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The study ananlyzed data from a survey about health risk behaviors and associated factors among school students. Its questionnaire was based on GSHS survey and Center for Epidemiological Studies-Depression scale. Students aged 13-17 in two schools, in urban and rural districts in Nghe An province, were selected for the research.
JOURNAL OF MEDICAL RESEARCH SCHOOL BULLYING AND SOME ASSOCIATED FACTORS AMONG STUDENTS AGED 13-17 IN NGHEAN PROVINCE IN 2017 Quynh Anh Tran1, Huong Le Vu Thuy1, Trang Pham Thi Thu1, Bac Truong Dinh2, Diem Nguyen Thi Hong2 Institute for Preventive Medicine and Public Health, Hanoi Medical University Department of Preventive Medicine, Ministry of Health Our study described the prevalence of being bullied among students aged 13-17 and associated factors in this group in two districts in Nghe An Province in Vietnam in 2017 A cross-sectional study was performed with 1074 students The study ananlyzed data from a survey about health risk behaviors and associated factors among school students Its questionnaire was based on GSHS survey and Center for Epidemiological Studies-Depression scale Students aged 13-17 in two schools, in urban and rural districts in Nghe An province, were selected for the research There were two schools in Vinh city and two in Do Luong district This study has identified that 16% of students reported that they were bullied during the last month The majority of victims were bullied on to days over 30 days Among bullied students, verbal bullying behaviors were more prevalent than physical behaviors (38% compared 9%) Being bullied was significant more prevalent among younger students and independent form gender Students who reported ever having health risk behaviors including tobacco and alcohol consumption; and mental health problems were significant more likely to be bullied than those who never reported such problems In conclusion, violence in school is becoming a persistent issue not only in Vietnam but also all over the world Findings support that the development of prevention strategies for victims is crucial to reducing the effect of school bullying on children’s future Key words: School bullying, school-aged students, students, violence, cyber bullying I INTRODUCTION In recent years, the number of children experiencing violence in school setting is increasing all over the world Accroding to WHO, it is estimated from children’s world data that over half of children on average report bullying Corresponding author: Huong Le Vu Thuy, Institute for Preventive Medicine and Public Health, Hanoi Medical University Email: lethuyhuong@hmu.edu.vn Received: 06 June 2017 Accepted: 16 November 2017 JMR 111 E2 (2) - 2018 Bullying is intentional and repeated aggression from which children lack the ability to protect themselves [1] Bullying at school has been associated with poor academic performance, and mental health problems including depression, anxiety, and suicidal thought [2 - 5] There have been number of studies on school bullying worldwide Per one review of low and middle –income countries, the prevalence of bullying within individual countries ranges from 20 to 61% in 18 107 JOURNAL OF MEDICAL RESEARCH countries, and Tajikistan was the country only with a prevalence of bullying of less than 20% [6] In the United State, data from a recent Youth Risk Behavior Surveillance showed that more than one- fifth of students are bullied on school property during 12 months [7] The Global School-based Student Health Survey (GHSH) in China found that around 32% of students were bullied over the past 30 days In South East Asia, the figures in Singapore revealed that about a quarter of secondary school students and one- fifth of primary school students were victims of bullying [8] Another study in Turkey showed that 22% were victims, 9.4% were bully/victims and 9.2% were bullies [9] In German, Richter showed that 17% of boys and 10% of girls from 11 to 15 years old were classified as repeated bullying perpetrators [10] Although studies on school bullying have been conducted in several sites in Vietnam, there is a lack of data on school students who are bullied in Nghe An province The aims of this study are to describe the prevalence of being bullied among students aged 13 - 17 and associated factors in two districts in Nghe An Province in Vietnam in 2017 II SUBJECTS AND METHODS Subjects and recruitment This study used a cross-sectional study design By using a formula, the minimum sample size was estimated to be 412 students To be more precise, once multiplied with design effect and a sample size of at least 824 students was determined necessary In fact, a total of 108 1074 participants involved The following formula was used to estimate the sample size for a proportion of the population n = Z21-α/2 x p(1- p) d2 p= 0.22 (Le Thi Hai Ha 's study) [9]; = 1.96 (95%CI) and d = 0.04 In Nghe An Province, located in the centre of Vietnam, some cases of school bullying were reported among students in grade to 12 via the internet Therefore,Vinh city, in a rural district, and Do Luong district, in a urban one, were selected In each location, a secondary school and high school were chosen, namely Hong Son secondary school (282 participants) and Le Viet Thuan high school (274 participants), located in Vinh city, and Nguyen Thai Nhu secondary school (270 participants) and Do Luong III high school (248 participants) in Do Luong district In secondary schools, students from grades 7, and were collected In high schools students form grades, that is 10 and 11 were collected Eventually, in each grade, three or four classes were randomly selected based on the sizes of classes and all students in chosen classes were eligible to participate Data was collected in the class setting First, researchers explained to students the aim of the survey and how to complete the questionnaire The researchers also expressed that participation was voluntary After that, it took 15 to 30 minutes for students to fill out questionnaire, which researchers collected directly There were around 20 to 40 students in a class JMR 111 E2 (2) - 2018 JOURNAL OF MEDICAL RESEARCH Methods Instrument and data collection We had applied GSHS questionnaire that was made by WHO to help countries measure the behavioural risk factors and protective factors among young people aged 13 to 17 years It focused bullying and determined current both bullying prevalence (during past 30 days) and types of bullying behaviors Mental health problems (feelings of loneliness, being worried, hard focus, and suicide attempt) and health risk behaviors (alcohol consumption, drug use, and tobacco use) were also collected Data analysis The data was entered into EPI and analyzed using STATA 12.0 Descriptive statistics, odds ratios with 95% CI (Confidence Interval), and Pearson Chi square tests were used to describe all the variables All missing or illogical data were excluded from the analysis Ethics In the study, all students were given the choice to participate and were assured that their answers would remain anonymously All personal identities of the respondents were protected The survey was performed with agreement of school leaders and the Nghe An Department of Education and Training III RESULTS General description of the participants The proportion of boys was lower than that of girls: 45.8% versus 54.2% In term of a total of 1074 participants (with the respondent rate is 100%), the percentage JMR 111 E2 (2) - 2018 of respondents aged from 13 to 15 years old was 49.8% compared to 50.2% of those aged 16 and 17 years old The percentages of urban and rural areas were 51.8 and 48.2 respectively There were about 14.1% of total students who reported that they not have any close friends to confide in Regarding BMI, the proportions of normal and underweight students were at with 46.4% and 49.6% respectively, while 4% of students were classified as overweight/ obese The proportion of alcohol consumption was the highest (one of three) health risk behaviors with about 20.5% of total students reporting alcohol use, followed by 8% of participants reporting tobacco use Approximately 80% of total respondents reported that they had diffculty concentrating during the last 12 months; followed by 70% of students reporting they felt lonely during the past 12 months In addition, more than half of students reported being worried during that period Finally, the rate of participants who had attempt suicide was around 10% Prevalence of being bullied among students aged 13-17 in Nghe An province in Vietnam The overall past 30 days prevalence of school bullying was 16% The majority of students were bullied on to days, constituting for 9.8%, followed by 2.7% of participants who suffered from school bullying on to days 1% of students reported bullying for at least days, and 1.4% of respondents reported being bullied all 30 days 109 JOURNAL OF MEDICAL RESEARCH Table Types of bullying behavior by personal characteristics of bullied students Physical bullying Characteristics Gender Age group Region Friendship BMI Verbal Others Total bullying (%) (%) 30 (35.7) 51 (60.7) 84 Girl (%) (3.6) Boy 12 (13.6) 35 (39.8) 41 (46.6) 88 13 -15 (9) 40 (40) 51 (51) 100 16 – 17 (8.3) 25 (34.7) 41 (57.0) 72 Urban (8.8) 36 (45.6) 36 (45.6) 79 Rural (8.6) 29 (31.2) 56 (60.2) 93 Yes 13 (9.0) 52 (36.1) 79 (54.9) 144 No (7.4) 12 (44.4) 13 (48.2) 27 18.5 to 24.99 10 (12.8) 32 (41.0) 36 (46.2) 78 Under 18.5 (5.6) 31 (34.8) 53 (59.6) 89 Over 25 (40) (60) Associated factors to being bullied among school students Table Association between personal characteristics and being bullied among school students Bullied students Characteristics Gender Age Group Region Friendship BMI 110 OR (95%CI) n % Girl 84 14.5 1.0 Boy 88 17.9 1.3 (0.9 - 1.8) 13 -15 100 18.7 1.5 (1.1 - 2.1) 16 – 17 72 13.4 1.0 Urban 79 14.2 1.0 Rural 93 18.0 1.3 (1 - 1.8) Have close friends 144 15.8 1.0 Have no close friend 27 18.0 1.2 (0.7-1.8) 18.5 to 24.99 78 15.7 Under 18.5 89 16.7 1.1 (0.8-1.5) Over 25 11.6 0.7 (0.3-1.9) p - value > 0.05 0.017 < 0.05 > 0.05 > 0.05 > 0.05 JMR 111 E2 (2) - 2018 JOURNAL OF MEDICAL RESEARCH Table presents, according to age group, the propotion among 13-15 year-old students roughtly one in five, whist it was 13,4% among those of 16-17 Table Association between mental health problem and being bullied among school students Bullied students Mental health problems Loneliness Being worried Hard focus Suicide attempt N % Ever 137 18.4 Never 34 10.4 Ever 121 20.2 Never 50 10.6 Ever 151 17.7 Never 19 8.8 Ever 35 31.8 Never 137 14.2 OR 1.9 (1.3-2.9) p- value 0.001 < 0.05 2.1 (1.5-3.1) < 0.05 2.2(1.3-3.7) 0.001 < 0.05 2.8 (1.8-4.4) < 0.05 Table indicates that mental health problems were associated with being victim of perpetration among school students There is also evidence that students with mental health problems were significant likely to be perpetrated than those who had no any psychiatric problems 29.1% of respondents who had ever smoked reported that they were bullied during the past 30 days In participants using alcohol at least one drink during their lives, 25.5% of them reported being bullied Statistically, students who had ever used tobacco and alcohol were associated with being bullied The prevalence of being bullied among students who had ever consumed drug in their lifetime was nearly 30% Although the odd ratio was reasonably high, there was no significant association between drug use and being a victim IV DISCUSSION Findings of current study indicated that nearly 16% of total students reported being bullied over the past 30 days This prevalence was lower than figures reported in previous studies conducted in Vietnam and other countries, which reported a range from 20-50% bullying victims among school students [7, 8] These distinctions can be explained by the discrepancies between sample sizes, instruments used or the time period when studies were carried out or even geographic features This current research investigated the percentages of each type of bullying behaviors JMR 111 E2 (2) - 2018 111 JOURNAL OF MEDICAL RESEARCH and differences in bullying among gender, age, region, friendship, and BMI With regard to age, the percentage of both age groups suffering from physical behaviors were almost equal at around 9%, while the proportion of younger students who reported verbal behaviors were both around 40%, much higher than the percentage amongst older students This was in accordance with previous findings [6,11] As for distinct geographies, the percentages of urban students who reported physical and verbal bullying behaviors were 8.8% and 45.6%, higher than percentage of students rural (8.6% and 31.2% respectively) A recent study on cyber bullying among high school students in three provinces of Vietnam also reported a higher figure in urban areas [12] As for age, in accordance with findings from previous studies, literature shows higher prevalence of bullying among younger students For instance, Indonesia GSHS data suggests higher prevalence of victimization in 13 - 15 year-old students than in 16 -17 year-old students This current study also indicated that being bullied was more prevalent among younger participants (p < 0.05) Our study investigated health risk behaviors including tobacco and alcohol consumption These results are in accord with recent studies all over the world indicating the association between being bullied and engaging in certain health behaviors [11] In Vietnam, there were the similar results in GSHS 2013 (2014) Although the OR was reasonably high, there was no significant association between drug use and being a victim This could be due to sampling sizes In future 112 studies we should increase the size of out sample This current study detects a strong association between being bullied and suffering from certain psychiatric problems among students Respondents who reported having one in four mental disorders including loneliness, being worried, hard focus, and suicide attempt were significant more likely to report being bullied than students who did not possess any mental health problems (p < 0.05) These results seem to be consistent with previous research in both Vietnam and other countries [14,15] V CONCLUSION The majority of victims were bullied on to days in all 30 days and totalled 16% of students Among bullied students, verbal bullying behaviors were more prevalent than physical behaviors Students who were bullied were significantly more prevalent among younger students but were and independent of gender Students who had health risk behaviors including tobacco, alcohol consumption, loneliness, being worried, difficulty focusing, depression and suicide attempts were significant more likely to being bullied than those who never reported mental health problems (p < 0.05) Additionally, the prevalence of being bullied among students who had ever reported one or two health risk behaviors was significant higher than that for those who had not Acknowledgements The authors thank the Department of Preventive Medicine - Ministry of Health for funding for this study JMR 111 E2 (2) - 2018 JOURNAL OF MEDICAL RESEARCH REFERENCES Olweus D (2013) School bullying: developmental and some important challenges Annu Rev Clin Psychol 9, 751780 Arseneault L, Bowes L, Shakoor S (2010) Bullying victimization in youths and mental health problems: Much ado about nothing? 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(95%CI) and d = 0.04 In Nghe An Province, located in the centre of Vietnam, some cases of school bullying were reported among students in grade to 12 via the internet Therefore,Vinh city, in a rural... focused bullying and determined current both bullying prevalence (during past 30 days) and types of bullying behaviors Mental health problems (feelings of loneliness, being worried, hard focus, and