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


Bullying is not a new phenomenon and is something many individuals experience at some point during their high school years. Using a secondary data analysis of a high school student sample, this study's findings found adolescents who experience bullying in both school and online settings also engage in both health and online risk behaviors. Differences, as well as significant overlap of risk behaviors, were found in the three adolescent groups (bully, victim, or bully-victim). Not surprisingly, there were sex differences in this adolescent sample, with males reporting more in-person or traditional bullying experiences and females reporting more online sexual harassment experiences. In nearly all risk behaviors, adolescents who reported being bullies were very similar to those who reported being bully-victims. Bullies generally reported the highest health risk behaviors, while bully-victims reported more online risk behaviors. Victims of bullying were the least likely to report health or online risk behaviors, but they did report certain risk behaviors, such as posting personal information online and frequently staying online longer than intended. Findings from this study suggest that high school students who experience bullying, either as a bully, victim, or both, should be considered vulnerable.

Health Risk Behaviors

Adolescence is viewed as a time of good health, with the majority of adolescent morbidity and mortality being attributed to preventable risk factors, including cigarette smoking, tobacco use, sedentary lifestyles, poor nutritional habits, and substance use and abuse (CDC, 2017b). In the United States, smoking is the leading cause of preventative death. As health choices made during adolescence have a lasting effect on decisions made later on in life, it is especially important to offer a preventative approach to reduce teen smoking. Although the number of high school students smoking has declined nationwide from 15.8% in 2011 to 8% in 2016, it remains a major public health concern (CDC, 2017c). In our study, all three groups exceeded the national average of smoking, with bullies and bully-victims reporting the strongest association with cigarette use. This finding supports the literature that identifies adolescents who bully as being more likely to engage in health risk behaviors, such as smoking and underage drinking, when compared to their peers (Shetgiri et al., 2012; Vieno et al., 2011). One possible explanation for the increase in cigarette use by adolescent bullies may be related to the desire to gain social status and to be perceived as 'cool' because smoking and drinking alcohol are often seen as behaviors that can contribute to one's social image (Vieno et al., 2011).

In the current study, being a bully or bully-victim had a strong relationship with drinking alcohol, a health risk behavior well documented in the high school student population. Nationwide, over 70% of high school students have had at least one drink of alcohol on at least one day during their life, and a quarter (24.1%) of high school students report having ridden one or more times in a car or other vehicle driven by someone who had been drinking alcohol (CDC, 2017a; Eaton et al., 2012). Although not a national study, it remains concerning that adolescents continue to report they are drinking and driving, a dangerous combination that accounts for teen drivers being three times more likely to be in a fatal crash (CDC, 2012, 2017b).

Online Risk Behaviors

According to the Pew Research Center's 2015 Report, 94% of teenagers who have Internet access on mobile devices use them daily, providing more online communication with peers and allowing for more opportunities for cyberbullying and exploitation (Lenhart, 2015; Patchin & Hinduja, 2010). High school students have the ability to use the Internet for a multitude of reasons, including schoolwork, social connections, and aggression. The relationship between bullying (bully, victim, or bully-victim) and the Internet, as well as online risk taking, is not well understood. Individual online risky behavior can be inclusive of more than one behavior and can cluster, much like health risk behaviors (Burgess Dowdell, 2011; Dowdell, Burgess, & Cavanaugh, 2009; Madden et al., 2013). Over 90% of adolescents in our study reported going online or accessing social media daily. Our sample was not too different from their national peers in reporting playing online jokes on peers, as well as online harassment and sexting. The group with the highest reporting of online risk taking was the bully-victim group, who frequently surpassed their peers in reporting these behaviors.


Study findings should be viewed in light of study limitations. Specifically, this study relied upon high school students' self-reports of bullying, and online and health risk behaviors. Selfreporting may be an accurate representation of risk taking, but there may also be an exaggeration or an under reporting of actual behavior(s). Another limitation of this study is that the sample obtained resided solely in the Northeast region of the United States, with the majority of participants being Caucasian. If the sample was directed towards a more diverse group of adolescents or surveyed participants from other parts of the country, different results may have been obtained. About half of the participants in this study classified themselves as above-average students, receiving A's and B's in school. Research has shown that many students who are bullies tend to have trouble academically in school, and more accurate analysis could have been obtained with a more academically diverse sample. Although limitations exist, results obtained in this study imply that further intervention with adolescents is needed to address these risk behaviors.