An Analysis of the Association between School Bullying Prevention and Control Measures and Secondary School Students' Bullying Behavior in Jiangsu Province.

(1) Background: China released regulations on school bullying prevention and control in 2017; however, current research on school bullying in China focuses on exploring influencing factors and lacks empirical research on the effectiveness of anti-bullying policies in schools. The objective of this study was to use an empirical model to explore the association between bullying prevention and control measures and secondary school students' bullying victimization and multiple bullying victimization in Chinese schools. (2) Methods: Data were derived from the 2019 Surveillance of Common Diseases and Health Influencing Factors among Students in Jiangsu Province. The school's bullying prevention and control measures, which was the independent variable, were obtained in the form of a self-report questionnaire and consisted of five measures: the establishment of bullying governance committees, thematic education for students, thematic training for parents, special investigations on bullying, and a bullying disposal process. Bullying victimization and multiple bullying victimization, which was the dependent variable, were obtained through a modified version of the Olweus bullying victimization questionnaire. In order to better explain the differences in the results, this study constructed multilevel logistic regression models to test the association between school bullying prevention and control measures and the rates of bullying victimization and multiple bullying victimization among secondary school students at both the school level and the student level. Meanwhile, this study constructed five models based on the null model by sequentially incorporating demographic variables, physical and mental health variables, lifestyle variables, and bullying prevention and control measures in schools to verify this association. (3) Results: A total of 25,739 students were included in the analysis. The range of bullying victimization rates for students in the different secondary schools in this study was between 6.8% and 37.3%, and the range of multiple bullying victimization rates was between 0.9% and 14.8%. The establishment of bullying disposal procedures was strongly associated with a reduction in bullying victimization (OR = 0.83, 95%CI: 0.71-0.99, p < 0.05). Establishing bullying disposal procedures was not significantly associated with multiple bullying victimization rates (OR = 0.89, 95%CI: 0.73-1.09, p > 0.05). The establishment of a bullying governance committee, thematic education for students, thematic training for parents, and special surveys on bullying were not significantly associated with bullying victimization rates or multiple bullying victimization rates (all p > 0.05). (4) Conclusions: Among the current bullying prevention and control measures for secondary school students in China, the establishment of a bullying disposal process was conducive to reducing the rate of bullying victimization, but it was ineffective in reducing the rate of multiple bullying victimization, and the other preventive and control measures did not achieve the purpose of anti-bullying in schools.

Developing a Multi-Tiered System of Support-Based Plan for Bullying Prevention Among Students with Disabilities: Perspectives from General and Special Education Teachers During Professional Development.

Students with disabilities or at risk for disability identification (SWD) are disproportionately affected by the bullying dynamic; however, professional development and educator-focused training on preventing bullying for this population is lacking. To address this gap, this study presents an analysis of qualitative data collected from general and special education teachers (n = 33) participating in an online professional development training using Multi-Tiered System of Supports (MTSS) to prevent bullying among students with disabilities. Braun and Clarke's six-step process was used to identify key themes and exemplar quotes from qualitative reflections collected as knowledge check responses embedded within two training modules. Three themes were identified and examined based on MTSS tiers: (1) teacher perceptions of SWD and their inclusion in a MTSS-based bullying prevention plan; (2) identifying key stakeholders for preventing bullying within a MTSS-based bullying prevention plan; and (3) potential challenges and solutions of implementing a MTSS-based bullying prevention plan within the individual, classroom, and school contexts. Findings highlight the need to educate teachers on how to use MTSS, especially for bullying prevention and interventions that are inclusive of SWD. Implications from this work extend to all students including those with mental health considerations, regardless of disability status. Supplementary Information: The online version contains supplementary material available at 10.1007/s12310-023-09589-8.

Middle School Students' Experiences with Cyberbullying and Perspectives Toward Prevention and Bystander Intervention in Schools.

Cyberbullying is a growing problem for middle school students. Bystander interventions that train witnesses to positively intervene can prevent cyberbullying. Through six focus groups, we explored forty-six middle school students' experiences with cyberbullying and opportunities for school-based prevention programs to encourage positive bystander behavior. Focus groups were recorded, transcribed, and analyzed using content analysis. Students viewed cyberbullying as an important problem with significant consequences. They noted hesitancy in reporting to parents and school personnel and felt more comfortable discussing cyberbullying with a near-peer (e.g., older sibling or friend). Students desired combining school-based and online programming with near-peer mentorship. This study suggests need for targeted prevention programs that center middle school students' lived experiences with cyberbullying and their preferences for learning and utilizing positive bystander strategies.

Parent-Based Prevention of Bullying and Cyberbullying During COVID-19 Social Distancing: A Pilot Intervention using the MOST Framework.

Parenting skills are important protective factors in the prevention of bullying and cyberbullying, yet few parent-based interventions have been developed and evaluated in this area. This pilot study examined participant responsiveness to and acceptability of an evidence-based parenting curriculum enhanced to address bullying and cyberbullying. Enhancements included intensive role playing, social emotional coaching, and media parenting. The pilot was delivered online via video conferencing during the unique circumstances of the coronavirus disease pandemic 2019 (COVID-19) shelter-at-home orders. Parents (N = 32; 88% female) participated in weekly online sessions; 30 completed all eight sessions. Using a sequential exploratory mixed method approach, we first conducted quantitative analyses to examine participant responsiveness and qualitative analyses to further explain outcomes and explore participant acceptability. Satisfaction with individual sessions was high. In a few sessions, satisfaction and home practice completion was lower among those with free- and reduced-price lunch eligibility. Qualitative data reinforced and explained quantitative findings. Participants were appreciative of the program and delivery, particularly during the shelter-at-home conditions. They voiced satisfaction with the online format and with home practice assignments. They also made suggestions to strengthen the emphasis on bullying and cyberbullying in the program. Results suggest that the program and enhancements to the program were acceptable to participants, and high rates of satisfaction suggest that video conferencing is a feasible delivery format. Further, parental programming during the stressful context of the COVID-19 pandemic was well received. Although few differences in satisfaction by free- and reduced-priced lunch were observed, technology support for low-income families may be warranted.

Empirical and theoretical foundations of family interventions to reduce the incidence and mental health impacts of school bullying victimization.

Bullying victimisation is a serious risk factor for mental health problems in children and adolescents. School bullying prevention programs have consistently produced small to moderate reductions in victimisation and perpetration. However, these programs do not necessarily help all students affected by bullying. Paradoxically whole-school programs lead to higher levels of depression and poorer self-esteem for students who continue to be victimised after program implementation. This may be because some elements of whole-school programs make victims more visible to their peers, thus further eroding their peer social status. Three main identified risk factors for children and adolescents who continue to be victimised following school bullying prevention programs are peer rejection, internalising problems, and lower quality parent-child relationships. All are potentially modifiable through family interventions. A large body of research demonstrates the influence of families on children's social skills, peer relationships and emotional regulation. This paper describes the theoretical foundations and empirical evidence for reducing the incidence and mental health outcomes of school bullying victimisation through family interventions. Family interventions should be available to complement school efforts to reduce bullying and improve the mental health of young people.

A pilot intervention study on bullying prevention among junior high school students in Shantou, China.

BACKGROUND: Bullying is common among adolescents and can have an adverse effect on victims. This study aims to implement and evaluate an educational intervention on bullying prevention among junior high school students in Shantou, China. METHODS: The four-session educational intervention was designed based on the knowledge-attitude-practice model and conducted from September to December 2018, with one session implemented a month. The intervention methods included holding bullying-themed class meetings, distributing bullying educational leaflets at school, and playing anti-bullying videos in class. The post-intervention assessment was measured at the end of session 4. The chi-square tests were used to examine the changes from baseline to after intervention in the intervention and control group. RESULTS: The results showed that the intervention group's awareness of bullying (percentage of the students who knew bullying very well, male: before vs. after intervention: 16.3% vs. 37.6%, P < 0.001; female: before vs. after intervention: 11.8% vs. 38.8%, P < 0.01), and the female students' acceptance of anti-bullying education (before vs. after intervention: 89.3% vs. 97.6%, P < 0.05) was improved after intervention. The incidence of cyber victimization (male: 32.3% vs. 18.5%, P < 0.05; female: 22.4 to 7.0%, P < 0.01) was also reduced in the intervention group, with the reduction in the incidence of social (19.4% vs. 8.7%, P < 0.05), verbal (40.9% vs. 27.2%, P < 0.05) victimization, and peer (36.6% vs. 20.7%, P < 0.05) and social bullying (11.8% vs. 2.2%, P < 0.01) among male students after intervention. CONCLUSIONS: This educational intervention was the first important step to develop effective intervention strategies for bullying prevention among junior high school students in China.

The Development, Preliminary Validation, and Clinical Application of the Quick Parenting Assessment.

To prevent diseases, efforts are needed to determine how to address Adverse Childhood Experiences (ACEs), including parenting behaviors. The objective of this study, conducted in Nashville TN in 2017, was to initiate testing the psychometric properties of two new Adverse Childhood Experiences (ACEs) screening tools, the Quick Parenting Assessment (QPA) and Other Childhood Stressors (OCS). In a clinic serving low-income families, caregivers of children ages 2-10 completed assessments of parenting (QPA), other stressors (OCS), child behavior problems ((Strength and Difficulties Questionnaire (SDQ)), and Attitudes Toward Spanking (ATS). The QPA takes 1 min to complete and assesses for healthy and unhealthy parenting behaviors. Seventy-five percent of eligible participants completed the survey (N=558). A reduced 10-item QPA yielded a Cronbach's alpha of 0.79 and, in 4-10-year-olds, was associated with high SDQ conduct, hyperactivity, and total difficulties scores (r=0.44, 0.48, and 0.47; all p< 0.001). Children with QPAs of >4 were nine times more likely than those children with scores of ≤2 to have behavior problems (OR=8.93, 95% CI = 3.74-21.32). Elevated QPAs were associated with the ATS (r=0.47, p < .001). The OCS was also associated with high SDQ total difficulties scores (r=0.28, p< 0.001). Two pediatric ACEs screening tools, the QPA and the OCS, have promising psychometric properties. The findings suggest that parenting behaviors may play an outsized role in the pathogenesis of outcomes associated with ACEs. We discuss the clinical application of QPA at our institution and the theoretical potential for this instrument to reduce the rates of short- and long-term health problems.

School-Based Diversity Education Activities and Bias-Based Bullying Among Secondary School Students.

Bias-based bullying (e.g., bullying related to race, weight, sexual orientation) is a common experience among youth, yet few school-based prevention programs explicitly address this type of bullying. This study explores whether schools that offer diversity education activities have lower rates of bias-based bullying among students compared to schools that do not offer these activities. Data came from two sources: the 2018 CDC School Profiles Survey (N = 216 schools) and the 2019 Minnesota Student Survey (N = 64,510 students). Multilevel logistic regression tested associations between diversity education activities (diversity clubs, lessons, or special events) and eight types of bias-based bullying among students, with attention to effect modification by relevant demographic characteristics. Students attending schools that offer a wider variety of diversity education opportunities had significantly lower odds of bullying about race, ethnicity, or national origin among boys of color (OR = 0.89, CI: 0.80, 1.00), about sexual orientation for gay, bisexual, and questioning boys (OR = 0.81, CI: 0.67, 0.97), and about disability for boys with a physical health problem (OR = 0.86, CI: 0.76, 0.99). Attending a school with more types of diversity education activities may protect vulnerable students against specific types of bias-based bullying and advance health equity. A diversity education is recommended as a key component of antibullying efforts and policy.

Evaluating Female Experiences of Electronic Dating Violence in Jordan: Motivations, Consequences, and Coping Strategies.

Gender stereotypes can influence electronic dating violence (EDV) because the victims' experiences with abusers depict crucial social mechanisms concerning relational dependency and unequal power relations between men and women, making it difficult for women to resist, report, or escape cyber abuse. In the Arab context, cyber abuse in romantic relationships has not been sufficiently examined. This study investigated female experiences of EDV through a qualitative exploratory descriptive approach. Participants experienced several short- and long-term negative psychological and emotional behavioral responses. Our findings validate that EDV heightened the probability of intimate partner violence definitively via psychological, emotional, verbal, and physical abuse. Their resistance strategies differed according to the extent and nature of the abuse. None of the participants sought help from family due to fear of being killed or forced out of university, and realizing that they would continue to experience multiple forms of abuse. Rather, they either sought help from female professors at the university or paid the abuser to be left alone. Further, they engaged in protective behaviors to block their abusive partner's access to them, consulted an Information Technology expert, and secretly requested assistance from the police. Preference for controlling and dominant roles, gaining monetary benefits, sexual exploitation, peer pressure, and revenge and anger due to abandonment were the leading motivations for abuse. Female students in their first year of university, those who lived in a disjointed family environment, or those who suffered abuse from their families were particularly susceptible to being victimized. Moreover, passwords shared with others or accounts left open on others' devices also enabled EDV. Hence, universities must conduct awareness sessions, for female students, on how to manage emotions and safe communication on social media and build healthy friendships and relationships. Curricula, seminars, workshops, and courses in the Jordanian educational sector should include programs and interventions that challenge perceived gender norms. These results have significant practical and clinical implications that help understand EDV in a poorly understood context and provide the groundwork for further research on the EDV problem in Jordan, addressing a lacuna in the literature on violence against Jordanian women.

The Zero Violence Brave Club: A Successful Intervention to Prevent and Address Bullying in Schools.

Bullying among peers in schools is a growing problem affecting children and adolescents from an early age worldwide. The consequences of bullying victimization in the emotional development of children and youth and their academic achievement are adverse for them and the rest of the school community, with its negative impact extending into the mid and long run. The Zero Violence Brave Club is implemented in schools in the framework of the Dialogic Model of Violence Prevention, a successful educational action according to the INCLUD-ED project [Strategies for inclusion and social cohesion in Europe from Education] (6th Framework Program of Research of the European Commission). The Zero Violence Brave Club has decreased peer bullying in schools by establishing and cultivating a culture of zero tolerance to violence in educational centers located in diverse socioeconomic and cultural contexts. This evidence-based intervention is grounded in the principle that only the person who denounces violence suffered by a peer and takes a stand always on the victim's side-and those who support her or him-against the aggressor can be considered brave. This article reports a qualitative study of the Zero Violence Brave Club as a successful intervention in seven schools in Spain. The schools are diverse in terms of public or private ownership, religious or lay background, and population served (different proportions of cultural minorities and students with special needs), challenging the misconception that the impact of educational interventions depends on the context. Interviews were conducted with teachers in the schools implementing the Zero Violence Brave Club in their class, using the communicative methodology of research. The results shed light on specific mechanisms through which the Zero Violence Brave Club prevents and responds to bullying in schools, such as emptying of social attractiveness any aggressive behaviors or attitudes. Benefits on mental health and psychological wellbeing are also reported.

The Potential of Anti-Bullying Efforts to Prevent Academic Failure and Youth Crime. A Case Using the Olweus Bullying Prevention Program (OBPP).

The effectiveness of bullying prevention programs has led to expectations that these programs could have effects beyond their primary goals. By reducing the number of victims and perpetrators and the harm experienced by those affected, programs may have longer-term effects on individual school performance and prevent crime. In this paper, we use Norwegian register data to study the long-term impact of the Olweus Bullying Prevention Program (OBPP) on academic performance, high school dropout, and youth crime for the average student, which we call population-level effects. The OBPP program is widely acknowledged as one of the most successful programs reducing school-level bullying; yet, using a difference-in-difference design, no statistically significant population-level effects of the OBPP were found on any of the long-term outcomes in this study. When studied at the population level, as in the current project, the base rate prevalence of bullying is a major explanatory factor for these results. Earlier studies have shown that OBPP reduces bullying prevalence by 30-50%. This decrease translates into absolute reductions in bullying victimization and perpetration at the population level of "only" four and two percentage points, respectively. Our results suggest the average causal effects of school bullying involvement are too small to translate this reduction in bullying into a sizeable population-level impact on students' long-term outcomes. However, a limited potential of anti-bullying programs to prevent population-level adversity can very well be compatible with substantial program effects for individual bullies and victims. Further, our results do not speak to the main objective of anti-bullying programs of limiting childhood abuse and safeguarding children's human rights.

Evaluation of the Olweus Bullying Prevention Program in US Urban Middle Schools Using a Multiple Baseline Experimental Design.

We evaluated the impact of the Olweus Bullying Prevention Program (OBPP) in an 8-year study in urban middle schools that served primarily African American students living in low-income areas. Participants included 2755 students and 242 teachers. We evaluated the OBPP with a multiple-baseline experimental design where the order and intervention start time was randomly assigned for each school. We assessed the frequency of bullying behaviors and experiences including physical, relational, and verbal aggression and victimization using teacher ratings of student behavior and student-reported data, as well as cyber aggression and victimization and school climate measures using student-reported data. For teacher ratings of student behavior, we found significant main effects across all subtypes of aggression and victimization, with some variability in the timing of effects. The pattern of findings showed delayed intervention effects for boys and a weaker impact of the OBPP on 6th graders. We found main effects for student-reported cyber aggression and victimization, relational aggression, and a composite of physical, verbal, and relational victimization. Decreases in victimization emerged in the 1st or 2nd year of intervention, and reductions in aggression emerged during the 3rd year. Across all findings, once intervention effects emerged, they remained significant in subsequent intervention years. The OBPP resulted in significant decreases in student- and teacher-reported aggression and victimization. However, this intervention had limited impact on general areas of school climate including teacher support, positive peer interactions, and school safety. Overall, the findings offer important prevention and research implications.

Effects of School Bullying Prevention Camp on the Adolescent Perpetrators of School Violence.

OBJECTIVES: The purpose of this study was to evaluate the effects of a school bullying prevention camp for adolescent perpetrators of chool violence. METHODS: A total of 95 adolescents (boys=73, girls=22) were included in this study. The changes after the program were evaluated using several self-rating scales for the assessment of the degree of depression, loneliness, impulsivity, self-esteem, and interpersonal reactivity compared with the baseline scales. RESULTS: The school bullying prevention camp significantly reduced the degree of depression severity (z=-5.874, p<0.001) and impul- sivity scale (z=-3.861, p<0.001), while increasing self-esteem (z=-2.091, p=0.037). The degree of depression severity (z=-4.635, p<0.001), loneliness (z=-2.168, p=0.030), and impulsivity (z=-2.987, p=0.003) significantly reduced, whereas self-esteem significantly increased (z=-2.221, p=0.026) for male students who had no history of child abuse. However, there were no significant changes after the program for the degree of depression, loneliness, impulsivity, self-esteem, and interpersonal reactivity among female students with a history of child abuse. CONCLUSION: The results of our study suggest that the development of diverse standardized guidance programs is necessary for teenagers with different characteristics and backgrounds. Such programs are expected to be more effective in preventing school violence.

What works in anti-bullying programs? Analysis of effective intervention components.

Previous research has shown that many school-based anti-bullying programs are effective. A prior meta-analysis (Gaffney, Ttofi, & Farrington, 2019) found that intervention programs are effective in reducing school-bullying perpetration by approximately 19-20% and school-bullying victimization by approximately 15-16%. Using data from this prior meta-analysis, the aim of the current study was to examine the relationship between effectiveness estimates and specific elements of anti-bullying programs. Specific intervention components in line with a socio-ecological framework were coded as present or absent. Components were coded on the following levels: school, classroom, teacher, parent, peer, individual, and intervention. Meta-analytical subgroup comparisons analogous to ANOVA were computed to examine the relationship between the presence of specific components and the effectiveness in reducing bullying perpetration (n = 82) and victimization (n = 86). Results indicated that the presence of a number of intervention components (e.g., whole-school approach, anti-bullying policies, classroom rules, information for parents, informal peer involvement, and work with victims) were significantly associated with larger effect sizes for school-bullying perpetration outcomes. The presence of informal peer involvement and information for parents were associated with larger effect sizes for school-bullying victimization outcomes. Meta-regression analyses showed no significant relationship between effectiveness and the number of intervention components included in a program. The present report contributes to the understanding of 'what works' in reducing school-bullying perpetration and victimization. The impact of these findings on future anti-bullying research is discussed.

Dimensions of empathy and bystander intervention in bullying in elementary school.

The current study investigated associations among cognitive empathy, affective empathy, internalizing problems, and the five steps of the bystander intervention model (notice bullying events, interpret as an event requiring intervention, accept responsibility for intervening, know how to intervene, and act). Participants included 336 fourth and fifth grade students (58.9% boys) at a school in the Midwest region of the United States. Hierarchical regression analyses indicated that greater cognitive empathy was related to noticing bullying events, accepting responsibility to intervene, and knowing how to intervene. Affective empathy was significantly related to the actual act of intervention. Further, significant interactions revealed that affective empathy was positively associated with interpreting bullying as an event that required intervention at low and moderate levels of internalizing problems, but not at high levels of internalizing problems. Overall these findings underscore the need to examine the decision to intervene as the culmination of a series of steps as outlined in the bystander intervention model, with each step potentially influenced by a unique set of precursors.

Long-term school-level effects of the Olweus Bullying Prevention Program (OBPP).

In agreement with two predictions, this somewhat unusual study documented that 70 elementary schools (A-schools) with continued and repeated use of the Olweus Bullying Questionnaire (OBQ) in a four-year follow-up period of 2007-2010, two to eight years after original implementation of the Olweus Bullying Prevention Program (OBPP), had a clearly more favorable long-term development in terms of being-bullied problems, as measured with a completely independent data source, the National Pupil Survey than 102 comparable schools (B-schools) that had not conducted any OBQ-surveys in the same period. The odds of being bullied for students in a Norwegian average elementary school were also almost 40% higher than for students who attended a school with continued use of the OBQ, and very likely, other components of the program. Several alternative explanations of the findings were explored and found wanting. Results suggested that A-schools with continued use had changed their "school culture" for the better with regard to awareness, preparedness and competence in handling and preventing bullying. This form of 'organizational learning' has major consequences in that new groups of students will benefit from such a school environment. It was generally concluded - in spite of a highly stable average of the level of bullying problems in Norway - that it is fully possible to substantially reduce such problems not only in one-year evaluations, as has been amply documented before, but also in the long term, up to eight years after original implementation, with a program such as the Olweus Bullying Prevention Program.

Emotional awareness and bullying prevention in children with autism spectrum disorder / 中国实用儿科杂志

Emotional disorder is one of the main clinical symptoms of autism spectrum disorder(ASD),which is related to the lack of emotional awareness,social cognition and alexithymia. It is often manifested as difficulty in recognizing,distinguishing and processing emotional information of oneself and others,resulting in making inappropriate emotional reactions. Children and adolescents with ASD often participate in school bullying as the perpetrator,victim,or victim-perpetrator,and this brings about a series of negative physical and mental effects on them. Bullying prevention should not only include interventions for core symptoms and comorbidities of ASD,but also involve building partner empathy and social skills,teacher responsibility and supportive services,parental involvement,and social integration.

Evaluation of the Olweus Bullying Prevention Program: A large scale study of U.S. students in grades 3-11.

The purpose of this quasi-experimental study was to evaluate a large-scale implementation of the Olweus Bullying Prevention Program with children and youth in grades 3-11 in the U.S. Two major sets of analyses are presented, one following 210 schools over two years (Study 1; n = 70,998 at baseline) and the other following a subsample of 95 schools over three years (Study 2; n = 31,675 at baseline). Schools were located in 49 counties in central and western Pennsylvania. The Mplus 7.0 program was used to analyze the data which had a multilevel structure, with students nested in schools and program effects based on school-aggregated outcome variables. For almost all grades, there were clear reductions in the two key dimensions, being bullied and bullying other students. Average Absolute Change amounted to approximately 3%, implying that almost 2000 students had escaped being bullied in the two-year study. School-level Cohen's d's were large or fairly large. The longitudinal analyses documented increases in students' expressions of empathy with bullied peers, marked decreases in their willingness to join in bullying, and perceptions that their primary teacher had increased his or her efforts to address bullying. Overall, effects were stronger the longer the program had been in place. The analyses provided strong support for the effectiveness of the OBPP with U.S. students in elementary, middle, and early high school grades in Pennsylvania schools. Future research is warranted to assess program effectiveness in different racial/ethnic and community settings and to examine the relation between fidelity of implementation and outcomes.

Involvement in Bullying During High School: A Survival Analysis Approach.

Knowledge about the risks of bullying involvement during any year of high school is an important element of interventions for changing the likelihood of being bullied. Three cohorts of Australian students (n = 1,382) were tracked from 7th grade to 11th grade. The study showed that some students continue their involvement in bullying, while in addition, new bullies and new victims emerge during each high school year. The findings indicated that the risk of bullying involvement ranged from 16% (as a bully) to 36% (as a victim), increasing to 54.5% and 56.3%, respectively, if a student was a bully or a victim in 7th grade. The risk to students of becoming victims, bullies, or bully-victims in each year of high school suggests that bullying prevention initiatives should be designed to suit students at different stages of adolescent development.

The Cost-Effectiveness of the Kiva Antibullying Program: Results from a Decision-Analytic Model.

Bullying causes substantial suffering for children and adolescents. A number of bullying prevention programs have been advocated as effective methods for counteracting school bullying. However, there is a lack of economic evaluations of bullying prevention programs assessing the "value for money." The aim of this study was to assess the cost-effectiveness of the Finnish bullying prevention program KiVa in comparison to "status quo" (treatment as usual) in a Swedish elementary school setting (grades 1 to 9). The cost-effectiveness analysis was carried out using a payer perspective based on a Markov cohort model. The costs of the program were measured in Swedish kronor and Euros, and the benefits were measured using two different metrics: (1) the number of victim-free years and (2) the number of quality adjusted life years (QALYs). Data on costs, probability transitions, and health-related quality of life measures were retrieved from published literature. Deterministic and probabilistic sensitivity analyses were carried out to establish the uncertainty of the cost-effectiveness results. The base-case analysis indicated that KiVa leads to an increased cost of €829 for a gain of 0.47 victim-free years per student. In terms of the cost per gained QALY, the results indicated a base-case estimate of €13,823, which may be seen as cost-effective given that it is lower than the typically accepted threshold value in Swedish health policy of around €50,000. Further research is needed to confirm the conclusions of this study, especially regarding the treatment effects of KiVa in different school contexts.