Standard Deviation vs. Gini Coefficient: Effects of Different Indicators of Classroom Status Hierarchy on Bullying Behavior.

Classroom status hierarchy (the degree to which popularity is unequally distributed in a classroom) has often been examined as a predictor of bullying. Although most research has relied on an operationalization of status hierarchy as the classroom standard deviation (SD) of popularity, other fields (e.g., sociology, economics) have typically measured resource inequality using the Gini coefficient. This multilevel study examines the concurrent and prospective associations of both status hierarchy indicators (referred to as SD-hierarchy and Gini-hierarchy) with peer-reported bullying, controlling for key variables (i.e., the structure of the classroom status hierarchy, average classroom level of popularity). The final sample included 3017 students (45.3% self-identified as a boy; T1 Mage = 13.04, SD = 1.73, approximately 93% born in Finland) from 209 classrooms. Concurrently, classroom SD-hierarchy was positively, linearly associated with bullying, whereas there was a curvilinear (inverted U) association between Gini-hierarchy and bullying. No significant longitudinal associations were found. The findings suggest that Gini-hierarchy provides unique information beyond the SD-hierarchy.

Inequitable Changes in School Connectedness During the Ongoing COVID-19 Pandemic in a Cohort of Canadian Adolescents.

BACKGROUND: We examined whether subgroups of adolescents experienced disparate changes in school connectedness-a robust predictor of multiple health outcomes-from before the COVID-19 pandemic to the first full school year following pandemic onset. METHODS: We used 2 waves of prospective survey data from 7178 students attending 41 Canadian secondary schools that participated during the 2019-2020 (T1; pre-COVID-19 onset) and 2020-2021 (T2; ongoing pandemic) school years. Fixed effects analyses tested differences in school connectedness changes by gender, race, bullying victimization, socioeconomic position, and school learning mode. RESULTS: Relatively greater declines in school connectedness were reported by students that identified as females, were bullied, perceived their family to be less financially comfortable than their classmates, and attended schools in lower income areas. Marginally greater school connectedness declines resulted among students attending schools that were fully online at T2 than those at schools using a blended model. CONCLUSION: Results point to disparate school connectedness declines during the pandemic, which may exacerbate pre-existing health inequities by gender and socioeconomic position, and among bullied youth. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY: Effective strategies to improve school climates for equity denied groups are critical for pandemic recovery and preparedness for future related events.

Emotional Distress Disparities Across Multiple Intersecting Social Positions: The Role of Bias-Based Bullying.

OBJECTIVES: To apply an intersectional lens to disparities in emotional distress among youth, including multiple social positions and experiences with bias-based bullying. METHODS: Data are from the 2019 Minnesota Student Survey (n = 80 456). Social positions (race and ethnicity, sexual orientation, gender) and 2 forms of bias-based bullying (racist, homophobic or transphobic) were entered into decision tree models for depression, anxiety, self-injury, suicidal ideation, and suicide attempts. Groups with the highest prevalence are described. Rates of emotional distress among youth with matching social positions but no bias-based bullying are described for comparison. RESULTS: LGBQ identities (90%) and transgender, gender diverse, and questioning identities (54%) were common among the highest-prevalence groups for emotional distress, often concurrently; racial and ethnic identities rarely emerged. Bias-based bullying characterized 82% of the highest-prevalence groups. In comparable groups without bias-based bullying, emotional distress rates were 20% to 60% lower (average 38.8%). CONCLUSIONS: Findings highlight bias-based bullying as an important point for the intervention and mitigation of mental health disparities, particularly among lesbian, gay, bisexual, transgender, gender-diverse, queer, and questioning adolescents. Results point to the importance of addressing bias-based bullying in schools and supporting lesbian, gay, bisexual, transgender, gender-diverse, queer, and questioning students at the systemic level as a way of preventing emotional distress.

Family economic status and vulnerability to suicidal ideation among adolescents: A re-examination of recent findings.

BACKGROUND: According to the "differential vulnerability hypothesis," individuals in adverse socioeconomic circumstances as less mentally resilient to stressful events. However, several recent papers radically challenged this hypothesis based on the accumulated literature on stress inoculation and presented cases in which lower-SES adolescents appear to be less vulnerable to suicidal ideation in the face of interpersonal aggression. OBJECTIVE: We re-examine the link between psychological vulnerability to acute stressors and SES using yearly longitudinal public survey data from South Korea. PARTICIPANTS AND SETTING: This is a secondary data analysis of a multi-year public health panel dataset on South Korean adolescents. METHODS: Logistic regression is used to examine the association between suicidal ideation and a range of predictor variables, with a particular focus on the interaction between bullying victimhood and log family income. These variables and the sample were chosen for consistency with recent revisionist research. RESULTS: We reaffirm the well-established finding that bullying victimhood strongly and consistently increases the odds of suicidal ideation (OR = 1.859, p < 0.01). However, we find no evidence in favor of the traditional "differential vulnerability hypothesis" or the recently proposed counterhypothesis. A subsample analysis from the latest wave (W4-W5) did produce results that are consistent with recent revisionist findings, but we suggest this is likely a false positive. CONCLUSIONS: There appears to be no systematic association between SES and vulnerability to suicidal ideation in the face of peer aggression among South Korean adolescents. The claim that lower-SES adolescents may be more resilient to stressful events stands on limited empirical support.

The associations of parental attitudes and peer bullying with alexithymia in adolescents: A structural equality model.

AIM: The aim of this study is to investigate the relationship between parental attitude and peer bullying and alexithymia in adolescents. METHODS: This cross-sectional descriptive study was conducted with adolescents aged 13-18 years within high schools in eastern Turkey. Cluster sampling method was applied, and the study was completed within four high schools determined by random selection method. Sociodemographic characteristics questionnaire form, Peer Bullying Scale Adolescent Form, and Twenty-item Toronto Alexithymia Scale (TAS-20) were used to collect the data. RESULTS: Among the adolescents, 52% were female, 60% had a medium income level, 25.3% were in the 11th grade, 83% were living with their parents, 7.4% had chronic illnesses, 9.2% had psychiatric illnesses, 25.3% had suicidal thoughts, 10.1% engaged in suicidal behavior, and 25.3% used TV, smartphones, or tablets for 3-4 h a day. Rejecting and indifferent parental attitudes were found to be a possible risk factor for alexithymia, bullying and victimization. CONCLUSIONS: This study highlights the connections between parental attitudes, peer bullying, and alexithymia in adolescents. By targeting positive parental attitudes and addressing peer interactions, nurses can effectively contribute to reducing the risk of alexithymia. PRACTICE IMPLICATIONS: Through collaboration with parents, nurses can establish supportive environments that nurture emotional understanding. Remaining attentive to risk factors, such as chronic illnesses and mental health issues in adolescents, empowers nurses to offer timely support or referrals. Partnerships with educators further enhance emotional awareness and encourage positive peer relationships.

Similarities and Differences between Psychosocial Determinants of Bullying and Cyberbullying Perpetration among Polish Adolescents.

Despite the extensive literature on the psychosocial determinants of bullying and cyberbullying among adolescents, there is not sufficient comprehensive analysis of the differences between perpetrators. This study aims to assess the psychosocial similarities and differences between bullies and cyberbullies. Data of 3650 students from two grades, K9 and K11 (47% females, mean age = 16.53), were used from a survey conducted in Poland in 2018 as part of the Health Behaviour in School-aged Children study. Perpetration was measured by questions adapted from the Olweus Bully/Victim Questionnaire. The following predictors were analyzed: demographic, socioeconomic status measured with the Family Affluence Scale-III (FAS), and individual and social factors. Multiple binary logistic regression was applied. The random sampling design was based on stratification according to the local deprivation index of the region where the school was located. Male gender, younger age, and non-intact family were associated with a higher risk of bullying and cyberbullying. Family support, empathy, school performance, and school attachment had a protective effect against both aggressive behaviors. Life dissatisfaction and high FAS were revealed as determinants of cyberbullying and local deprivation of bullying only. Bullying and cyberbullying school prevention programs should take into account these psychosocial differences and consider the economic deprivation of the region.

Suicide risk assessment and depressive symptoms among Spanish adolescent bully-victims: Evidence for the importance of emotional intelligence and sex.

The aim of this study is to explore a model examining how emotional intelligence (EI), sex, depressive symptoms and suicidal thoughts and behaviours (STB) may interact. The sample included 380 Spanish adolescent bully-victims (61.6% boys; mean age = 14.38 years). The results indicated that EI is a significant negative predictor of decreased STB and that this relation is fully mediated by depressive symptoms. This effect was moderated by sex, such that the mediation is stronger for girls compared to boys. The promotion of EI may be core in the development of prevention programmes for suicide, especially among female bully-victims.

The Healthy Context Paradox: When Reducing Bullying comes at a Cost to Certain Victims.

Bullying remains one of the most serious problems affecting school systems around the world. The negative consequences of bullying in the short and long term have been widely documented, showing that victimized students are at greater risk of suffering psychosocial distress. In this paper, we first summarize the current situation of bullying prevention, adopting a contextual perspective, and briefly highlighting the characteristics of the most effective prevention programs. Secondly, we address a disturbing phenomenon detected in classrooms where bullying has been reduced through interventions and which has been termed "the healthy context paradox". In these healthier contexts, students who remain in a situation of victimization have been found to present poorer psychological adjustment after the intervention. Understanding the causes of this phenomenon may offer clues for the prevention of bullying. In this regard, we present three hypotheses recently proposed to explain the phenomenon. Finally, we offer some implications for the study and prevention of bullying derived from "the healthy context paradox".

Pathways to socioeconomic health differences in Armenian adolescents: The role of bullying perpetration.

Bullying perpetration might be an alternative way of hierarchy formation among adolescents. It can potentially compensate for the negative health influences of low socioeconomic status (SES), rewarding this unwanted behavior. This study aimed to investigate the role of bullying perpetration in the relationship between SES and health among Armenian adolescents. A nationally representative sample of 3679 adolescents aged 11-15 years (mean = 13.1, standard deviation = 1.6) participated in the Health Behavior in School-aged Children 2013/14 survey in Armenia. Complex samples multiple logistic regression were used to estimate the associations between two SES measures (family socioeconomic position [SEP] and material well-being) and three health outcomes (perceived health status, psychosocial well-being, and psychosomatic symptoms). Bullying perpetration was not associated with less than good health or low psychosocial well-being (P > 0.05) but increased the odds of reporting high psychosomatic symptoms (P < 0.05). Perpetration did not change the SES-health gradient substantially. However, in stratified analyses, socioeconomic inequalities in health were consistently weaker among perpetrators. The largest observed difference was in the relationship between low family SEP and less than good health (OR = 3.60, 95% CI = 2.77-4.67 vs. OR = 1.80, 95% CI = 1.06-3.04), whereas the smallest difference was in the relationship between low family SEP and high psychosomatic symptoms (OR = 1.27, 95% CI = 1.03-1.56 vs. OR = 1.04, 95% CI = 0.61-1.77). Our findings suggest that bullying perpetration, as an alternative hierarchy, may be looked at as a compensatory but vicious strategy in the face of the negative health influences of low SES in Armenian adolescents. For high-SES adolescents, on the other hand, social, emotional, or psychological problems might contribute to bullying perpetration. Consequently, bullying prevention activities in Armenia should focus on both low and high-SES adolescents, considering SES-specific pathways and mechanisms.

Research on the governance of campus bullying and prevention mechanism of students' mental health problem.

At present, juvenile campus bullying is seriously threatening their own physical and mental health, campus security and even social security, making social instability factors increase. It is to explore how to reduce and avoid the frequent occurrence of campus bullying and provide effective countermeasures for the governance of campus bullying. The relevant research on the governance of campus bullying and the prevention mechanism of students' mental health problems is conducted from the judicial perspective. The methods of literature survey and questionnaire are employed to investigate and analyze the campus bullying problem governance and the influencing factors of students' mental health. The results show that the causes of campus bullying are not only due to external factors, but also due to internal factors from students themselves. The principle of timely prevention and comprehensive management must be followed in the construction of the multigovernance system of campus bullying. It suggests that there are many factors for the occurrence of campus bullying. Only by finding out the root cause of the problem and taking measures to deal with it can the occurrence of campus bullying be effectively avoided.

The UK stand together trial: protocol for a multicentre cluster randomised controlled trial to evaluate the effectiveness and cost-effectiveness of KiVa to reduce bullying in primary schools.

BACKGROUND: Reducing bullying is a public health priority. KiVa, a school-based anti-bullying programme, is effective in reducing bullying in Finland and requires rigorous testing in other countries, including the UK. This trial aims to test the effectiveness and cost-effectiveness of KiVa in reducing child reported bullying in UK schools compared to usual practice. The trial is currently on-going. Recruitment commenced in October 2019, however due to COVID-19 pandemic and resulting school closures was re-started in October 2020. METHODS: Design: Two-arm pragmatic multicentre cluster randomised controlled trial with an embedded process and cost-effectiveness evaluation. PARTICIPANTS: 116 primary schools from four areas; North Wales, West Midlands, South East and South West England. Outcomes will be assessed at student level (ages 7-11 years; n = approximately 13,000 students). INTERVENTION: KiVa is a whole school programme with universal actions that places a strong emphasis on changing bystander behaviour alongside indicated actions that provide consistent strategies for dealing with incidents of bullying. KiVa will be implemented over one academic year. COMPARATOR: Usual practice. PRIMARY OUTCOME: Student-level bullying-victimisation assessed through self-report using the extensively used and validated Olweus Bully/Victim questionnaire at baseline and 12-month follow-up. SECONDARY OUTCOMES: student-level bullying-perpetration; student mental health and emotional well-being; student level of, and roles in, bullying; school related well-being; school attendance and academic attainment; and teachers' self-efficacy in dealing with bullying, mental well-being, and burnout. SAMPLE SIZE: 116 schools (58 per arm) with an assumed ICC of 0.02 will provide 90% power to identify a relative reduction of 22% with a 5% significance level. RANDOMISATION: recruited schools will be randomised on 1:1 basis stratified by Key-Stage 2 size and free school meal status. Process evaluation: assess implementation fidelity, identify influences on KiVa implementation, and examine intervention mechanisms. Economic evaluation: Self-reported victimisation, Child Health Utility 9D, Client Service Receipt Inventory, frequency of services used, and intervention costs. The health economic analysis will be conducted from a schools and societal perspective. DISCUSSION: This two-arm pragmatic multicentre cluster randomised controlled trial will evaluate the KiVa anti-bullying intervention to generate evidence of the effectiveness, cost-effectiveness and scalability of the programme in the UK. Our integrated process evaluation will assess implementation fidelity, identify influences on KiVa implementation across England and Wales and examine intervention mechanisms. The integrated health economic analysis will be conducted from a schools and societal perspective. Our trial will also provide evidence regarding the programme impact on inequalities by testing whether KiVa is effective across the socio-economic gradient. TRIAL REGISTRATION: Trials ISRCTN 12300853 Date assigned 11/02/2020.

Psychosocial Determinants of Adolescents' Cyberbullying Involvement-The Role of Body Satisfaction.

BACKGROUND: Although the relationship between adolescents' body image and cyberviolence has been proved, little is known about the place of body image among other psychosocial determinants. The study aimed to assess the relationship between body satisfaction and cyberbullying in the context of other psychosocial factors. METHODS: We used data of 5817 adolescents (47.6% boys, mean age = 15.43) from the survey conducted in 2018 in Poland as a part of the Health Behaviour in School-Aged Children. Four groups of cyberbullying involvement were defined: only bullies, only victims, both bullies and victims, and not involved. Body satisfaction and ten other independent variables were classified as sociodemographic, socioeconomic, individual and social factors. A series of multinomial logistic regression models were estimated and compared using the pseudo R-sq Nagelkerke coefficient. RESULTS: Although family support seemed to be the most protective, the findings have proved that body satisfaction reduces significantly the risk of cyberbullying. The relationship was more pronounced in victims and bully-victims. A slightly stronger protective effect of body satisfaction has been observed in boys. CONCLUSIONS: The strengthening of body image may be an effective measure to prevent adolescents' cyberbullying, as well as to bring about improvements in social support, connections to others, and school performance.

Cannabis use and suicidal ideation among youth: Can we democratize school policies using digital citizen science?

BACKGROUND: School policies and programs are important in preventing Cannabis use among youth. This study uses an innovative digital citizen science approach to determine the association between Cannabis use and suicidal ideation among youth while investigating how school health policies mediate this association. METHODS: The study engaged 818 youth (aged 13-18 years) and 27 educators as citizen scientists via their own smartphones. Youths responded to time-triggered validated surveys and ecological momentary assessments to report on a complex set of health behaviours and outcomes. Similarly, educators' reported on substance misuse and mental health school policies and programs. Multivariable logistic regression modeling and mediation analyses were employed. RESULTS: 412 youth provided data on substance misuse and suicidal ideation. Cannabis use and other factors such as bullying, other illicit drug use, and youth who identified as females or other gender were associated with increased suicidal ideation. However, school policies and programs for substance misuse prevention did not mediate the association between Cannabis use and suicidal ideation. CONCLUSIONS: In the digital age, it is critical to reimagine the role of schools in health policy interventions. Digital citizen science not only provides an opportunity to democratize school policymaking and implementation processes, but also provides a voice to vulnerable youth.

Sexual Minority Status, Bullying Exposure, Emotion Regulation Difficulties, and Delinquency Among Court-Involved Adolescent Girls.

Sexual minority adolescent girls are overrepresented in the justice system. This study used the minority stress model and psychological mediation framework to investigate a pathway for this disparity among court-involved girls ages 14-18 (N = 226; mean age: 15.58; 48% sexual minority). The hypotheses were that sexual minority status would be associated with delinquency, bullying exposure would be associated with delinquency indirectly via emotion regulation difficulties, and the relationship between bullying exposure and emotion regulation difficulties would be stronger for sexual minority girls. Bullying exposure and emotion regulation difficulties were not related. Sexual minority status was related to delinquency, and emotion regulation difficulties mediated this relationship. The findings suggest interventions to build emotion regulation skills may reduce delinquency for sexual minority girls.

Factors Promoting Posttraumatic Growth in Sexual Minority Adults Following Adolescent Bullying Experiences.

The minority stress model posits that stigmatized identities expose sexual minority individuals to chronic stressors that contribute to health disparities, but that individual-level resources may mitigate psychological distress. Sexual minority adolescents experience one such stressor, bullying victimization, at higher rates than heterosexual peers. Whereas negative consequences of sexual identity-based bullying are well documented, potential positive outcomes are not well understood. The present work examined hypothesized pathways to posttraumatic growth (PTG)-positive psychological changes stemming from trauma-in sexual minority adults following adolescent bullying experiences. We predicted that attributing bullying to one's sexual identity, as opposed to other factors (e.g., weight/appearance, personality), would exacerbate perceived bullying severity but, in turn, enhance PTG. We also predicted that outness about sexual identity would enhance social support and, in turn, facilitate PTG. The hypothesized conceptual model was tested in two samples of sexual minority adults who had experienced bullying during adolescence (Sample 1: Community Sample [N = 139]; Sample 2: National Online Sample [N = 298]), using structural equation modeling with Bayesian estimation. Mediation hypotheses were tested using the PROCESS v3.4 macro. Participants reported their adolescent experiences with bullying, attributions for bullying, outness, social support, and PTG as a result of adolescent bullying experiences, in addition to demographics. Supporting the hypothesized model, in both samples, attributions to sexual identity-based bullying directly and indirectly (via bullying severity) predicted greater PTG, and outness predicted greater PTG through proximal impact on social support. This research underscores the importance of supportive responses to individuals who disclose sexual minority identities and of (re)framing attributions about bullying to facilitate growth.

Grade repetition and bullying victimization in adolescents: A global cross-sectional study of the Program for International Student Assessment (PISA) data from 2018.

BACKGROUND: Grade repetition is practiced worldwide and varies considerably across the globe. Globally, around 32.2 million students repeated a grade at the primary education level in 2010. Although a large body of research has documented grade repetition's academic and non-academic effects, the limited evidence on associations between grade repetition and school bullying is inconsistent and ambiguous. This study aimed to investigate the global association of grade repetition with bullying victimization in a large-scale school-based cross-sectional study. METHODS AND FINDINGS: We used the latest global data from the Program for International Student Assessment (PISA) 2018. PISA 2018 was conducted between March and August 2018 in 80 countries and economies among students aged 15-16 years attending secondary education. The students reported their experiences of repeating a grade at any time point before the survey and of being bullied in the past 12 months. The outcome measures were 6 types of bullying victimization. We accounted for the complex survey design and used multivariate logistic regression models to estimate the odds ratios (ORs) with 95% confidence intervals (CIs) of grade repetition with bullying victimization after adjusting for potential confounders (sex; age group; migrant status; school type; economic, social, and cultural status; and parental emotional support). This study included 465,146 students (234,218 girls and 230,928 boys) with complete data on grade repetition and bullying victimization in 74 countries and economies. The lifetime prevalence of grade repetition was 12.26%, and 30.32% of students experienced bullying at least a few times a month during the past 12 months. Grade repetition was statistically significantly associated with each type of bullying victimization. The OR (95% CI) of overall bullying victimization for grade repeaters compared with their promoted peers was 1.42 (95% CI 1.32-1.52, p < 0.001). The sex-specific analysis produced similar results in both boys and girls. Furthermore, girls who repeated a grade had higher risks of being made fun of, being threatened, having possessions taken away, and being pushed around than boys. The major limitation is that this study only included students attending schools and therefore may be subject to possible selection bias. In addition, the cross-sectional design hinders us from establishing causality between grade repetition and bullying victimization. CONCLUSIONS: In this study, we observed that, globally, both boys and girls who repeat a grade are at increased risk of being bullied compared with promoted peers, but girls may experience higher risks than boys of specific types of bullying associated with repeating a grade. These findings provide evidence for the association of grade repetition with bullying victimization. Sex differences in risk of experiencing some types of bullying suggest that tailored interventions for girls who repeat a grade may be warranted.

Predicting suicidal thoughts and behavior among adolescents using the risk and protective factor framework: A large-scale machine learning approach.

INTRODUCTION: Addressing the problem of suicidal thoughts and behavior (STB) in adolescents requires understanding the associated risk factors. While previous research has identified individual risk and protective factors associated with many adolescent social morbidities, modern machine learning approaches can help identify risk and protective factors that interact (group) to provide predictive power for STB. This study aims to develop a prediction algorithm for STB among adolescents using the risk and protective factor framework and social determinants of health. METHODS: The sample population consisted of more than 179,000 high school students living in Utah and participating in the Communities That Care (CTC) Youth Survey from 2011-2017. The dataset includes responses to 300+ questions from the CTC and 8000+ demographic factors from the American Census Survey for a total of 1.2 billion values. Machine learning techniques were employed to extract the survey questions that were best able to predict answers indicative of STB, using recent work in interpretable machine learning. RESULTS: Analysis showed strong predictive power, with the ability to predict individuals with STB with 91% accuracy. After extracting the top ten questions that most affected model predictions, questions fell into four main categories: familial life, drug consumption, demographics, and peer acceptance at school. CONCLUSIONS: Modern machine learning approaches provide new methods for understanding the interaction between root causes and outcomes, such as STB. The model developed in this study showed significant improvement in predictive accuracy compared to previous research. Results indicate that certain risk and protective factors, such as adolescents being threatened or harassed through digital media or bullied at school, and exposure or involvement in serious arguments and yelling at home are the leading predictors of STB and can help narrow and reaffirm priority prevention programming and areas of focused policymaking.

Exploration of Experiences and Perpetration of Identity-Based Bullying Among Adolescents by Race/Ethnicity and Other Marginalized Identities.

Importance: Race-based discrimination represents an ongoing public health crisis in the US, manifested by wide-ranging disparities in youth health, mental health, and violence exposure. However, studies of racial discrimination often neglect experiences of identity-based bullying (IBB) stemming from other marginalized identities, such as gender identity and sexual orientation. Objective: To examine associations between experiences of IBB based on race/ethnicity/national origin and other social identities and youth health, mental health, and violence outcomes. Design, Setting, and Participants: This cross-sectional study analyzed responses from an anonymous survey conducted at 13 public high schools in Pittsburgh, Pennsylvania, between October 15, 2018, and October 19, 2018. Participants included in the study were in the 9th through 12th grades. Data were analyzed from October 15, 2020, to February 14, 2021. Exposures: Experiences of bullying and bullying perpetration based on race/ethnicity/national origin and other social identities (ie, gender identity, sexual orientation, religion, physical or mental disability, immigration status, other unspecified reason). Main Outcomes and Measures: Youth health (delayed well care; forgone medical care; physical, mental, or emotional limitations), mental health (nonsuicidal self-injury, suicidal ideation), and violence involvement (weapon perpetration or survivorship, fighting, sexual assault, adolescent relationship abuse, experiencing homicide of friend or family member) were assessed using self-reported items modeled on the Centers for Disease Control and Prevention Youth Risk Behavior Survey. Results: Among 3939 participants, the mean (SD) age was 15.7 (1.3) years; 1380 students (36.3%) identified as Black/African American, 2086 (53.7%) as assigned female at birth, 1021 (32.6%) as belonging to a sexual minority group, and 313 (10.0%) as gender diverse. Among reported social identities, race/ethnicity-based experiences of bullying (375 students [9.5%]) and bullying perpetration (209 students [5.8%]) were the most common. Youth with multiple stigmatized identities experienced even higher rates of experiences of IBB and IBB perpetration. Specifically, the highest rates of IBB were reported by gender diverse Black and Hispanic youth. Experiencing IBB based on multiple stigmatized identities was associated with all outcomes, including delayed well care (aOR, 1.41; 95% CI, 1.20-1.65), forgone medical care (aOR, 1.64; 95% CI, 1.44-1.87), nonsuicidal self-injury (aOR, 2.86; 95% CI, 2.53-3.24), suicidal ideation (aOR, 2.49; 95% CI, 2.20-2.83), and greater violence involvement (experiencing violence: aOR, 2.90; 95% CI, 2.45-3.43; homicide survivorship: aOR, 1.19; 95% CI, 1.06-1.33). Conclusions and Relevance: These results further encourage the development of youth health, mental health, and violence prevention programs that address experiences of bullying based on multiple marginalized identities.

LGBTQ state policies: A lever for reducing SGM youth substance use and bullying.

PURPOSE: Sexual and gender minority youth (SGMY) are more likely than their cisgender and heterosexual peers to use substances and to be bullied, yet it is unknown whether the absence/presence of youth- and LGBTQ-specific equity laws drive these disparities. The purpose of this study was to extend previous research focused on adult- and LGBTQ-specific structural factors (e.g., same-sex marriage laws) to determine whether the youths' structural environment (i.e., state-level LGBTQ youth-focused equity laws) was associated with bullying and recent alcohol use, binge drinking, and cigarette use among SGMY. PROCEDURES: We utilized data from the LGBTQ National Teen Survey, collected in 2017 (N = 8,841 sexual and gender minority youth). Linear regression analyses examined the association between bullying and substance use and between state-level LGBTQ youth-focused equity laws (individually and as a composite variable) and bullying and substance use. FINDINGS: SGMY living in states with LGBTQ equity laws were less likely to experience bullying. Findings regarding the relation between LGBTQ equity laws and substance use were mixed, such that LGBTQ equity laws were associated with a higher likelihood of binge drinking and alcohol use, and a lower likelihood of cigarette use. CONCLUSIONS: Findings highlight the role of state-level equity laws in reducing bullying and substance use disparities for SGMY. Yet, given the finding that equity laws were associated with a higher likelihood of binge drinking, it is important to continue to explore how the structural environment shapes SGMY health.

Behind the Mask: An Exploratory Assessment of Female Surgeons' Experiences of Gender Bias.

Though overt sexism is decreasing, women now experience subtle, often unconscious, gender bias as microaggressions. The authors sought to explore the prevalence and impact of the sexist microaggressions female surgeons experience, using a sequential exploratory mixed methods approach (January 2018-April 2018), to identify opportunities for education and prevention. First, all resident, fellow, and attending female surgeons at the University of New Mexico Health Sciences Center (UNM HSC) were invited to participate in focus groups conducted by experienced moderators using a semistructured interview guide based on the 7 Sexist Microaggressions Experiences and Stress Scale (Sexist MESS) domains. Qualitative analysis was performed using line-by-line manual coding to identify themes aligned with the Sexist MESS domains as well as other gender bias experiences of female surgeons. Next, a survey was sent to all resident, fellow, and attending female surgeons at the UNM HSC, which included the Sexist MESS questionnaire and questions related to surgeon-specific experiences of gender bias that the authors developed based on major thematic categories from the focus groups.Four focus groups of 23 female surgeons were conducted, revealing 4 themes: exclusion, increased effort, adaptation, and resilience to workplace slights. The survey response rate was 64% (65/101 surgeons). Across Sexist MESS domains, the frequency and severity of microaggressions was higher for trainees than attendings. The variables of non-White race/ethnicity, having children under 18, and fellowship training generally did not demonstrate statistical significance. This exploratory study adds to the growing body of evidence that gender bias in surgery continues and frequently manifests as microaggressions. Trainees reported the highest rates and severity of microaggressions and bias experiences. Further research should investigate how to address microaggressions, the experiences of male surgeons, the perspectives of medical students and groups who were reported as often perpetuating gender bias, and the efficacy of possible interventions.