people: Health Behaviour in School-aged Children (HBSC) study: international report from the 2009/2010 survey [Internet]. WHO; 2012 [cited 2022 dez 19]. Available from: https://apps.who.int/iris/handle/10665/326406.
https://apps.who.int/iris/handle/10665/3... . Characterized by repeated physical or verbal harassment involving an imbalance of power between the aggressor and the victim²2 Olweus D. Bully/victim problems in school: Facts and intervention. Eur J Psychol Educ 1997; 12(4):495-510., where it covers a wide range of types, frequencies, and levels of aggression, from teasing and name-calling to physical, verbal, and social abuse intended to harm other individuals³3 Kljakovic M, Hunt C. A meta-analysis of predictors of bullying and victimisation in adolescence. J Adolesc 2016; 49:134-145.^,44 Weimer WR, Moreira EC. Violência e bullying: manifestações e consequências nas aulas de Educação Física escolar. Rev Bras Cien Esporte 2014; 36(1):257-274.. Epidemiological research shows that, on average, 26-30% of schoolchildren worldwide are involved in at least one bullying situation, playing the role of perpetrator, victim, or victim and perpetrator simultaneously⁵5 Craig W, Harel-Fisch Y, Fogel-Grinvald H, Dostaler S, Hetland J, Simons-Morton B, Molcho M, Mato MG, Overpeck M, Due P, Pickett W; HBSC Violence & Injuries Prevention Focus Group; HBSC Bullying Writing Group. A cross-national profile of bullying and victimization among adolescents in 40 countries. Int J Public Health 2009; 54(Supl. 2):216-224.^,66 Elgar FJ, McKinnon B, Walsh SD, Freeman J, D Donnelly P, Matos MG, Gariepy G, Aleman-Diaz AY, Pickett W, Molcho M, Currie C. Structural Determinants of Youth Bullying and Fighting in 79 Countries. J Adolesc Health 2015; 57(6):643-650.. However, a report by the United Nations Educational, Scientific and Cultural Organization showed that there is substantial regional variation in the prevalence of bullying worldwide, ranging from 22.8% in Central America, 25.0% and 31.7% in Europe and North America respectively, and 30.2% in South America⁷7 United Nations Educational, Scientific and Cultural Organization (UNESCO). Behind the numbers: ending school violence and bullying [Internet]. 2019 [cited 2022 dez 19]. Available from: https://unesdoc.unesco.org/ark:/48223/pf0000366483.
https://unesdoc.unesco.org/ark:/48223/pf... . There is also significant geographic variation between low- and middle-income countries compared to high-income countries, thus requiring further exploratory research to identify their particularities⁸8 Alfonso-Rosa RM, García-Hermoso A, Sanders T, Parker P, Oriol-Granado X, Arnott H, Del Pozo Cruz B. Lifestyle behaviors predict adolescents bullying victimization in low and middle-income countries. J Affect Disord 2020; 273:364-374..

According to the literature, the perpetration of bullying is the result of aggressive physical or verbal behavior against other individuals without necessarily being provoked⁹9 Bandeira CM, Hutz CS. Bullying: Prevalence, implications and gender differences. Psicol Esc Educ 2012; 16(1):35-44.^,1010 Monteiro RP, Medeiros ED, Pimentel CE, Soares AKS, Medeiros HA, Gouveia VV. Valores Humanos e Bullying: Idade e Sexo Moderam essa Relação? Trends Psychol 2017; 25(3):1317-1328.. However, bullying victimization refers to individuals who have suffered intentional and repeated victimization that places them in a power imbalance with their aggressor⁹9 Bandeira CM, Hutz CS. Bullying: Prevalence, implications and gender differences. Psicol Esc Educ 2012; 16(1):35-44.^,1111 Olweus D. School bullying: development and some important challenges. Annu Rev Clin Psychol 2013; 9:751-780.. Such behaviors can lead to short- and long-term health-related consequences for those involved as a result of lifelong bullying determined by multiple factors, such as sociodemographic (e.g., gender, age, and income) and lifestyle characteristics (e.g., physical activity, screen time, and substance use). Although the effects of participation in bullying are similar, the incidence of bullying can vary depending on the role played by individuals (perpetrators and/or victims)¹²12 Horta CL, Horta RL, Mester A, Lindern D, Weber JLA, Levandowski DC, Lisboa CSM. Bullying e uso de substâncias psicoativas na adolescência: uma revisão sistemática. Cien Saude Colet 2018; 23(1):123-140.^,1313 Zych I, Ortega-Ruiz R, Del Rey R. Systematic review of theoretical studies on bullying and cyberbullying: Facts, knowledge, prevention, and intervention. Aggress Violent Behav 2015; 23:1-21..

Previous studies have shown that youth’s sociodemographic and lifestyle characteristics may differ according to their role in bullying¹⁴14 Silva GRR, Lima MLC, Acioli RML, Barreira AK. Prevalence and factors associated with bullying: differences between the roles of bullies and victims of bullying. J Pediatr (Rio J) 2020; 96(6):693-701.^,1515 Malta DC, Mello FCM, Prado RR, Sá ACMGN, Marinho F, Pinto IV, Silva MMAD, Silva MAI. Prevalência de bullying e fatores associados em escolares brasileiros, 2015. Cien Saude Colet 2019; 24(4):1359-1368.. Data from the Global School-based Student Health Survey show that the global prevalence of bullying is 30.4% among girls and 34.8% among boys aged 13-15⁷7 United Nations Educational, Scientific and Cultural Organization (UNESCO). Behind the numbers: ending school violence and bullying [Internet]. 2019 [cited 2022 dez 19]. Available from: https://unesdoc.unesco.org/ark:/48223/pf0000366483.
https://unesdoc.unesco.org/ark:/48223/pf... , other studies have shown that men are more likely than women to be victims and/or perpetrators of traditional bullying¹¹11 Olweus D. School bullying: development and some important challenges. Annu Rev Clin Psychol 2013; 9:751-780.^,1616 Lucia S. Correlates of bullying in Switzerland. Eur J Criminol 2016; 13(1):50-66.. It is also observed that bullying can vary with age, reaching a peak in early adolescence when bullying can be misused to strengthen or improve one’s social status¹⁰10 Monteiro RP, Medeiros ED, Pimentel CE, Soares AKS, Medeiros HA, Gouveia VV. Valores Humanos e Bullying: Idade e Sexo Moderam essa Relação? Trends Psychol 2017; 25(3):1317-1328.. A systematic review observed that bullying and age have a curvilinear pattern of correlations, i.e., the chances of bullying steadily increases until age 14, after that age, the likelihood of bullying from and among peers decreases¹⁷17 Álvarez-García D, García T, Núñez JC. Predictors of school bullying perpetration in adolescence: A systematic review. Aggress Violent Behav 2015; 23:126-136.. However, other characteristics (e.g. maternal education and having and/or having a job) related to family income have been little explored in studies with South American adolescents, as some adolescents may need to help contribute to the family income, according to data from the International Labor Organization and the United Nations Children’s Fund, more than eight million children are working in Latin America and the Caribbean alone¹⁸18 Hassfurter K. Child Labour: Global estimates 2020, trends and the road forward [Internet]. UNICEF DATA; 2021 [cited 2022 dez 19]. Avalable from: https://data.unicef.org/resources/child-labour-2020-global-estimates-trends-and-the-road-forward/.
https://data.unicef.org/resources/child-... . Therefore, investigating the interactions between sociodemographic variables and bullying may be necessary in understanding the behaviors.

Moreover, lifestyle characteristics were associated with distinct roles in bullying situations. The importance of a healthy lifestyle is widely advocated in developed nations, where it is commonly perceived that the demands of modern life often exceed people’s ability to deal with them¹⁹19 Matuska KM, Christiansen CH. A proposed model of lifestyle balance. J Occup Sci 2008; 15(1):9-19.. According to World Health Organization, lifestyle is a set of habits and customs that are influenced, modified, encouraged or inhibited by the prolonged process of socialization²⁰20 World Health Organization (WHO). Australian Government Department of Health, 2014 [Internet]. [cited 2020 jan 7]. Available from: https://www1.health.gov.au/internet/main/publishing.nsf/Content/health-pubhlth-strateg-phys-act-guidelines.
https://www1.health.gov.au/internet/main... . From this perspective, a multicenter study with data from 82 countries shows that lifestyle behaviors may predict bullying behaviors in adolescents from low- and middle-income countries⁸8 Alfonso-Rosa RM, García-Hermoso A, Sanders T, Parker P, Oriol-Granado X, Arnott H, Del Pozo Cruz B. Lifestyle behaviors predict adolescents bullying victimization in low and middle-income countries. J Affect Disord 2020; 273:364-374.. For example, the likelihood of bullying victimization is higher among adolescents such as insomniacs and loners, who use alcohol and tobacco, and spend high amounts of time in front of screens²¹21 Katapally TR, Thorisdottir AS, Laxer R, Leatherdale ST. The association of school connectedness and bullying involvement with multiple screen-time behaviours among youth in two Canadian provinces: a COMPASS study. Health Promot Chronic Dis Prev Can 2018; 38(10):368-379.^,2222 Moore SE, Norman RE, Suetani S, Thomas HJ, Sly PD, Scott JG. Consequences of bullying victimization in childhood and adolescence: A systematic review and meta-analysis. World J Psychiatry 2017; 7(1):60-76..

In contrast, adolescents who play the role of the perpetrator were more likely to have sleep disturbances and involved in substance abuse (e.g., tobacco, alcohol, and drugs), have low school performance and not meet physical activity guidelines²³23 Sampasa-Kanyinga H, Chaput JP, Hamilton HA, Colman I. Bullying involvement, psychological distress, and short sleep duration among adolescents. Soc Psychiatry Psychiatr Epidemiol 2018; 53(12):1371-1380.^,2424 García-Hermoso A, Hormazabal-Aguayo I, Oriol-Granado X, Fernández-Vergara O, del Pozo Cruz B. Bullying victimization, physical inactivity and sedentary behavior among children and adolescents: a meta-analysis. Int J Behav Nutr Phys Act 2020; 17(1):114.. We emphasize that the epidemiological studies carried out in Brazil did not include behavioral variables (e.g., sleep, screen behavior, and physical activity) within their conceptual models, thus requiring further studies on the possible impacts of bullying on these behaviors¹⁵15 Malta DC, Mello FCM, Prado RR, Sá ACMGN, Marinho F, Pinto IV, Silva MMAD, Silva MAI. Prevalência de bullying e fatores associados em escolares brasileiros, 2015. Cien Saude Colet 2019; 24(4):1359-1368.^,2525 Mello FCM, Silva JL, Oliveira WA, Prado RR, Malta DC, Silva MAI. A prática de bullying entre escolares brasileiros e fatores associados, Pesquisa Nacional de Saúde do Escolar 2015. Cien Saude Colet 2017; 22(9):2939-2948.. The relationship between physical activity and bullying may arise from the contextual characteristics of physical activity practice²⁶26 Méndez I, Ruiz-Esteban C, Ortega E. Impact of the Physical Activity on Bullying. Front Psychol 2019; 10:1520.. Exposure to distinct types of activities, particularly comparing non-sports with sports activities, may influence youth to engage in prosocial²⁶26 Méndez I, Ruiz-Esteban C, Ortega E. Impact of the Physical Activity on Bullying. Front Psychol 2019; 10:1520. or aggressive behaviours²⁷27 Cascales JÁM, Prieto MJR. Incidencia de la práctica de actividad física y deportiva como reguladora de la violencia escolar. Retos 2019; 35:54-60., respectively. Thus involvement in bullying situations may be influenced by the context in which different types of physical activity are practiced. However, the direction of these associations remains to be explored in underrepresented populations such as low- and middle-income countries²⁸28 Martínez-Baena A, Faus-Boscá J. Acoso escolar y Educación Física: una revisión sistemática. Retos 2018; 34:412-419..

In this direction, knowing factors related to bullying enables early identification of children more likely to aggress their peers. This aspect is fundamental in that it helps in the design of interventions that focus on reducing bullying, fostering a school environment conducive to learning, and preventing future violent behaviour¹⁰10 Monteiro RP, Medeiros ED, Pimentel CE, Soares AKS, Medeiros HA, Gouveia VV. Valores Humanos e Bullying: Idade e Sexo Moderam essa Relação? Trends Psychol 2017; 25(3):1317-1328.^,1717 Álvarez-García D, García T, Núñez JC. Predictors of school bullying perpetration in adolescence: A systematic review. Aggress Violent Behav 2015; 23:126-136.. Few studies have investigated factors associated with bullying victimization and perpetration jointly in low- and middle-income countries, and the scenario of Latin American countries is underrepresented in the scientific literature⁸8 Alfonso-Rosa RM, García-Hermoso A, Sanders T, Parker P, Oriol-Granado X, Arnott H, Del Pozo Cruz B. Lifestyle behaviors predict adolescents bullying victimization in low and middle-income countries. J Affect Disord 2020; 273:364-374.^,1414 Silva GRR, Lima MLC, Acioli RML, Barreira AK. Prevalence and factors associated with bullying: differences between the roles of bullies and victims of bullying. J Pediatr (Rio J) 2020; 96(6):693-701.. Therefore, this study aimed to identify the association of sociodemographic factors and lifestyle behaviours with bullying perpetration and victimization among high school students.

Methods

Study design and population

This study utilized cross-sectional data from the baseline sample of the Longitudinal Study of the Lifestyle of Adolescents (ELEVA). Further information regarding ELEVA can be found on the study’s official website (https://eleva.ufsc.br/en/). The ELEVA study aimed to investigate lifestyle factors and health outcomes among public high school students that offered integrated courses with professional college-level programs within the mesoregion of Grande Florianópolis, located in southern Brazil. Three suitable schools affiliated with the Federal Institutes of Technological Education of Santa Catarina (IFSC) were identified and included in the study. Baseline data collection took place between August and December 2019. A census approach was employed, wherein all students present in the schools during the data collection period were deemed eligible and were invited to participate in the study. Consent forms were given to those who wished to participate, and they were required to obtain consent from their parents or legal guardians. After these steps, 1,010 of the 1,618 eligible students returned the signed forms and were able to participate in the study. The project was approved by the Ethics Committee in Research with Human Beings of the Universidade Federal de Santa Catarina (protocol number: 3,168,745).

Measurements

The variables used in the present study were measured using an online questionnaire hosted on the SurveyMonkey® platform, which could be answered using students’ electronic devices or those provided by the researchers. The average response time was 24 minutes. The complete questionnaire is available online (https://eleva.ufsc.br/en/).

To assess information related to bullying, students answered two questions. The first, related to bullying victimization, was as follows: “In the last 30 days, how often have any of your classmates ridiculed, mocked, made fun of, intimidated, or teased you to such an extent that you were hurt, bothered, upset, offended, or humiliated?”. The five possible responses indicated on a Likert-like scale (ranging from never to always) were dichotomized as yes (rarely, sometimes, frequently, and always) or no (never). The second question, related to bullying perpetration, was as follows: “In the last 30 days, have you punched, scoffed, mocked, bullied, or teased one of your schoolmates so much that he was hurt, upset, offended, or humiliated?”. There were two possible responses: yes or no. These questions were based on the Brazilian National School-based Health Survey (PeNSE) and have been used in previous research on Brazilian adolescents¹⁵15 Malta DC, Mello FCM, Prado RR, Sá ACMGN, Marinho F, Pinto IV, Silva MMAD, Silva MAI. Prevalência de bullying e fatores associados em escolares brasileiros, 2015. Cien Saude Colet 2019; 24(4):1359-1368.^,2525 Mello FCM, Silva JL, Oliveira WA, Prado RR, Malta DC, Silva MAI. A prática de bullying entre escolares brasileiros e fatores associados, Pesquisa Nacional de Saúde do Escolar 2015. Cien Saude Colet 2017; 22(9):2939-2948.^,2929 Oliveira BN, Santos PC, Costa BGG, Malheiros LEA, Lopes MVV, Silva KS. Screen Time Correlates of Bullying Perpetration and Victimization in Brazilian Adolescents. J Child Adolesc Trauma 2023; 16(3):607-613.. Reliability was tested in the pilot sample of the ELEVA study (n=100 [complete case analysis]; 68% girls; 16.3±0.99 years old). Gwet’s Agreement Coefficients were 0.79 and 0.78 for the questions on bullying victimization and bullying perpetration, respectively.

Furthermore, the socio-demographic factors of sex (male and female), age (full years), mother’s education (incomplete elementary school [0-8 years], elementary school [8-10 years], high school [at least 11 years], college [at least graduated], or unknown), and participants’ work status (yes or no) were assessed.

The following questions were used to assess alcohol use, tobacco smoking, and illicit drug experimentation, respectively: “During the past 30 days, on how many days did you have at least one drink containing alcohol?”, “During the last 30 days, how many days have you smoked cigarettes?”, “Have you ever used a drug like marijuana, cocaine, crack, ecstasy, etc.?”. For alcohol use and tobacco smoking, participants were coded as “No” or “At least once in the past 30 days”. Original responses of “No” or “Yes” were considered for illicit drug experimentation. These questions were originally from the Global School-based Student Health Survey³⁰30 World Health Organization (WHO). Global school-based student health survey (GSHS) purpose and methodology: 2013 core questionnaire modules. Geneva: WHO; 2013..

Physical activity was assessed using an adapted version of the Self-administered Physical Activity Checklist³¹31 Sallis JF, Strikmiller PK, Harsha DW, Feldman HA, Ehlinger S, Stone EJ, Williston J, Woods S. Validation of interviewer- and self-administered physical activity checklists for fifth grade students. Med Sci Sports Exerc 1996; 28(7):840-851., which has been validated for Brazilian adolescents³²32 Farias Júnior JC, Lopes AS, Mota J, Santos MP, Ribeiro JC, Hallal PC. Validade e reprodutibilidade de um questionário para medida de atividade física em adolescentes: uma adaptação do Self-Administered Physical Activity Checklist. Rev Bras Epidemiol 2012; 15:198-210.. It consists of the following question: “In general, which of the following activities do you engage in? Please state how many days in a normal week and for how long each day you engage in any of the activities”. Participants indicated the frequency (0-7 days/week) and duration (min) of 22 activities. The volume of sports was calculated by summing the volume of soccer, futsal, basketball, handball, volleyball, tennis, table tennis, swimming, athletics, combat sports, gymnastics, cycling, skating, and surfing³³33 Costa BGG, Barreto PS, Silveira PM, Silva JA, Silva KS. The association between practicing sport and non-sport physical activities and health-related quality of life of Brazilian adolescents: A cross-sectional study. Sci Sports 2020; 35(4):e109-e119.. Non-sports were coded as the sum of the volume of capoeira, dancing, collective fitness sessions (e.g., aerobics and functional training), walking, jogging, and active play. Previous studies have also used this categorization³⁴34 Costa BGG, Chaput JP, Lopes MVV, Malheiros LEA, Silva KS. Movement behaviors and their association with depressive symptoms in Brazilian adolescents: A cross-sectional study. J Sport Health Sci 2020; 11(2):252-259..

Screen time was assessed using the Questionnaire for Screen Time of Adolescents (QueST), validated for Brazilian adolescents³⁵35 Knebel MTG, Costa BGG, Santos PC, Sousa ACFC, Silva KS. The conception, content validation, and test-retest reliability of the questionnaire for screen time of adolescents (QueST). J Pediatr (Rio J) 2021; 98(2):175-182.. This questionnaire is composed of items related to five activities regardless of the device used to perform them (e.g., computer, television, smartphone): studying, working, watching videos (e.g., series, news, movies), playing video games, and using social media or chat applications. Students reported the time in hours they performed each activity on weekdays and weekends. To obtain the daily volume of each screen time indicator, the following formula was used: [volume on weekdays*5 + volume on weekends*2]/7). This approach has been employed in previous studies³⁴34 Costa BGG, Chaput JP, Lopes MVV, Malheiros LEA, Silva KS. Movement behaviors and their association with depressive symptoms in Brazilian adolescents: A cross-sectional study. J Sport Health Sci 2020; 11(2):252-259.^,3636 Malheiros LEA, Costa BGG, Lopes MVV, Chaput JP, Silva KS. Association between physical activity, screen time activities, diet patterns and daytime sleepiness in a sample of Brazilian adolescents. Sleep Med 2021; 78:1-6..

Sleep duration was calculated as the difference between self-reported bedtimes and wake-up times on weekdays and weekends. Implausible sleep duration values were detected through data inspection (<1 or >20 hours, n=3) and were excluded. To obtain the daily volume of sleep duration, the following formula was used: [(volume on weekdays *5 + volume on weekend days*2]/7). This procedure has previously been employed³⁴34 Costa BGG, Chaput JP, Lopes MVV, Malheiros LEA, Silva KS. Movement behaviors and their association with depressive symptoms in Brazilian adolescents: A cross-sectional study. J Sport Health Sci 2020; 11(2):252-259.^,3636 Malheiros LEA, Costa BGG, Lopes MVV, Chaput JP, Silva KS. Association between physical activity, screen time activities, diet patterns and daytime sleepiness in a sample of Brazilian adolescents. Sleep Med 2021; 78:1-6..

Statistical analysis

Participants’ characteristics were described using means and standard deviations for continuous variables and absolute and relative frequencies for categorical variables. Multilevel binary logistic regression models were performed to analyze the association of socio-demographic and lifestyle behaviours with bullying victimization and perpetration. All exposure variables were simultaneously included in both models, one for each bullying outcome. The clustering structure of the data, with students (level 1) nested within schools (level 2), was considered by including a random intercept for schools. The results were expressed as odds ratios (OR) and their respective 95% confidence intervals (95%CI). All statistical analyses were performed in Stata version 15 (Stata Corp., College Station, Texas, USA).

Results

Of the 1,010 participants, 852 had complete data for all variables in this study (Table 1). Around half of the sample reported being female (50.2%), and the mean age was 16.4±1.1 years. The proportion of participants whose parents had at least college or university degree was 42.1% and 19.6% of the participants reported working. Approximately 45% of students reported being a victim of bullying in the 30 days before data collection, and approximately 10% reported being a perpetrator of bullying in the same period. Regarding substance use, alcohol consumption was the most prevalent (43.3%), followed by illicit drug experimentation (20.2%) and smoking (8.2%). The participants spent approximately more than 12 hours per day in screen time and practiced an average of 2h per day in sports and non-sports activities, respectively.

The associations between socioeconomic factors and lifestyle behaviours with bullying are presented in Table 2. Age was associated with lower odds of bullying victimization (OR=0.77; 95%CI: 0.67-0.89). Being female was associated with both lower odds of bullying perpetration (OR=0.52; 95%CI: 0.31-0.88) and of bullying victimization (OR=0.66; 95%CI: 0.49-0.89). Students who were currently working were more likely to be perpetrators (OR=1.80; 95%CI: 1.03-3.13) and victims of bullying (OR=1.67; 95%CI: 1.16-2.41). Among the lifestyle behaviours, engaging in non-sport activities (OR=1.04; 95%CI: 1.00-1.09) and consuming alcohol (OR=1.39; 95%CI: 1.02-1.90) were associated with higher odds of bullying victimization. No associations were observed for smoking, illicit drug experimentation, screen time, and sleep duration.

Discussion

This study examined the association of socioeconomic factors and lifestyle behaviours with involvement in bullying situations among Brazilian adolescents. Noteworthy is that almost half (45%) of the high school students reported being a victim of bullying, and this victimization was higher in specific subgroups. Our results showed that sex and working status were associated with bullying perpetration and victimization, while age and non-sport activities were associated with bullying victimization. These results demonstrate that these groups are more susceptible to involvement in bullying situations and may benefit from specific interventions.

In the present study we investigated population subgroups that may be more exposed to bullying and observed associations based on sex, age, and work. With regard to age, the observed association is similar to those reported in other studies; possibly older adolescents were less likely to be victims of bullying in the present study. This result is supported by other studies in the literature, which indicate that victimization decreases with advancing age¹¹11 Olweus D. School bullying: development and some important challenges. Annu Rev Clin Psychol 2013; 9:751-780.^,1515 Malta DC, Mello FCM, Prado RR, Sá ACMGN, Marinho F, Pinto IV, Silva MMAD, Silva MAI. Prevalência de bullying e fatores associados em escolares brasileiros, 2015. Cien Saude Colet 2019; 24(4):1359-1368.. One possible explanation is that as students mature, they become more adept at self-defense because of the development of physical, cognitive, and social skills³⁷37 Bowes L, Maughan B, Ball H, Shakoor S, Ouellet-Morin I, Caspi A, Moffitt TE, Arseneault L. Chronic bullying victimization across school transitions: the role of genetic and environmental influences. Dev Psychopathol 2013; 25(2):333-346.. Thus, they develop more adequate strategies to deal with the aggressive situations to which they may be exposed³⁸38 Silva JL, Mello FCM, Oliveira WA, Prado RR, Silva MAI, Malta DC. Vitimização Por Bullying Em Estudantes Brasileiros: Resultados Da Pesquisa Nacional De Saúde Do Escolar (PeNSE). Texto Contexto Enferm 2018; 27(3):e0310017.. In relation to sex, we observed that females were less likely to be involved in bullying situations than their male counterparts. This result has also been reported in other studies⁹9 Bandeira CM, Hutz CS. Bullying: Prevalence, implications and gender differences. Psicol Esc Educ 2012; 16(1):35-44.^,1515 Malta DC, Mello FCM, Prado RR, Sá ACMGN, Marinho F, Pinto IV, Silva MMAD, Silva MAI. Prevalência de bullying e fatores associados em escolares brasileiros, 2015. Cien Saude Colet 2019; 24(4):1359-1368.^,2525 Mello FCM, Silva JL, Oliveira WA, Prado RR, Malta DC, Silva MAI. A prática de bullying entre escolares brasileiros e fatores associados, Pesquisa Nacional de Saúde do Escolar 2015. Cien Saude Colet 2017; 22(9):2939-2948.. According to the authors, cultural differences in the formation and social development between males and females may influence such behaviour, regardless of their role(39). However, males tend to engage in bullying through direct physical means, while females focus more on rumors, nicknames, or exclusion from social groups³⁹39 Pigozi PL, Machado AL. Bullying na adolescência: visão panorâmica no Brasil. Cien Saude Colet 2015; 20:3509-3522.^,4040 Silva RA, Cardoso TA, Jansen K, Souza LDM, Godoy RV, Cruzeiro ALS, Horta BL, Pinheiro RT. Bullying and associated factors in adolescents aged 11 to 15 years. Trends Psychiatry Psychother 2012; 34(1):19-24.. Another point that can explain this difference is that males are in a phase in which the competition for status and search for prestige among females increases considerably, causing them to assume risky behaviours⁴¹41 Rech RR, Halpern R, Tedesco A, Santos DF. Prevalence and characteristics of victims and perpetrators of bullying. J Pediatr (Rio J) 2013; 89(2):164-170.. Based on this, strategies are suggested for behaviour change focusing on developing strategies to improve the conviviality, sense of belonging, protection, and a sense of responsibility among those involved that can mitigate such actions⁴²42 Tzani-Pepelasi C, Ioannou M, Synnott J, McDonnell D. Peer Support at Schools: the Buddy Approach as a Prevention and Intervention Strategy for School Bullying. Int J Bullying Prev 2019; 1(2):111-123.^,4343 Costa BGG, Lopes MVV, Pizani J, Silva KS. Prática de atividade física e participação esportiva associadas à violência em adolescentes: uma revisão sistemática. J Phys Educ 2020; 31(1):e-3132..

Our results show that work status was associated with bullying perpetration and victimization, which corroborates other studies conducted with Brazilian adolescents¹⁵15 Malta DC, Mello FCM, Prado RR, Sá ACMGN, Marinho F, Pinto IV, Silva MMAD, Silva MAI. Prevalência de bullying e fatores associados em escolares brasileiros, 2015. Cien Saude Colet 2019; 24(4):1359-1368.^,2525 Mello FCM, Silva JL, Oliveira WA, Prado RR, Malta DC, Silva MAI. A prática de bullying entre escolares brasileiros e fatores associados, Pesquisa Nacional de Saúde do Escolar 2015. Cien Saude Colet 2017; 22(9):2939-2948.. This can be linked to socioeconomic issues, which generate the need for adolescents to contribute to the family income²⁵25 Mello FCM, Silva JL, Oliveira WA, Prado RR, Malta DC, Silva MAI. A prática de bullying entre escolares brasileiros e fatores associados, Pesquisa Nacional de Saúde do Escolar 2015. Cien Saude Colet 2017; 22(9):2939-2948.. The period of adolescence is related to constructing social relationships with peers, and entering the labor market during this time can interrupt or reduce the chances of developing social and communication skills at the same pace as their peers⁴⁴44 Hong JS, Kim DH, Piquero AR. Assessing the links between punitive parenting, peer deviance, social isolation and bullying perpetration and victimization in South Korean adolescents. Child Abuse Negl 2017; 73:63-70.. Consequently, some problems can occur, such as peer discrimination and even violent behaviour arising from this exclusion²⁵25 Mello FCM, Silva JL, Oliveira WA, Prado RR, Malta DC, Silva MAI. A prática de bullying entre escolares brasileiros e fatores associados, Pesquisa Nacional de Saúde do Escolar 2015. Cien Saude Colet 2017; 22(9):2939-2948..

Concerning substance use and involvement in bullying situations, our results showed that victims of bullying were more likely to be alcohol users. This corroborates the findings of previous studies²²22 Moore SE, Norman RE, Suetani S, Thomas HJ, Sly PD, Scott JG. Consequences of bullying victimization in childhood and adolescence: A systematic review and meta-analysis. World J Psychiatry 2017; 7(1):60-76.^,4545 Forster M, Dyal SR, Baezconde-Garbanati L, Chou CP, Soto DW, Unger JB. Bullying victimization as a mediator of associations between cultural/familial variables, substance use, and depressive symptoms among Hispanic youth. Ethn Health 2013; 18(4):415-432.^,4646 Luk JW, Wang J, Simons-Morton BG. The Co-occurrence of Substance Use and Bullying Behaviors among U.S. Adolescents: Understanding Demographic Characteristics and Social Influences. J Adolesc 2012; 35(5):1351-1360.. Previous evidence showed that adolescents involved in any bullying experience, regardless of the role played, had a higher chance of developing risk behaviours, including substance use (e.g., alcohol, tobacco, and cannabis)⁴⁷47 Gaete J, Tornero B, Valenzuela D, Rojas-Barahona CA, Salmivalli C, Valenzuela E, Rojas-Barahona CA, Salmivalli C, Valenzuela E, Araya R. Substance Use among Adolescents Involved in Bullying: A Cross-Sectional Multilevel Study. Front Psychol 2017; 8:1056.^,4848 Bradshaw CP, Waasdorp TE, Goldweber A, Johnson SL. Bullies, gangs, drugs, and school: understanding the overlap and the role of ethnicity and urbanicity. J Youth Adolesc 2013; 42(2):220-234.. Another study of 44,532 high school adolescents in Florida reported that engaging in any bullying behaviour resulted in a high risk of alcohol consumption⁴⁹49 Peleg-Oren N, Cardenas GA, Comerford M, Galea S. An Association Between Bullying Behaviors and Alcohol Use Among Middle School Students. J Early Adolesc 2012; 32(6):761-775.. Studies conducted with Brazilian schoolchildren showed an association between bullying victimization and alcohol use during elementary school, which corroborates our findings, which showed that such behaviour is maintained during high school¹⁵15 Malta DC, Mello FCM, Prado RR, Sá ACMGN, Marinho F, Pinto IV, Silva MMAD, Silva MAI. Prevalência de bullying e fatores associados em escolares brasileiros, 2015. Cien Saude Colet 2019; 24(4):1359-1368.^,5050 Malta DC, Porto DL, Crespo CD, Silva MMA, Andrade SSC, Mello FCM, Monteiro R, Silva MAI. Bullying em escolares brasileiros: análise da Pesquisa Nacional de Saúde do Escolar (PeNSE 2012). Rev Bras Epidemiol 2014; 17:92-105.. Although present in the literature, the association between bullying and substance use in adolescence is lacking in Latin American countries¹²12 Horta CL, Horta RL, Mester A, Lindern D, Weber JLA, Levandowski DC, Lisboa CSM. Bullying e uso de substâncias psicoativas na adolescência: uma revisão sistemática. Cien Saude Colet 2018; 23(1):123-140.^,2525 Mello FCM, Silva JL, Oliveira WA, Prado RR, Malta DC, Silva MAI. A prática de bullying entre escolares brasileiros e fatores associados, Pesquisa Nacional de Saúde do Escolar 2015. Cien Saude Colet 2017; 22(9):2939-2948.^,4747 Gaete J, Tornero B, Valenzuela D, Rojas-Barahona CA, Salmivalli C, Valenzuela E, Rojas-Barahona CA, Salmivalli C, Valenzuela E, Araya R. Substance Use among Adolescents Involved in Bullying: A Cross-Sectional Multilevel Study. Front Psychol 2017; 8:1056.. Furthermore, identifying and promoting actions to reduce substance use during adolescence may help decrease future risk behaviours.

We did not find an association between sports practice and bullying perpetration and victimization, contrasting with the literature findings. For instance, a study showed that the practice of non-competitive physical activities is an excellent means for the transmission of values and helps to promote prosocial attitudes; thus, it can help prevent and treat bullying and victimization and in ensuring a lower risk of developing aggressive and deviant behaviours²⁶26 Méndez I, Ruiz-Esteban C, Ortega E. Impact of the Physical Activity on Bullying. Front Psychol 2019; 10:1520.. Other studies reported an increase in aggressiveness associated with participation in sports²⁷27 Cascales JÁM, Prieto MJR. Incidencia de la práctica de actividad física y deportiva como reguladora de la violencia escolar. Retos 2019; 35:54-60.^,4343 Costa BGG, Lopes MVV, Pizani J, Silva KS. Prática de atividade física e participação esportiva associadas à violência em adolescentes: uma revisão sistemática. J Phys Educ 2020; 31(1):e-3132.. Evidence from other studies suggests that the amount of physical activity performed and the type of sport practiced can act as regulators in bullying victimization²⁶26 Méndez I, Ruiz-Esteban C, Ortega E. Impact of the Physical Activity on Bullying. Front Psychol 2019; 10:1520.^,2828 Martínez-Baena A, Faus-Boscá J. Acoso escolar y Educación Física: una revisión sistemática. Retos 2018; 34:412-419.. On the other hand, we found that adolescents who practiced non-sports physical activities were more likely to be victims of bullying than their peers. Some factors may underpin this relationship, such as (a) bullying victimization occurs frequently in activities not closely supervised, and therefore youth tend to avoid these activities²⁴24 García-Hermoso A, Hormazabal-Aguayo I, Oriol-Granado X, Fernández-Vergara O, del Pozo Cruz B. Bullying victimization, physical inactivity and sedentary behavior among children and adolescents: a meta-analysis. Int J Behav Nutr Phys Act 2020; 17(1):114., and (b) being overweight, having educational needs, and/or and/or low self-confidence to engage in physical activities²⁴24 García-Hermoso A, Hormazabal-Aguayo I, Oriol-Granado X, Fernández-Vergara O, del Pozo Cruz B. Bullying victimization, physical inactivity and sedentary behavior among children and adolescents: a meta-analysis. Int J Behav Nutr Phys Act 2020; 17(1):114. may increase the risk of being bullied during physical education classes²⁶26 Méndez I, Ruiz-Esteban C, Ortega E. Impact of the Physical Activity on Bullying. Front Psychol 2019; 10:1520.. Thus, the adolescents who choose to engage in non-sportive physical activities may be those who do not have adult/teacher supervision and/or lack well-developed motor skills to practice sports that require more complex movement coordination and/or puts them in a position of conflict or competition⁵¹51 Barnett LM, Beurden E van, Morgan PJ, Brooks LO, Beard JR. Childhood Motor Skill Proficiency as a Predictor of Adolescent Physical Activity. J Adolesc Health 2009; 44(3):252-259.. However, this hypothesis needs to be tested in future studies. Furthermore, the cross-sectional design meant we were unable to confirm whether the adolescents were bullied for practicing non-sport physical activities or if they practiced non-sport physical activities because they were bullied while practicing sports.

Overall, the results of the present study suggest that a large proportion of students in the high school integrated with professional degrees has experienced bullying either as a victim and/or as a perpetrator, with some subgroups being more likely to have either outcome. This result is alarming, as it suggests that youth may be experiencing negative social relations and being exposed to its consequences for health. Bullying has been observed in other countries and settings as well, but particularly in Brazil, it may be related to broader social problems such as the health and social inequalities⁵²52 Landmann-Szwarcwald C, Macinko J. A panorama of health inequalities in Brazil. Int J Equity Health 2016; 15(1):174., and the culture of violence⁵³53 Murray J, Cerqueira DRC, Kahn T. Crime and violence in Brazil: Systematic review of time trends, prevalence rates and risk factors. Aggress Violent Behav 2013; 18(5):471-483., which may affect individuals in different degrees. Major societal changes are unlikely to happen in short spans of time. Thus, intervention, policies, and changes in services provided to adolescents are needed not only to prevent bullying, but also to help those afflicted by it to cope and heal. It was beyond the scope of the present study to identify where or when bullying happened. Still, it is important that adolescents feel welcomed and experience empathy from teachers, family, coaches, health professionals, and peers. Previous interventions, or those which encompass all members of the target population, regardless of risk for bullying, have shown not only positive results for youth, but also for those implementing the interventions, including increased prosocial behaviours, positive school climate, and positive interactions between peers, families, and school staff⁵⁴54 Rivara F, Menestrel SL. Preventive Interventions. In: Rivara F, Menestrel SL, editors. Preventing Bullying Through Science, Policy, and Practice [Internet]. National Academies Press; 2016 [cited 2023 maio 29]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK390407/.
https://www.ncbi.nlm.nih.gov/books/NBK39... . For children who are exposed to trauma, expert interventions can take shape in sports, as shown by the Bounce Back League program⁵⁵55 Shaikh M, Bean C, Bergholz L, Rojas M, Ali M, Forneris T. Integrating a Sport-Based Trauma-Sensitive Program in a National Youth-Serving Organization. Child Adolesc Soc Work J 2021; 38(4):449-461., where staff were trained to deliver sports activities in a fun and empowering environment, aiming to improve health outcomes and contribute to healing from trauma. In addition, other forms of sport or physical activity interventions have also shown successful results in improving life skills⁵⁶56 How Sports Can Prepare You for Life. Frontiers for Young Minds [Internet]. [cited 2023 maio 29]. Available from: https://kids.frontiersin.org/articles/10.3389/frym.2022.666078.
https://kids.frontiersin.org/articles/10... , reduce aggressiveness⁴³43 Costa BGG, Lopes MVV, Pizani J, Silva KS. Prática de atividade física e participação esportiva associadas à violência em adolescentes: uma revisão sistemática. J Phys Educ 2020; 31(1):e-3132., and contribute to youth as citizens⁵⁷57 Ciampolini V, Milistetd M, Kramers S, Nascimento JV. What are life skills and how to integrate them within sports in Brazil to promote positive youth development? J Phys Educ 2020; 31:e3150.. Lastly, counseling and other forms of heal services provided by professionals should also be provided to youth, as barriers such as costs and wait times still need to be improved even in high-income countries⁵⁸58 Moroz N, Moroz I, D'Angelo MS. Mental health services in Canada: Barriers and cost-effective solutions to increase access. Healthc Manage Forum 2020; 33(6):282-287..

In this study, the lifestyle was delimited solely to the individual behaviors chosen by adolescents. However, the personal risk approach tends to favor those from more privileged socioeconomic backgrounds, with higher levels of education and easier access to consumer goods, and it fails to consider the subjective dimension and the socio-historical context in which these individuals are embedded⁵⁹59 Madeira FB, Filgueira DA, Bosi MLM, Nogueira JAD. Estilos de vida, habitus e promoção da saúde: algumas aproximações. Saude Soc 2018; 27:106-115..

All variables analyzed in this study were self-reported by participants, thus allowing for different interpretations of bullying behaviours and other variables, since such measures are subject to memory biases and social desirability on the part of participants. This is especially true for bullying perpetration and substance use, which may be underreported among students. However, all variables were obtained from instruments adapted and validated in the pediatric population. The strengths of this study include that it investigated the different social roles identified among those involved in bullying, contributing to further clarifying the negative impacts both roles exert on adolescent health. Furthermore, this is a cross-sectional study, which offers a circumstantial perception of reality and does not allow for establishing a cause-and-effect relationship. Longitudinal research with the same variables is needed to investigate the direction of any of the associations. Finally, it should be noted that the scope of the current study was constrained to students who were enrolled in public high schools offering integrated programs with professional degrees at the college level within the mesoregion of Grande Florianópolis. As such, the generalizability of the findings may be limited by the specific social, cultural, and environmental attributes of the local context, thereby restricting their applicability to other settings.

Conclusion

The results of the present study indicate that specific population subgroups are more susceptible to being victims and/or perpetrators of bullying. Sociodemographic factors, such as gender and work, were positively associated with both those who bully and victims of bullying, respectively. In addition, associations were observed between age, non-sport activity, and alcohol consumption with bullying victimization. These results support the development of targeted actions and public initiatives to protect young people, considering their specific subgroups. These initiatives should prioritize health promotion, protection, integrality, and intersectionality, as bullying can have detrimental effects on both physical and mental health. Collaborative efforts from educators, health professionals, parents, and the community are crucial for addressing this issue comprehensively.

Acknowledgements

The authors would like to thank the participants and school staff for their voluntary participation and contribution to the study. In addition, we thank the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) for providing funding for the ELEVA study [grant number 406258/2018-0], the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brasil (CAPES) - Finance Code 001 and Fundação de Amparo à Pesquisa do Estado do Amazonas (FAPEAM) for providing scholarships.

References

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