ABSTRACT:

Objective:

To analyze sociodemographic, school, nutritional, and behavioral factors and body perception associated with being bullied in Brazilian students aged 13 to 17 years old.

Methods:

This was a cross-sectional study based on data from sample 2 of the 2015 Brazilian School Health Survey. The sample for this study was composed of 10,699 teenagers from schools in each of the largest regions of Brazil.

Results:

The prevalence of being bullied was 6.2%, with the highest chance of in teens who bully others (OR = 1.91 95%CI 1.48 - 2.45), who are 13 years old (OR = 1.76, 95%CI 1.04 - 2.97), who consider themselves fat (OR = 1.45, 95%CI 1.06 - 1.98) and who are not treated well by their schoolmates (OR = 2.78, 95%CI 2.17 - 3.45).

Conclusion:

Preventive efforts that include programs to encourage greater social support among students, as well as the implementation of practices that encourage respect for students’ differences and singularities can contribute to reducing bullying practices.

Keywords:
Bullying; Violence; Victimization; Adolescents

INTRODUCTION

Nowadays, bullying is considered a serious public health problem that affects mainly children and adolescents, and is a common phenomenon in schools¹1. Jones SN, Waite R, Thomas Clements P. An evolutionary concept analysis of school violence: from bullying to death. J Forensic Nurs 2012; 8(1): 4-12. https://doi.org/10.1111/j.1939-3938.2011.01121.x
https://doi.org/https://doi.org/10.1111/... ^,22. Silva MAI, Pereira B, Mendonça D, Nunes B, Oliveira WA. The involvement of girls and boys with bullying: an analysis of gender differences. Int J Environ Res Public Health 2013; 10(12): 6820-31. https://dx.doi.org/10.3390%2Fijerph10126820
https://doi.org/https://dx.doi.org/10.33... ^,33. 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. Ciên Saúde Coletiva 2017; 22(9): 2939-48. https://doi.org/10.1590/1413-81232017229.12762017
https://doi.org/https://doi.org/10.1590/... . It is characterized by repeated, intentional actions based on imbalances of power⁴4. Olweus D. School bullying: development and some important challenges. Annu Rev Clin Psychol 2013; 9: 751-80. https://doi.org/10.1146/annurev-clinpsy-050212-185516
https://doi.org/https://doi.org/10.1146/... .

Bullying can occur directly and include physical and verbal aggressions, or indirectly, through socially isolating a victim⁵5. Calbo AS, Busnello FDB, Rigoli MM, Schaefer LS, Kristensen CH. Bullying na escola: comportamento agressivo, vitimização e conduta pró-social entre pares. Contextos Clin 2009; 2(2): 73-80.. This generates consequences that can be observed in the short, medium and long term, and there are serious implications for the victims of this type of violence with regard to their ability to socialize⁶6. Santos AKC, Ramos N. Violência e bullying em contexto escolar: contributos da perspectiva intercultural. Cad Pesq 2016; 23(2): 16-30. http://dx.doi.org/10.18764/2178-2229.v23n2p16-30
https://doi.org/http://dx.doi.org/10.187... . Bullying also causes a negative psychological impact, such as feelings of anger, depression, low self-esteem and stress⁷7. Lopes Neto AA. Bullying: comportamento agressivo entre estudantes. J Pediatr 2005; 81(5 Supl. 5): s164-s172.^,88. Mello FCM, Malta DC, Prado RR, Farias MS, Alencastro LCS, Silva MAI. Bullying e fatores associados em adolescentes da Região Sudeste segundo a Pesquisa Nacional de Saúde do Escolar. Rev Bras Epidemiol 2016; 19(4): 866-77. https://doi.org/10.1590/1980-5497201600040015
https://doi.org/https://doi.org/10.1590/... , with suicide⁸8. Mello FCM, Malta DC, Prado RR, Farias MS, Alencastro LCS, Silva MAI. Bullying e fatores associados em adolescentes da Região Sudeste segundo a Pesquisa Nacional de Saúde do Escolar. Rev Bras Epidemiol 2016; 19(4): 866-77. https://doi.org/10.1590/1980-5497201600040015
https://doi.org/https://doi.org/10.1590/... ^,99. Sampaio JMC, Santos GV, Oliveira WA, Silva JL, Medeiros M, Silva MAI. Prevalência de bullying e emoções de estudantes envolvidos. Texto Contexto Enferm 2015; 24(2): 344-52. https://doi.org/10.1590/0104-07072015003430013
https://doi.org/https://doi.org/10.1590/... and homicide¹⁰10. Daemon F. Entre os muros e as mídias: o bullying e o school shooting numa perspectiva comunicacional. Rev Epos 2015; 6(2): 6-26. as possible outcomes.

However, social and cultural nuances that impact bullying must be considered, in addition to individualistic aspects, such as socially constructed hegemonic patterns.¹¹11. Francisco MV, Coimbra RM. Análise do bullying escolar sob o enfoque da psicologia histórico-cultural. Estud Psicol 2015; 20(3): 184-95. http://dx.doi.org/10.5935/1678-4669.20150020
https://doi.org/http://dx.doi.org/10.593... ^,1212. Francisco MV, Coimbra RM. Bullying escolar e os processos de resiliência em-si sob a ótica da teoria histórico-cultural. Educ Temat Digit2019; 21(1): 145-63. https://doi.org/10.20396/etd.v21i1.8651418
https://doi.org/https://doi.org/10.20396... Furthermore, school and family contexts must be considered, as they are usually marked by the presence of parental abuse and parenting styles that do not impose boundaries¹³13. Esteves PSM. O (não) reconhecimento da diferença: o bullying como um desafio das sociedades multiculturais. Rev Eletrônica Pesquiseduca 2016; 8(16): 440-57..

Studies carried out in several countries indicate a high prevalence of bullying¹⁴14. United Nations Children's Fund (UNICEF). Hidden in plain sight: a statistical analysis of violence against children [Internet]. Nova York: UNICEF; 2014 [acessado em 19 nov. 2018]. Disponível em: Disponível em: http://files.unicef.org/publications/files/Hidden_in_plain_sight_statistical_analysis_EN_3_Sept_2014.pdf
http://files.unicef.org/publications/fil... ^,1515. Elgar FJ, McKinnon B, Walsh SD, Freeman J, Donnely PD, Matos MG, et al. Structural Determinants of Youth Bullying and Fighting in 79 Countries. J Adolesc Health 2015; 57(6): 643-50. https://doi.org/10.1016/j.jadohealth.2015.08.007
https://doi.org/https://doi.org/10.1016/... ^,1616. Kann L, McManus T, Harris WA, Shanklin SL, Flint KH, Queen B, et al. Youth Risk Behavior Surveillance - United States, 2017. MMWR Surveill Summ [Internet] 2018 [acessado 12 out. 2018]; 67(8): 1-114. Disponível em: Disponível em: https://www.cdc.gov/mmwr/volumes/67/ss/ss6708a1.htm
https://www.cdc.gov/mmwr/volumes/67/ss/s... , which demonstrates that it is a public health problem worldwide⁶6. Santos AKC, Ramos N. Violência e bullying em contexto escolar: contributos da perspectiva intercultural. Cad Pesq 2016; 23(2): 16-30. http://dx.doi.org/10.18764/2178-2229.v23n2p16-30
https://doi.org/http://dx.doi.org/10.187... ^,1414. United Nations Children's Fund (UNICEF). Hidden in plain sight: a statistical analysis of violence against children [Internet]. Nova York: UNICEF; 2014 [acessado em 19 nov. 2018]. Disponível em: Disponível em: http://files.unicef.org/publications/files/Hidden_in_plain_sight_statistical_analysis_EN_3_Sept_2014.pdf
http://files.unicef.org/publications/fil... ^,1717. Oliveira WA, Silva MAI, Mello FCM, Porto DL, Yoshinaga ACM, Malta DC. Causas do bullying: resultados da Pesquisa Nacional de Saúde do Escolar. Rev Latino-Am Enfermagem 2015; 23(2): 275-82. https://doi.org/10.1590/0104-1169.0022.2552
https://doi.org/https://doi.org/10.1590/... . The 2014 United Nations Children's Fund Report found, in the 190 countries surveyed, that more than 1/3 of students suffer or have suffered at least one experience of being bullied¹⁴14. United Nations Children's Fund (UNICEF). Hidden in plain sight: a statistical analysis of violence against children [Internet]. Nova York: UNICEF; 2014 [acessado em 19 nov. 2018]. Disponível em: Disponível em: http://files.unicef.org/publications/files/Hidden_in_plain_sight_statistical_analysis_EN_3_Sept_2014.pdf
http://files.unicef.org/publications/fil... . High prevalence of school bullying was also found in a survey involving 79 countries, in which about 30% of students reported being bullied¹⁵15. Elgar FJ, McKinnon B, Walsh SD, Freeman J, Donnely PD, Matos MG, et al. Structural Determinants of Youth Bullying and Fighting in 79 Countries. J Adolesc Health 2015; 57(6): 643-50. https://doi.org/10.1016/j.jadohealth.2015.08.007
https://doi.org/https://doi.org/10.1016/... . In the United States, data from the 2017 Youth Risk Behavior Survey (YRBS), involving more than 15,000 high school teenagers from public and private schools, showed a 19% prevalence of being bullied at school in the 12 months prior to the survey¹⁶16. Kann L, McManus T, Harris WA, Shanklin SL, Flint KH, Queen B, et al. Youth Risk Behavior Surveillance - United States, 2017. MMWR Surveill Summ [Internet] 2018 [acessado 12 out. 2018]; 67(8): 1-114. Disponível em: Disponível em: https://www.cdc.gov/mmwr/volumes/67/ss/ss6708a1.htm
https://www.cdc.gov/mmwr/volumes/67/ss/s... .

It is worth mentioning that these studies¹⁴14. United Nations Children's Fund (UNICEF). Hidden in plain sight: a statistical analysis of violence against children [Internet]. Nova York: UNICEF; 2014 [acessado em 19 nov. 2018]. Disponível em: Disponível em: http://files.unicef.org/publications/files/Hidden_in_plain_sight_statistical_analysis_EN_3_Sept_2014.pdf
http://files.unicef.org/publications/fil... ^,1515. Elgar FJ, McKinnon B, Walsh SD, Freeman J, Donnely PD, Matos MG, et al. Structural Determinants of Youth Bullying and Fighting in 79 Countries. J Adolesc Health 2015; 57(6): 643-50. https://doi.org/10.1016/j.jadohealth.2015.08.007
https://doi.org/https://doi.org/10.1016/... ^,1616. Kann L, McManus T, Harris WA, Shanklin SL, Flint KH, Queen B, et al. Youth Risk Behavior Surveillance - United States, 2017. MMWR Surveill Summ [Internet] 2018 [acessado 12 out. 2018]; 67(8): 1-114. Disponível em: Disponível em: https://www.cdc.gov/mmwr/volumes/67/ss/ss6708a1.htm
https://www.cdc.gov/mmwr/volumes/67/ss/s... did not use the same characterization for bullying in their methodology, overestimating its prevalence by considering it in one or more occurrences of being bullied in the last 30 days or two months. On the other hand, some risk factors for bullying have been verified in national and international surveys. Factors such as sex²2. Silva MAI, Pereira B, Mendonça D, Nunes B, Oliveira WA. The involvement of girls and boys with bullying: an analysis of gender differences. Int J Environ Res Public Health 2013; 10(12): 6820-31. https://dx.doi.org/10.3390%2Fijerph10126820
https://doi.org/https://dx.doi.org/10.33... , age, color, feelings of depression and loneliness, administrative affiliation, mother's education⁸8. Mello FCM, Malta DC, Prado RR, Farias MS, Alencastro LCS, Silva MAI. Bullying e fatores associados em adolescentes da Região Sudeste segundo a Pesquisa Nacional de Saúde do Escolar. Rev Bras Epidemiol 2016; 19(4): 866-77. https://doi.org/10.1590/1980-5497201600040015
https://doi.org/https://doi.org/10.1590/... ^,1818. Malta DC, Porto DL, Crespo CD, Silva MMA, Andrade SSC, Mello FCM, et al. Bullying em escolares brasileiros: análise da Pesquisa Nacional de Saúde do Escolar (PeNSE 2012). Rev Bras Epidemiol 2014; 17 (Supl. 1): 92-105. https://doi.org/10.1590/1809-4503201400050008
https://doi.org/https://doi.org/10.1590/... and being overweight¹⁹19. Martins FS, Rech RR, Halpern R, Pedroni JL, Julianote MNS, Frata B, et al. Prevalência de sintomas para transtornos alimentares, sobrepeso e obesidade em escolares do município de Bom Jesus-RS. Rev Bras Obes Nutr Emagr 2017; 11(61): 31-8. have been shown to be significantly associated with bullying.

In Brazil, primary studies have pointed out victimization rates for bullying that vary from approximately 10 to 30%⁹9. Sampaio JMC, Santos GV, Oliveira WA, Silva JL, Medeiros M, Silva MAI. Prevalência de bullying e emoções de estudantes envolvidos. Texto Contexto Enferm 2015; 24(2): 344-52. https://doi.org/10.1590/0104-07072015003430013
https://doi.org/https://doi.org/10.1590/... ^,2020. Zequinão MA, Medeiros P, Pereira B, Cardoso FL. Bullying escolar: um fenômeno multifacetado. Educ Pesqui 2016; 42(1): 181-98. https://doi.org/10.1590/S1517-9702201603138354
https://doi.org/https://doi.org/10.1590/... ^,2121. Nova ISV, Sena CL, Oliveira IR. Ocorrência do bullying entre alunos de uma escola pública do município de Salvador, Brasil. Rev Ciênc Méd Biol 2015; 14(3): 338-42.^,2222. Santos JA, Cabral-Xavier AF, Paiva SM, Leite-Cavalcanti A. Prevalência e Tipos de Bullying em Escolares Brasileiros de 13 a 17 anos. Rev Salud Pública 2014; 16(2): 173-83. http://dx.doi.org/10.15446/rsap.v16n2.30302
https://doi.org/http://dx.doi.org/10.154... ^,2323. Rech RR, Halpern R, Tedesco A, Santos DF. Prevalence and characteristics of victims and perpetrators of bullying. J Pediatr (Rio J) 2013; 89(2): 164-70. https://doi.org/10.1016/j.jped.2013.03.006
https://doi.org/https://doi.org/10.1016/... ^,2424. Isolan L, Salum GA, Osowski AT, Zottis GH, Manfro GG. Victims and bully-victims but not bullies are groups associated with anxiety symptomatology among Brazilian children and adolescents. Eur Child Adolesc Psychiatry 2013; 22(10): 641-8. https://doi.org/10.1007/s00787-013-0412-z
https://doi.org/https://doi.org/10.1007/... , while other studies, based on secondary data from the National School Health Survey (Pesquisa Nacional de Saúde do Escolar - PeNSE), have demonstrated the prevalence of being bullied ranging from 5.4% to 7.4%³3. 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. Ciên Saúde Coletiva 2017; 22(9): 2939-48. https://doi.org/10.1590/1413-81232017229.12762017
https://doi.org/https://doi.org/10.1590/... ^,88. Mello FCM, Malta DC, Prado RR, Farias MS, Alencastro LCS, Silva MAI. Bullying e fatores associados em adolescentes da Região Sudeste segundo a Pesquisa Nacional de Saúde do Escolar. Rev Bras Epidemiol 2016; 19(4): 866-77. https://doi.org/10.1590/1980-5497201600040015
https://doi.org/https://doi.org/10.1590/... ^,1717. Oliveira WA, Silva MAI, Mello FCM, Porto DL, Yoshinaga ACM, Malta DC. Causas do bullying: resultados da Pesquisa Nacional de Saúde do Escolar. Rev Latino-Am Enfermagem 2015; 23(2): 275-82. https://doi.org/10.1590/0104-1169.0022.2552
https://doi.org/https://doi.org/10.1590/... ^,1818. Malta DC, Porto DL, Crespo CD, Silva MMA, Andrade SSC, Mello FCM, et al. Bullying em escolares brasileiros: análise da Pesquisa Nacional de Saúde do Escolar (PeNSE 2012). Rev Bras Epidemiol 2014; 17 (Supl. 1): 92-105. https://doi.org/10.1590/1809-4503201400050008
https://doi.org/https://doi.org/10.1590/... ^,2525. Malta DC, Silva MAI, Mello FCM, Monteiro RA, Sardinha LM, Crespo C, et al. Bullying nas escolas brasileiras: resultados da Pesquisa Nacional de Saúde do Escolar, 2009. Ciên Saúde Coletiva 2010; 15(Supl. 2): 3065-76. https://doi.org/10.1590/S1413-81232010000800011
https://doi.org/https://doi.org/10.1590/... . Although PeNSE data have been properly explored by the surveys, they have only been concentrated on sample 1 of the referred survey, in which the participants are teenage students in the 9th grade. As of 2015, under the argument of allowing comparability with international studies, a new sample (sample 2) of adolescent students aged 13 to 17 was included, but it still has been used infrequently in national studies. However, there are also few national studies on the risk factors associated with being bullied.

The identification of such factors and their implications for public health and the quality of life of adolescents is indispensable for the design and implementation of multidisciplinary and intersectoral actions to prevent bullying. In addition, it is important for health promotion in the school environment, as the negative outcomes for the physical and mental health of school adolescents are well-known, not to mention the damage on students’ learning processes⁷7. Lopes Neto AA. Bullying: comportamento agressivo entre estudantes. J Pediatr 2005; 81(5 Supl. 5): s164-s172.^,88. Mello FCM, Malta DC, Prado RR, Farias MS, Alencastro LCS, Silva MAI. Bullying e fatores associados em adolescentes da Região Sudeste segundo a Pesquisa Nacional de Saúde do Escolar. Rev Bras Epidemiol 2016; 19(4): 866-77. https://doi.org/10.1590/1980-5497201600040015
https://doi.org/https://doi.org/10.1590/... ^,99. Sampaio JMC, Santos GV, Oliveira WA, Silva JL, Medeiros M, Silva MAI. Prevalência de bullying e emoções de estudantes envolvidos. Texto Contexto Enferm 2015; 24(2): 344-52. https://doi.org/10.1590/0104-07072015003430013
https://doi.org/https://doi.org/10.1590/... .

Thus, this study aimed to analyze school, sociodemographic, nutritional, and body and behavioral perceptions associated with being bullied, among Brazilian students aged 13 to 17 years old.

METHODS

This was a descriptive study with a quantitative approach.

SAMPLE

The study sample consisted of adolescent students who were part of the PeNSE sampling plan 2 (sample 2), conducted in 2015 by the Brazilian Institute of Geography and Statistics (Instituto Brasileiro de Geografia e Estatística - IBGE), in partnership with the Ministry of Health. Sample 2, which is only present in the 2015²⁶26. Instituto Brasileiro de Geografia e Estatística (IBGE). Pesquisa Nacional de Saúde do Escolar, (PeNSE), 2015 [Internet]. Rio de Janeiro: IBGE; 2016 [acessado em 10 dez. 2018]. Disponível em: Disponível em: https://biblioteca.ibge.gov.br/visualizacao/livros/liv97870.pdf
https://biblioteca.ibge.gov.br/visualiza... version, represents the 13 to 17 age group and includes students from the 6th to the 9th grade of elementary and high school in public and private schools throughout Brazil. With it, it is possible to monitor changes resulting from social, behavioral and biological factors of the study population.

The sample of this study was composed of 10,699 adolescents aged 13 to 17 years old. For the PeNSE, data from the 2015 School Census record were used and schools were selected in each of the country's major regions (North, Northeast, Southeast, South and Center West). They are called geographic strata. In each stratum, schools that had students with the characteristics of interest were grouped, and all students were asked to answer the survey questionnaires²⁶26. Instituto Brasileiro de Geografia e Estatística (IBGE). Pesquisa Nacional de Saúde do Escolar, (PeNSE), 2015 [Internet]. Rio de Janeiro: IBGE; 2016 [acessado em 10 dez. 2018]. Disponível em: Disponível em: https://biblioteca.ibge.gov.br/visualizacao/livros/liv97870.pdf
https://biblioteca.ibge.gov.br/visualiza... .

PENSE DATA COLLECTION PROCEDURES

Data collection took place from April to September 2015, through the application of an electronic questionnaire, using smartphones. It was structured and self-applicable to all students in the selected classes. Data were collected in schools during students' class time.

STUDY VARIABLES

The study’s dependent variable was “being bullied”, which was obtained based on the question: “in the last 30 days, how often did any of your colleagues at your school abuse, mock, sneer, intimidate or tease you so much that you were hurt/annoyed/upset/offended/humiliated?”. The answers were categorized as “no” (never, rarely, sometimes) and “yes” (most of the time, always).

The independent variables were categorized as follows:

ANALYSIS PROCEDURES

Initially, the prevalence of being bullied was calculated. In order to check for associated factors, analyzes of the bivariate relationships of the referred tables were performed using odds ratios (OR), 95% confidence intervals (95%CI) and p values. These analyzes were only for the purpose of selecting variables for the adjusted (multivariate) model. Then, the multivariate analysis was conducted with the variables that were significant at the level of 0.20, in a bivariate manner. The statistical level of significance adopted was 0.05. All the estimated results of the tests were analyzed, including the test of multicollinearity for the logistic regression. All of the bivariate and multivariate analyses were performed using the statistical program SPSS, version 18.0, using the Complex Samples Module procedure, adjusted for the analysis of the data from the complex sample plan.

ETHICAL CONSIDERATIONS OF THE STUDY AND PENSE

Because this study used a secondary database in the public domain, it was exempted from approval by the Ethics Committee (Resolution No. 466/2012 of the National Health Council). With regard to the ethical and legal aspects of PeNSE 2015, the research was approved by the National Research Ethics Commission (CONEP) of the National Health Council²⁶26. Instituto Brasileiro de Geografia e Estatística (IBGE). Pesquisa Nacional de Saúde do Escolar, (PeNSE), 2015 [Internet]. Rio de Janeiro: IBGE; 2016 [acessado em 10 dez. 2018]. Disponível em: Disponível em: https://biblioteca.ibge.gov.br/visualizacao/livros/liv97870.pdf
https://biblioteca.ibge.gov.br/visualiza... .

RESULTS

The participants had an average age of 14.8 (± 1.3) years old. A total of 50.2% were male and 49.8% were female. The prevalence of schoolchildren who suffered from bullying was 6.2%. Light-skinned black color/race was most reported by the sample (41.8%), followed by white (39.5%).

Most adolescents stated that they did not attend school on a full-time basis (74.4%). The eighth year of elementary school and the 1st and 2nd years of high school had the highest prevalence of students, and only 2.7% were in 6th grade. Practically two thirds of the students (64.9%) reported being treated well at school by their peers, while 19% reported bullying others. A feeling of dissatisfaction in relation to their body was reported by 20.2% of the adolescents. A total of 24.9% were overweight, 83% considered their body image important, and 20.8% considered themselves fat.

The bivariate analysis of being bullied with the independent variables (Table 1) was performed to verify the magnitude of the associations and their significance. Being bullied was significantly associated (p < 0.20) with independent variables related to sociodemographic, behavioral, school and body perception characteristics, such as grade, sex, age, time of day when studying, if they bullied others, if they are well treated at school by colleagues, nutritional status, feelings about the body, body image and consideration about their own body.

The data reveal that younger adolescents, 13 and 14 years old, were more likely to report being bullied (OR=2.29, 95%CI 1.53 - 3.40 and (OR = 1.67, 95%CI 1.06 - 2.61, respectively) when compared to adolescents aged 17 years old. The association of being bullied was also significant with adolescents in the first three grades of elementary school who reported studying full-time.

Overweight adolescents were more likely to report being bullied when compared to those of adequate weight (OR = 1.38, 95% CI 1.10 - 1.74). Those who indicated a feeling of satisfaction in relation to their body were less likely to report being bullied compared to those who said they were indifferent about this feeling (OR = 0.61, 95%CI 0.43 - 0.86). Adolescents who admitted to bullying others were twice as likely to suffer from bullying (OR = 2.16, 95%CI 1.70 - 2.75), while those who reported not being treated well at school had three times more chances of suffering from bullying (OR = 3.03, 95%CI 2.50 - 3.85).

In the multivariate model (Table 2), adolescents who reported being 13 years old (OR = 1.76, 95%CI 1.04 - 2.97), practicing bullying ( OR = 1.91, 95%CI 1.48 - 2.46), not being treated well at school by peers (OR = 2.78, 95%CI 2.17 - 3.45) and considering themselves fat (OR = 1.45, 95%CI 1.06 - 1.98) had a higher chance of suffering from bullying.

DISCUSSION

This study identified that 6.2% of students had already been bullied, with a prevalence of 6.6% in males and 5.9% in females. The bivariate analysis showed significant associations of being bullied with the following variables: age, full-time school, being treated well at school by colleagues, practicing bullying, nutritional status, consideration of one's own body, body image and satisfaction with their body. However, in the adjusted model, only the variables age (only 13 years old), consideration of one's own body (only the fat category), bullying others, and the treatment received at school remained as statistically significant.

Significant differences in the prevalence of being bullied were found in research conducted in Brazil and in other countries. A national study with data from PeNSE 2012 indicated a prevalence of being bullied of 7.2%¹⁸18. Malta DC, Porto DL, Crespo CD, Silva MMA, Andrade SSC, Mello FCM, et al. Bullying em escolares brasileiros: análise da Pesquisa Nacional de Saúde do Escolar (PeNSE 2012). Rev Bras Epidemiol 2014; 17 (Supl. 1): 92-105. https://doi.org/10.1590/1809-4503201400050008
https://doi.org/https://doi.org/10.1590/... . A study based on data from an international report similar to PeNSE, called Health Behavior in School-aged Children (HBSC) and involving adolescents from 33 countries in Europe and North America, showed that in the 2009/2010 cycle, 29.2% of students reported one or more experiences of being bullied in the past few months²⁷27. Chester KL, Callaghan M, Cosma A, Donnelly P, Craig W, Walsh S, et al. Cross-national time trends in bullying victimization in 33 countries among children aged 11, 13 and 15 from 2002 to 2010. Eur J Public Health 2015; 25(Supl. 2): 61-4. https://doi.org/10.1093/eurpub/ckv029
https://doi.org/https://doi.org/10.1093/... . Victimization rates for bullying from 23 to 32% were also obtained in the HBSC's Global School Health Survey, in the 2013/2014 cycle, conducted with adolescents from different countries in Europe²⁸28. World Health Organization (WHO). Growing up unequal: gender and socioeconomic differences in young people's health and well-being. Health Behaviour in School-aged Children (HBSC) study: international report from the 2013/2014 survey [Internet]. Copenhagen: WHO Regional Office for Europe; 2016 [acessado em 12 dez. 2018]. (Health Policy for Children and Adolescents, n. 7). Disponível em: Disponível em: http://www.euro.who.int/__data/assets/pdf_file/0003/303438/HSBC-No.7-Growing-up-unequal-Full-Report.pdf?ua=1
http://www.euro.who.int/__data/assets/pd... .

The discrepancy in the prevalence of being bullied in several studies can be attributed to the variation in sample size and the victim criterion. In this study, being a bully victim was defined as when it occurred "most of the time" or "always" in the past 30 days. This characterization, however, does not follow the same pattern as other studies²⁷27. Chester KL, Callaghan M, Cosma A, Donnelly P, Craig W, Walsh S, et al. Cross-national time trends in bullying victimization in 33 countries among children aged 11, 13 and 15 from 2002 to 2010. Eur J Public Health 2015; 25(Supl. 2): 61-4. https://doi.org/10.1093/eurpub/ckv029
https://doi.org/https://doi.org/10.1093/... ^,2828. World Health Organization (WHO). Growing up unequal: gender and socioeconomic differences in young people's health and well-being. Health Behaviour in School-aged Children (HBSC) study: international report from the 2013/2014 survey [Internet]. Copenhagen: WHO Regional Office for Europe; 2016 [acessado em 12 dez. 2018]. (Health Policy for Children and Adolescents, n. 7). Disponível em: Disponível em: http://www.euro.who.int/__data/assets/pdf_file/0003/303438/HSBC-No.7-Growing-up-unequal-Full-Report.pdf?ua=1
http://www.euro.who.int/__data/assets/pd... ^,2929. Lian Q, Su Q, Li R, Elgar FJ, Liu Z, Zheng D. The association between chronic bullying victimization with weight status and body self-image: a cross-national study in 39 countries. Peer J 2018; 6: e4330. https://doi.org/10.7717/peerj.4330
https://doi.org/https://doi.org/10.7717/... ^,3030. Mark L, Värnik A, Sisask M. Who suffers most from being involved in bullying-bully, victim, or bully-victim? J Sch Health 2019; 89(2): 136-44. https://doi.org/10.1111/josh.12720
https://doi.org/https://doi.org/10.1111/... ^,3131. Cosma A, Whitehead R, Neville F, Currie D, Inchley J. Trends in bullying victimization in Scottish adolescents 1994-2014: changing associations with mental well-being. Int J Public Health 2017; 62: 639-46. https://doi.org/10.1007/s00038-017-0965-6
https://doi.org/https://doi.org/10.1007/... .

After the adjusted analysis, it was observed that students aged 13 were almost twice as likely to be victims of bullying compared to students aged 17 years old. A survey of 11 to 15-year-old Scottish teenagers showed an increase in being bullied over a period of two decades, except for 13-year-old boys, with a significant decrease in older adolescents³¹31. Cosma A, Whitehead R, Neville F, Currie D, Inchley J. Trends in bullying victimization in Scottish adolescents 1994-2014: changing associations with mental well-being. Int J Public Health 2017; 62: 639-46. https://doi.org/10.1007/s00038-017-0965-6
https://doi.org/https://doi.org/10.1007/... . The finding regarding the age of 13-year-olds is in disagreement with the present study, however, the relationship between age and being bullied was similar to the results of this study.

Previous investigations have shown a higher prevalence of being bullied in younger adolescents³¹31. Cosma A, Whitehead R, Neville F, Currie D, Inchley J. Trends in bullying victimization in Scottish adolescents 1994-2014: changing associations with mental well-being. Int J Public Health 2017; 62: 639-46. https://doi.org/10.1007/s00038-017-0965-6
https://doi.org/https://doi.org/10.1007/... ^,3232. Seo HJ, Jung YE, Kim MD, Bahk WM. Factors associated with bullying victimization among Korean adolescents. Neuropsychiatr Dis Treat 2017; 13: 2429-35. https://doi.org/10.2147/ndt.s140535
https://doi.org/https://doi.org/10.2147/... and with lower levels of schooling³³33. Carlyle KE, Steinman KJ. Demographic Differences in the Prevalence, Co-occurrence, and correlates of Adolescent Bullying at School. J Sch Health 2007; 77(9): 623-9. https://doi.org/10.1111/j.1746-1561.2007.00242.x
https://doi.org/https://doi.org/10.1111/... ^,3434. Hymel S, Swearer SM. Four decades of research on school bullying: an introduction. Am Psychol 2015; 70(4): 293-9. https://doi.org/10.1037/a0038928
https://doi.org/https://doi.org/10.1037/... ^,3535. Moon SS, Kim H, Seay K, Small E, Kim YK. Ecological factors of being bullied among adolescents: a classification and regression tree approach. Child Ind Res 2015; 9: 743-56. https://doi.org/10.1007/s12187-015-9343-1
https://doi.org/https://doi.org/10.1007/... . Thirteen-year-olds were more likely to become targets of bullying when they were under academic pressure³⁵35. Moon SS, Kim H, Seay K, Small E, Kim YK. Ecological factors of being bullied among adolescents: a classification and regression tree approach. Child Ind Res 2015; 9: 743-56. https://doi.org/10.1007/s12187-015-9343-1
https://doi.org/https://doi.org/10.1007/... . Although the literature shows similarities with our study in terms of more bullying in the youngest group, it did not find a significant association between schooling level and being bullied.

Data from an epidemiological-based survey (PeNSE 2012) showed age as a protective factor as a student becomes older (16 years or older)¹⁸18. Malta DC, Porto DL, Crespo CD, Silva MMA, Andrade SSC, Mello FCM, et al. Bullying em escolares brasileiros: análise da Pesquisa Nacional de Saúde do Escolar (PeNSE 2012). Rev Bras Epidemiol 2014; 17 (Supl. 1): 92-105. https://doi.org/10.1590/1809-4503201400050008
https://doi.org/https://doi.org/10.1590/... . A study carried out in Malawi (South Africa), based on the Global School-based Health Survey (GSHS), 2009, found that 14-year-old students are more likely to be bullied compared to 16-year-olds³⁶36. Kubwalo HW, Muula AS, Siziya S, Pasupulati S, Rudatsikira E. Prevalence and correlates of being bullied among in-school adolescents in Malawi: results from the 2009 Global School-Based Health Survey. Malawi Med J 2013; 25(1): 12-4.. A systematic revision study showed that being bullied is associated with anxiety disorders in adolescents over 13 years old³⁷37. 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 Psychiatr 2017; 7(1): 60-76. https://doi.org/10.5498/wjp.v7.i1.60
https://doi.org/https://doi.org/10.5498/... .

The higher prevalence of younger schoolchildren in lower grades being bullied is probably explained by the greater memory of episodes of bullying in the 11 to 13 age group³⁸38. Santos LCS, Faro A. Bullying entre adolescentes em Sergipe: estudo na Capital e Interior do Estado. Psicol Esc Educ 2018; 22(3): 485-92. https://doi.org/10.1590/2175-35392018036741
https://doi.org/https://doi.org/10.1590/... . Furthermore, older students might consider bullying to be a joke or something funny³⁹39. Fonseca KBC, Micucci MD, Costa PSC, Lemes S, Santos NA, Cunha JVA. Incidência do Bullying nos Cursos de Administração e Ciências Contábeis. Psicol Esc Educ 2017; 21(1): 79-92. https://doi.org/10.1590/2175-3539201702111079
https://doi.org/https://doi.org/10.1590/... . The decline in bullying rates with increasing age can also be explained by greater social adaptation and greater effectiveness in inhibiting bullying, linked to the physical development of adolescents³²32. Seo HJ, Jung YE, Kim MD, Bahk WM. Factors associated with bullying victimization among Korean adolescents. Neuropsychiatr Dis Treat 2017; 13: 2429-35. https://doi.org/10.2147/ndt.s140535
https://doi.org/https://doi.org/10.2147/... .

The present study also indicated that considering oneself fat is associated with a greater propensity to suffer from bullying, a result that is in agreement with the literature. A survey of Slovak teenagers aged 11 to 15 years old found a significant association between self-reported body image and involvement in bullying, and adolescents who considered themselves overweight were more likely to suffer from bullying⁴⁰40. Holubcikova J, Kolarcik P, Geckova AM, Van Dijk JP, Reijneveld SA. Is subjective perception of negative body image among adolescents associated with bullying? Eur J Pediatr 2015; 174: 1035-41. https://doi.org/10.1007/s00431-015-2507-7
https://doi.org/https://doi.org/10.1007/... .

An investigation carried out based on data from PeNSE 2012 pointed to a higher prevalence of those who considered themselves very thin and very fat being bullied¹⁷17. Oliveira WA, Silva MAI, Mello FCM, Porto DL, Yoshinaga ACM, Malta DC. Causas do bullying: resultados da Pesquisa Nacional de Saúde do Escolar. Rev Latino-Am Enfermagem 2015; 23(2): 275-82. https://doi.org/10.1590/0104-1169.0022.2552
https://doi.org/https://doi.org/10.1590/... . A study carried out in 39 countries in Europe and North America showed that adolescents who self-reported themselves as very fat were three times more likely to be chronically bullied than those who perceived themselves as having a normal weight²⁹29. Lian Q, Su Q, Li R, Elgar FJ, Liu Z, Zheng D. The association between chronic bullying victimization with weight status and body self-image: a cross-national study in 39 countries. Peer J 2018; 6: e4330. https://doi.org/10.7717/peerj.4330
https://doi.org/https://doi.org/10.7717/... .

In this sense, the difficulty in accepting one’s own physical characteristics and dealing with the difference indicates the need to work on psychosocial aspects with adolescents, in order to create a school climate that is more favorable to their health⁴¹41. Pigozi PL, Machado AL. Bullying na adolescência: visão panorâmica no Brasil. Ciênc Saúde Coletiva 2015; 20(11): 3509-22. https://doi.org/10.1590/1413-812320152011.05292014
https://doi.org/https://doi.org/10.1590/... . In addition, those who did not conform to the aesthetic standards of normality imposed by the media and disseminated by society are largely rejected, especially individuals of the female gender, for whom higher relative weight is a factor of discontent¹⁹19. Martins FS, Rech RR, Halpern R, Pedroni JL, Julianote MNS, Frata B, et al. Prevalência de sintomas para transtornos alimentares, sobrepeso e obesidade em escolares do município de Bom Jesus-RS. Rev Bras Obes Nutr Emagr 2017; 11(61): 31-8..

Thus, for a better understanding of bullying, it is necessary to analyze it from a historical-cultural perspective and consider the repetitive persecutions of one student towards another as a reflection of socially and culturally constructed patterns, which provoke humiliations, insults, and verbal and physical aggressions against those who are said to be different¹¹11. Francisco MV, Coimbra RM. Análise do bullying escolar sob o enfoque da psicologia histórico-cultural. Estud Psicol 2015; 20(3): 184-95. http://dx.doi.org/10.5935/1678-4669.20150020
https://doi.org/http://dx.doi.org/10.593... ^,1212. Francisco MV, Coimbra RM. Bullying escolar e os processos de resiliência em-si sob a ótica da teoria histórico-cultural. Educ Temat Digit2019; 21(1): 145-63. https://doi.org/10.20396/etd.v21i1.8651418
https://doi.org/https://doi.org/10.20396... ^,1313. Esteves PSM. O (não) reconhecimento da diferença: o bullying como um desafio das sociedades multiculturais. Rev Eletrônica Pesquiseduca 2016; 8(16): 440-57..

Another finding of this research showed that the practice of bullying increases the chances of the individual suffering from bullying by almost twice. Studies indicate situations in which students are victims and producers of this type of violence, with prevalences from 7.4 to 19.63%, the highest being among male students³³33. Carlyle KE, Steinman KJ. Demographic Differences in the Prevalence, Co-occurrence, and correlates of Adolescent Bullying at School. J Sch Health 2007; 77(9): 623-9. https://doi.org/10.1111/j.1746-1561.2007.00242.x
https://doi.org/https://doi.org/10.1111/... ^,4242. Khamis V. Bullying among school-age children in the greater Beirutarea: Risk and protective factors. Child Abuse Neglect 2015; 39: 137-46. https://doi.org/10.1016/j.chiabu.2014.08.005
https://doi.org/https://doi.org/10.1016/... ^,4343. Oliveira MGD. Comportamento violento, bullying e atividade física em adolescentes [ dissertação]. São Cristóvão: Universidade Federal de Sergipe; 2018.. Although the study developed here does not focus on the existence of abusive victims, we observed in our results that the fact of perpetrating bullying significantly increases the chances of suffering from it.

Similar to our results, a survey of Hong Kong high school students revealed that different types of perpetration of and suffering from bullying are positively correlated, pointing out that the chances of an adolescent being the target of bullying at school increases 236% when he practices bullying, and the opposite is also valid⁴⁴44. Chan HCO, Wong DSW. The overlap between school bullying perpetration and victimization: assessing the psychological, familial, and school factors of Chinese adolescents in Hong Kong. J Child Fam Stud 2015; 24): 3224-34. https://doi.org/10.1007/s10826-015-0125-7
https://doi.org/https://doi.org/10.1007/... . Another study involving adolescents, carried out in the Macau region, in China, also found a positive correlation between practicing bullying and suffering from bullying⁴⁵45. Chan HCO, Chui WH. Social bonds and school bullying: a study of macanese male adolescents on bullying perpetration and peer victimization. Child Youth Care Forum 2013; 42(6): 599-616. https://doi.org/10.1007/s10566-013-9221-2
https://doi.org/https://doi.org/10.1007/... . And a study carried out in municipal schools in Campina Grande found that a victim of bullying had a 1.92 more chance of becoming a producer of violence⁴⁶46. Marcolino EM, Calvacanti AL, Padilha WWN, Miranda FAN, Clementino FS. Bullying: prevalência e fatores associados à vitimização e à agressão no cotidiano escolar. Texto Contexto Enferm 2018; 27(1). http://dx.doi.org/10.1590/0104-07072018005500016
https://doi.org/http://dx.doi.org/10.159... .

It appears that, from these studies⁴⁴44. Chan HCO, Wong DSW. The overlap between school bullying perpetration and victimization: assessing the psychological, familial, and school factors of Chinese adolescents in Hong Kong. J Child Fam Stud 2015; 24): 3224-34. https://doi.org/10.1007/s10826-015-0125-7
https://doi.org/https://doi.org/10.1007/... ^,4545. Chan HCO, Chui WH. Social bonds and school bullying: a study of macanese male adolescents on bullying perpetration and peer victimization. Child Youth Care Forum 2013; 42(6): 599-616. https://doi.org/10.1007/s10566-013-9221-2
https://doi.org/https://doi.org/10.1007/... ^,4646. Marcolino EM, Calvacanti AL, Padilha WWN, Miranda FAN, Clementino FS. Bullying: prevalência e fatores associados à vitimização e à agressão no cotidiano escolar. Texto Contexto Enferm 2018; 27(1). http://dx.doi.org/10.1590/0104-07072018005500016
https://doi.org/http://dx.doi.org/10.159... , being bullied does not occur in isolation, and it cannot be predicted, with the current research, which phenomenon precedes the other. However, regardless of the role of adolescents in bullying, they are equally exposed to situations of vulnerability that affect their well-being and quality of life⁴⁷47. Souza JM, Silva JP, Faro A. Bullying e Homofobia: Aproximações Teóricas e Empíricas. Psicol Esc Educ 2015; 19(2): 289-98. https://doi.org/10.1590/2175-3539/2015/0192837
https://doi.org/https://doi.org/10.1590/... ^,4848. Cavalcanti JG, de Lima Coutinho MDP, de Lima Pinto AV, Silva KC, do Bú EA. Vitimização e percepção do bullying: Relação com a sintomatologia depressiva de adolescentes. Rev Psicol IMED 2018; 10(1): 140-59. https://doi.org/10.18256/2175-5027.2018.v10i1.2725
https://doi.org/https://doi.org/10.18256... .

Among the results obtained in this study, it is worth noting that adolescents who are not treated well at school by their peers were almost three times more likely to suffer from bullying compared to those who were well treated at school. Findings in agreement with the study were obtained in research carried out in several European countries, which revealed that the low social support of classmates increased the propensity for being bullied, as it was slightly stronger than the support from teachers and friends⁴⁹49. Šmigelskas K, Vaičiūnas T, Lukoševičiūtė J, Malinowska-Cieślik M, Melkumova M, Movsesyan E, et al. Sufficient social support as a possible preventive factor against fighting and bullying in school children. Int J Environ Res Public Health 2018; 15(5): 870. https://doi.org/10.3390/ijerph15050870
https://doi.org/https://doi.org/10.3390/... . A study conducted in Iceland found that peer support is a protective factor against being bullied⁵⁰50. Mann MJ, Kristjansson AL, Sigfusdottir ID, Smith ML. The role of community, family, peer, and school factors in group bullying: implications for school‐based intervention. J Sch Health 2015; 85(7): 477-86. https://doi.org/10.1111/josh.12270
https://doi.org/https://doi.org/10.1111/... . Another investigation involving adolescents aged 13 to 17 from public and private schools in Spain showed a greater propensity to suffer from bullying among students who perceived they had less support in the school environment⁵¹51. Herráiz ED, Gutiérrez RB. Social Support as a School Victimisation Risk Factor. J Child Fam Stud 2016; 25: 3473-80. https://doi.org/10.1007/s10826-016-0503-9
https://doi.org/https://doi.org/10.1007/... .

The literature highlights the importance of social support perceived by adolescents at school, where the quality of peer relationships plays an essential role in situations of bullying⁴⁹49. Šmigelskas K, Vaičiūnas T, Lukoševičiūtė J, Malinowska-Cieślik M, Melkumova M, Movsesyan E, et al. Sufficient social support as a possible preventive factor against fighting and bullying in school children. Int J Environ Res Public Health 2018; 15(5): 870. https://doi.org/10.3390/ijerph15050870
https://doi.org/https://doi.org/10.3390/... ^,5050. Mann MJ, Kristjansson AL, Sigfusdottir ID, Smith ML. The role of community, family, peer, and school factors in group bullying: implications for school‐based intervention. J Sch Health 2015; 85(7): 477-86. https://doi.org/10.1111/josh.12270
https://doi.org/https://doi.org/10.1111/... ^,5151. Herráiz ED, Gutiérrez RB. Social Support as a School Victimisation Risk Factor. J Child Fam Stud 2016; 25: 3473-80. https://doi.org/10.1007/s10826-016-0503-9
https://doi.org/https://doi.org/10.1007/... . It is suggested that intervention projects be implemented that include family, educators and students, so that all actors in the school context feel responsible for ensuring a constructive climate, where there is acceptance of differences and mutual respect between students, thus producing better interpersonal relationships at school¹¹11. Francisco MV, Coimbra RM. Análise do bullying escolar sob o enfoque da psicologia histórico-cultural. Estud Psicol 2015; 20(3): 184-95. http://dx.doi.org/10.5935/1678-4669.20150020
https://doi.org/http://dx.doi.org/10.593... ^,1313. Esteves PSM. O (não) reconhecimento da diferença: o bullying como um desafio das sociedades multiculturais. Rev Eletrônica Pesquiseduca 2016; 8(16): 440-57.^,4141. Pigozi PL, Machado AL. Bullying na adolescência: visão panorâmica no Brasil. Ciênc Saúde Coletiva 2015; 20(11): 3509-22. https://doi.org/10.1590/1413-812320152011.05292014
https://doi.org/https://doi.org/10.1590/... ^,5050. Mann MJ, Kristjansson AL, Sigfusdottir ID, Smith ML. The role of community, family, peer, and school factors in group bullying: implications for school‐based intervention. J Sch Health 2015; 85(7): 477-86. https://doi.org/10.1111/josh.12270
https://doi.org/https://doi.org/10.1111/... ^,5252. Trevisol MTC, Pereira B, Mattana P. Bullying na adolescência: causas e comportamentos de alunos portugueses e brasileiros. Rev Educ PUC-Camp 2019; 24(1): 55-72. https://doi.org/10.24220/2318-0870v24n1a4238
https://doi.org/https://doi.org/10.24220... .

Although the analysis of the risk factors associated with being bullied is based on data from a national survey, this article has limits, including: the cross-sectional nature of the study, which did not allow for the investigation into the causes of bullying; the self-reported responses to the questionnaire, which may be subject to specific biases and student understandings; the possibility that explanatory variables of the phenomenon of bullying have not been included, requiring other approaches that allow for a deeper understanding of the risk factors associated with it.

Although this work has limitations, its results need to be taken into account when thinking about intervention alternatives to minimize bullying. In addition, the phenomenon must be analyzed as something complex, which is influenced by values and beliefs that are socially and culturally constructed, and which are reproduced in the school environment. Therefore, preventive efforts that include programs to encourage greater social support among students, the implementation of practices that reinforce respect for students' differences and peculiarities, as well as the promotion of interventions that involve all actors at school, can contribute to the reduction of bullying.

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