Determinants for Bullying Victimization among 11–16-Year-Olds in 15 Low- and Middle-Income Countries:\ud A Multi-Level Study

Bullying is an issue of public health importance among adolescents worldwide. The present study aimed at explaining differences in bullying rates among adolescents in 15 low- and middle-income countries using globally comparable indicators of social and economic well-being. Using data derived from the Global School-based Health Survey, we performed bivariate analyses to examine differences in bullying rates by country and by bullying type. We then constructed a multi-level model using four fixed variables (age, gender, hunger and truancy) at the individual level, random effects at the classroom and\ud school levels and four fixed variables at the country level (Gini coefficient, per capita Gross Domestic Project, homicide rate and pupil to teacher ratio). Bullying rates differed significantly by classroom, school and by country, with Egypt (34.2%) and Macedonia (3.6%) having the highest and lowest rates, respectively. Eleven-year-olds were the most likely of the studied age groups to report being bullied, as was being a male. Hunger and truancy were found to significantly predict higher rates of bullying. None of the explanatory variables at the country level remained in the final model. While self-reported bullying varied significantly between countries, the variance between classrooms better explained these differences. Our findings suggest that classroom settings should be considered when designing approaches aimed at bullying prevention.\u

Suicidal ideation among school-attending adolescents in Dar es Salaam, Tanzania

 Background: Suicidal ideation is an understudied risk factor for suicidal intent. The present study investigates the patterns and risk factors for suicidal ideation among a sample of school-attending adolescents in Dar es Salaam, Tanzania. Methods: This study examined secondary data collected in 2006 through the Global School-Based Student Health Survey. The data were collected via two-stage cluster sampling representative of all secondary schools in Dar es Salaam. We compared adolescents who reported suicidal ideation (SI) and those who reported a plan to carry out a suicide attempt (SP), with those reporting neither ideation nor an attempt (controls) within the 12 months preceding the survey. Our analyses targeted demographic, behavioral, social, mental health and family factors. Results: A total of 2,176 students aged 11-16 years participated. Within the recall period, 7% (n=149) of participants had thought about suicide with 6.3% (n=136) having created a plan to carry out an attempt. Fifty percent of those reporting SP were female. We found that significant associations existed across all categories of psychological health, substance use and among those who reported being bullied. In the multivariate analysis adolescents reporting suicidal intent were more than twice as likely to report having been lonely (RRR=2.33; CI=1.36-4.01); more likely to suffer from depressive symptoms (RRR=2.26; CI=1.56-3.27) and have previously used an illicit substance (RRR=1.97; CI=1.12-3.48). We found an inverse association with age and suicidal planning (RRR=0.74; CI=0.62-0.90) as well as poverty and SP (RRR=0.53; CI=0.29-0.98) and an increased likelihood for adolescents reporting SP to be lonely (RRR=2.76; CI=1.55-4.90) and depressed (RRR=3.98; CI=2.71-5.86). Tobacco use (RRR=2.15; CI=1.22-3.78) and illicit substance use (RRR=1.99; CI=1.10-3.60) were associated with SP as was having parents who were knowledgeable of what adolescents did during their free time (RRR=2.15; CI=1.07-4.31). Respondents who reported having no friends were also more likely to report SP (RRR=3.68; CI=2.22-6.08). Conclusion: Our results suggest that, as in high-income settings, psychological factors, risky health behaviors such as substance use, and social and familial support impact suicidal ideation. This knowledge should be used to help inform further research as well as prevention and intervention strategies.

Effects of non-health-targeted policies on migrant health: a systematic review and meta-analysis

Background: Government policies can strongly influence migrants' health. Using a Health in All Policies approach, we systematically reviewed evidence on the impact of public policies outside of the health-care system on migrant health. Methods: We searched the PubMed, Embase, and Web of Science databases from Jan 1, 2000, to Sept 1, 2017, for quantitative studies comparing the health effects of non-health-targeted public policies on migrants with those on a relevant comparison population. We searched for articles written in English, Swedish, Danish, Norwegian, Finnish, French, Spanish, or Portuguese. Qualitative studies and grey literature were excluded. We evaluated policy effects by migration stage (entry, integration, and exit) and by health outcome using narrative synthesis (all included studies) and random-effects meta-analysis (all studies whose results were amenable to statistical pooling). We summarised meta-analysis outcomes as standardised mean difference (SMD, 95% CI) or odds ratio (OR, 95% CI). To assess certainty, we created tables containing a summary of the findings according to the Grading of Recommendations Assessment, Development, and Evaluation. Our study was registered with PROSPERO, number CRD42017076104. Findings: We identified 43 243 potentially eligible records. 46 articles were narratively synthesised and 19 contributed to the meta-analysis. All studies were published in high-income countries and examined policies of entry (nine articles) and integration (37 articles). Restrictive entry policies (eg, temporary visa status, detention) were associated with poor mental health (SMD 0·44, 95% CI 0·13–0·75; I2=92·1%). In the integration phase, restrictive policies in general, and specifically regarding welfare eligibility and documentation requirements, were found to increase odds of poor self-rated health (OR 1·67, 95% CI 1·35–1·98; I2=82·0%) and mortality (1·38, 1·10–1·65; I2=98·9%). Restricted eligibility for welfare support decreased the odds of general health-care service use (0·92, 0·85–0·98; I2=0·0%), but did not reduce public health insurance coverage (0·89, 0·71–1·07; I2=99·4%), nor markedly affect proportions of people without health insurance (1·06, 0·90–1·21; I2=54·9%). Interpretation: Restrictive entry and integration policies are linked to poor migrant health outcomes in high-income countries. Efforts to improve the health of migrants would benefit from adopting a Health in All Policies perspective

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Determinants for Bullying Victimization among 11–16-Year-Olds in 15 Low- and Middle-Income Countries: A Multi-Level Study

social science

Effects of non-health-targeted policies on migrant health: a systematic review and meta-analysis

Summary: Background: Government policies can strongly influence migrants' health. Using a Health in All Policies approach, we systematically reviewed evidence on the impact of public policies outside of the health-care system on migrant health. Methods: We searched the PubMed, Embase, and Web of Science databases from Jan 1, 2000, to Sept 1, 2017, for quantitative studies comparing the health effects of non-health-targeted public policies on migrants with those on a relevant comparison population. We searched for articles written in English, Swedish, Danish, Norwegian, Finnish, French, Spanish, or Portuguese. Qualitative studies and grey literature were excluded. We evaluated policy effects by migration stage (entry, integration, and exit) and by health outcome using narrative synthesis (all included studies) and random-effects meta-analysis (all studies whose results were amenable to statistical pooling). We summarised meta-analysis outcomes as standardised mean difference (SMD, 95% CI) or odds ratio (OR, 95% CI). To assess certainty, we created tables containing a summary of the findings according to the Grading of Recommendations Assessment, Development, and Evaluation. Our study was registered with PROSPERO, number CRD42017076104. Findings: We identified 43 243 potentially eligible records. 46 articles were narratively synthesised and 19 contributed to the meta-analysis. All studies were published in high-income countries and examined policies of entry (nine articles) and integration (37 articles). Restrictive entry policies (eg, temporary visa status, detention) were associated with poor mental health (SMD 0·44, 95% CI 0·13–0·75; I2=92·1%). In the integration phase, restrictive policies in general, and specifically regarding welfare eligibility and documentation requirements, were found to increase odds of poor self-rated health (OR 1·67, 95% CI 1·35–1·98; I2=82·0%) and mortality (1·38, 1·10–1·65; I2=98·9%). Restricted eligibility for welfare support decreased the odds of general health-care service use (0·92, 0·85–0·98; I2=0·0%), but did not reduce public health insurance coverage (0·89, 0·71–1·07; I2=99·4%), nor markedly affect proportions of people without health insurance (1·06, 0·90–1·21; I2=54·9%). Interpretation: Restrictive entry and integration policies are linked to poor migrant health outcomes in high-income countries. Efforts to improve the health of migrants would benefit from adopting a Health in All Policies perspective. Funding: Swedish Council for Health, Working Life, and Social Research; UK Medical Research Council; Scottish Government Chief Scientist Office