Bullying Prevention:

2015 Resource Guide

Introduction

In the 2013 Youth Risk Behavior Survey (YRBS), 20 percent of students

reported being bullied on school property and 15 percent reported
being electronically bullied in the 12 months preceding the survey.
Victimized youth are at increased risk for depression, anxiety, sleep
difficulties, and poor school adjustment. Youth who bully others are
at increased risk for substance use, academic problems, and violence
later in adolescence and adulthood. Compared to youth who only
bully, or who are only victims, bully-victims suffer the most serious
consequences and are at greater risk for both mental health and
behavior problems.

Introduction
Organizations and Websites
Data, Definitions, and Research
Programs, Campaigns, and
Toolkits
Policies, Laws, and Legislation
Publications and Resources
At-Risk Populations
Bullying and Co-Occurring
Issues

No single factor puts a child at risk of being bullied or bullying

others. Bullying can happen anywherecities, suburbs, or rural
towns. Depending on the environment, some groupssuch as lesbian,
gay, bisexual, or transgendered (LGBT) youth, youth with disabilities,
and socially isolated youthmay be at an increased risk of being
bullied.
This resource guide provides links to organizations, programs,
publications, and resources focused on bullying prevention. It is
divided into seven sections: (1) Organizations and Websites; (2) Data,
Definitions, and Research; (3) Programs, Campaigns, and Toolkits;
(4) Policies, Laws, and Legislation; (5) Publications and Resources;
(6) At-Risk Populations; and (7) Bullying and Co-Occurring Issues.
Each item in this resource guide includes a short description and a
link to the resource itself. Descriptions of reports, guides, toolkits,
campaigns, websites, and initiatives are, in most cases, excerpted
from the resources themselves while descriptions of research studies
are excerpted from the study abstracts.

www.ChildrensSafetyNetwork.org

Organizations and Websites

StopBullying.gov is managed by the U.S. Department of Health and Human
Services in partnership with the Department of Education and the Department of
Justice. It features webpages on What Is Bullying, Cyberbullying, Who Is at Risk, Preventing Bullying, and
Responding to Bullying. The website also has a section on state bullying prevention policies and laws and
resources for parents, educators, communities, teens, and kids.
http://www.stopbullying.gov
Bullying Prevention Training Center
The StopBullying.gov Bullying Prevention Training Center includes a research-based training module
presentation that can help you lead bullying prevention efforts in your local community, the Community
Action Toolkit, user guides tailored to 11 audiences, and trainings for educators and school bus drivers.
http://www.stopbullying.gov/prevention/training-center/index.html
Other StopBullying.gov Resources
Bullying: What You Need to Know Infographic: http://www.stopbullying.gov/image-gallery/what-youneed-to-know-infographic.html
Youth Leaders Toolkit: http://www.stopbullying.gov/resources-files/youth-leader-toolkit.pdf
Youth Engagement Toolkit: http://www.stopbullying.gov/what-you-can-do/teens/YouthEngagement_
brieftoolkit_Compliant.pdf
StopBullying.gov Blog: http://www.stopbullying.gov/blog

The Bully Project

The Bully Project, from the makers of the film BULLY, has information on the film, as well as information and
tools for students, educators, advocates, and parents.
http://www.thebullyproject.com/
Cyberbullying Research Center
The Cyberbullying Research Center, directed by Sameer Hinduja at Florida Atlantic University and Justin
Patchin at the University of Wisconsin-Eau Claire, provides information about the nature, extent, causes, and
consequences of cyberbullying among adolescents.
http://www.cyberbullying.us/index.php
Eyes on Bullying
With growing numbers of children spending their early years, afternoons, and summers in child care centers,
afterschool and youth programs, and camps, it is important to identify and support the important role that staff
in these settings can play in bullying prevention. The website includes a comprehensive toolkit for caregivers and
parents.
http://www.eyesonbullying.org/index.html

www.ChildrensSafetyNetwork.org

www.ChildrensSafetyNetwork.org

PACER Centers National Bullying Prevention Center

Founded in 2006, PACERs National Bullying Prevention Center provides
resources for students, parents, educators, and others, and recognizes
bullying as a serious community issue that impacts education, physical
and emotional health, and the safety and well-being of students. The
website includes videos, toolkits, posters, and handouts. To visit the
website, go to: http://www.pacer.org/bullying/
Special Needs Bullying Prevention Toolkit from PACER and the Bully
Project:
http://specialneeds.thebullyproject.com/toolkit
Promote Prevent
PromotePrevent works closely with hundreds of diverse communities across the country on improving student
outcomes through school-community partnerships. PromotePrevent helped SS/HS and Project LAUNCH
grantees engage schools, mental health providers, law enforcement and juvenile justice agencies, and other
youth-serving organizations to bridge gaps in services and supports that benefit students, families, and their
communities.
http://www.promoteprevent.org
Stop Bullying: Speak Up Campaign | Cartoon Network
This website has an educators guide, parent tip sheet, resources on what to do to stop bullying, Q & A, videos,
and messages from celebrities. It is also features the campaigns 30-minute documentary special on bullying
introduced by President Obama.
http://www.cartoonnetwork.com/promos/stopbullying/index.html
UCLA Bullying Prevention Online Clearinghouse |
UCLA
In October 2011, in honor of National Bullying
Prevention Month, UCLA created an online
clearinghouse of bullying prevention information that
includes newsletter articles, introductory packets,
quick training aids, technical assistance samplers,
practice notes, and policy and practice briefs and
notes.
http://smhp.psych.ucla.edu/qf/bully.htm
Welcoming Schools: Bullying and Name Calling
Welcoming Schools, a project of the Human Rights
Campaign Foundation, provides an LGBT-inclusive
approach to addressing family diversity, gender
stereotyping, bullying, and name-calling in K-5 learning
environments. The Bullying and Name Calling webpage
provides definitions, tips for elementary school
educators, lesson plans, and films.
http://www.welcomingschools.org/bullying-namecalling/

KnowBullying App | SAMHSA

Research shows that parents and caregivers
who spend at least 15 minutes a day talking
with their child can build the foundation for a
strong relationship and help prevent bullying.
KnowBullying has simple conversation starters
to begin a discussion with your child. The app
also features bullying prevention tips, bullying warning signs, reminders to talk with your
child, social media options, and a section for
educators.
App: http://store.samhsa.gov/apps/knowbullying/index.html
StopBullying.Gov blog post about the app:
http://www.stopbullying.gov/
blog/2014/08/18/put-power-prevent-bullying-your-hand

www.ChildrensSafetyNetwork.org

www.ChildrensSafetyNetwork.org

Building Capacity to Reduce Bullying and Its

Impact on Youth across the Lifecourse | Institute
of Medicine and National Research Council (2014)
The Board on Children, Youth, and Families of the
Institute of Medicine (IOM) and the National Research Council (NRC) held this two-day workshop
to bring together representatives of key sectors
involved in bullying prevention. Their focus was to
identify the conceptual models and interventions
that have proven effective in decreasing bullying, to
examine models that could increase protective factors and mitigate the negative effects of bullying,
and to explore the appropriate roles of different
groups in preventing bullying.
http://www.iom.edu/Reports/2014/BuildingCapacity-to-Reduce-Bullying.aspx

Data, Definitions, and Research

Bullying and Gangs | International Journal of
Adolescent Medicine and Health (2012)
Although bullying is associated with gangs,
questions arise as to whether bullying, as such,
takes place within gangs. This study from the
International Journal of Adolescent Medicine and
Health provides a critical analysis of bullying as it
pertains to youth gangs and especially to violence
within gangs and as applied to the behavior
of individual gang members. The study found
that bullying has implications for related and/
or subsequent types of street violence but is less
relevant for descriptions of violence within a youth
gang context as such.
http://www.degruyter.com/view/j/ijamh.2012.24.
issue-1/ijamh.2012.008/ijamh.2012.008.xml

Bullying among Siblings | International Journal of Adolescent Medicine and Health (2012)
Parents are often concerned about repeated conflicts between their daughters and sons. However, there is
little empirical research of sibling bullying. This review from the International Journal of Adolescent Medicine
and Health suggests that for those victimized at home and at school behavioral and emotional problems are
highly increased. Sibling relationships appear to be a training ground with implications for individual well-being.
Strengthening families and parenting skills and increasing sibling support are likely to reduce bullying and
increase well-being.
http://www.degruyter.com/view/j/ijamh.2012.24.issue-1/ijamh.2012.004/ijamh.2012.004.xml
Bullying and Aggression on the School Bus: School Bus Drivers Observations and Suggestions | Journal of
School Violence (2008)
This 2008 study from the Journal of School Violence collected information from school bus drivers about student
behavior on their buses and drivers perceptions of school administrators interest in their input.
http://www.tandfonline.com/doi/abs/10.1080/15388220801955554
Bullying in Schools: An Overview | Office of Juvenile Justice and Delinquency Prevention (2011)
This bulletin summarizes studies exploring the connections between bullying in schools, school attendance and
engagement, and academic achievement. Some key findings include:
Bullying is a complex social and emotional phenomenon that plays out differently on an individual level.
Bullying does not directly cause truancy.
School engagement protects victims from truancy and low academic achievement.
When schools provide a safe learning environment in which adults model positive behavior, they can
mitigate the negative effects of bullying.
Any interventions to address bullying or victimization should be intentional, student-focused engagement
strategies that fit the context of the school where they are used.
http://www.ojjdp.gov/pubs/234205.pdf
www.ChildrensSafetyNetwork.org

www.ChildrensSafetyNetwork.org

Bullying on the School Bus: A Video Analysis | Journal

of School Violence (2005)
The purpose of this 2005 study from the Journal of School
Violence was to assess the nature of bullying on the
school bus. Videotapes were used to identify occurrences
of bullying on buses of elementary school students.
Incidents were reviewed for forms of bullying, fullness,
presence of friends, and severity of acts.
http://www.tandfonline.com/doi/abs/10.1300/
J202v04n03_08

Bullying Surveillance among Youths:

Uniform Definitions for Public Health and
Recommended Data Elements Version 1.0 |
CDC (2014)
This CDC publication contains a uniform
definition of bullying, considerations when
gathering data on bullying using the uniform
definition, recommended data elements for
bullying, and federal government resources
on bullying.
http://www.cdc.gov/violenceprevention/
pdf/bullying-definitions-final-a.pdf

Bullying Prevalence Across Contexts: A Meta-analysis

Measuring Cyber and Traditional Bullying | Journal of
Adolescent Health (2014)
This review of the literature identified 80 studies that reported corresponding prevalence rates for cyber
and traditional bullying and/or aggression in adolescents. Weighted mean effect sizes were calculated, and
measurement features were entered as moderators to explain variation in prevalence rates and in traditional
cyber correlations within the sample of studies. Prevalence rates for cyber bullying were lower than for
traditional bullying, and cyber and traditional bullying were highly correlated. A number of measurement
features moderated variability in bullying prevalence, whereas a focus on traditional relational aggression
increased correlations between cyber and traditional aggressions. In this meta-analytic review, traditional
bullying was twice as common as cyber bullying. Cyber and traditional bullying were also highly correlated,
suggesting that poly-aggression involvement should be a primary target for interventions and policy. Results of
moderation analyses highlight the need for greater consensus in measurement approaches for both cyber and
traditional bullying.
http://www.jahonline.org/article/S1054-139X%2814%2900254-7/abstract
Co-Occurrence of Victimization from Five Subtypes of Bullying: Physical, Verbal, Social Exclusion,
Spreading Rumors, and Cyber | Journal of Adolescent Health (2010)
This study finds that different types of bullying victimization appear to co-occur among U.S. adolescents. 7,475
adolescents were asked how often they were bullied in the past couple of months. The following three classes
were extracted: all-types victims teens victimized by the four traditional bullying behaviors and cyberbullying;
verbal-relational victims teens victimized by verbal
bullying, social exclusion, and rumor spreading, but
not physically and online; and non-victims teens who
are not victimized by any bullying behavior.
The all-types victims reported higher depression, more
injuries, and more medicine use for sleeplessness
and nervousness than the verbal-relational victims,
followed by the non-victims. The authors conclude that
intervention efforts should address various symptoms
among victims of bullying and especially those who
suffer from multiple types of victimization.
http://www.ncbi.nlm.nih.gov/pmc/articles/
PMC2980945/?tool=pubmed

www.ChildrensSafetyNetwork.org

www.ChildrensSafetyNetwork.org

Cyber Aggression: The Relation between Online

Offenders and Offline Social Competence | Social
Development (2011)
This 2011 study uses a younger sample of children
than most previous research on cyberbullying. The
researchers looked at 192 3rd-6th grade children to
evaluate grade and gender effects on cyber aggression
and the classroom peer social consequences of
engaging in cyber aggression. Children reported
engaging in cyber aggression at comparable rates
across grades and gender. Engaging in cyber aggression
was related to higher rates of loneliness and lower
rates of global selfworth, peer optimism, number of
mutual friendships, social acceptability, and popularity.
The authors conclude that cyber aggression is related
to significant negative peer relations outcomes.
http://onlinelibrary.wiley.com/doi/10.1111/j.14679507.2011.00609.x/abstract

Connecting the Dots: An Overview of the Links

Among Multiple Forms of Violence | CDC and the
Prevention Institute (2014)
Different types of violence are connected and
often share the same root causes. They can all
take place under one roof, in the same community
or neighborhood, at the same time, or at different
stages of life. Understanding the overlapping
causes of violence and the things that can protect
people and communities can help us better
prevent violence in all its forms, inlcuding child
maltreatment, teen dating violence, intimate
partner violence, sexual violence, youth violence,
and bullying.
http://www.cdc.gov/violenceprevention/pub/
connecting_dots.html

Cyberbullying, School Bullying, And Psychological Distress: A Regional Census of High School Students |
American Journal of Public Health (2012)
In a study by the Education Development Center, 16.5 percent of students reported being bullied at
school only, 6.4 percent of students reported being bullied online only; and 9.4 percent both at school and
online. High school students who are bullied online are more likely to report symptoms of depression and
suicide attempts than students who were bullied only at school, according to a survey of students in the
communities west of Boston. The study, also found that girls are more likely than boys to report being victims
of cyberbullying, and students who do not identify themselves as heterosexual are more likely to report being
bullied online and at school.
http://www.ncbi.nlm.nih.gov/pubmed/22095343
Cyber and Bias-Based Harassment: Associations with Academic, Substance Use, and Mental Health
Problems | Journal of Adolescent Health (2012)
This study examines how two forms of inter-student harassment, cyber and bias-based harassment, are
associated with academic, substance use, and mental health problems. The study found that students
experiencing both cyber and bias-based harassment were at the greatest risk for adjustment problems across
all indicators, with suicidal ideation and attempts having the largest risk differences.
http://www.sciencedirect.com/science/article/pii/S1054139X11003326
IAN Research Report: Bullying and Children with ASD | Interactive Autism Network (2011)
It has been suggested that children with autism spectrum disorders (ASDs) are especially vulnerable to
bullying. The Interactive Autism Network (IAN) is now sharing initial results of a national survey on the bullying
experiences of children on the autism spectrum. The findings show that children with ASD are bullied at a very
high rate and are also often intentionally triggered into meltdowns or aggressive outbursts by ill-intentioned
peers.
http://www.iancommunity.org/cs/ian_research_reports/ian_research_report_bullying

www.ChildrensSafetyNetwork.org

www.ChildrensSafetyNetwork.org

Measuring Bullying Victimization, Perpetration, and Bystander Experiences: A Compendium of Assessment

Tools | CDC
Bullying, particularly among school-age children, is a major public health problem. This compendium provides
researchers, prevention specialists, and health educators with tools to measure a range of bullying experiences:
bully perpetration, bully victimization, bully-victim experiences, and bystander experiences. Some researchers
continue to examine the risk and protective factors associated with bullying experiences. Others are working
to design, implement, and evaluate bully prevention interventions aimed at reducing bully victimization
and perpetration, as well as increasing prosocial bystander involvement in bullying situations. The ability
to measure bullying experiences broadly and completely is crucial to the success of these activities. This
compendium represents a starting point from which researchers can consider a set of psychometrically-sound
measures for assessing self-reported incidence and prevalence of a variety of bullying experiences.
http://www.cdc.gov/violenceprevention/pub/measuring_bullying.html
Observing Bullying at School: The Mental Health Implication of Witness Status | School Psychology
Quarterly (2009)
This study explores the impact of bullying on the mental health of students who witness it. Researchers
surveyed 2,002 students aged 12 to 16 years attending 14 schools in the United Kingdom using a questionnaire
that included measures of bullying at school, substance abuse, and mental health risk. The results suggest that
observing bullying at school predicted risks to mental health over and above that predicted for those students
who were directly involved in bullying behavior as either a perpetrator or a victim. Observing others was also
found to predict higher risk irrespective of whether students were or were not victims themselves. The results
are discussed with reference to past research on bystander and witness behavior.
http://www.apa.org/pubs/journals/releases/spq-24-4-211.pdf
Relationships between Bullying School Climate and Student Risk Behaviors | School Psychology (2012)
This study examined whether characteristics of a positive school climate were associated with lower student
risk behavior. It found that a positive school climate could be an important protective factor in preventing
student risk behavior.
http://psycnet.apa.org/?&fa=main.doiLanding&doi=10.1037/a0029350
School Bullying among Adolescents in the United
States: Physical, Verbal, Relational, and Cyber |
Journal of Pediatric Psychology (2009)
This study analyzed data from the World Health
Organizations (WHO) 2005/2006 survey of human
behavior in school-aged children. The results show
that plenty of students still suffer from bullying, but
today some aggressors operate electronically. 20.8
percent of the WHO survey respondents reported
being perpetrators or victims of physical bullying
in the past two months; 53.6 percent were victims
of verbal bullying; 51.4 percent were victims of
relational bullying, which involves social exclusion;
and 13.6 percent were victims of cyberbullying.

www.ChildrensSafetyNetwork.org

www.ChildrensSafetyNetwork.org

Researchers found that 8 percent of students had received harassing computer pictures or messages, and
6 percent were bullied by cell phone. More boys were cyber bullies; more girls were cyber victims. Verbal
bullying was the most prevalent of the four major forms of bullying.
The researchers conclude that good parental support helps children avoid abusive behavior: kids who come
from loving homes and feel good about themselves are less likely to want to harass someone and are less likely
to appear weak to potential bullies.
http://www.jahonline.org/article/S1054-139X(09)00138-4/fulltext
School Bullying: Extent of Legal Protections for Vulnerable Groups Needs to be More Fully Assessed | The
Government Accountability Office (2012)
The Government Accountability Office (GAO) found that nationally representative surveys conducted from
2005 to 2009 suggest that up to 28% of youth, primarily at the middle school and high school levels, reported
having been bullied during the survey periods. But the GAO noted that differences in definitions and questions
posed to youth make it difficult to discern trends and affected groups. For example, the surveys did not collect
information about respondents sexual orientation or gender identity. The GAO also noted that the Departments
of Education and Health and Human Services are partially addressing the issue by collaborating with other
federal departments to develop a uniform definition of bullying that can be used for research purposes.
http://www.gao.gov/assets/600/591202.pdf
School Climate: Research, Policy, Practice and Teacher Education | Teachers College Record (2009)
This article uses several research methods to understand the current state of school climate research, policy,
practice, and teacher education: historical analysis; a review of the literature; a systemic national State
Department of Education policy scan; and a national survey of school, district, and state educational leaders. A
review of the literature reveals that positive school climate is associated with: academic achievement; school
success; effective violence prevention; students healthy development; and teacher retention. There is a gap
between these research findings on the one hand, and state departments of education, school climate policy,
practice guidelines, and teacher education practice on the other. The authors suggest a series of detailed
recommendations for policy makers, practice leaders, and teacher educators to narrow this gap.
http://www.tcrecord.org/Content.asp?ContentId=15220
Social and Emotional Learning and Bullying Prevention | EDC (2009)
This brief, published by the Education Development Center (EDC) in collaboration with the Collaborative
for Social and Emotional Learning (CASEL) and the American Institutes for Research (AIR), examines the
interconnection of social and emotional learning (SEL) and bullying
prevention school curricula.Schools using an SEL framework can
foster an overall climate of inclusion, warmth, and respect. Because
bullying prevention is entirely congruent with SEL, it can be
embedded in a schools SEL framework. The brief aims to: provide
a basic description of a school-wide SEL framework, illustrate the
relationship between social and emotional factors and bullying, and
explain how an SEL framework can be extended to include bullying
prevention.
http://static.squarespace.com/static/513f79f9e4b05ce7b70e9673/t/
5367958ee4b0dbc1364dbb7b/1399297422536/3_SEL_and_Bullying_
Prevention_2009.pdf
www.ChildrensSafetyNetwork.org

www.ChildrensSafetyNetwork.org

Understanding the Bullying Dynamic among Students in Special and General Education | Journal of School
Psychology (2012)
This 2012 study from the Journal of School Psychology examined data on students (both general education
and special education) involvement in bullying, office referrals, and prosocial behavior. Results indicated that
students with behavioral disorders and those with observable disabilities reported bullying others more and
being victimized more than their general education counterparts.
http://www.sciencedirect.com/science/article/pii/S0022440512000374
What Can Be Done About School Bullying? Linking Research to Educational Practice | Educational
Researcher (2010)
This article reviews research on individual, peer, and school contributions that may be critical factors for
enhancing efforts to address bullying among students. The impact of school-based anti-bullying programs and
the challenges currently facing educators and researchers in this area are discussed. The article concludes with
a proposal for a broader, ecologically based model of school bullying based on the emerging literature.
http://edr.sagepub.com/content/39/1/38.full.pdf
What Characteristics of Bullying, Bullying Victims, and Schools are Associated with Increased Reporting of
Bullying to School Officials? | Regional Educational Laboratory (REL) Northeast and Islands (2010)
This Regional Educational Laboratory (REL) Northeast and Islands study tested 51 characteristics of bullying
victimization, bullying victims, and bullying victims schools to determine which were associated with reporting
to school officials. It found that 11 characteristics showed a significant association with reporting. When
bullying involved injury, physical threats, destruction of property, physical contact, greater frequency, multiple
types, more than one location, or at least one occurrence on a school bus, bullying victims were more likely to
indicate that their victimization was reported to a school official. 64 percent of respondents who experienced
bullying did not report it.
http://ies.ed.gov/ncee/edlabs/regions/northeast/pdf/REL_2010092.pdf

Programs, Campaigns, and Toolkits

Anti-Bullying Programs in Schools: How
Effective Are Evaluation Practices? |
Prevention Science (2009)
The purpose of this study was to assess the
rigor of recent peer-reviewed anti-bullying
program evaluations. Thirty-one evaluations,
published within the last 10 years, were
identified and coded for study characteristics.
Shortcomings were identified in many. The
authors suggest that researchers should
consider more rigorous designs to identify
cause-effect relationships, more appropriate
pre-post intervals, and more advanced
methods of analyses.
http://www.springerlink.com/content/
m15058898nr17657

www.ChildrensSafetyNetwork.org

www.ChildrensSafetyNetwork.org

Bullying Prevention: Strategies to Support Statewide Collaboration: An archived CSN Webinar | CSN (2010)
This webinar, hosted by CSN on December 6, 2010, described the scope of the bullying problem, the current
research on bullying and its consequences, existing state laws on bullying, the Olweus Bullying Prevention
Program for Schools, and the collaboration between the Pennsylvania Bullying Prevention Campaign and
the Highmark Foundation. The speakers were Susan Limber from Clemson University, Janice Seigle from the
Highmark Foundation, and Matthew Masiello from the Windber Research Institute.
http://edc.acrobat.com/p20227207
Creating a Safe and Respectful Environment on Our Nations School Buses | Safe Supportive Learning
(2011)
This webpage provides two modules from the American Institutes for Research (AIR) that trainers can use
to address bullying on school buses. Specifically, it is designed to assist school bus drivers in cultivating
meaningful relationships with students while creating a positive climate on the bus.
http://safesupportivelearning.ed.gov/resources/creating-safe-and-respectful-environment-our-nations-schoolbuses
Cybersmart!: A Cyberbullying Awareness Curriculum for Grades K12 | National Association of School
Psychologists
This curriculum, developed by the National Association of School Psychologists and CyberSmart!, utilizes best
practices from the fields of cyber security, school violence prevention, and character education. The curriculum
guides students to think and act creatively and critically, defining the problems and issues themselves and thus
owning them. The free lesson plans address safety and security online, manners, cyberbullying and ethics,
authentic learning and creativity, research information and fluency, and 21st-century challenges.
http://www.nasponline.org/resources/cyberbullying
Integrating Bullying Prevention and
Restorative Practices in Schools:
Considerations for Practitioners
and Policymakers | Safe Schools
(2014)
This white paper addresses the
integration of two common
approaches to improving school
climate and school connectedness:
bullying prevention (BP) and
restorative practices (RP).
Specifically, the paper focuses on
the compatibility of the Olweus
Bullying Prevention Program and
common approaches to RP in
schools.
http://www.safeschools.info/
content/BPRPWhitePaper2014.pdf
www.highmarkfoundation.org

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National Institute for Health Care Management

(NIHCM) Foundation Webinar: Creating Safer
Schools and Healthier Children: A Model Bullying
Prevention Program | National Institute for
Health Care Management (2012)
The Center for Safe Schools Director Lynn Cromley
presented during a national webinar that explored
how the Highmark Foundation spearheaded the
creation of a coalition of experts to implement
the Olweus Bullying Prevention Program (OBPP)
in the largest statewide bullying prevention
initiative in the country. Cromley spoke about the
practices that made this initiative so successful,
including the decision to tap into existing bullying
prevention training networks and the focus on
continuous evaluation of the initiative from its inception.
http://www.nihcm.org/component/content/article/136-mch-conferences-and-webinars/594-creating-saferschools-and-healthier-children-a-model-bullying-prevention-program
Olweus Bullying Prevention Program: A School Program for Ages 6-14 | Olweus Bullying Prevention Program
This program is a universal intervention developed to promote the reduction and prevention of bullying
behavior and victimization problems. It is based on an ecological model and involves intervening with a childs
environment on many levels: the individual children who are bullying and being bullied; the families; the
teachers and students within the classroom; the school as a whole; and the community. The main arena for
the program is the school, and school staff has the primary responsibility for introducing and implementing the
program. Schools are provided ongoing support by project staff. The intervention is recommended by the U.S.
Department of Education and the Blueprints Program.
http://www.violencepreventionworks.org/public/olweus_bullying_prevention_program.page
The Pennsylvania Bullying Prevention Toolkit | Center for Safe Schools (2014)
The Pennsylvania Bullying Prevention Toolkit was developed by the Center for Safe Schools with funding
from the Highmark Foundation. It provides information about the issue of bullying and the role of adults and
professionals in supporting children who are affected by it. This toolkit was developed with input from an
interdisciplinary group of stakeholders. It is part of a multi-tiered strategy to promote coordination of bullying
prevention efforts across the state of Pennsylvania and to encourage local communities to develop effective,
collaborative approaches to bullying prevention and intervention.
http://www.safeschools.info/content/BPToolkit2014.pdf
Pennsylvania: Highmark Healthy 5 Bullying Prevention Institute | Highmark Foundation
The Highmark Healthy High 5 Bullying Prevention Institute was founded by, and is supported by, the Highmark
Foundation. The Bullying Prevention Institute was created to provide professional development and educational
opportunities to school personnel and other professionals as part of the wide-scale implementation of the
Olweus Bullying Prevention Program in Pennsylvania.
http://www.bullyingpreventioninstitute.org

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Preventing Bullying in Schools through Partnerships | National Institute for Health Care Management
Foundation (2013)
This NIHCM Foundation fact sheet describes emerging and promising programs or policies in Maternal and Child
Health (MCH), promotes program replication and new collaborations, and creates a dedicated space where
health plans and other MCH leaders can share their success stories with peers.
http://www.nihcm.org/images/stories/Bullying_Fact_Sheet_reissued_012913.pdf
Reducing Youth Violence through Community-Level Strategies | National Conference of State Legislators
(2014)
Youth violence is a pervasive problem in many communities across the United States. Youth violence includes
behavior such as schoolyard physical fighting, gang violence, bullying and electronic aggression. http://www.
ncsl.org/research/health/reducing-youth-violence-through-community-level-strategies.aspx
School-Based Programs to Reduce Bullying and Victimization | U.S. Department of Justice (2010)
This report presents a systematic review and meta-analysis of the effectiveness of programs designed to reduce
school bullying perpetration and victimization. The authors analyzed 44 evaluations of bullying prevention
programs. The results showed that, overall, school-based anti-bullying programs are effective in reducing
bullying and victimization. On average, bullying decreased by 20-23 percent, and victimization decreased
by 17-20 percent. The authors suggest that new anti-bullying programs should be designed based on the key
program elements that they have found to be most effective. They recommend that a system of accrediting
anti-bullying programs should be developed, supervised by an international body such as the International
Observatory on Violence in Schools.
http://www.ncjrs.gov/pdffiles1/nij/grants/229377.pdf
Second Step: A Violence Prevention Curriculum for Grades Prek-8 | Committee for the Children
This curriculum is designed to reduce impulsive and aggressive behavior in children by increasing their social
competency skills. The program is composed of three grade-specific curricula: preschool/kindergarten (Pre/K),
elementary school (grades 15), and middle school (grades 68). The curricula are designed for teachers and
other youth service providers to present in a classroom or other group setting. A parent education component,
A Family Guide to Second Step for Pre/K through grade 5, is also available. The program is listed as
evidenced-based on the Bullyinginfo.org website.
https://www.crimesolutions.gov/ProgramDetails.aspx?ID=221
Steps to Respect: A Bullying Prevention Program for
Grades 3-6 | Committee for Children
This program is designed to decrease school bullying
problems by (1) increasing staff awareness and
responsiveness, (2) fostering socially responsible
beliefs, and (3) teaching socialemotional skills to
counter bullying and promote healthy relationships.
The program also aims to promote skills (e.g., group
joining, conflict resolution) associated with general
social competence. The program is recommended by
the U.S. Department of Education.
http://www.cfchildren.org/steps-to-respect.aspx

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Sustained Decreases in Risk Exposure and Youth

Problem Behaviors after Installation of the
Communities That Care Prevention System in a
Randomized Trial | JAMA Pediatrics (2012)
The objective of this study was to test whether
the Communities That Care (CTC) prevention
system reduced levels of risk and adolescent
problem behaviors community-wide 6 years after
installation of CTC and 1 year after study-provided
resources ended. Researchers concluded that using
the CTC system can produce enduring reductions
in community-wide levels of risk factors and
problem behaviors among adolescents beyond the
years of supported implementation, potentially
contributing to long-term public health benefits.
http://archpedi.jamanetwork.com/article.aspx?articleid=1107692

Policies, Laws, and Legislation

Bullying as a Disability in Public Elementary and Secondary Education | Social Science Research Network
(2012)
By 2012, 46 states had enacted anti-bullying statutes, 36 of which explicitly reached cyberbullying. The statutes
typically amended the state education act to require public school districts to adopt written anti-bullying
policies, teach prevention curricula, discipline bullies, and cooperate with law enforcement when bullying turns
criminal. By acting in such unison, the state legislatures articulated a national consensus that school bullying
inhibits learning by substantially disrupting or interfering with the educational mission and compromising
victims physical or emotional security.
http://papers.ssrn.com/sol3/papers.cfm?abstract_id=2035568
State Cyberstalking and Cyberharassment Laws | National Conference of State Legislators (2013)
States have enacted cyberstalking or cyberharassment laws or have laws that explicitly include electronic
forms of communication within more traditional stalking or harassment laws. In addition, recent concerns
about protecting minors from online bullying or harassment have led states to enact cyberbullying laws.
This chart identifies state laws that include specific references to electronic communication. However, other
state laws may still apply to those who harass, threaten or bully others online, although specific language may
make the laws easier to enforce. This chart classifies the various state laws addressing different types of online
behaviors, cyberstalking and cyber
http://www.ncsl.org/research/telecommunications-and-information-technology/cyberstalking-andcyberharassment-laws.aspx
State Laws on Bullying: A Stop Bullying Campaign Webpage
The laws include one or more of the following requirements: (1) develop a policy to prohibit bullying, (2)
encourage the implementation of a bullying prevention program,(3) provide employee training on bullying
prevention, (4) report school bullying incidents to authorities, and (5) emphasize the importance of disciplinary
action for children who bully.
http://www.stopbullying.gov/laws/index.html
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State Legislation on Bullying,

Cyberbullying, and Online
Impersonation | Council of State
Governors (2011)
The Council of State Governments
Committee on Suggested State
Legislation has compiled and reviewed
state bills about bullying, cyberbullying,
and impersonating someone online,
along with related resources about
these topics.
http://knowledgecenter.csg.org/drupal/
content/bullyingcyberbullyingonlineimpersonation
U.S. Education Secretary Highlights
Best Practices of Bullying Policies |
U.S. Department of Education (2010)
In response to requests for assistance from state and local officials across the country following a rash of
bullying-related suicides, U.S. Secretary of Education Arne Duncan distributed a memo to state leaders outlining
key components of strong state bullying laws and policies. The technical assistance memo is intended to serve
as a reference for state and local officials developing or revising anti-bullying legislation or policies. In the
memo, the Department compiled key components of existing anti-bullying laws from 29 states. The laws were
divided into 11 categories, which ranged from listing examples of bullying behavior to specifying procedures for
investigating incidents.
For Secretary Duncans letter with the attached memo, visit: http://www.ed.gov/news/press-releases/useducation-secretary-highlights-best-practices-bullying-policies
U.S. Education Department Guidance on Addressing Harassment and Bullying in Schools | U.S Department
of Education (2010)
The U.S. Department of Education (ED) issued guidance to support educators in combating bullying in schools
by clarifying when student bullying may violate federal education anti-discrimination laws. The guidance also
makes clear that, while current laws do not protect against harassment based on religion or sexual orientation,
they do include protection against harassment of members of religious groups based on shared ethnic
characteristics as well as gender and sexual harassment of gay, lesbian, bi-sexual, and transgender individuals.
http://www2.ed.gov/about/offices/list/ocr/docs/dcl-factsheet-201010.pdf
2013 Year in Review: Violence and Injury Prevention Laws | National Conference of State Legislators
This report from the National Conference of State Legislatures (NCSL) summarizes state laws related to violence
and injury prevention that were enacted by state legislatures in 2013. It also provides information about
current violence and injury prevention issues.
Prior to 2013, 46 states adopted anti-bullying laws. Of these, 45 directed school districts to adopt bullying
policies. In 2013, six states passed laws aimed at preventing bullying by creating new requirements for schools
or modifying existing bullying laws. A brief description of these laws is provided.
http://www.ncsl.org/research/health/2013-year-in-review-violence-and-injury-prevention-laws.aspx

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Publications and Resources

Cyberbullying: A Special Issue of the Challenge Newsletter |
Challenge (2010)
The Challenge newsletter, published by the Office of Safe and DrugFree Schools, provides news for school safety and health programs.
This special issue of the newsletter is focused on cyberbullying.
The materials include a discussion on bullying in the digital age, led
by Dr. Susan Limber, a nationally recognized bullying prevention expert, an overview of the current research
on the subject, suggestions on the steps that school officials can take to address cyberbullying, a brief on
legislation and policies, and some guidelines for teens online safety.
http://issuu.com/challengeorg/docs/challenge_16_1
Electronic Media and Youth Violence: A CDC Issue Brief for Educators and Caregivers (2008)
This issue brief focuses on the phenomena of electronic aggression, which is defined as any kind of harassment
or bullying that occurs through email, chat rooms, instant messaging, websites, blogs, or text messaging.
The brief summarizes what is known about young people and electronic aggression, provides strategies for
addressing the issue with young people, and discusses the implications for school staff, education policy
makers, and parents and caregivers.
http://www.cdc.gov/violenceprevention/pdf/EA-brief-a.pdf
The Overlap Between Cyberbullying and Traditional Bullying | Journal of Adolescent Health (2015)
Cyberbullying appears to be on the rise among adolescents due in part to increased access to electronic devices
and less online supervision. Less is known about how cyberbullying differs from traditional bullying which
occurs in person and the extent to which these two forms overlap. Our first aim was to examine the overlap of
traditional bullying (relational, verbal, and physical) with cyberbullying. The second aim examined student- and
school-level correlates of cyber victimization as compared to traditional victims. The final aim explored details
of the cyberbullying experience (e.g., who sent the message, how was the message sent, and what was the
message about).
http://www.jahonline.org/article/S1054-139X(14)00758-7/abstract
Preventing Bullying: The Role of Public Health and Safety Professionals | CSN (2011)
This CSN publication explains what maternal and child health and other public health and safety practitioners
can do about bullying. It includes examples of how public health and safety professionals can help prevent
bullying and its consequences.
http://www.childrenssafetynetwork.org/sites/childrenssafetynetwork.org/files/
PreventingBullyingRolePublicHealthSafetyProfessionals.pdf
A Public Health Approach to Bullying Prevention | American Public Health Association (2014)
This publication serves as a practical, sustainable, cost-efficient strategy to tackle bullying. More importantly,
it may be the best approach to providing legitimate and sustainable hope to our children at a time when
bullying is becoming increasingly more difficult to tackle. This text serves as invaluable resource to parents and
professionals looking for advice on specific facets of school-based bullying.
http://secure.apha.org/imis/ItemDetail?iProductCode=978-087553-0413&CATEGORY=BK
http://ajph.aphapublications.org/doi/book/10.2105/9780875530413
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Understanding Bullying Fact Sheet | CDC (2013)

This fact sheet by the Centers for Disease Control and
Prevention (CDC) has six sections: (1) How Does Bullying
Affect Healt?, (2) Why Is Bullying a Public Health Problem?
(3) Who Is at Risk for Bullying? (4) How Can We Prevent
Bullying? (5) How Does CDC Approach Bullying Prevention?
and (6) Where Can I Learn More?
http://www.cdc.gov/violenceprevention/pdf/bullying_
factsheet.pdf
Understanding the Roles of Health and Safety
Professionals in Community-Wide Bullying Prevention
Efforts: What is Known About Bullying and How It
Relates to Health and Safety Professionals? | Stop
Bullying
This resource is tailored for health and safety
professionals as a guide to the StopBullying.gov training
module.
http://www.stopbullying.gov/prevention/training-center/
hrsa_guide_health-and-safety-professionals_508v2.pdf

At-Risk Populations
Bullying, Harassment, School-Based Violence | Safe Schools Coalition
The Safe Schools Coalition (SSC) is an international public-private partnership in support of LGBT youth that
is working to help schools in the U. S. and all over the world become safe places. A special page of the SSC
website considers bullying, harassment, and school violence. It offers numerous materials for school-wide
prevention projects.
http://www.safeschoolscoalition.org/RG-bullying_harassment_schoolbasedviolence.html
Bullying of Students with Disabilities Addressed in Guidance to Americas Schools | US Department of
Education (2014)
The U.S. Education Departments Office for Civil Rights (OCR) issued guidance to schools reminding them that
bullying is wrong and must not be toleratedincluding against Americas 6.5 million students with disabilities.
http://www.ed.gov/news/press-releases/bullying-students-disabilities-addressed-guidanceamerica%E2%80%99s-schools
Growing up LGBT in America: A Quality of Life Report | Human Rights Campaign (2012)
In 2012, the Human Rights Campaign released Growing Up LGBT in America, a study of 10,000 LGBT young
people and straight youth ages 13-17. The study is the largest known survey of LGBT youth. A major finding of
the study was that LGBT youth are twice as likely as their peers to say they have been physically assaulted,
kicked, or shoved at school. More than one-half of LGBT youth (54 percent) say they have been verbally
harassed and called names involving anti-gay slurs.
http://www.hrc.org/files/assets/resources/Growing-Up-LGBT-in-America_Report.pdf

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National School Climate Survey | GLSEN

(2013)
This project, coordinated by the Gay,
Lesbian, and Straight Education Network
(GLSEN) since 1999, is the only national
survey to document the experiences of
students who identify as LGBT in Americas
secondary schools. The 2013 National
School Climate Survey is GLSENs 8th
biennial report on the school experiences
of LGBT youth in schools, including the
in-school resources that support LGBT
students well-being, the extent of the
challenges that they face at school, and
insights into many other aspects of LGBT
students experiences. The survey has consistently indicated that a safer school climate directly relates to the
availability of LGBT school-based resources and support, including Gay-Straight Alliances, inclusive curriculum,
supportive school staff, and comprehensive anti-bullying policies.
The full 2013 National School Climate Survey report includes information LGBT middle and high school students
experiences with hearing biased language, experiences of harassment and assault, anti-LGBT discrimination
at school, and the availability and impact of supportive school resources, as well as demographic and school
characteristic differences and information about changes in school climate over time.
http://glsen.org/nscs
A Report on the Status of Gay, Lesbian, Bisexual and Transgender People in Education: Stepping Out of the
Closet, Into the Light | National Education Association (2009)
This report considers the status of LGBT students based on the principle that every student has the human and
civil right to a quality public education. Interspersed throughout this report are vignettes from students that
the authors interviewed, including the testimonials from students attending the LGBT-friendly Harvey Milk
School in New York City.
http://www.eric.ed.gov/PDFS/ED505970.pdf
Safe at School: Addressing the School Environment and LGBT Safety through Policy and Legislation | UCLA
and NEPC (2010)
This brief by the Williams Institute in the UCLA Law School and the National Education Policy Center (NEPC)
describes numerous cases of mistreatment of LGBT students, including recurring examples of traumatic
peer mistreatment; the resulting harm to the academic achievement and aspirations of LGBT students;
lives lost through assaults and suicide; disproportionately high LGBT runaway and teen homelessness rates;
and the particular ongoing challenges faced by LGBT students of color. The brief also presents evidence of
the institutional failures to appreciate the overarching importance of school climate, recognize that LGBT
educators can play positive roles, and address the overt homophobia in many school sports programs. To address
these issues, the brief presents a menu of policy recommendations and legislative options for school districts
and states.
http://www.greatlakescenter.org/docs/Policy_Briefs/Biegel_LGBT.pdf

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Bullying and Co-Occurring Issues

Association between Bullying and Psychosomatic Problems: A Meta-Analysis | Pediatrics (2009)
According to this systematic review, bullying doubles the risk for psychosomatic illness in children. The authors
looked at 11 recent studies that examined the association between involvement in bullying and psychosomatic
complaints in youth aged 7-16 years. The results showed that victims and bullies had a significantly higher
risk for psychosomatic problems than their uninvolved peers. Given that school bullying is a widespread
phenomenon in many countries, the authors suggest that bullying be considered an international public health
issue.
http://pediatrics.aappublications.org/content/123/3/1059.abstract
Bullying and Depressive Symptomatology among Low-Income, African-American Youth | Journal of Youth
and Adolescence (2010)
This study explores the effects of bullying on depression in African American youth. By removing race/ethnicity
from the current analysis, the researchers examined intra-racial behavior among youth. The authors identify
risk and protective factors associated with symptoms of depression and point the way to further study.
http://www.springerlink.com/content/vw16r583t125h67x/fulltext.pdf
Bullying and Suicide among LGBT Youth | Suicide Prevention Resource Center (2011)
The Suicide Prevention Resource Center has released, Suicide and Bullying, a brief on the relationship
between bullying and suicide, especially as it relates to lesbian, gay, bisexual, and transgendered (LGBT) youth.
The brief describes the extent of the problem and identifies strategies for bullying and suicide prevention.
http://www.sprc.org/library/Suicide_Bullying_Issue_Brief.pdf
Bullying and Suicide: The Dangerous Mistake We Make | Huffington Post (2012)
Though bullying-related suicides frequently make headlines, experts warn that the majority of suicides are not
so simple; there are many factors that contribute to suicide. Professionals in the field worry that focusing too
much on external factors such as bullying or family problems not only ignores underlying mental health issues,
but also rationalizes suicidal thoughts and behavior.
http://www.huffingtonpost.com/2012/02/08/bullying-suicide-teens-depression_n_1247875.html?ref=tw
Bullying and Suicidal Behaviors among Urban High School Youth | Journal of Adolescent Health (2012)
This 2012 study determines whether involvement in bullying as a perpetrator, victim, or both victim and
perpetrator (victim-perpetrator) was associated with a higher risk of suicidal ideation or suicide attempts
among a multiethnic urban high school population in the U. S.
http://www.sciencedirect.com/science/article/pii/S1054139X1100677X
Bullying and Suicide: A Public Health Approach | Journal of Adolescent Health (2013)
Several recent studies have found an association between bullying and depression or bullying and suiciderelated behaviors, and one study found evidence consistent with a causal link, at least for girls. These studies,
in conjunction with extensive media coverage of the deaths by suicide of several young people who were
victims of bullying, led the CDC to convene an expert panel focusing on the relationship between bullying
involvement and suicide-related behaviors.
http://www.jahonline.org/issue/S1054-139X%2813%29X0015-1

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Bullying as a Longitudinal Predictor of Adolescent Dating

Violence | Journal of Adolescent Health (2014)
One suggested approach to preventing adolescent dating
violence is to prevent behavioral precursors to dating
violence, such as bullying. However, no longitudinal
study has examined bullying as a behavioral precursor
to dating violence. In this study, longitudinal data were
used to examine: (1) whether direct and indirect bullying
perpetration in the sixth grade predicted the onset of
physical dating violence perpetration by the eighth grade
and (2) whether the associations varied by sex and race/
ethnicity of the adolescent.
http://www.jahonline.org/article/S1054139X%2814%2900116-5/abstract
Bullying Predicts Reported Dating Violence and Observed Qualities in Adolescent Dating Relationships |
Journal of Interpersonal Violence (2014)
The relationship between reported bullying, reported dating violence, and dating relationship quality measured
through couple observations was examined. The bullying of boys, but not girls, was significantly related to
dating violence perpetration. Age interactions showed that bullying was positively predictive of dating violence
perpetration and victimization for older, but not younger adolescents. Positive affect was also negatively
predicted by bullying, but only for girls. These findings add to the growing body of evidence that adolescents
carry forward strategies learned in the peer context to their dating relationships.
http://jiv.sagepub.com/content/early/2014/10/27/0886260514554428.abstract
The Bully-Sexual Violence Pathway in Early Adolescence | CDC
This document highlights the early findings from a three-year study aimed to examine the overlap between
bullying and sexual violence victimization and perpetration in five middle schools in a Midwest state. The
first two waves of the study have shown that bullying perpetration and homophobic teasing were significant
predictors of sexual harassment perpetration over time. While these findings are preliminary, they do suggest
that homophobic teasing may be a component of bullying that may increase the potential for sexual harassment
later. In other words, a bully perpetrator who also used homophobic teasing may later turn to sexual
harassment.
http://www.cdc.gov/violenceprevention/pdf/asap_bullyingsv-a.pdf
The Co-Occurrence of Substance Use and Bullying Behaviors among U.S. Adolescents: Understanding
Demographic Characteristics and Social Influences | Journal of Adolescence (2012)
This 2012 study found that older and Hispanic adolescents were more likely to be substance users and
substance-using bullies, whereas younger and African American adolescents were more likely to be bullies.
Females were more likely to be substance users, whereas males were more likely to be bullies and substanceusing bullies. Spending more evenings with peers posed greater risks for substance use, bullying, and the
co-occurrence of both problem behaviors. Paternal knowledge exerted protective effects over-and-above the
effects of maternal knowledge. This article also discussed implications for prevention and intervention efforts.
http://www.sciencedirect.com/science/article/pii/S0140197112000802

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Illuminating the Relationship between Bullying and Substance Use among Middle and High School Youth |
Addictive Behaviors (2012)
This study looks at rates of substance abuse among middle and high school students and compares it with
student involvement with bullying, establishing a connection between the two and finding that victims of
bullying were the most likely to use substances.
http://www.sciencedirect.com/science/article/pii/S0306460312000020
Inside the Bullied Brain: The Alarming Neuroscience of Taunting: A News Article | Boston Globe (2010)
This Boston Globe article reviews a new wave of research that bullying can leave an indelible imprint on a
teens brain. Being ostracized by ones peers, it seems, can lead to reduced connectivity in the brain and even
sabotage the growth of new neurons. Research into the neurological effects of bullying is still preliminary, and
animal models are not perfect replicas of human social behavior. But together, these early findings suggest that
bullying -- even the verbal kind -- is more similar to physical and sexual abuse than considered earlier. The two
kinds of mistreatment can both produce the same kind of trauma.
http://www.boston.com/bostonglobe/ideas/articles/2010/11/28/inside_the_bullied_brain/?page=1
The Relationship between Bullying and Suicide: What We Know and What It Means for Schools | CDC (2014)
This CDC fact sheet explains what is known about the link between bullying and suicide. The publication
examines what the research shows, what school personnel can do, and where to find additional information.
http://www.cdc.gov/violenceprevention/pdf/bullying-suicide-translation-final-a.pdf
Suicide and Bullying: An SPRC Issue Brief | Suicide Prevention Resource Center (2011)
This issue brief examines the relationship between suicide and bullying among children and adolescents,
with special attention to lesbian, gay, bisexual, and transgender (LGBT) youth. It also explores strategies for
preventing these problems.
http://www.sprc.org/library/Suicide_Bullying_Issue_Brief.pdf

CSN National Resource Center

43 Foundry Avenue
Waltham, MA 02453
csninfo@edc.org
This project is supported by the Health Resources and
Services Administration (HRSA) of the U.S. Department
of Health and Human Services (HHS) under the Child
and Adolescent Injury and Violence Prevention
Resource Centers Cooperative Agreement (grant
number U49MC07499) for $850,000. This information or
content and conclusions are those of the author and
should not be construed as the official position or policy
of, nor should any endorsements be inferred by HRSA,
HHS or the U.S. Government.

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