Traumatic injury and access to care in rural areas: leveraging linked data and geographic information systems for planning and advocacy.

INTRODUCTION: The purpose of this ecological study was to apply Geographic Information System (GIS) methods to patterns of traumatic injury and access to trauma care to facilitate system planning and advocacy. METHODS: Four US state (Colorado) and national data sources were linked to examine county-level disparities. Average ambulance drive times to trauma centers for populated places in each county were estimated and mapped. RESULTS: Independent samples t-tests demonstrated Colorado's rural counties had significantly higher injury hospitalization rates (mean (M)=685.4 v M=566.3; p=0.005)) and fatality rates (M=93.8 v M=71.6, p<0.001), indicating residents with the least access to care are the most impacted by the burden of injury; this finding was supported by GIS analyses of drive times to level I and II trauma centers and underlying injury rates, which are visually displayed. CONCLUSIONS: These methods are useful tools for rural public health professionals to conduct system optimization, identify training and resource needs, assess prevention priorities, and advocate for trauma system support.

Early labor force exit subsequent to permanently impairing occupational injury or illness among workers 50-64 years of age.

BACKGROUND: Severity of workplace injury tends to increase with age. Whether older workers who experience a workplace injury or illness exit the labor force sooner than comparable peers is not established. METHODS: A case-cohort study design and complementary log-log model were used to identify factors associated with average time to early substantial labor force exit among workers' compensation claimants 50-64 years of age with permanent impairment from an occupational injury or illness. Analysis was based on Ontario's workers' compensation claimant data from 1998 to 2006 linked with Canadian tax files. RESULTS: Workers with permanent impairment left the labor force earlier, on average, than peers without claims. Early retirement was associated with older age in the injury/illness year, greater impairment, lower pre-claim income, physically demanding jobs, and soft-tissue injuries. CONCLUSIONS: Policies aiming to extend older adults' working lives should account for the potentially disparate impacts on older workers of occupational injury and illness.

Same-level fall injuries in US workplaces by age group, gender, and industry.

BACKGROUND: As the workforce ages, occupational injuries from falls on the same level will increase. Some industries may be more affected than others. METHODS: We conducted a cross-sectional study using data from the Bureau of Labor Statistics to estimate same-level fall injury incidence rates by age group, gender, and industry for four sectors: 1) healthcare and social assistance; 2) manufacturing; 3) retail; and 4) transportation and warehousing. We calculated rate ratios and rate differences by age group and gender. RESULTS: Same-level fall injury incidence rates increase with age in all four sectors. However, patterns of rate ratios and rate differences vary by age group, gender, and industry. Younger workers, men, and manufacturing workers generally have lower rates. CONCLUSIONS: Variation in incidence rates suggests there are unrealized opportunities to prevent same-level fall injuries. Interventions should be evaluated for their effectiveness at reducing injuries, avoiding gender- or age-discrimination and improving work ability.

Case Control Study of Impulsivity, Aggression, Pesticide Exposure and Suicide Attempts Using Pesticides among Farmers.

A case-control study was conducted to investigate associations between organophosphate pesticide (OP) exposure, aggression, impulsivity, and attempted suicide. Questionnaires were used to collect information; impulsivity and aggression were measured by the Barratt Impulsivity Scale (BIS) and the Aggression Inventory (AI). A greater number of OP symptoms was associated with an increased odds of a suicide attempt after adjusting for marital status and income (OR = 1.45; CI 1.14-1.86). Attempted suicide was significantly associated with high impulsivity scores (means: 72.4 vs. 60.6, P < 0.0001) and high aggression scores (means: 38.5 vs. 26.1, P < 0.0001). Suicide attempters had a higher number of OP exposure symptoms than controls and scored higher on scales of impulsivity and aggression.

Characteristics of nonfatal occupational injuries among U.S. workers with and without disabilities.

BACKGROUND: Workers with disabilities have a higher risk of nonfatal occupational injuries than workers without disabilities. The characteristics of these injuries are not well described. METHODS: Using 1997-2011 National Health Interview Survey (NHIS) data, we compared the nonfatal occupational injuries sustained by U.S. workers with and without disabilities. RESULTS: Overexertion or strenuous movements and falls accounted for 56.7% of all occupational injuries in workers with disabilities, compared with 45.6% in workers without a disability. Workers with disabilities were more frequently injured in the lower extremity (32.3% vs. 26.6%) or torso (22.9% vs. 16.9%). Workers with disabilities sustained more unspecified injuries (13.5% vs. 7.9%) and fewer open wound injuries (15.7% vs. 24.2%) than their counterparts without a disability. CONCLUSIONS: U.S. workers with disabilities had a higher rate of occupational injuries and these injuries tended to be more severe and were more likely to be caused by overexertion/ strenuous movement or falls.

Interventions for primary prevention of suicide in university and other post-secondary educational settings.

BACKGROUND: Suicide is a leading cause of death among post-secondary students worldwide. Suicidal thoughts and planning are common among post-secondary students. Previous reviews have examined the effectiveness of interventions for symptomatic individuals; however, many students at high risk of suicide are undiagnosed and untreated. OBJECTIVES: We evaluated the effect on suicide and suicide-related outcomes of primary suicide prevention interventions that targeted students within the post-secondary setting. SEARCH METHODS: We searched the following sources up to June 2011: Specialised Registers of two Cochrane Groups, Cochrane Central Register of Controlled Trials, and nine other databases, trial registers, conference proceedings, and websites of national and international organizations. We screened reference lists and contacted authors of included studies to identify additional studies. We updated the search in November 2013; we will include these results in the review's next update. SELECTION CRITERIA: We included studies that tested an intervention for the primary prevention of suicide using a randomized controlled trial (RCT), controlled before-and-after (CBA), controlled interrupted time series (CITS), or interrupted time series (ITS) study design. Interventions targeted students within the post-secondary setting (i.e. college, university, academy, vocational, or any other post-secondary educational institution) without known mental illness, previous suicide attempt or self-harm, or suicidal ideation. Outcomes included suicides, suicide attempts, suicidal ideation, changes in suicide-related knowledge, attitudes and behavior, and availability of means of suicide. DATA COLLECTION AND ANALYSIS: We used standardized electronic forms for data extraction, risk of bias and quality of evidence determination, and analysis. We estimated standardised mean differences (SMD) with 95% confidence intervals (CIs). We analysed studies by intervention type and study design. We summarized RCT effect sizes using random-effects models meta-analyses; and analysed statistical heterogeneity using the Chi(2) test and I(2) statistic. We described narratively the results from studies that used other study designs. MAIN RESULTS: Eight studies met inclusion criteria. They were heterogeneous in terms of participants, study designs, and interventions. Five of eight studies had high risk of bias. In 3 RCTs (312 participants), classroom-based didactic and experiential programs increased short-term knowledge of suicide (SMD = 1.51, 95% CI 0.57 to 2.45; moderate quality evidence) and knowledge of suicide prevention (SMD = 0.72, 95% CI 0.36 to 1.07; moderate quality evidence). The effect on suicide prevention self-efficacy in one RCT (152 participants) was uncertain (SMD = 0.20, 95% CI -0.13 to 0.54; low quality evidence). One CBA analysed the effects of an institutional policy that restricted student access to laboratory cyanide and mandated professional assessment for suicidal students. The incidence of student suicide decreased significantly at one university with the policy relative to 11 control universities, 2.00 vs. 8.68 per 100,000 (Z = 5.90; P < 0.05). Four CBAs explored effects of training 'gatekeepers' to recognize and respond to warning signs of emotional crises and suicide risk in students they encountered. The magnitude of effect sizes varied between studies. Gatekeeper training enhanced short-term suicide knowledge in students, peer advisors residing in student accommodation, and faculty and staff, and suicide prevention self-efficacy among peer advisors. There was no evidence of an effect on participants' suicide-related attitudes or behaviors. One CBA found no evidence of effects of gatekeeper training of peer advisors on suicide-related knowledge, self-efficacy, or gatekeeper behaviors measured four to six months after intervention. AUTHORS' CONCLUSIONS: We found insufficient evidence to support widespread implementation of any programs or policies for primary suicide prevention in post-secondary educational settings. As all evaluated interventions combined primary and secondary prevention components, we were unable to determine the independent effects of primary preventive interventions. Classroom instruction and gatekeeper training increased short-term suicide-related knowledge. We found no studies that tested the effects of classroom instruction on suicidal behavior or long-term outcomes. Limited evidence suggested minimal longer-term effects of gatekeeper training on suicide-related knowledge, while no evidence was found evaluating its effect on suicidal behavior. A policy-based suicide intervention reduced student suicide, but findings have not been replicated. Our findings are limited by the overall low quality of the evidence and the lack of studies from middle- and low-income countries. Rigorously designed studies should test the effects of preventive interventions on important health outcomes, including suicidal ideation and behavior, in varying post-secondary settings.

"Death by a Thousand Cuts": Agriculture Producer Resiliency in the Western United States.

OBJECTIVE: Agricultural producers face a wide array of stress triggers, shocks, and long-term pressures such as drought, flooding, fire, government policies, financial insecurity, and physical injuries. Extant research has revealed that mental health stigma, lack of access to care in rural areas, and negative coping responses (alcohol abuse, suicide, prescription drugs use) exacerbate the challenge of producer responses to short and long-term adversity. Resilience, the traits, processes, and capacities of producers to adapt and transform their approach to farming or ranching, when necessary, in response to stress triggers or long-term pressures, has received less research attention, particularly in the Western United States. The purpose of the study was to apply an interactionist occupational resilience theoretical perspective to the investigation of contextual factors contributing to resilience in Western United States agricultural producers. METHODS: Qualitative interviews (45 to 90 minutes) were conducted with agricultural producers (n=51) from Western states and territories. Applied thematic analysis with a phenomenological lens was utilized to analyze interview transcriptions. First and second level coding were conducted to derive themes. RESULTS: The analysis revealed that resilience is based upon the interactions between traits of producers and the context of agriculture. Four themes were generated (Agricultural Life, External Stressors, Traits and Adaptations, and Supports and Resources), supported by subthemes. The themes and subthemes are depicted in an agricultural producer resiliency model. The findings shed light on the equivocal role of neighbors in providing support for each other and the double-edged sword of co-working with family. CONCLUSIONS: The findings underscore that social capital is an important mechanism for supporting farmers and ranchers, as those with stronger social resources are more resilient. We recommend more funding to tailor stress and mental health programming to the specifics of agriculture, integration of behavioral health in primary care as a mechanism to increase access to care, and more intentional technical assistance for farmers and ranchers on strategic planning and problem solving.

Agricultural exposures and farm-related injuries among adolescents in rural China.

This cross-sectional study explored the incidence of farm injuries and the relationship between agricultural exposures and injury among 2053 adolescents aged 13-19 years in Macheng, China. A comprehensive self-administered questionnaire was given to adolescents. The cumulative incidence rate of farm injury was 19.8%. Adolescents who were male, aged 10-15 years, left behind, working more days each month and living on the plains, reported higher rates. Specific agricultural exposures, such as large animals, pesticides and operating farm machinery were associated with higher injury rates. Prevention programmes are needed to reduce farm injuries.

Occupation and suicide: Colorado, 2004-2006.

BACKGROUND: Occupation has been identified as a risk factor for suicide. Changes in work environments over time suggest occupations at high risk of suicide may also change. Therefore, periodic examination of suicide by occupation is warranted. The purpose of this article is to describe suicide rates by occupation, sex, and means used in Colorado for the period 2004-2006. METHODS: To provide information useful in designing suicide prevention programs, the methods used in suicide across occupational groups also are examined. Data from the Colorado Violent Death Reporting System (COVDRS) were obtained for suicides that occurred between 2004 and 2006. Denominators to calculate rates by age, sex, and race used are from the 2000 US Census of the Population data. RESULTS: Men had higher suicide rates than women in all occupation categories except computers and mathematics. Among men, those in farming, fishing, and forestry (475.6 per 100,000) had the highest age-adjusted suicide rates. Among women, workers with the highest suicide rates were in construction and extraction (134.3 per 100,000). The examination of lethal means showed that workers in farming, fishing, and forestry had higher rates of suicide by firearms (50.18 per 100,000) compared with other workers. Healthcare practitioners and technicians had the highest rate of suicide by poisoning (14.25 per 100,000). Workers involved in construction and extraction (26.43 per 100,000) had higher rates of suicide by hanging, suffocation, or strangling. CONCLUSIONS: Significant differences in means of suicide were seen by occupation, which could guide future suicide prevention interventions that may decrease work-related suicide risks.

Sustainability and the Thoroughbred Breeding and Racing Industries: An Enhanced One Welfare Perspective.

As society debates the use of animals in sport, entertainment, and leisure, there is an increasing focus on the welfare, social, and ecological impacts of such activities on the animals, human participants, people close to them, and the physical environment. This article introduces the "Enhanced One Welfare Framework" to reveal significant costs and benefits associated with Thoroughbred breeding and racing globally. In addition, relative to calls to ban horseracing and similar activities as part of sustainability approaches that focus chiefly on animals, the "Enhanced One Welfare Framework" is better positioned politically to guide discussions that renegotiate the conditions under which horses are used for sport and the impact racing has on humans and the planet. In 2020, the International Federation of Horseracing Authorities issued its minimum horse welfare standards based on the Five Domains model, positioning lifelong horse welfare as "fundamentally important to the viability and sustainability of the industry". In this article, we critique the One Welfare framework's historic lack of focus on sport and enhance it by including sport, leisure, and entertainment and framing it within the Five Domains model. We offer a novel extension of the Five Domains model beyond animal welfare to consider human welfare and the physical environmental impacts of the sport, leisure, and entertainment industries and propose innovations that may help thoroughbred breeding and racing assure a sustainable future.

A nationwide survey on producer and veterinarian perceptions of the painfulness of procedures and disease states in dairy and beef cattle.

Failure to adequately manage pain in cattle causes suffering and is thus a welfare concern for the livestock industry. The objectives of this study were to summarize caregiver perceptions of the painfulness of various procedures and disease conditions in cattle. This survey also assessed factors that impact the perception of painfulness and determined relationships between pain perception and mitigation in producers and veterinarians in the United States beef and dairy cattle industries. An online survey was distributed via organization listservs and social media groups representing beef and dairy veterinarians and producers. The survey included questions about respondent demographics and pain perception and frequency of pain mitigation use for a variety of common husbandry procedures and disease conditions in cattle less than 2 months, 2-12 months, and greater than 12 months of age. Descriptive statistics were generated, and ordinal logistic regressions were used to assess the relationship between perceived pain level, frequency of pain mitigation use, and respondent demographic factors (e.g., gender, age, and role). There was a relatively low percentage of respondents that identified there was "no pain" associated with the listed procedures and conditions. Across the majority of procedures and conditions and cattle age categories, men perceived procedures to be less painful than women (P < 0.05). Veterinarians and producer-veterinarians perceived procedures to be more painful than producers (P < 0.05) for the majority of procedures and conditions. There were some differences identified between respondent age groups in pain perception but the trends were not consistent across procedures and conditions. There was a significant positive linear trend, with greater perceived pain associated with greater likelihood of providing local and systemic analgesia for all procedures and conditions across all cattle age categories (P ≤ 0.02). Perception of pain is complex and multifactorial, and it influences the likelihood to treat pain in cattle. This research highlighted the importance of understanding how these factors may play a role in increasing the use of pain mitigation within the beef and dairy industries.

The potential usefulness of standardized assessments to measure participant outcomes of adaptive/therapeutic horseback riding: a survey study.

Adaptive or therapeutic riding (A/TR) is a recreational activity which provides mounted and ground-based horsemanship opportunities adapted to the abilities of the participants. A/TR provides physical and psychological benefits to participants with diverse disabilities, including physical, developmental, cognitive, and age-related disabilities, promoting higher quality of life. A/TR professionals may be limited in their capacity to implement outcome assessments and report the benefits of their community-based A/TR services to a broad audience. The purpose of this study was to identify whether and how A/TR professionals currently measure participant outcomes; benefits and barriers to implementing standardized assessments in A/TR; and characteristics which would make assessments useful in the community-based A/TR environment. To address this purpose, we conducted a survey among A/TR professionals. We found that while A/TR professionals measure outcomes among their participants, they typically do not use standardized assessments. Survey respondents believed benefits of implementing standardized assessments included bolstering the A/TR profession, acquiring funding, and communicating about A/TR services to a broad audience. Respondents also identified several barriers to implementing standardized assessments including time, systemic, and expertise constraints. Respondents reported that useful standardized assessments would be relevant to all age groups and populations who receive A/TR services. Finally, respondents shared that for standardized assessments to be useful, they would need to be low-cost, require less than 10-20 min, and available in either paper or computer format. This study revealed that standardized assessments may be a strong support to the A/TR profession; however, assessments must meet the unique needs of A/TR professionals.

School Bullying Victimization and Associated Factors Among School-Aged Adolescents in China.

There has been a significant amount of research on correlates of bullying victimization, but most prior studies are descriptive and do not distinguish between different types of bullying. The current study used a case-control study design to explore factors related to different types of bullying victimization, including physical, relational, verbal, sexual, property, and poly-bullying victimization. This study was conducted in a southern city in China, including 3054 cases who self-reported being victims of school bullying and 3054 controls who reported not being involved in any school bullying in the past 12 months. Each victim case was matched with a control on gender, school, and grade level. Univariate logistic analyses and multivariate conditional logistic regression analyses were used to identify factors associated with being a victim of school bullying. Results suggest physical bullying victimization was only associated with a family-level characteristic (parenting style) while the other four types of bullying victimization (relational, verbal, sexual, and property bullying) and poly-bullying victimization were associated with multiple social domain variables at individual, family, and school levels. Findings from this study provide evidence of factors for different types of bullying victimization and have implications for potential measures to prevent bullying. Measures from multiple social domains, including individual, family and school (e.g., developing healthy behaviors, improving social skills, positive parent-child interactions, building trust between teachers and peers, and forming strong friendships), should be considered in order to effectively prevent adolescent victimization from bullying.

Nonoccupational and occupational injuries to US workers with disabilities.

OBJECTIVES: We examined medically treated injuries among US workers with disability. METHODS: Using 2006-2010 National Health Interview Survey data, we compared 3-month rates of nonoccupational and occupational injuries to workers with disability (n = 7729) and without disability (n = 175 947). We fitted multivariable logistic regression models to calculate odds ratios and 95% confidence intervals of injuries by disability status, controlling for sociodemographic variables. We also compared leading causes of injuries by disability status. RESULTS: In the 3-month period prior to the survey, workers with disability were more likely than other workers to have nonoccupational injuries (odds ratio [OR] = 2.35; 95% confidence interval [CI] = 2.04, 2.71) and occupational injuries (OR = 2.39; 95% CI = 1.89, 3.01). For both groups, the leading cause was falls. CONCLUSIONS: Disability status was strongly associated with risk of nonoccupational and occupational injuries among US workers. The safety issues facing US workers with disability in the workplace warrant future research. Federal agencies with an interest in the employment of workers with disability and their safety in the workplace should take a lead in further assessing injury risk and in promoting a safe working environment for workers with disability.

Colorado Agricultural Workers' Rights of Access to Key Healthcare Providers: A Policy Brief.

Health is a human right. In order to exercise their right to health, agricultural workers need to have access to medical, dental, and behavioral health care. Agricultural workers need to have medical, dental, and behavioral health care available at times and locations that are amenable to their work schedules and worksites. Many agricultural workers do not have access to transportation due to the nature of their working conditions, therefore policies to provide transportation will increase access to medical, dental, and behavioral health services.

Frequency of disagreements between producers and veterinarians about pain management in cattle.

Pain management is a key element of ensuring animal welfare. Although the opinions of both producers and veterinarians affect decisions about the use of pain mitigation on cattle operations, little is known about how they communicate about this topic. Given the importance of a veterinary-client-patient relationship for developing pain mitigation protocols, understanding the communication between veterinarians and producers is key to the implementation of robust, industry-wide pain management protocols. The objectives of this survey were to understand how producers and veterinarians may respond to disagreements about pain mitigation and to determine where respondents obtain their knowledge about pain recognition and treatment. Results presented herein are part of a larger study previously described. An online survey was distributed to 6 cattle industry groups. Surveys that were >80% complete were included for analysis (n = 1,066). Approximately half of the respondents identified as producers (497, 46.6%) and half as veterinarians (569, 53.4%). The majority of producers believed that disagreements about the use of pain management in cattle never affected their relationship with their veterinarians (349, 70.2%). The veterinarian respondents indicated more disagreements, although the frequency was relatively low, with 43.9% (250) indicated having a disagreement less than once a year. Most producers and veterinarians indicated they were either "extremely unlikely" or "somewhat unlikely" to dissolve the relationship completely if disagreements about pain management arose (veterinarians: 398/569, 70%; producers: 294/497, 59.1%). Veterinarians and producers reported gaining their knowledge about pain recognition from a variety of sources including personal experience and continuing education opportunities. Disagreements about pain mitigation occurred infrequently; however, this could be due to few discussions about pain management in general. These results indicated that there is opportunity for veterinarians to engage with their producers in more discussions about pain management.

Unintentional injuries and risk behaviours of internal migrant children in southern China: A cross-sectional study.

The purpose of this study was to estimate the prevalence of unintentional injuries and to identify factors mediating the risk of unintentional injuries among internal migrant children in southern China using self-reported data collected between April 2016 and March 2017. Logistic regression models were used to identify significant risk factors for unintentional injuries among the internal migrant children. The prevalence of self-reported unintentional injuries among internal migrant children in this study was 19.15%. Internal migrant children exhibiting antisocial (antisocial behaviour vs. no behaviour problems, OR = 2.162, 95% CI: 1.194-3.915, p = .011) and neurotic behaviours (neurotic behaviour vs. no behaviour problems, OR = 2.064, 95% CI: 1.098-3.880, p = .024) were more likely to report unintentional injuries. There was a positive correlation between the number of risk behaviours and the prevalence of unintentional injuries among non-migrant and internal migrant children. Children's behavioural problems were closely related to unintentional injuries and may be useful as predictors of unintentional injuries in children.

Preliminary Exploration of Weekly Peer Group Discussions as a Strategy for Coping with Feelings Associated with Euthanasia in Dairy Caretakers.

Dairy caretakers experience a variety of occupational risks including stress related to performing euthanasia and making euthanasia-related decisions for cattle in their care. Few supportive interventions exist to help caretakers cope with euthanasia-related stress. The aim of this study was to assess the impact of weekly peer discussion sessions as an intervention to reduce euthanasia-related stress and grief in dairy caretakers. This study utilized scores from a modified pet-based bereavement questionnaire to assess the change in bereavement of caretakers in response to euthanasia-related stress in a non-treatment group (who did not attend peer discussion sessions, n = 7) and a treatment group (who attended peer discussion sessions, n = 15). Key findings of this study were that discussion sessions did not have a direct impact on the study outcomes as measured using a pet bereavement scale, as there was no difference in the change in bereavement scores during the 8 week study period between the treatment and non-treatment groups. Thematic analysis of peer discussions revealed that compassion towards dairy cattle is a prominent factor in areas of decision making, protocols, and training. Further studies should continue to explore how performing euthanasia and making euthanasia-related decisions impacts caretakers and what supportive interventions can reduce stress and grief.

Risk Factors for Brain Health in Agricultural Work: A Systematic Review.

Certain exposures related to agricultural work have been associated with neurological disorders. To date, few studies have included brain health measurements to link specific risk factors with possible neural mechanisms. Moreover, a synthesis of agricultural risk factors associated with poorer brain health outcomes is missing. In this systematic review, we identified 106 articles using keywords related to agriculture, occupational exposure, and the brain. We identified seven major risk factors: non-specific factors that are associated with agricultural work itself, toluene, pesticides, heavy metal or dust exposure, work with farm animals, and nicotine exposure from plants. Of these, pesticides are the most highly studied. The majority of qualifying studies were epidemiological studies. Nigral striatal regions were the most well studied brain area impacted. Of the three human neuroimaging studies we found, two focused on functional networks and the third focused on gray matter. We identified two major directions for future studies that will help inform preventative strategies for brain health in vulnerable agricultural workers: (1) the effects of moderators such as type of work, sex, migrant status, race, and age; and (2) more comprehensive brain imaging studies, both observational and experimental, involving several imaging techniques.

Risk Factors Associated With School Bullying Behaviors: A Chinese Adolescents Case-Control Study, 2019.

This research aimed to identify risk factors including individual characteristics and environment circumstances related to different types of school bullying (physical, relational, verbal, sexual, and possession bullying) among middle school students in China. Cases were the respondents reporting perpetrating bullying behaviors three or more times in the past year. One control was selected for each case from those participants who were not involved in school bullying in the past 12 months. Data were collected between April 2019 and May 2019 in China. After considering potential confounding variables including gender, grade level, and school, multivariable conditional logistic regression analysis was performed based on the univariate logistic analysis including 1,594 adolescents. According to conditional logistic regression analysis, alcohol use and lack of emotional management and control were the significant individual characteristics positively associated with involvement in school bullying. Alcohol use was related to all five types of school bullying perpetration. Poor relationships between family members, father's alcohol use, and parental neglect were strong risk factors for relational bullying. Lack of a sense of safety and absence of trusted people were associated with physical, relational, and verbal bullying perpetration. Results of this study provide evidence about risk factors for school bullying and have implications for potential policies to reduce bullying. Effective policies and programs need to take individual characteristics (social-emotional skills, anger control), family (parent training in conflict resolution, appropriate disciplining), peer and school factors (promoting prosocial networks, zero tolerance for bullying, appropriate disciplining policies against students who bully others, teacher training on building positive teacher-student relationships and positive discipling techniques) into consideration in order to develop effective prevention programs.