ORIGINAL ARTICLE

https://doi.org/10.1590/1984-0462/2025/43/2023215

Association between bullying victimization and health

risk behavior in adolescents
Associação entre vitimização de bullying e comportamentos de risco à saúde
em adolescentes
Ana Beatriz Pacíficoa,* , Eliane Denise Araújo Bacila , Mariana Ardengueb , Thiago Silva Piolaa ,
Michael Pereira da Silvac , Fabio Fontanad , Ademar Avelarb , Wagner de Camposa

Corresponding author: ABSTRACT

E-mail: ana_pacifico@hotmail.com Objective: The aim of this study was to examine the association between bullying victimization
(A. B. Pacífico)
and health risk behaviors in adolescents.
a
Universidade Federal do Paraná, Curitiba, Methods: A representative sample of 1020 adolescents participated in the study. The variables
PR, Brazil. such as bullying, health risk behaviors (tobacco, drugs, alcohol, sedentary behavior, smartphone
b
Universidade Estadual de Maringá,
use, level of physical activity, and sleep), and economic status were assessed using self-reported
Maringá, PR, Brazil.
c
Universidade Federal de Rio Grande, questionnaires. Odds ratios with 95% confidence intervals (95%CI) were obtained using binary
Rio Grande, RS, Brazil. logistic regression and ordinal, gross, and adjusted logistic regression (p<0.05).
d
University of Northern Iowa, Cedar Falls,
Results: Victims of bullying were more likely to smoke (OR 1.75; 95%CI 1.28–2.40), consume alcohol
Iowa, United States.
(OR1.43; 95%CI 1.05–1.94), have worse sleep quality (OR 1.94; 95%CI 1.28–2.91), and more sedentary
Editor-in-Chief: Ruth Guinsburg behavior (OR 1.43; 95%CI 1.08–1.89) than those who were not bullied. However, victims were more
Associate editor: Sonia Regina Testa da likely to have high levels of physical activity than their non-bullied peers (OR 1.66; 95%CI 1.22–2.27).
Silva Ramos
Executive Editor: Cléa R Leone Conclusions: Bullying victimization was associated with an increased predisposition for the
Reviewers: Mercia Medeiros and Renata adoption of health risk behaviors. Interestingly, victims were also more prone to participate in
Waksman physical activity.

Receid on November 06, 2023; approved Keywords: Bullying; Physical activity; Sedentary behavior; Health risk behaviors; Adolescents.
on March 29, 2024.

Funding
This study was funded in part by the
Coordenação de Aperfeiçoamento de
Pessoal de Nível Superior – Brasil (CAPES)
RESUMO
Objetivo: Examinar a associação entre vitimização por bullying e comportamentos de risco à
financing code 001.
saúde em adolescentes.
Conflict of interests
Métodos: Uma amostra representativa de 1.020 adolescentes participou do estudo. As variáveis
The authors declare that there is no conflict
of interests. bullying, comportamentos de risco à saúde (tabaco, drogas, álcool, comportamento sedentário,
uso de smartphone, nível de atividade física, sono) e situação econômica foram avaliadas por
Authors’ contributions
Study design: Pacífico AB, Bacil EDA, Piola meio de questionários autorreportados. Razões de chance com intervalos de confiança de 95%
TS, Fontana F, Campos W. Data collection: (IC95%) foram obtidas por meio de regressão logística binária e regressão logística ordinal, bruta
Pacífico AB, Ardengue M, Piola TS, Avelar e ajustada (p<0,05).
A. Data analysis: Pacífico AB, Bacil EDA,
Ardengue M, Piola TS, Silva MP, Fontana Resultados: As vítimas de bullying apresentaram maior probabilidade de fumar (OR 1,75; IC95%
F. Manuscript writing: Pacífico AB, Bacil 1,28–2,40), consumir álcool (OR 1,43; IC95% 1,05–1,94), ter pior qualidade de sono (OR 1,94; IC95%
EDA, Ardengue M. Manuscript revision: 1,28–2,91) e apresentar mais comportamento sedentário (OR 1,43; IC95% 1,08–1,89) do que aqueles
Silva MP; Fontana F, Avelar A, Campos W.
Study supervision: Pacífico AB, Avelar A, que não sofreram bullying. No entanto, as vítimas eram mais propensas a ter níveis elevados de
Campos W. atividade física do que os seus pares não vítimas de bullying (OR 1,66; IC95% 1,22–2,27).
Conclusões: A vitimização por bullying esteve associada ao aumento da predisposição para a
Declaration
The database that originated the article is adoção de comportamentos de risco à saúde. Curiosamente, as vítimas também eram mais
available with the corresponding author. propensas a participar de atividades físicas.
Palavras-chave: Bullying; Atividade física; Comportamento sedentário; Comportamentos de
risco à saúde; Adolescentes.

© 2024 Sociedade de Pediatria de

São Paulo. Published by Zeppelini
Publishers. This is an open access
article under the CC BY license (http://
creativecommons.org/licenses/by/4.0/).
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Bullying and health risk behaviors

INTRODUCTION period of social isolation caused by the COVID-19 pandemic.

Adolescence is a stage of development characterized by several The target population was middle-school students attending
biological, behavioral, and psychosocial changes. It may be a trou- public schools in Maringá (PR). Based on IBGE statistics, the
bled and confusing developmental period in which contradictory total number of students was 12,130.9
and inconsistent feelings may turn into aggressive behaviors such The sample consisted of adolescents from both sexes aged
as bullying.1 Bullying is a repetitive act of physical or verbal vio- 15–17 years. Sample size calculations were performed using the
lence, which is a highly prevalent behavior during adolescence Cochran-Mantel-Haenszel10 method for analysis of the associ-
worldwide.2 Bullying is also prevalent in Brazil. For example, ation between dichotomous variables. All calculations were per-
according to PeNSE 2019, 23% of school age adolescents in formed considering a significance level of 5%, a power of 80%,
Brazil (13–17 years of age) reported feeling humiliated by col- and a 1:1 ratio of exposed to unexposed. Bullying was considered
leagues in the past 30 days.3 Bullying is a serious public health the main predictor variable. The study outcomes were smoking,
problem3 and can negatively affect adolescents. According to alcohol consumption, illicit drug use, poor sleep quality, insuffi-
the Centers for Disease Control and Prevention (CDC), young cient practice of physical activity, and sedentary behavior. A total
people who are victims of bullying tend to experience loneliness, of six sample size calculations were carried out. For each calcu-
anxiety, depression, sleep difficulties, poor school performance,4 lation, the prevalence of the outcome in each exposure group
and are also more likely to commit suicide.5 was considered to be 50%, a default value when there is insuffi-
Victimization may also lead to health risk behaviors (HRBs) cient information about the prevalence of outcomes in the expo-
such as sedentary behavior, insufficient levels of physical activ- sure groups. The estimated ORs were obtained from previous
ity, insufficient sleep, and the use of tobacco, illicit drugs, and literature studies (supplementary document). The sample size
alcohol.6–8 Unfortunately, the literature examining the associ- required for the study ranged from 172 (illicit drug use) to 776
ation between bullying and HRBs is limited, and the findings individuals (sedentary behavior). Due to possible losses, 30%
are not consistent across studies. The literature examining the was added to the highest estimate so that the minimum esti-
association between bullying and HRB is even scarcer in Brazil. mated sample size was 1009 adolescents.
In addition, many existing studies have methodological weak- Based on the division of neighborhoods in Maringá (PR),
nesses, including the use of non-validated questionnaires for the a single school from each region (north, south, east, west, and
assessment of bullying and non-representative participant sam- central) was randomly selected according to student enrollment.
ples. Thus, this study aims to examine the association between Thus, the sample was selected in a probabilistic way in
bullying victimization and HRBs in male and female adolescents three stages:
in Maringá (PR). We hypothesized that adolescents reporting 1. All public schools were listed and stratified according
victimization are more likely to engage in HRB. to the five city regions;
2. A school was randomly selected from each region;
3. A simple random selection of classrooms from each
METHOD school was performed.
This is a cross-sectional study with a representative sample
of adolescents enrolled in public schools in Maringá (PR). The number of classrooms depended on the number of stu-
Maringá is a medium- to large-sized urban center. It has the dents necessary to accurately represent each region. A total of
third largest population in the state, with approximately 436,472 1,308 adolescents were assessed. The final sample was made up
inhabitants. The study adopted resolution CNS 466/2012 of 1,020 adolescents after the exclusion of participants according
of the National Health Council of the Ministry of Health, to the following criteria: age under 15 or over 17 years, reporting
which approved the “New Guidelines and Regulatory Norms a disability, and questionnaires with missing data.
for Research Involving Human Beings” (DOU 1996 Oct 16; The Olweus Bullying Questionnaire (QBO),11 a Brazilian
no201, section 1:21082-21085). The study was approved by the version of the Revised Olweus Bully/Victim Questionnaire
Research Ethics Committee of Unicesumar University, CAAE: (OBVQ),12 was used to assess and classify victims of bullying.
57872522.6.0000.5539. Data collection was carried out in 2022 This instrument contains 23 items inquiring about the frequency
from April to June by a trained team. The data collection took in which individuals have experienced and/or engaged in bullying
place shortly after schools returned to in-person classes after a behavior. Those who answered that they were bullied “once or more

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times a week” were classified as victims of bullying. The internal five or more points were classified as having poor sleep quality.
reliability of the victim scale was adequate (Cronbach’s α=0.85). The PSQI was translated and validated to assess sleep time and
Sedentary behavior was assessed using the Brazilian version13 quality among Brazilian adolescents. It has adequate internal
of the Sedentary Activities Questionnaire (QASA) for adoles- consistency (α=0.82) and test–retest reliability.
cents.14 This instrument provides information on the time spent The Brazilian version19 of the Youth Risk Behavior Survey
in hours and/or minutes on different types of sedentary activities (YRBS) was used to assess the consumption of cigarettes,
during week and weekend days of a typical week. The classification illicit drugs, and alcohol. YRBS was initially developed by the
was given by the tertile of hours presented by the sample: “High,” Center for Disease Control and Prevention.20 The following were
“Medium,” and “Low” time in sedentary behavior. The valid- considered risk factors: consuming at least one cigarette, some
ity of QASA to measure the sedentary behaviors of Brazilian type of illicit drug (at least once), and at least one dose of alco-
adolescents is adequate. For example, the test–retest weekday hol in the last 30 days before data collection. The mean Kappa
ICC was 0.88 (95%CI 0.82–0.91), and the test–retest weekend concordance was 68.6% indicating the quality of psychometric
ICC was 0.77 (95%CI 0.68–0.84). properties of the Portuguese version.
The Short Version of the Smartphone Addiction Scale The control variables in this study were sex, age group (divided
(SAS-SV)15 was used to verify whether adolescents are classi- by the age of 15, 16, and 17 years), socioeconomic class, and
fied as addicted to smartphone use. This questionnaire consists weight status. Sex and age range were obtained through anam-
of 10 questions about the use of phone devices, with response nesis. The assessment of socioeconomic class was carried out
options ranging from 1 to 6 on a Likert scale from “Totally dis- using the Brazil Economic Classification Criteria Questionnaire,
agree” to “Totally agree.” Total scores may vary from 10 to 60 proposed by the Brazilian Association of Research Companies.21
points. The authors suggested a cutoff point of 33. Those with This criterion estimates the purchasing power of families based
a score greater than 33 are considered to have a smartphone on the availability of home appliances and the level of educa-
addiction.15 SAS-SV has adequate reliability for assessing smart- tion of the head of the household. For this study, the sample
phone addiction among Brazilian adolescents (α=0.81; ω=0.78). was classified into high (class A), medium (classes B1 and B2),
The Brazilian version of the Physical Activity Questionnaire and low (classes C and D) socioeconomic classes.
for Adolescents (PAQ-A)16 was used to assess insufficient levels Absolute and relative frequencies were used to describe socio-
of physical activity. This questionnaire is aimed at adolescents demographic characteristics and the outcome and predictor vari-
aged between 14 and 18 years. It measures engagement in phys- ables. The chi-square test was used to compare proportions and
ical activity in the last 7 days through 8 Likert items ranging possible differences between sexes. For the analysis of the associ-
from 1 to 5. More specifically, the PAQ-A gathers information ation between bullying and HRBs (insufficient levels of physical
regarding the frequency and intensity of physical activity during activity, insufficient sleep, sleep quality, use of tobacco, illicit drugs,
free time and physical education classes. Adolescents were clas- and alcohol), the binary logistic regression procedure was used for
sified as less and more active using the median of the sample as dichotomous outcomes, and the ordinal logistic regression was
the cutoff point. The PAQ-A has positive indicators of validity used for the ordinal outcome (sedentary behavior). The control
and test–retest reliability, with ICCs ranging between 0.68 and variables used during adjusted analyses were nutritional status, sex,
0.88 and an internal consistency of α=0.76. age, and economic class. The analyses were performed using the
The Brazilian version of the Pittsburgh Sleep Quality Index Stata statistical software version 15.0 (StataCorp LLC, College
(PSQI)17 was used to assess sleep time and quality. Individuals Station, TX, USA) with a significance level of p≤0.05.
with less than 8 h of sleep per day (during the week and week-
ends) were classified as having inadequate sleep time, while those
with more than 8 h of sleep per day were classified as having RESULTS
adequate sleep time.18 The questionnaire assessed seven com- The final sample consisted of 1020 adolescents evenly distributed
ponents of sleep quality: subjective quality, sleep latency, sleep by sex (Male=50.1%). Table 1 shows the description of exposure
duration, sleep efficiency, sleep disturbances, medication use, and variables, outcome, and covariates. Approximately 20% of the
daily dysfunction. Scores varied from 0 to 3 for each compo- sample reported being a victim of bullying. Victimization was
nent. The maximum total sleep quality score was 21 points, with not significantly different between the sexes. A large proportion
higher scores representing worse sleep quality. Adolescents with of the sample (75%) reported poor sleep quality. The proportion

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of females (83.3%) with poor sleep quality was significantly larger alcohol consumption (42%) than males (31.1% and 35%, respec-
than that of males (68.3%, p<0.001). Most of the adolescents tively). The proportion of girls (59.1%) classified as less active was
(72.5%) reported sleeping less than 8 h/day, and sleep duration significantly larger than that of boys (40.9%, p<0.001). The pro-
was not different between sexes. Notably, 31% of the sample portion of adolescents classified as addicted to smartphones was
reported smoking within the past 30 days, and 38.5% reported 34.4%. A significantly larger proportion of girls (43.6%) reported
alcohol consumption. More females reported smoking (35.4%) and smartphone addiction than boys (25.2%, p<0.001).

Table 1. Descriptive characteristics of participants (n=1020).

Total Male Female
χ2 p-value
n (%) n (%) n (%)
Age (years)
15 257 (25.1) 128 (25.1) 128 (25.2)
16 362 (35.5) 172 (33.7) 190 (37.4) 2.99 0.393
17 401 (39.4) 211 (41.2) 190 (37.4)
Economic class
High 340 (33.3) 168 (32.9) 172 (33.8)
Middle 567 (55.6) 287 (56.1) 280 (55.0) 0.14 0.933
Low 113 (11.1) 56 (11.0) 57 (11.2)
Bullying-victim
No 815 (79.9) 415 (81.2) 400 (78.6)
1.10 0.295
Yes 205 (20.1) 96 (18.8) 109 (21.4)
Sleep quality
Good 247 (24.2) 162 (31.7) 85 (16.7)
31.28 <0.001
Bad 773 (75.8) 349 (68.3) 424 (83.3)
Hours of sleep per day
<8 740 (72.5) 358 (70.1) 382 (75.0)
3.19 0.074
≥8 280 (27.5) 153 (29.9) 127 (25.0)
Smoking in the last 30 days
No 696 (68.2) 367 (71.8) 329 (64.6)
6.07 0.014
Yes 324 (31.8) 144 (28.2) 180 (35.4)
Alcohol consumption
No 627 (61.5) 332 (65.0) 295 (58.0)
5.30 0.021
Yes 393 (38.5) 179 (35.0) 214 (42.0)
Use of illicit drugs in the last 30 days
No 970 (95.1) 477 (93.3) 493 (96.9)
6.74 0.009
Yes 50 (4.9) 34 (6.7) 15 (3.1)
Physical activity*
Less active 510 (50.0) 209 (40.9) 301 (59.1)
33.92 <0.001
More active 510 (50.0) 302 (59.1) 208 (40.9)
Smartphone addiction
No 669 (65.6) 382 (74.8) 287 (56.4)
38.13 <0.001
Yes 351 (34.4) 129 (25.2) 222 (43.6)
Sedentary behavior
Low sedentary time 341 (33.4) 179 (35.0) 162 (31.8)
Medium sedentary time 339 (33.3) 173 (33.9) 166 (32.6) 2.41 0.299
High sedentary time 340 (33.3) 159 (31.1) 181 (35.6)
χ2: chi-square test; p≤0.05. *Classification obtained by the median scores: median (IQR)=2.19 (1.67–2.77). Bold denotes statistically significant p-values.

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Table 2 shows the association between HRBs and being a sedentary behavior categories from low to medium or medium
victim of bullying. Adolescent victims of bullying were 1.75 times to high (OR 1.69; 95%CI 1.14–2.51).
more likely to smoke (95%CI 1.28–2.40), 1.43 times more likely Table 3 shows the adjusted associations between HRBs and
to consume alcohol (95%CI 1.05–1.94), 1.94 times more likely to being a victim of bullying. The unadjusted analysis using the total
have worse sleep quality (95%CI 1.28–2.91), and 1.66 times sample produced very similar results to the analysis adjusted by
more likely to do more physical activity than those who were sex, socioeconomic level, and age. When stratified by sex and
not victims of bullying (95%CI 1.22–2.27). adjusted by age and socioeconomic status, boys reporting being
When stratified by sex, boys who were victims of bullying victims of bullying had a 1.54 times greater chance of consuming
were 1.81 times more likely to smoke (95%CI 1.13–2.88), 1.98 alcohol compared to nonvictims (95%CI 1.10–1.73).
times more likely to have poorer sleep quality (95%CI 1.16–
3.37), and 2.41 times more likely to engage in physical activity
(95%CI 1.46–3.98). Girls reporting victimization were 1.68 DISCUSSION
times more likely to smoke compared to those who were not This study showed that a high number of adolescents are victims of
victims of bullying (95%CI 1.09–2.58). bullying in schools. In fact, 20.1% of participants reported bullying
Finally, being a victim of bullying increased the chance of victimization. This value is higher when compared to the national
switching sedentary behavior categories from low to medium survey by PeNSE (2015),22 which showed that 7.4% of Brazilian
or medium to high by 43% (OR 1.43; 95%CI 1.08–1.89). adolescents had been bullied. However, the number is closer to the
When stratified by sex, girls were 69% more likely to switch average prevalence of 35% of bullying victimization worldwide.23

Table 2. Associations between victimization and health risk behaviors.

Bullying-victim
Total Male Female
OR (95%CI) OR (95%CI) OR (95%CI)
Smoking 1.75 (1.28–2.40) 1.81 (1.13–2.88) 1.68 (1.09–2.58)
Alcohol consumption 1.43 (1.05–1.94) 1.49 (0.95–2.35) 1.34 (0.88–2.05)
Use of illicit drugs 1.13 (0.57–2.24) 1.13 (0.48–2.68) 1.23 (0.39–3.90)
Smartphone addiction 1.25 (0.91–1.72) 1.54 (0.95–2.50) 1.02 (0.67–1.56)
Sleep quality 1.94 (1.28–2.91) 1.98 (1.16–3.37) 1.80 (0.94–3.46)
Hours of sleep per day 1.02 (0.73–1.44) 1.15 (0.71–1.85) 0.93 (0.56–1.52)
Physical activity 1.66 (1.22–2.27) 2.41 (1.46–3.98) 1.36 (0.89–2.08)
Sedentary behavior* 1.43 (1.08–1.89) 1.18 (0.79–1.76) 1.69 (1.14–2.51)
*Ordinal logistic regression model for ordinal polytomous outcomes.

Table 3. Adjusted associations between health risk behaviors and victimization.

Bullying-victim
Total* Male† Female†
OR (95%CI) OR (95%CI) OR (95%CI)
Smoking 1.75 (1.28–2.41) 1.83 (1.15–2.92) 1.68 (1.09–2.60)
Alcohol consumption 1.45 (1.06–1.98) 1.54 (1.10–1.73) 1.37 (0.88–2.12)
Use of illicit drugs 1.18 (0.59–2.37) 1.16 (0.49–2.76) 1.20 (0.38–3.86)
Smartphone addiction 1.21 (0.87–1.67) 1.55 (0.95–2.52) 1.00 (0.65–1.53)
Sleep quality 1.91 (1.26–2.88) 1.99 (1.17–3.39) 1.77 (0.92–3.39)
Hours of sleep per day 1.03 (0.73–1.45) 1.13 (0.69–1.83) 0.95 (0.57–1.55)
Physical activity 1.75 (1.27–2.40) 2.44 (1.47–4.03) 1.35 (0.88–2.07)
Sedentary behavior 1.42 (1.07–1.88) 1.21 (0.81–1.81) 1.70 (1.14–2.52)
*Adjusted for sex, age, and socioeconomic status; †Adjusted for age and socioeconomic status.

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Besides that, this study indicated that being bullied is associ- possible that those who are bullied choose to be more reserved to
ated with HRBs among adolescents. Victims of bullying were at decrease exposure to uncomfortable situations. Environments with
greater risk for smoking, consuming alcohol, having worse sleep less exposure to bullying, such as staying at home, may encourage
quality, and engaging in more sedentary behavior than those who sedentary behaviors including time sitting or lying down. The lack
were not victims of bullying. The only exception was physical of such an association for boys in the present study may be due
activity. Victims of bullying reported practicing more physical to the fact that boys are generally more active and perhaps prefer
activity than adolescents who reported not being victims of bul- to adopt other activities rather than sedentary behavior.
lying. As detailed in-depth below, these behaviors are associated Although bullying was related to an increase in the adoption
with significant short- and long-term health risks for adolescents. of HRBs, that was not the case for physical activity. In fact, the
Victimization, independent of sex, was associated with a higher analysis carried out by combining both sexes showed a positive
likelihood of smoking during adolescence. This finding is supported association between victimization and physical activity. When
by other studies.24 Victims may take refuge in smoking addiction or stratified by sex, only boys who were victims of bullying practiced
other actions to fit in with their peers. The habit of smoking is often more physical activity. Similar to this study, a positive association
established during adolescence. In fact, most smokers first try or between victimization and physical activity has been previously
become addicted to tobacco before the age of 18 years. This associ- demonstrated,29 but there have also been studies suggesting a
ation can have extremely negative long-term consequences for ado- negative association6 or a lack of association.30 This divergence
lescents. In fact, smoking is the main cause of death for about half indicates that further studies on the topic are needed. The posi-
of those who continue to smoke after adolescence.25 Public policy tive association for boys can perhaps be explained by the fact that
to prevent bullying may inadvertently reduce adolescent smoking. those who practice physical activity are more exposed to their
Victimization was also shown to be associated with alcohol peers and consequently to bullying.30 Physical activity environ-
consumption in the analysis combining boys and girls. When strat- ments tend to have less surveillance from adults, as such sport
ified by sex, this association remained significant for boys only. environments may be a “trigger” for bullying actions.29 Besides,
The results are in agreement with previous studies showing an asso- being more active than girls during adolescence may predispose
ciation between being a victim of bullying and alcohol consump- boys to bullying victimization.30
tion in both sexes.24,26 Alcohol consumption in adolescence tends The study is not without limitations. Although the sample
to be associated with a series of negative outcomes such as low aca- covered participants in all economic groups, this study selected
demic performance, higher incidence of car accidents, higher levels participants only from public education institutions. The self-re-
of engagement violent behavior, and higher consumption of other port measures used to collect data in this study may underesti-
harmful substances such as tobacco and illicit drugs.26 Similar to mate or overestimate the study results. To minimize this risk,
smoking, alcohol consumption may be a way for adolescents to deal questionnaires were carefully selected to have extensive validity
with stress or improve their sense of belonging to peers. evidence to measure adolescents. As a limitation, it is also nec-
Additionally, the analysis using the total sample indicated that essary to mention that data collection took place shortly after
victims of bullying were more likely to report poor sleep qual- schools returned to in-person classes after a long period of social
ity. When stratified by sex, this association remained significant isolation caused by the COVID-19 pandemic. This may have
for boys only. Other studies have also demonstrated an associa- affected some of the adolescents’ behaviors beyond what would
tion between sleep and victimization.27 Sleep problem is another have happened pre-pandemic.
health outcome that should be added to the array of negative There are strengths to this study as well. The sample was
consequences of bullying for adolescents. Poor sleep quality is representative of the population in the city of Maringá (PR).
associated with worse perceptions of health in general and, more In addition, this work contributes to the accumulation of scien-
specifically, psychosomatic health complaints, including headache, tific evidence examining the relationship between bullying and
back pain, irritability, bad mood, nervousness, and dizziness.28 health risk factors. This literature is particularly scarce in Brazil.
Sedentary behavior was also associated with victimization in Findings from this study may help guide public policy to reduce
the analysis combining boys and girls. This association was present bullying during adolescence.
only among girls in the analysis stratified by sex. A meta-analysis6 In conclusion, bullying victimization was associated with an
with a large sample of children and adolescents also supported an increased predisposition to the adoption of HRBs. Interestingly,
association between victimization and sedentary behavior. It is victims were also more prone to participate in physical activity.

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