World Journal of Pediatrics

, Volume 14, Issue 5, pp 454–460 | Cite as

Health correlates, addictive behaviors, and peer victimization among adolescents in China

  • Qi-Qi Chen
  • Meng-Tong Chen
  • Yu-Hong Zhu
  • Ko Ling ChanEmail author
  • Patrick Ip
Original Article



Peer victimization has been recognized as a common social problem affecting children and adolescents in all parts of the world. This study aims to examine the prevalence of different types of peer victimization and to evaluate the associations between peer victimization and health correlates.


Using a large population sample of 18,341 adolescents aged 15–17 years from 6 cities in China, this study estimated the prevalence of different types of peer victimization, addictive behaviors, and health-related variables with self-administrated questionnaires. A three-phase logistical regression analysis was conducted to investigate the associations between peer victimization and addictive behaviors as well as health-related factors among adolescents.


A total of 42.9% of the surveyed Chinese adolescents have been bullied by peers, with boys reporting higher rate on overt victimization (36.9%) and girls on relational forms (33.9%). School environment (34.7%) was the most frequent scene of peer violence, followed by neighborhood, family, and internet. Addictive behaviors except substance abuse were found related to higher possibility of peer victimization (aOR 1.21–1.73, P < 0.001). Peer victimization was significantly associated with more depressive symptoms, post-traumatic stress disorder symptoms, and suicide ideation and deliberate self-harm (aOR 1.05–2.27, P < 0.001), and poorer self-esteem and health-related quality of life (aOR 0.95–0.97, P < 0.001).


Possible explanations of the associations found in this study are discussed and implications for future services are raised.


Addictive behavior Adolescent Health Peer victimization 


Author contributions

KLC developed the study design and conceptualization, and contributed to the data collection and analysis. QQC contributed to the data collection and analysis. PI developed the study design and conceptualization. All authors prepared and reviewed the manuscript, and approved the final version of the manuscript.


The optimus study was initiated and funded by the UBS Optimus Foundation.

Compliance with ethical standards

Ethical approval

The Institutional Review Board of the University of Hong Kong, the Hospital Authority Hong Kong West Cluster, and the local institutional review boards of the five mainland cities granted the ethical approval.

Conflict of interest

No financial or non-financial benefits have been received or will be received from any party related directly or indirectly to the subject of this article.


  1. 1.
    Ybrandt H, Armelius K. Peer aggression and mental health problems: self-esteem as a mediator. Sch Psychol Int. 2010;31:146–63.CrossRefGoogle Scholar
  2. 2.
    Graham S, Bellmore AD. Peer victimization and mental health during early adolescence. Theory Pract. 2007;46:138–46.CrossRefGoogle Scholar
  3. 3.
    Chan KL, Yan E, Brownridge DA, Ip P. Associating child sexual abuse with child victimization in China. J Pediatr. 2013;162:1028–34.CrossRefPubMedCentralPubMedGoogle Scholar
  4. 4.
    Cross D, Shaw T, Hearn L, Epstein M, Monks H, Lester L, et al. Australian covert bullying prevalence study (ACBPS). Perth: Child Health Promotion Research Centre, Edith Cowan University; 2009.Google Scholar
  5. 5.
    Sharp S, Smith PK. Bullying in UK schools: the DES Sheffield bullying project. Early Child Dev Care. 1991;77:47–55.CrossRefGoogle Scholar
  6. 6.
    Olweus D. School bullying: development and some important challenges. Annu Rev Clin Psychol. 2013;9:751–80.CrossRefPubMedCentralPubMedGoogle Scholar
  7. 7.
    Griffin RS, Gross AM. Childhood bullying: current empirical findings and future directions for research. Aggress Violent Behav. 2004;9:379–400.CrossRefGoogle Scholar
  8. 8.
    Moore SE, Norman RE, Sly PD, Whitehouse AJ, Zubrick SR, Scott J. Adolescent peer aggression and its association with mental health and substance use in an Australian cohort. J Adolesc. 2014;37:11–21.CrossRefPubMedCentralPubMedGoogle Scholar
  9. 9.
    Copeland WE, Wolke D, Angold A, Costello EJ. Adult psychiatric outcomes of bullying and being bullied by peers in childhood and adolescence. JAMA Psychiatry. 2013;70:419–26.CrossRefPubMedCentralPubMedGoogle Scholar
  10. 10.
    Goebert D, Else I, Matsu C, Chung-Do J, Chang JY. The impact of cyberbullying on substance use and mental health in a multiethnic sample. Matern Child Health J. 2011;15:1282–6.CrossRefPubMedCentralPubMedGoogle Scholar
  11. 11.
    Ewing Lee EA, Troop-Gordon W. Peer socialization of masculinity and femininity: differential effects of overt and relational forms of peer victimization. Br J Dev Psychol. 2011;29:197–213.CrossRefPubMedCentralPubMedGoogle Scholar
  12. 12.
    Crick NR, Grotpeter JK. Relational aggression, gender, and social-psychological adjustment. Child Dev. 1995;6:710–22.CrossRefGoogle Scholar
  13. 13.
    Aspenlieder L, Buchanan CM, McDougall P, Sippola LK. Gender nonconformity and peer victimization in pre-and early adolescence. Int J Dev Sci. 2009;3:3–16.Google Scholar
  14. 14.
    Chan KL. Victimization and poly-victimization among school-aged Chinese adolescents: prevalence and associations with health. Prev Med. 2013;56:207–10.CrossRefPubMedCentralPubMedGoogle Scholar
  15. 15.
    American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington, DC: American Psychiatric Association; 1994.Google Scholar
  16. 16.
    Rosenberg M. Society and the adolescent self-image. Princeton: Princeton University Press; 1965.CrossRefGoogle Scholar
  17. 17.
    Cheng ST, Hamid PN. An error in the use of translated scales: the Rosenberg Self-Esteem Scale for Chinese. Percept Mot Skills. 1995;81:431–4.CrossRefGoogle Scholar
  18. 18.
    Shek DT. A longitudinal study of the relations between parent-adolescent conflict and adolescent well-being. J Genet Psychol. 1998;159:53–67.CrossRefPubMedCentralPubMedGoogle Scholar
  19. 19.
    Leung RKW. A validation of the traditional Chinese (Hong Kong) versions of the beck anxiety inventory (BAI) and the beck depression inventory-II (BDI-II). Hong Kong: University of Hong Kong; 2001.CrossRefGoogle Scholar
  20. 20.
    Lam CL, Tse EY, Gandek B. Is the standard SF-12 health survey valid and equivalent for a Chinese population? Qual Life Res. 2005;14:539–47.CrossRefPubMedCentralPubMedGoogle Scholar
  21. 21.
  22. 22.
    Geoffroy MC, Boivin M, Arseneault L, Turecki G, Vitaro F, Brendgen M, et al. Associations between peer victimization and suicidal ideation and suicide attempt during adolescence: results from a prospective population-based birth cohort. J Am Acad Child Adolesc Psychiatry. 2016;55:99–105.CrossRefPubMedCentralPubMedGoogle Scholar
  23. 23.
    Ybarra ML, Mitchell KJ. Youth engaging in online harassment: associations with caregiver–child relationships, internet use, and personal characteristics. J Adolesc. 2004;27:319–36.CrossRefPubMedCentralPubMedGoogle Scholar
  24. 24.
    Rose AJ, Rudolph KD. A review of sex differences in peer relationship processes: potential trade-offs for the emotional and behavioral development of girls and boys. Psychol Bull. 2006;132:98–131.CrossRefPubMedCentralPubMedGoogle Scholar
  25. 25.
    Salmivalli C. Is there an age decline in victimization by peers at school? Educ Res. 2002;44:269–77.CrossRefGoogle Scholar
  26. 26.
    Tucker CJ, Finkelhor D, Turner H, Shattuck AM. Sibling and peer victimization in childhood and adolescence. Child Abuse Negl. 2014;38:1599–606.CrossRefPubMedCentralPubMedGoogle Scholar
  27. 27.
    Khoury-Kassabri M, Benbenishty R, Astor AR, Zeira A. The contributions of community, family, and school variables to student victimization. Am J Commun Psychol. 2004;34:187–204.CrossRefGoogle Scholar
  28. 28.
    Peker A. Analyzing the risk factors predicting the cyberbullying status of secondary school students. Eğitim Ve Bilim. 2015;40:57–75.Google Scholar
  29. 29.
    Farrington DP, Ttofi MM. School-based programs to reduce bullying and victimization. Campbell Collab. 2009;6:1–49.Google Scholar
  30. 30.
    Hipwell AE, Stepp SD, Xiong S, Keenan K, Blokland A, Loeber R. Parental punishment and peer victimization as developmental precursors to physical dating violence involvement among girls. J Res Adolesc. 2014;24:65–79.CrossRefPubMedCentralPubMedGoogle Scholar
  31. 31.
    Emery CR, Thapa S, Do MH, Chan KL. Do family order and neighbor intervention against intimate partner violence protect children from abuse? Findings from Kathmandu. Child Abuse Negl. 2015;41:170–81.CrossRefPubMedCentralPubMedGoogle Scholar

Copyright information

© Children's Hospital, Zhejiang University School of Medicine 2018

Authors and Affiliations

  1. 1.Department of Applied Social SciencesThe Hong Kong Polytechnic UniversityHong KongChina
  2. 2.Department of Social WorkRenmin University of ChinaBeijingChina
  3. 3.Department of Pediatrics and Adolescent MedicineThe University of Hong KongHong KongChina

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