The Taller the Better? Psychobiological Influences on Bullying Behaviour Among Portuguese Adolescents
Context: Bullying has been identified as an important adolescent health problem. Objective: This study aimed to examine the relationship
between being involved in bullying either as a bully, a victim or a provocative-victim with stature and health-related quality of life
Design: Cross-sectional study.
Results: Data were collected from a national representative sample of adolescents in 2006 (n=4946) and 2010 (n=4724). Measures
included involvement in bullying, stature, and HRQoL. Adolescents were placed in 4 groups (not involved, bully, bullied, and bully/
Results: Adolescents classified as bullies were more likely to be boys (OR=2.23, p<0.001), taller (OR=4.79, p<0.01), and had poorer
HRQoL (OR=0.97, p<0.001). Victims were more likely to be boys (OR=1.37, p<0.01), and had poorer HRQoL (OR=0.94, p<0.001).Provocative victims were more likely to be boys (OR=1.58, p<0.01), to be taller (OR=0.10, p<0.01), and to have lower HRQoL(OR=0.94, p<0.001).
Conclusions: During adolescence where differences in body height are maximal due to the heterogeneity of human development, it is important to develop bullying prevention programs aimed to prevent and reduce the occurrence of bullying. The target population is boys, those in the extreme range of height (shorter/victims; and taller/bullies) and those with a lower perception of HRQoL.
Adolescent, Observational study, School
In several countries, bullying has been identified as an important
adolescent health problem; several studies have described the
prevalence of bullying and victimization[2-4]. Bullying affects the
physical health of adolescents, resulting in headaches, stomach
and back aches. There are also psychological health effects,
such as depression, bad temper, loneliness, helplessness[5,6], and
an increased risk of suicidal ideation. These effects might persist
into later adolescence, and adulthood, for victims as well as for
Bullying is defined as a deliberate, repeated long-term use of power
and aggression by a person, or a group of persons, to cause distress
or to control another person[9,10]. The use of power and aggression
might be through direct or indirect forms. Direct forms of bullying
can include physical aggression (e.g. hitting, kicking) and verbal
aggression (e.g. threats, racial or sexual harassment). Indirect
bullying is usually the manipulation of a social relationship to hurt
(e.g. spreading rumours, gossiping). Studies on bullying usually
separate groups of adolescents involved in bullying (not involved,
bullies, victims and those who are both bullies and bullied)[2,4,11],
and each group is associated with different characteristics.
There is a variation in stature because, among adolescents,
development is not at the same rhythm. Considering that short
adolescents may be physically weaker than taller ones, stature
seems to be related with bullying at school. Although studies
have demonstrated the normality of the psychosocial functioning
of short normal young people, they seem to be more likely to
be bullied than their taller peers. Also, they report a degree of
social isolation as the result, or possibly even the cause, of their
victimisation. Moreover, the following have been found to be
detrimental to the reported health-related quality of life (HRQoL)
of adolescents: physical aggression, verbal aggression and/or
social relationship to intentionally to hurt. Therefore, this paper
examined the relationship between being involved in bullying
either as a bully, a victim, or a provocative victim, with stature and
Study design and participants:
This study is based on data from Health Behaviour in School-Aged
Children (HBSC) Portuguese survey. The sample consisted of 9670
adolescents aged 11-17 years, attending grades 6, 8 and 10, from
the HBSC 2006 (n=4946) and 2010 (n=4724) waves. The HBSC
is a school-based survey of adolescents’ health behaviours, carried
out every 4 years. Data is used at a national and international level,
using an international standardized methodological protocol,
to gain new vision into young people’s health and well-being,
to understand the social and psychological dueterminants of
health, and to incorporate policies to improve young people’s
lives. The survey is based on a self-administered questionnaire
that is completed in public schools. The schools are randomly
selected from a national list of schools which has been stratified
by Portuguese administrative regions. The methodological aspects
of the HBSC study are well-developed; a detailed description of
the methods and instrument can be found elsewhere. Research
was conducted in accordance with both the Ethical Committee of
Porto Medical School and the National Data Protection System.
All school administrators gave their consent, legal guardians gave
written informed consent, and students provided assent.
After reading a brief definition of bullying from the Olweus Bully/
Victim Questionnaire adolescents were asked to answer, “How
often have you taken part in bullying another student at school in
the past couple of months?” and “How often have you been bullied
at school in the past couple of months?” Response options were:
1. I haven’t been bullied/been involved in bullying in school in the
past couple of months;
2. It has only happened once or twice;
3. Three times a month;
4. About once a week; and
5. Several times a week.
A cut-off point of once a week was used to indicate being involved
in bullying repeatedly. The answers were then dichotomized into
bully/bullied never or rarely and bully/bullied weekly. Using the
dichotomous computed variables of taken part in bullying, and
being bullied, adolescents were grouped as follows:
1) not involved,
3) bullied, and
School grade, sex, age, weight and height:
The study base includes school children from 6th, 8th and 10th
grade. During data collection students were in their classes and
school grade was automatically defined. Gender and age was selfreported.
Actual weight (to the nearest 0.5 kg) and height (to the
nearest 0.5 cm) were also self-reported. Adolescents were aware of
their weight and height because they performed a physical fitness
test (FitnessGram) several times a year, and physical education
teachers provided them with information about their weight and
height. Body mass index (BMI) was then calculated based on mass
(kilograms) divided by height (square metres). Adolescents were
classified into normal weight, overweight, and obese categories
according to age- and gender-specific cut-off points proposed by
the International Obesity Task Force.
Health-related quality of life:
HRQoL was assessed by KIDSCREEN-10. The KIDSCREEN-10
is a generic non-preference based measure of well-being and
HRQoL, developed and validated internationally and for
Portuguese children and adolescents. It contains 10 items
regarding family life, peers, and school life. The items result in
one global score. This one-dimensional measure represents a
global score adequate for use in large (epidemiological) surveys,
as described elsewhere.
Questionnaires were administered in schools in January 2006 and
2010, and were answered anonymously. Participation in the study
was voluntary. The administration of the surveys was conducted
according to standard guidelines from the HBSC survey protocol
 and it was carried out by trained school teachers during class
Descriptive statistics were calculated for all variables (means,
standard deviation, and percentages) for the entire sample and
according to HBSC survey years (2006 and 2010), for taking
part in bullying, and for being bullied in its dichotomous form.
Chi square and Student t-test were used to assess the differences
among HBSC survey years. Bivariate analyses were also used
to examine whether being a bully and being bullied differed by
HBSC wave, gender, school grade, age, weight, height, BMI
category and HRQoL. Specifically, Chi-square was used to
examine differences in categorical variables and t-test was used
to assess differences in continuous variables. All data were tested
for normality prior to any analyses. For the combined association
between being a bully and being bullied ANOVA and Chi-square
tested the differences among adolescent groups. Afterwards,
the relationship between gender, school grade, weight, height,
HRQoL and combined association of being a bully and being
bullied was analysed using multinomial logistic regression. The
group “not involved” was used as the reference group. To avoid
multicollinearity in multinomial regression analysis, variables that
were strongly associated with one another were omitted. Age was
omitted because it was strongly associated with school grade, and
BMI category was omitted because was associated with weight
and height. All statistical analyses were performed using IBM
SPSS Statistics 22.0. The level of significance was set at 0.05.
Sample characteristics and displayed in table 1. The prevalence
of being a bully weekly was 5.4%, and being a victim of bullying
was 8.3%. The number of bully adolescents at school decreased
significantly between 2006 and 2010 (χ2(1)=4.178, p=0.041), but
being bullied at school every week remained relatively stable over
the years. HRQoL increased significantly over the years (t(8808)=-
The prevalence of being a bully and being bullied at school every
week, according selected variables, is presented in table 2. For
taking part in bullying another student at school every week, the
number of boys was significantly higher than girls (χ2(1)=46.654,
p<0.001) and the peak of was in the 8th grade (χ2(2)=12.370,
p=0.002). Heavy (t(8977)=-4.364, p<0.001) and taller (t(8991)=-
2.632, p=0.008) adolescents more frequently took part in bullying,
but had poor HRQoL (t(8808)=-8.582, p<0.001). For those who
reported being bullied weekly, the number of boys was higher
than the number of girls (χ2(1)=9.584, p=0.002), and adolescents
attending grade 6 were more frequently the victim of bullying
(χ2(1)=49.578, p<0.001). Results from age reflect, in part, the results
of school grades. The adolescents bullied weekly were younger
than those who were not bullied so frequently (t(9413)=5.885,
p<0.001). The victims of bullying were significantly shorter than
those who had not suffered the abuses (t(8991)=3.232, p=0.001).
Taking into account the results of height and the fact that weight
was not a significant variable to differentiate the two groups,
it helps to explain the BMI category results. The number of
overweight or obese adolescents was significantly higher among
those who were bullied weekly (17.6% vs. 25.1%) (χ2(1)=24.257,
p<0.001). Frequently bullied adolescents had poorer HRQoL
The combined association between being a bully and being bullied
is present in table 3. Results clearly showed that boys were more
frequently associated with both being a bully and being bullied
than girls (χ2(3)=57652, p< 0.001). Adolescents that attended
grade 8 were more frequently a bully, independent of being
bullied. On the other hand, those who attended grade 6 were more
frequently bullied (χ2(6)=69.651, p<0.001). The mean age of bully
adolescents was significantly higher than those only being bullied,
which means that the older students were normally the aggressors,
and the younger students were the victims (F(3)=16.159, p<0.001).
The bullies were significantly taller than those who were victims
of bullying (only bullied, and bully and bullied) (F(3)=9.560,
p<0.001). For the weight, those involved in bullying as the one
bullying others or being bully and bullied, were significantly
heavier than the other groups of adolescents (F(3)=6.832,
p<0.001). The index of HRQoL was poorer for adolescents
responsible for bullying others and being bullied, followed by
those only bullied. These two groups of adolescents are different
from the groups of not bully or bullied and the one that was only
bullying others. Additionally, adolescents not involved in any type
of bullying were also significantly different from those responsible
for bullying (F(3)=84.71, p<0.001).
Results of the multinomial logistic regression analysis for the
combined associations between bullying others or being bullied
are shown in table 4. Adolescents classified as only a bully were
more likely to be boys (OR=2.23, 95% CI: 1.71-3.01, p<0.001),
taller (OR=4.79, 95% CI: 1.00-23.70, p<0.01), and had poorer
HRQoL (OR=0.97, 95% CI: 0.96-0.98, p<0.001) than not being
a bully or bullied. Adolescents that were only victims of bullying
had greater chances of being boys (OR=1.37, 95% CI: 1.121.66,
p<0.01), had less likelihood of attending grades 8 (OR=0.53, 95%
CI: 0.41-0.68, p<0.001), and 10 (OR=0.24, 95% CI: 0.18-0.33,
p<0.001), and had poorer HRQoL (OR=0.94, 95% CI: 0.93-0.94,
p<0.001) than not being a bully or bullied. Finally, bullying others
and being bullied compared with not being bully or bullied had
significantly higher odds of being boys (OR=1.58, 95% CI: 1.16-
2.14, p<0.01) and being heavier (OR=1.03, 95% CI: 1.01-1.04,
p<0.01), and had less likelihood of attending grade 10 (OR=0.49,
95% CI: 0.30-0.78, p<0.001), being taller (OR=0.10, 95% CI:
0.02-0.57, p<0.01), and had good HRQoL (OR=0.94 95% CI:
Table 1.Sample characteristics according HBSC year survey of 2006 and 2010.
Table 2. Bivariate analysis (Chi-square or Student t test) between being a bully and being bullied and the remaining independent
Table 3. Characteristics of adolescents according to different types of involvement in bullying.
Table 4. Multivariate multinomial logistic regression predicting bullying.
This study aimed to examine the relationship between being
involved in bullying repeatedly as bullies, bullied and bullies/
bullied with stature and HRQoL. This study adds to the existing
body of literature that stature is an important variable to be
considered in bullying interventions, and confirms the detrimental
effects of bullying on adolescents’ health and quality of life.
Bullies were significantly taller than bullied adolescents and being
involved in bullying (as victims or perpetrators) was related with
The results show clearly that gender and school year, which is
related with age, are risk factors. Bullying rates were higher in
boys than in girls, a result consistent with previous studies in
several countries[3,4]. The same pattern was also observed for
adolescents victimized by bullying, but the difference was not as
pronounced as observed previously[3,4]. This difference between
genders could be due to the physical aggression bullying form
(e.g. hitting, kicking), which is a gendered behaviour that presents
customarily as a feature of boys. The higher prevalence of being
bully and being bully/bullied was seen in grade 8. In this grade,
adolescents are mostly 13 years of age, but surprisingly the average
of bully adolescents was 14.2±1.7 years of age. This means that
adolescents who have attended grade 8 and failed to move to the
next grade are a risk group for bullying.
Victims of bullying are generally reported to be weaker than the
bullies[22,23], and perhaps the bullied adolescents are chosen because
of their vulnerability. It seems that short adolescents might present
higher odds of being victims and less likely to be the perpetrator
. However, in the present study height was not significantly
related with being bullied when compared with adolescents not
involved in any type of bullying. On the other hand, being taller
highly increased the likelihood of being a bully when compared
with those not involved in bullying. This means that being short
was not per se related with being a victim of bullying, but being
taller was in fact a positive correlate of bullying. Considering
that bullied adolescents are chosen because of their vulnerability,
perhaps taller adolescents look to their peers as weaker and do not
have a fear of provoking others. It was interesting to observe that
being both a bully and bullied was negatively related with stature,
which might suggest that some short adolescents who are victims
of bullying are, at the same time, perpetrators. Voss assumed
that short adolescents might perceive that they are bullied more
often, mistaking the normal rough and tumble of the playground
with bullying. Fortunately, although short adolescents experience
more social isolation, perhaps as a result of being bullied, it
does not have a significant effect on school performance or selfesteem
. In fact, bullying is widespread regardless of stature; so
far few studies have analysed the relationship between bullying
and stature. Therefore, more studies are needed to understand
clearly the role of stature in bullying in childhood and adolescence.
This study demonstrated that being a bullied is associated
with a significantly poorer HRQoL, which is in accordance with
previous investigations[16,25]. HRQoL is not merely a function of
matter of life status. It is a construct that involves psychosocial
adjustment, well-being, self-esteem, stress and coping, emphasizing
adolescents’ perceptions of the words, including perception of
happiness[20,26]. If being involving in bullying as perpetrator and/or
victim is related with poorer HRQoL, it confirms the detrimental
effects of bullying on adolescents’ psychological well-being
and social functions. Although there are only a few studies that
investigate different groups of bullying, they have demonstrated
that children and adolescents involved in bullying experience more
physical and emotional difficulties than their peers not involved
in bullying. Thus, not being involved in bullying is a health
protective factor, increasing QoL. Considering that adolescence
is an important period of change and challenge concerning control
over behaviour, psychosocial orientation and social interaction,
exposure to bullying may influence health through a variety of
pathways. For instance, bullying might be an indicator of social
exclusion, and social exclusion may result in a lack of social
participation and weaker social competencies that can be negative
for future social and work prospects. Bullying has not only
contemporary negative effects for adolescents, but may also have
long-term effects on health and well-being.
Some limitations and strengths should be addressed to qualify
the conclusion. Bullying was self-reported, and therefore is
subject to bias. No socioeconomic information was included in
the analysed, which is unfortunate because it may affect results
of bullying and HRQoL. Further, the cross-sectional design of the
study precludes any inference about causality and we cannot rule
out that our results are explained by residual confounding due to
unmeasured confounders. The main strengths of this study were
the representative adolescents’ population based sample, and the
use of HBSC validated instruments.
The results of the present study suggest strongly that during
childhood and adolescence it is important to develop bullying
prevention programs aimed to prevent and reduce the occurrence
of bullying in schools. School-based intervention programs have
shown to be effective not only to reduce bullying significantly, but
also to lead to more constructive relationships at school[9,29], and
reduce students’ health complaints. The target populations are
boys, those in the extreme range of height (shorter/victims; and
taller/bullies), and those with a lower perception of HRQOL.
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