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UNLABELLED: Based on a national representative sample of United States (US) middle and high school students, we studied the association between different health, safety, and educational risk factors and involvement in a variety of bullying behaviors. DESIGN: Based on an analysis of US data of the 1996 World Health Organization Health Behavior in School-aged Children survey, with cross-sectional survey information on 9,938 students in grades 6 through 10. RESULTS: Thirty-nine per cent of the students were involved in bullying others and/or were victims of bullies at least three times in the preceding 12 months. Bullies, victims, and those who are both, are at a significantly higher risk of suffering from self-inflicted, accidental, and perpetrated injuries, abusing-over-the counter medications, hurting animals and people on purpose, using a weapon that could seriously hurt someone, and being frequently absent from school, as compared with their peers who are not involved in bullying or rarely participated in it. Those students who are both bullies and victims experience a wide array of associated risk behaviors with odd ratios stretching from 1.54 to 14.17. CONCLUSIONS: The present study confirmed that participation in bullying behaviors, as a bully or as a victim, is associated with multiple health, safety, and educational hazards. Students who are bullies and/or victims are at a high risk of dying from self-inflicted, accidental, or perpetrated injuries.
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