Socioeconomic inequalities in health among Armenian adolescents: the role of bullying perpetration

Abstract

Abstract Background Bullying perpetration might be an alternative way of hierarchy formation among adolescents. It can potentially suppress the socioeconomic inequalities in health or might compensate for the negative health influences of low socioeconomic status (SES), rewarding this unwanted behavior. Methods A nationally representative sample of 3679 adolescents aged 11-15 years participated in the Health Behavior in School-aged Children 2013/14 survey in Armenia. Complex samples multiple logistic regression were used to estimate the associations between two SES measures (family socioeconomic position [SEP], material well-being) and three health outcomes (perceived health status, psychosocial well-being, psychosomatic symptoms). Results Bullying perpetration was not associated with less than good health or low psychosocial well-being (P > 0.05) but increased the odds of reporting high psychosomatic symptoms (P < 0.05). Perpetration did not change the SES-health gradient substantially. However, in stratified analyses, socioeconomic inequalities in health were consistently weaker among perpetrators. The largest observed difference was in the relationship between low family (SEP) and less than good health (OR = 3.60, 95% CI = 2.77-4.67 vs. OR = 1.80, 95% CI = 1.06 - 3.04), whereas the smallest difference was in the relationship between low family SEP and high psychosomatic symptoms (OR = 1.27, 95% CI = 1.03-1.56 vs. OR = 1.04, 95% CI = 0.61-1.77). Conclusions Our findings suggest that bullying perpetration, as an alternative hierarchy, may be looked at as a compensatory but vicious strategy in the face of the negative health influences of low SES in Armenian adolescents. For high-SES adolescents, on the other hand, social, emotional, or psychological problems might contribute to bullying perpetration. Key messages Less vicious alternatives to bullying perpetration should be encouraged, especially for Armenian adolescents from low-SES families. Targeted health interventions might be necessary for bulling perpetrators from high-SES families.