Gender differences in the association between health literacy and bully victimization among middle school students

Abstract

Objective To explore the association between middle school students’ health literacy and bully victimization and associated sex difference, and to provide guidance for bully prevention in adolescents. Methods During November 2017 to January 2018, 18 900 junior and senior high school students were enrolled from Hefei of Anhui Province, Shenyang of Liaoning Province, Yangjiang of Guangdong Province and Chongqing by multistage cluster sampling. A self-rated questionnaires were used to collect demographic information, health literacy, and bully victimization. Group differences by different characteristics and the association between health literacy and bully victimization were analyzed. Results The detection rates of campus and cyber-bullying victimization were 15.8% (2 992/18 900) and 9.1% (1 723/18 900). Boys, junior high school students, students with poor family financial status and few close friends had a detection rate of 28.0%, 18.8%, 23.3%, and 33.6% of school bullying, which are higher than those of the control group ( χ 2 = 225.64, 148.07, 141.13, 143.49, P<0.01); boys, students with poor household income and few close friends, the detection rates of cyber bullying were 10.9%, 14.4%, and 20.1%, respectively, are higher than the control group ( χ 2 = 62.96, 112.82, 88.49, P<0.01). Multivariate Logistic regression analysis indicated that students with low overall and dimensions scores of health literacy were more likely to suffer from campus-and cyber-bullying, except for the dimension of physical activity. In addition, at all levels of health literacy, males are more likely to be bullied than females ( P<0.05). Conclusion Health literacy of middle school students is related to bully victimization, which is sex-specific. Intervention programs of bullying should focus on health literacy enhancement. 【摘要】 目的 探讨中学生健康素养和遭受欺凌的关联及其性别间的差异, 为改善青少年遭受欺凌提供依据。 方法 2017 年 11月至 2018年 1 月采用多阶段整群抽样方法, 在安徽省合肥市、辽宁省沈阳市、广东省阳江市和重庆市抽取 18 900名中学生进行问卷调査。采用自填式问卷调査研究对象的基本特征、健康素养水平和遭受欺凌情况, 比较不同特征中学生遭受欺凌检出率的差异, 并分析健康素养与遭受欺凌的关联及其性别间的差异。 结果 中学生遭受校园欺凌和网络欺凌的检出率分别为 15.8% 和 9.1%。男生、初中生、家庭经济状况较差和亲密伙伴个数较少的学生遭受校园欺凌的检出率分别为 28.0%, 18.8%, 23.3% 和 33.6%, 分别髙于女生、髙中、家庭经济状况良好和亲密伙伴个数较多的学生( χ 2 值分别为 225.64, 148.07, 141.13, 143.49, P 值均<0.01);男生、家庭经济状况较差和亲密伙伴个数较少的学生遭受网络欺凌的检出率分别为 10.9%, 14.4%和 20.1%, 分别髙于女生、家庭经济状况良好和亲密伙伴个数较多的学生 ( χ 2值分别为 62.96, 112.82,88.49, P 值均<0.01)。多因素Logistic回归显示, 除体力活动维度外, 总体及各维度健康素养得分越低的学生越容易遭受校园欺凌和网络欺凌, 且在健康素养各水平组中, 男生均比女生易遭受欺凌( P 值均<0.05)。 结论 中学生健康素养和遭受欺凌有关联且存在性别差异, 可通过提髙学生的健康素养水平改善欺凌的发生。