Article

Trends and Socioeconomic Correlates of Adolescent Physical Fighting in 30 Countries

Departments of Community Health and Epidemiology, and.
PEDIATRICS (Impact Factor: 5.47). 12/2012; 131(1). DOI: 10.1542/peds.2012-1614
Source: PubMed

ABSTRACT

Background and objectives:
No recent international studies provide evidence about its prevalence, trends, or social determinants of physical fighting in adolescents. We studied cross-national epidemiologic trends over time in the occurrence of frequent physical fighting, demographic variations in reported trends, and national wealth and income inequality as correlates.

Methods:
Cross-sectional surveys were administered in school settings in 2002, 2006, and 2010. Participants (N = 493874) included eligible and consenting students aged 11, 13, and 15 years in sampled schools from 30 mainly European and North American countries. Individual measures included engagement in frequent physical fighting, age, gender, participation in multiple risk behaviors, victimization by bullying, and family affluence. Contextual measures included national income inequality, absolute wealth and homicide rates. Temporal measure was survey cycle (year).

Results:
Frequent physical fighting declined over time in 19 (63%) of 30 countries (from descriptive then multiple Poisson regression analyses). Contextual measures of absolute wealth (relative risk 0.96, 95% confidence interval 0.93-0.99 per 1 SD increase in gross domestic product per capita) but not income inequality (relative risk 1.01, 95% confidence interval 0.98-1.05 per 1 SD increase) related to lower levels of engagement in fighting. Other risk factors identified were male gender, younger age (11 years), multiple risk behaviors, victimization by bullying, and national homicide rates.

Conclusions:
Between 2002 and 2010, adolescent physical fighting declined in most countries. Specific groups of adolescents require targeted violence reduction programs. Possible determinants responsible for the observed declines are discussed.

Full-text

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DOI: 10.1542/peds.2012-1614
; originally published online December 3, 2012; 2013;131;e18Pediatrics
Harel-Fisch and Candace Currie
Sigmundová, Margarida Gaspar de Matos, Wendy Craig, Sophie D. Walsh, Yossi
Katharina Rathmann, Tom F.M. ter Bogt, Saoirse Nic Gabhainn, Dagmar
William Pickett, Michal Molcho, Frank J. Elgar, Fiona Brooks, Margaretha de Looze,
Countries
Trends and Socioeconomic Correlates of Adolescent Physical Fighting in 30
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Page 1
Trends and Socioeconomic Correlates of Adolescent
Physical Fighting in 30 Countries
WHATS KNOWN ON THIS SUB JECT: Adolescent physical ghting
is an important public health concern with known social origins.
However, existing international studies of adolescent ghting
provide little evidence about its prevalence, trends over time, or
possible socioeconomic determinants.
WHAT THIS STUDY ADDS: We studied frequent physical ghting
among 494 874 adolescents in 30 countries over an 8-year period.
Physical ghting declined in most countries. National measures of
absolute wealth but not socioeconomic inequalities related to risk
of frequent physical ghting.
abstract
BACKGROUND AND OBJECTIVES: No recent international studies pro-
vide evidence about its prevalence, trends, or social determinants of
physical ghting in adolescents. We studied cross-national epidemiologic
trends over time in the occurrence of frequent physical ghting, demo-
graphic variations in reported trends, and national wealth and income
inequality as correlates.
METHODS: Cross-sectional surveys were administered in school settings
in 2002, 2006, and 2010. Pa rticipants (N 5 493 874) included eligible and
consenting students aged 11, 13, and 15 years in sampled schools from
30 mainly European and North American countries. Individual measures
included engagement in frequent physical ghting , age, gender,
participation in multiple risk behaviors, victimization by bullying, and
family afuence. Contextual measures included national income inequality,
absolute wealth and homicide rates. Temporal measure was survey
cycle (year).
RESULTS: Fr equent physical ghting declined over time in 19 (63%) of 30
countries (from descriptive then multiple Poisson r egression analyses). Con-
textual measures of absolute wealth (relative risk 0.96, 95% condence in-
terval 0.930.99 per 1 SD incr ease in gross domestic product per capita) but
not income inequality (relative risk 1.01, 95% condence interval 0.981.05
per 1 SD increase) related to lower levels of engagement in ghting. Other
risk factors identied were male gender, younger age (11 years), multiple
risk behaviors, victimization by bullying, and national homicide rates.
CONCLUSIONS: Between 2002 and 2010, adolescent physical ghting de-
clined in most countries. Specic groups of adolescents require targeted
violence reduction programs. Possible determinants responsible for the
observed declines are discussed. Pediatrics 2013;131:e18e26
AUTHORS: William Pickett, PhD,
a
Michal Molcho, PhD,
b
Frank J. Elgar, PhD,
c
Fiona Brooks, BA, PhD,
d
Margaretha
de Looze, MSc,
e
Katharina Rathmann, Dipl.-Soz,
f
Tom F.M.
ter Bogt, PhD,
e
Saoirse Nic Gabhainn, PhD,
b
Dagmar
Sigmundová, PhD,
g
Margarida Gaspar de Matos, PhD,
h
Wendy Craig, PhD,
I
Sophie D. Walsh, PhD,
j
Yossi Harel-
Fisch, PhD,
j
and Candace Currie, PhD
k
Departments of
a
Community Health and Epidemiology, and
i
Psychology, Queens University, Kingston, Canada;
b
Centre for
Health Promotion, National University of Ireland, Galway,
Republic of Ireland;
c
Institute for Health a nd Social Policy and
Douglas Institute, McGill University, Montreal, Canada;
d
Centre f or
Research in Primary and Community Care, University of
Hertf ordshire, United Kingdom;
e
Departme nt of Child and
Adolescent Studies, Faculty of Social and Behavioral Sciences,
Utrecht University, Utrecht, Netherlands;
f
Hertie School of
Governance, Humboldt University, Berlin, Germany;
g
Institute
of Active Lifestyle, Faculty of Physical Culture, Palacky
University in Olomouc, Olomouc, Czech Republic;
h
Faculdade de
Motricidade Humana, Universidade Tecnica de Lisboa, Cruz
Quebrada, Portugal;
j
International Research Program on
Adolescent Well-Being and Health, School of Education, Bar
Ilan University, Tel Aviv, Israel; and
k
Child and Adolescent
Health Research Unit, University of St. Andrews, St. Andrews,
United Kingdom
KEY WORDS
adolescent, epidemiology, inequality, ghting, socioeconomic,
trends, violence
ABBREVIATIONS
FASFamily Afuence Scale
GDPgross domestic product
HBSCHealth Behavior in School-Aged Children
RRrelative risk
Drs Pickett, Molcho, and Elgar and Ms Rathmann contributed to
the conception and design of this study; acquisition of data
involved Drs Pickett, Molcho, Brooks, ter Bogt, Nic Gabhainn,
Gaspar de Matos, Harel-Fisch, and Currie and Ms de Looze; data
analyses were conducted by Dr Pickett with support from Drs
Molcho and Elgar and Mss Rathmann and de Looze; all authors
were involved in the interpretation of the data; drafting of the
ar ticle including subsections was performed by Drs Pickett,
Molcho, Elgar, and Brooks; and all authors were involved in
revision of the article for important intellectual content, and
each provided nal approval of the article for submission to the
journal.
(Continued on last page)
e18 PICKETT et al
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Page 2
Youth v iolenceis a majorconcernin most
countries and physical ghting is the
most common manifestation of such vi-
olence.
1,2
Physical ghting increases
risks for injury
3,4
and relates to sub-
stance use and other problem beh av-
iors.
3,58
Children who ght report lower
life satisfaction, poorer family and peer
relationships, and worse perceptions of
their school environments than do chil-
dren not involved in ghting.
911
Although
patterns of adolescent ghting have
been described cross-sectionally,
1,4,10,12,13
no international studies have pro-
vided evidence about recent trends in
physical ghting with the exception of
one US-based study conducted in the
1990s.
14
Adolescent physical ghting relates to
individual, family, and societal factors.
Individually, established risk factors in-
clude male gender, youngerage, misuse
of alcohol, and multiple risk or clus-
tered problem behaviors
1517
;thelatter
are particularly strong for those who
regularly ght.
10,18
At contextual levels,
ghting relates to socioeconomic posi-
tion of families
19,20
and to indicators of
wealth and income inequalities within
regions and countries.
2126
The recent
Commission on Social Determinants of
Health reported on the effects of socio-
economic position on the general health
status of populations,
27
whereas others
have identied specic associations be-
tween income inequalities and school
bullying.
2830
Plausible social explan-
ations (eg, violence as a response to
deprivation and inequalities)
1,31,32
and
biological explanations (eg, physiologic
responses to the stress of deprivation)
33
exist for such associations. Yet, there is
a paucity of studies linking socioeco-
nomic factors to adolescent ghting.
The Health Behavior in School-Aged
Children study (HBSC) offers a unique
opportunity to examine adolescent
ghting and its potential determinants.
The HBSC study is a World Health Or-
ganization collaborative study of health
and health risk behaviors in 11- to 15-