How Well Do We Understand the Long-Term Health Implications of Childhood Bullying?

Bullying at School and Students' Learning Outcomes: International Perspective and Gender Analysis

The present study empirically investigates how school-based bullying victimization affects students' learning outcomes, taking into consideration international and gender perspectives. The main objective of the present research is to provide a better understanding of the consequences of bullying victimization in the learning process of adolescents. We estimate a statistical function that empirically establishes the relationship between the students' outcomes in mathematics, reading, and science (output) and a wide set of explanatory variables (educational factors), one of which is that of being bullied. The present study uses a large sample of 612,004 students between 15 and 16 years old, attending 21,903 schools in 79 countries. The data come from the 2018 round of the Programme for International Student Assessment. The results indicate that bullying victimization is associated with decreases in academic achievement in mathematics, reading, and science. In addition, no relevant differences by gender are observed in reading and science but, other factors being equal, bullied males score less than bullied females in mathematics.

Adverse childhood experiences in mental health of young adults: An exploratory study from Delhi-NCR, India

BACKGROUND

Despite the growing realization regarding the importance of adverse childhood experiences (ACEs) in adult health outcomes, this area of research has received little scientific attention in low- and middle-income countries, including India.

AIMS

To understand the overall and domain-specific association of exposure to ACEs with current depression, anxiety, stress, and well-being among young adults of Delhi-NCR.

METHODS

This cross-sectional study was carried out among 1,812 young adults (aged 18-25 years) of both sexes (68.7% females). Fieldwork was conducted on the campuses of the University of Delhi, Delhi, and Amity University, Noida, India. ACEs, depression, anxiety, stress, and well-being were screened using the Adverse Childhood Experiences International Questionnaire, Beck Depression Inventory-II, Beck Anxiety Inventory, Perceived Stress Scale, and WHO-5 Well-Being Index, respectively.

RESULTS

Exposure to ACEs was found to increase the odds of moderate/severe depression, moderate/severe anxiety, and high stress and decreased the odds of good well-being in a dose-response manner. Being bullied, followed by emotional abuse, was associated with the highest odds of current moderate/severe depression, moderate/severe anxiety, and high stress and the lowest odds of good well-being. Further, while several domains of household dysfunction showed poor association with studied mental health outcomes, domains of abuse and violence were more consistently associated.

CONCLUSIONS

The present study revealed the detrimental impact of ACEs on mental health outcomes among young adults of Delhi-NCR, India, and underscored the relevance of ACEs in the Indian context. Considering the lack of trauma awareness in Indian societies, there is an urgent need to create widespread awareness regarding ACEs and associated health implications.

Longitudinal study of peer victimization, social support, and mental health during early adolescence

BACKGROUND

Peer victimization predicts the development of mental health symptoms in the transition to adolescence, but it is unclear whether and how parents and school environments can buffer this link.

METHODS

We analyzed two-year longitudinal data from the Adolescent Brain Cognitive Development (ABCD) study, involving a diverse sample of 11 844 children across the United States (average at baseline = 9.91 years; standard deviation = 0.63; range = 8.92-11.08; complete case sample = 8385). Longitudinal associations between peer victimization and two-year changes in mental health symptoms of major depression disorder (MDD), separation anxiety (SA), prodromal psychosis (PP), and attention-deficit/hyperactivity disorder (ADHD) were examined including a wide range of covariates. Mixed linear models were used to test for the moderating effects of parental warmth and prosocial school environment.

RESULTS

20% of children experienced peer victimization. Higher exposure to peer victimization was associated with increases in MDD, SA, and ADHD symptoms. Parental warmth was associated with decreases in MDD symptoms but did not robustly buffer the link between peer victimization and mental health symptoms. Prosocial school environment predicted decreases in PP symptoms and buffered the link between peer victimization and MDD symptoms but amplified the link between peer victimization and SA and ADHD symptoms.

CONCLUSIONS

Peer victimization is associated with increases in mental health symptoms during the transition to adolescence. Parental warmth and prosocial school environments might not be enough to counter the negative consequences of peer victimization on all mental health outcomes.

Consequences of high school bullying on stress and health of Arab American college students

PROBLEM

Existing bullying research among Arab Americans is limited, focusing mainly on school-age adolescents and victimization. There is a lack of studies that examine retrospective bullying perpetration, bullying victimization, and physical fights during high school and their effect on current Arab American college students' stress and health outcomes. This study examines if bullying perpetration, bullying victimization, and physical fights during high school predict current stress and the physical and mental health of Arab American college students. In addition, we examined if perceived psychological stress mediates the relationships between bullying and fighting involvement and health.

METHODS

One hundred and sixty-two undergraduate Arab American college students were recruited from a Midwestern university and completed self-report measures of bullying, stress, and health (both physical and mental).

FINDINGS

Controlling for demographic variables, only high school victimization was significantly associated with current stress and physical and mental health. Stress fully mediated the relationship between victimization and health (both physical and mental).

CONCLUSIONS

Victimization during high school years may result in serious physical and mental health consequences during college years. However, perpetration and fighting may not have similar effects. Addressing stress among bullying victims may reduce the negative impact of this experience on immigrant Arab American college students. Implications for practice and future research are discussed.

The effect of bullying victimization on sleep quality among Chinese medical students: Timing, duration, and patterns

BACKGROUND

Bullying victimization (BV) is a potential factor to sleep quality, but the role of BV characteristics in this association remains unclear. This study aimed to investigate correlation between the timing, duration, and patterns of BV and sleep quality among Chinese medical students.

METHODS

4035 participants (mean age of 19.2 ± 1.0) were recruited. BV patterns from pre-school to college were estimated using latent class analysis. Multinomial logistic regression was conducted to evaluate the odds ratio (OR) and 95 % confidence interval (CI) between sleep quality and BV. E values were used to assess unmeasured confounding.

RESULTS

Three patterns of BV were identified as follows: persistent BV (6.2 %), moderate BV (10.5 %), and low BV (83.3 %). BV during pre-school, elementary school, junior high school, senior high school, and college were all positively associated with poor sleep quality. The ORs were 2.30 (1.43-3.70), 3.00 (2.28-3.95), 2.71 (2.14-3.43), 3.34 (2.57-4.33) and 4.13 (3.19-5.36), respectively. The E value were 4.03 (2.21-NA), 5.45 (3.99-NA), 4.86 (3.70-NA), 6.14 (4.58-NA), 7.73 (5.83-NA), respectively. Those who experienced more periods of BV were more strongly associated with poor sleep quality, presenting a dose-response relationship [OR = 1.78, 95 % CI: 1.63-1.95, E value: 2.96 (2.64-NA)]. Those who experienced moderate BV [OR = 2.58, 95 % CI: 1.99-3.35; E value: 4.60 (3.39-NA)] and persistent BV [OR = 4.01, 95 % CI: 2.95-5.46; E value: 7.48(5.35-NA)] had higher odds of poor sleep quality.

LIMITATIONS

Retrospective design may introduce recall bias.

CONCLUSION

BV was positively related to poor sleep quality and chronic exposure to BV had a cumulative effect on poor sleep quality.

Early origins of health and disease risk: The case for investigating adverse exposures and biological aging in utero, across childhood, and into adolescence

In this article, we suggest that aging and development are two sides of the same coin, and that developing a comprehensive understanding of health and disease risk requires examining age-related processes occurring throughout the earliest years of life. Compared to other periods in life, during this early period of acute vulnerability, when children's biological and regulatory systems are developing, biological aging occurs most rapidly. We review theory and empirical research suggesting that processes of development and aging are intricately linked, and that early adversity may program biological parameters for accelerated aging and disease risk early in life, even though clinical signs of age-related disease onset may not be evident until many years later. Following from this, we make the case for widespread incorporation of biological aging constructs into child development research.

Bullying and School Violence

Rates of traditional bullying have remained stable (30%) but rates of cyberbullying are increasing rapidly (46% of youth). There are significant long-term physical and mental health consequences of bullying especially for vulnerable youth. Multi-component school-based prevention programs that include caring adults, positive school climate, and supportive services for involved youth can effectively reduce bullying. While bullying has emerged as a legitimate concern, studies of surviving perpetrators to date suggest bullying is not the most significant risk factor of mass school shootings. Pediatricians play a critical role in identification, intervention, awareness, and advocacy.

Peer victimization and developmental psychopathology in childhood and adolescence Italian psychiatric emergency unit. A single center retrospective observational study

Peer victimization is a public health concern that affects a significant proportion of children and adolescents. The study evaluated the prevalence of peer victimization among 440 subjects referred to Emergency Department for a psychiatric consultation and analyzed the association with psychopathological symptoms. Sample was divided into two categories (6-13 and 14-18 years old). Logistics regression analysis was performed. Peer victimized were reported in 16.3% of subjects; 27.7% were younger than13 years old and 72.3% were between 14-18 years old, representing the main targets for peer victimization.A significant association was found between being peer victimized and depressive disorder (OR=4.57) in subjects younger than 13 years old and, with post-traumatic stress disorder (PTSD)(OR=6.52) in subjects older than 13 years old. Furthermore, linkage between being peer victimized and obsessive-compulsive disorder (OCD)(OR=4.45) was noted. Increased frequency of repeated hospitalizations was also documented.This is the first Italian study about children and adolescent peer victimization in psychiatric setting, showing a significant higher risk for depressive disorder in subjects younger than 13 years old and PTSD and OCD in subjects older than 13 years old. Investigating experiences of peer victimization provides an early diagnosis and a more efficient treatment plans, guaranteeing an improved clinical outcome.

Factors Predictive of Being Bullies or Victims of Bullies in US Elementary Schools

We analyzed a population-representative cohort (N=13,611; Mage at kindergarten, first, and second grade = 67.5, 79.5, and 91.5 months, respectively) to identify kindergarten to second grade factors predictive of being bullies or victims during third to fifth grade. We did so by estimating a block recursive structural equation model (SEM) with three sets of predictors. These were: (a) individual and school socio-demographics; (b) family distress and harsh parenting; and (c) individual behavior and achievement. Relations between each of the included variables and the bullying outcomes were simultaneously estimated within the SEM. Thus, each variable served as a control for estimating the effects of the other variables. We used robust standard errors to account for student clustering within schools. Results indicated that externalizing problem behavior strongly predicted being a bully ([ES] = .56, p<.001) and a victim (ES=.29, p<.001). We observed a negative relation between being Hispanic and being a victim (ES = -.10, p<.001) and a positive relation between being Black and being a bully (ES = .11, p<.001). We also observed statistically significant relations between a family's socioeconomic status and being a bully (ES = -.08, p<.001) as well as school poverty and being a victim (ES = .07, p<.001). The results advance the field's limited understanding of risk and protective factors for bullying perpetration or victimization during elementary school and provide additional empirical support for assisting young children already exhibiting externalizing problem behaviors.

Which Children are Frequently Victimized in U.S. Elementary Schools? Population-based Estimates

We analyzed a population-based cohort of 11,780 U.S. kindergarten children to identify risk and protective factors predictive of frequent verbal, social, reputational, and/or physical bullying victimization during the upper elementary grades. We also stratified the analyses by biological sex. Both girls and boys displaying kindergarten externalizing problem behaviors were at consistently higher risk of frequent victimization during 3rd-5th grade (for the combined sample of boys and girls, verbal odds ratio [OR] = 1.82, social OR = 1.60, reputational OR = 1.85, physical OR = 1.67, total OR = 1.93). Hispanic children relative to non-Hispanic White children and those from higher income families were the most strongly and consistently protected from victimization. Boys were more likely to be physically bullied but less likely to be verbally, socially or reputationally bullied than girls. Other variables including disability, cognitively stimulating parenting, academic achievement, and internalizing behavior problems had statistically significant but less consistent and generally weaker relations with frequent victimization.

The impact of resilience as a protective factor on Health-Related Quality of Life's psychological dimensions among adolescents who experience peer victimization

Peer victimization have a negative impact on Health-Related Quality of Life (HRQoL) during adolescence, however some personal skills such a person's resilience could play a significant role in this relationship. In this context, this study aims to analyse if resilience is a moderator of the relation between peer victimization and HRQoL's psychological dimensions. Sociodemographic data, peer victimization, psychological domains of HRQoL and resilience were measures in a sample of 1428 secondary school students using the following scales: "Adolescent Peer Relations Instrument-Bullying", "KIDSCREEN-52" and "Brief Resilient Coping Scale. Different multivariate analyses were carried out using linear regression. PROCESS tool was used to examine the moderating role of resilience, with John-Neyman post-hoc approach to quantify moderation. Results suggest that resilience could moderate the association between physical (β =  - 0.0021; p = 0.025) and verbal victimization (β =  - 0.0018; p = 0.024) and the "Mood and Emotions" dimension of adolescents' HRQoL. Nevertheless, this regulating influence appears to be faint (∆R2 0.004). Resilience showed no moderating effect between social victimization and psychological dimensions of HRQoL. We concluded that resilience could function as a protective factor that weakly regulates the negative association between physical and verbal victimization and the psychological sphere of adolescents' HRQoL.

Body mass index and bullying victimization as antecedents for depressive symptoms in a Swedish youth cohort

Aim

The bidirectional association between obesity and depression seen in adults is not clearly established in adolescents. The aim of this study was to investigate the longitudinal association between body mass index (BMI), depressive symptoms and interactions between bullying victimization and BMI, taking gender differences into account.

Subjects and methods

In a Swedish county, self-reported bullying victimization, BMI and depressive symptoms from 1729 adolescents ($$ \overline{y} $$ y ¯ = 14.4, 56% females) were collected in 2012 (wave 1), in 2015 (wave 2) ($$ \overline{y}=17.3 $$ y ¯ = 17.3 ) and in 2018 (wave 3) ($$ \overline{y} $$ y ¯ = 19.9). Longitudinal associations were assessed using binary logistic regression models controlling for confounding factors. Interaction effects between BMI and victimization on depressive symptoms were also assessed.

Results

Wave 1 obese males had approximately six times increased odds ratio compared to normal weight, for wave 2 depressive symptoms. W1 overweight was associated with an odds ratio of 1.5 in all participants for wave 3 depressive symptoms. Victimization was consistently associated with higher odds ratio for future depressive symptoms. We found interaction effects between bullying victimization and BMI for future depressive symptoms with different patterns depending on sex.

Conclusion

Given the present findings, bullying needs to be prevented, and, if it occurs, it needs to be stopped at an early stage to prevent future depressive symptoms.

Is There a Relationship Between Youth Bullying and Internet Addiction? An Integrative Review

Youth bullying is a global public health problem; Internet addiction is on the rise globally among youths. Because the linkage between these behaviors has not been clearly explicated, this integrative review evaluated the relevant empirical evidence. A search of five electronic databases identified 2,761 original citations published between January 2000 and May 2019. After further abstract screening and detailed evaluation of 262 full-text articles, the final sample consisted of 14 prospective descriptive studies representing 10 countries. Review results clearly established that the relationship between bullying and Internet addiction is firmly supported; less is known as to the contribution of gender, age, and other demographic variables, their impact on health outcomes, problematic behaviors, and the role of parental mediation. Inconsistent definitions and instrumentation and lack of sophisticated study designs limited the synthesis of findings. Future research is needed to explicate these relationships, so data-driven interventions can be developed.

The Impact of the Magnitude of the Group of Bullies on Health-Related Quality of Life and Academic Performance Among Adolescents

This study examines the consequences that physical and verbal/social victimization by peers and the magnitude of the groups of bullies have on academic performance and the psychological and social domains of Health-related Quality of Life (HRQoL). 1428 secondary school students in the south-east Spain completed the Spanish version of the "Adolescent Peer Relations Instrument-Bullying" and "KIDSCREEN-52" questionnaires in order to analyse, respectively, peer victimization and the psychological and social domains of HRQoL. Data on sociodemographic characteristics and academic achievement was also collected. Findings emphasise the potential of peer victimization in all its forms as risk factors explaining poor HRQoL in psychological, social and emotional domains. The number of bullies was an imponent and significant risk factor that explains a worse HRQoL in the five socio-psychological dimensions studied (Odds Ratio 4.08, Odds Ratio 9.25, Odds Ratio 4.69, Odds Ratio 2.91, Odds Ratio 11.92). Nevertheless, peer victimization rarely seems to affect academic achievement. Results suggest that much of prevention and intervention are still needed to reduce peer victimization, focusing on large bullies' groups and their harmful impact on adolescent's HRQoL.

Victimization among children and adolescents accessing the Meyer pediatric hospital: A retrospective study

Problem

The consistent prevalence and occasionally severe consequences of bullying and victimization suggest the need to include a more accurate assessment of these episodes within the Emergency Departments (ED). However, the literature on mental health related symptoms of bullying/victimization treated in the ED is still scarce. The aim of this study is to assess the prevalence of peer victimization amongst children and adolescents referred to an Italian Pediatric Emergency Department. Differences between Hospital Departments, type of victimization and ages are tested.

Methods

A retrospective observational study was conducted with 705 subjects. The age range was from 6 to 18 years old (M = 13.09; SD = 3.048).

Findings

15.3% of the sample reported to be victimized (8.2% occasionally; 7.1% systematically). For the Child and Adolescent Psychiatry Unit, we found a significant association between peer victimization and being adolescent (Fisher's p = 0.003). In addition, a significant association was found between verbal victimization and Child and Adolescent Psychiatry Unit (Fisher's p = 0.02) and physical victimization and Child Abuse Department (Fisher's p < 0.001).

Conclusion

Findings suggest the importance of an accurate assessment of victimization experiences of children and adolescents with access to ED, to prevent future re‐victimization and crystallization of symptoms across time.

Associations between weight-based teasing and disordered eating behaviors among youth

Weight-based teasing (WBT) is commonly reported among youth and is associated with disinhibited and disordered eating. Specifically, youth who experience WBT may engage in disordered eating behaviors to cope with the resultant negative affect. Therefore, we examined associations between WBT and disordered eating behaviors among youth and assessed whether negative affect mediated these relationships. Two hundred one non-treatment seeking youth (8-17y) completed questionnaires assessing WBT, disinhibited eating, depression, and anxiety. Disordered eating and loss-of-control (LOC) eating were assessed via semi-structured interview. Analyses of covariance were conducted to examine relationships between WBT and eating-related variables, and bootstrapping mediation models were used to evaluate negative affect (a composite of depressive and anxiety symptoms) as a mediator of these associations. All models were adjusted for sex, race, age, and adiposity. Among 201 participants (13.1 ± 2.8y; 54.2% female; 30.3% Black; 32.8% with overweight/obesity), WBT was associated with emotional eating, eating in the absence of hunger, and disordered eating attitudes and behaviors (ps ≤ 0.02). These associations were all mediated by negative affect. WBT was also associated with a threefold greater likelihood of reporting a recent LOC eating episode (p = .049). Among boys and girls across weight strata, WBT was associated with multiple aspects of disordered eating and these relationships were mediated by negative affect. Longitudinal studies are needed to clarify the directionality of these associations and to identify subgroups of youth that may be particularly vulnerable to WBT and its sequelae.

Sensitive periods for the effect of bullying victimization on suicidal behaviors among university students in China: The roles of timing and chronicity

OBJECTIVE

To examine whether timing and chronicity of bullying victimization (BV) play a significant role in linking exposure to BV to suicidal behaviors in university students.

METHODS

A multistage stratification sampling method was used to select a sample of 4034 university students (18-23 years, mean age 20.38±1.35 years, 41.9% female). We used latent class analysis and developmental-stage-based characterizations of BV timing and chronicity to explore the sensitive periods for the effect of BV on suicidal behaviors.

RESULTS

The prevalence rates of suicidal ideation, plans and attempts among our study participants were 9.9%, 3.0% and 1.3%, respectively. BV during primary school (OR = 2.12, 95% CI: 1.55-2.90) and secondary school (OR = 2.65, 95% CI: 1.80-3.90) was associated with suicidal ideation among university students. We identified four classes of life-course BV experiences (low BV, 73.8%; moderate BV, 18.6%; secondary school BV, 4.4% and persistent BV, 3.2%). Persistent BV was associated with 2.50 times (95% CI: 1.56-3.98), 2.98 times (95% CI: 1.48-6.02), and 6.13 times (95% CI: 2.48-15.14) higher risk of suicide ideation, plans, and attempts, respectively. Both moderate BV (OR = 1.75, 95% CI: 1.35-2.26) and secondary school BV (OR=2.01, 95% CI: 1.29-3.12) were positively correlated with suicidal ideation. Furthermore, there was a dose-response relationship between the number of periods of BV and suicidal behaviors.

LIMITATIONS

This study was a cross-sectional study based on self-reported measures, especially BV experiences in each school stage.

CONCLUSIONS

This study identifies sensitive periods for the effect of BV on suicidal behaviors among university students in China.

Effects of an intervention to prevent the bullying in first-grade secondary schools of Palermo, Italy: the BIAS study

BACKGROUND

Bullying is one of the most common expressions of violence in the peer context during school years. This study investigates the prevalence of bullying and the short-term effects on students' bullying perceptions of a preventive intervention conducted among teachers of first-grade secondary schools in Palermo, Sicily (Italy).

METHODS

Between the 2017/2018 and 2018/2019 school years, a pre-post intervention study was conducted among nine school institutions, sampled and categorized by neighbourhood socioeconomic index. A questionnaire investigating physical, verbal, and indirect bullying, the role of observers, prosociality, and resiliency in bullying was administered before and after intervention with formative cascade training of the teachers of the selected classes. Three different methods (sentinel questions, the five-question method, the 'score of seven' method) were used to detect the baseline level of bullying.

RESULTS

A total of 402 students participated in the study (72.7% response rate). A decrease in the number of bullying episodes after the intervention was reported by the students in all types of bullying explored (physical, verbal, and indirect bullying, observers, resiliency, and prosociality), with all three methods. In particular, a statistically significant decrease in all the bullying areas investigated (except for resiliency) was reported for students attending schools of an intermediate socioeconomic level.

CONCLUSIONS

Even if many school-based interventions have been implemented to reduce school bullying throughout the world, this is one of the first conducted in Europe and it assesses the effectiveness among students of an anti-bullying intervention tailored for teachers. The encouraging results in reducing the number of bullying episodes together with the low cost in terms of human and economic resources could suggest an extension of this research on a regional/national scale.

Bullying Victimization among LGBTQ Youth: Current and Future Directions

PURPOSE OF REVIEW

This paper examines recent research on bullying victimization among lesbian, gay, bisexual, transgender, and queer (LGBTQ) youth to identify critical issues and advocate for future research priorities.

RECENT FINDINGS

Recent studies have begun to document the importance of bullying in general, and bias-based bullying (rooted in stigma) in particular, on the health and wellbeing of this vulnerable subgroup of adolescents, as well as drivers of disparities. Current research demonstrates the role of multiple identities for and important differences among LGBTQ youth and has begun to identify protective factors for youth who are the targets of bullying.

SUMMARY

Researchers, clinicians, and those working with and on behalf of LGBTQ youth must measure and acknowledge the multiple reasons for which LGBTQ youth are the targets of bullying. Intervention and prevention efforts should focus on improving the supportiveness of the climates within which LGBTQ youth live.

Poor Dietary Habits in Bullied Adolescents: The Moderating Effects of Diet on Depression

The prevalence of bullying has increased dramatically during recent years, with numerous negative consequences for the health and quality of life of bullied adolescents. Although negative psychological consequences of this type of situation have been widely investigated, no previous research has evaluated the effects of bullying victimization on dietary habits, and its relationship with psychological outcomes, such as depression. For this reason, the main aim of the present study was to evaluate the association between bullying, dietary habits, and depression in a sample of 527 Spanish adolescents. The results obtained showed that being bullied was correlated negatively with healthy dietary habits and positively with depression. Moderation analysis revealed dietary habits as moderator of the association between bullying and depression. These results underline the relevance of diet in the phenomenon of bullying, especially in victims, as could be related to the high levels of depression characteristic of this population. The inclusion of nutritional education in intervention programs oriented to victims of bullying might significantly improve their efficacy, reducing depression levels.

A Review of Personality-Targeted Interventions for Prevention of Substance Misuse and Related Harm in Community Samples of Adolescents

Several school-based prevention programmes have been developed and used to prevent, delay, or reduce substance misuse, and related problems among community samples of adolescents. However, findings indicate that many of these interventions are associated with null, small, or mixed effects in reducing adolescent substance misuse, in particular for those mostly at risk of transitioning to substance use disorders. These findings highlight the need to shift the focus of substance use prevention efforts toward intervention strategies which directly target high-risk adolescents. The Preventure programme was designed to target four personality risk factors for substance misuse: hopelessness, anxiety sensitivity, impulsivity, and sensation seeking. This article reviews findings from the previous trials of personality-targeted interventions (i.e., Preventure programme) with adolescents and discuss the promises and benefits of these interventions for targeting community samples of high-risk adolescents at school level for reducing substance misuse and related mental health problems. Findings indicated that this programme has been successful in reducing the rates of alcohol and illicit drug use and substance-related harms by ~50% in high-risk adolescents with the effects last for up to 3 years. These interventions were also associated with a 25% reduction in likelihood of transitioning to mental health problems, such as anxiety, depression, suicidal ideation, and conduct problems. The programme is particularly beneficial for youth with more significant risk profiles, such as youth reporting clinically significant levels of externalizing problems, and victimized adolescents. A key strength of the Preventure programme is that it is embedded in the community and provides substance use intervention at school level to the general samples of high-risk adolescents who might not otherwise have access to those programmes.