Online and Health Risk Behaviors in High School Students

An Examination of Bullying

Meghan N. Long; Elizabeth B. Dowdell


Pediatr Nurs. 2018;44(5):223-228. 

In This Article

Abstract and Introduction


Background/Purpose: The purpose of this study was to examine the health and online risk behaviors of adolescents who bully, are victims of bullying, and those who report being both a bully and victim (bully-victim).

Methods: This descriptive correlational study used a secondary analysis design from a larger study of high school students. This sample consisted of 975 adolescents (48% female and 52% male) who reported one or more experiences of bullying in person.

Results: Findings revealed significant differences (p<0.0001) between type of bully as well as type of victim. Bullies were more likely to report having trouble in school, vandalize property, smoke cigarettes, and engage in illicit drug use. Those who reported being a bully-victim were more likely to drink alcohol while driving, post personal information online, view inappropriate material online, and sext. Victims reported participating in some health and online risk behaviors, but were less likely to engage in these behaviors compared to bullies and bully-victims.

Conclusion and Implications: Although all groups reported participating in health and online risk behaviors, bullies had overwhelmingly higher health risk behaviors, while the bully-victim group reported higher online risk behaviors. Findings from this study suggest important areas of intervention with adolescents who bully, are victimized, and partake in health and online risk behaviors. Specifically, nurses as well as community leaders can develop interdisciplinary educational programs that focus on prevention, risk reduction, and safety, as well as implement an evidence-based practice model that incorporates a screening tool, brief interventions, and referrals for treatment for at-risk adolescents with correlational risk behaviors.


Bullying has been identified as a growing and pervasive problem among children and adolescents (Schneider, O'Donnell, & Smith, 2015; Schneider, O'Donnell, Stueve, & Coulter, 2012). Bullying often takes various forms that include physical (e.g., hitting), verbal (e.g., name-calling), relational (e.g., social isolation), or cyberbullying, which takes place online (e.g., harassment on social media websites) (Schneider et al., 2012). Individuals can be involved as a bully (those who use bullying behaviors), as a victim (those who experience bullying behaviors), or as a bully-victim (those who are both a bully and a victim) (Boulton & Smith, 1994; Vieno, Gini, & Santinello, 2011).

Adolescents who bully are more likely to engage in health risk behaviors, such as smoking, underage drinking, and weapon carrying, when compared to their peers (Shetgiri, Lin, & Flores, 2012; Vieno et al., 2011). The literature has also shown that victims of bullying are more likely to engage in health risk behaviors and report psychological issues, including using illicit drugs, and having depression and suicidal thoughts (Hertz, Everett-Jones, Barrios, David-Ferdon, & Holt, 2015; Klomek et al., 2013). Research suggests that both adolescent bullies and victims are being harmed emotionally and physically as a result of bullying.

In today's modern world of mobile devices and social media, 92% of adolescents in the United States aged 13 to 17 years go online daily (Lenhart, 2015). With this increase in online use and accessibility, adolescents now more than ever have the opportunity to engage in online risk behaviors. Cyberbullying, which is defined as bullying that takes place on digital devices via social media and Internet forums, and includes harassing, sharing, or posting harmful, mean, or false information about someone online, has been identified as a growing concern (Centers for Disease Control and Prevention [CDC], 2017a). Bullying today can extend from the classroom to the Internet, with adolescents reporting that those who bully in school continue to bully online (Hertz et al., 2015).

Cyberbullies have reported higher psychological issues and health risk behaviors compared to their peers, including depressive symptoms, school suspension, and binge drinking (Hemphill, Kotevski, & Heerde, 2015). Victims of cyberbullying have higher suicide attempts, are more likely to be depressed, have lower academic performances in school, and are more likely to be victims of bullying in the school setting (CDC, 2017a; Hepburn, Azrael, Molnar, & Miller, 2011; Schneider et al., 2012; Waasdorp & Bradshaw, 2015).

Although there has been extensive research conducted on potential longterm effects associated with being involved with bullying, there is a paucity of literature that focuses on behaviors of those who only bully, those who are only victimized, and adolescents who report being both a bully and victim. The purpose of this study was to examine and compare the reported health and online risk behaviors of adolescents who bully, adolescents who are victims of bullying, and those who reported being a bully and victim (bully-victim).