Violence Prevention: School-based Anti-bullying Interventions

CPSTF uses recently published systematic reviews to conduct accelerated assessments of interventions that could provide program planners and decision-makers with additional, effective options. The following published review was selected and evaluated by a team of specialists in systematic review methods, and in research, practice, and policy related to school-based violence prevention interventions.

Fraguas D, Diaz-Caneja CM, Ayora M, Duran-Cutilla M, Abregu-Crespo R, et al. Assessment of school anti-bullying interventions: a meta-analysis of randomized clinical trials. JAMA Pediatrics 2021;175(1):44-55.

The published review included 69 studies overall (search period through February 2020). The CPSTF abstracted supplemental information about study, intervention, and population characteristics for the subset of 19 studies conducted in the United States or Canada.

The CPSTF finding is based on results from the published review, additional information from the subset of studies from the United States and Canada, and expert input from team members and CPSTF.

Bullying is a form of youth violence and an adverse childhood experience (Gladden et al. 2014). Bullying is a common behavioral problem that is prevalent at all school levels (Diliberti et al. 2019). Bullying has been associated with physical and mental health problems for perpetrators (David-Ferdon et al. 2016), victims (Singham et al. 2017), and youth who witness bullying (Doumas et al. 2020). Exposure to bullying is also related to adverse effects on academic achievement, employment status, and social relationships (Wolke et al. 2015).

Schools can have an important role in bullying prevention efforts, which may contribute to a safe and supportive environment for learning. School-based interventions may complement family- and community-based prevention efforts to reduce bullying both inside and outside of school (David-Ferdon et al. 2016; Hahn et al. 2007).

Detailed results from the systematic review are available in the CPSTF Finding and Rationale Statement.

The published systematic review and meta-analyses included 69 studies.

• Students reported small reductions in both bullying perpetration (35 studies) and victimization (32 studies).
• Student assessments of mental symptoms including anxiety, depression, and well-being improved (20 studies).
• Studies addressing cyberbullying found small reductions in combined measures of cyberbullying perpetration and victimization (5 studies).

A systematic review of economic evidence has not been conducted.

Based on the results from the review, findings should be applicable to primary and middle school students in the United States.

CPSTF identified several areas that have limited information. Additional research and evaluation could help answer the following questions and fill remaining gaps in the evidence base. (What are evidence gaps?)

• Which activities and combinations increase intervention effectiveness?
• How effective are interventions for groups at increased risk for bullying and cyberbullying including students who self-identify as LGBTQI+, have disabilities, or are overweight (Fraguas et al. 2019; National Academy of Sciences 2016)?
• How effective are school-based anti-bullying interventions when implemented in the following settings?
  • High schools
  • Charter or private schools
  • Rural communities
  • Communities with lower incomes
• What are the effects of school-based anti-bullying interventions on the following outcomes?
  • Specific mental and behavioral health outcomes (e.g., depression)
  • Educational outcomes and attainment
  • Bystander action
  • Number of students who witness bullying perpetration on others
  • Risk behaviors
  • Other forms of violence and delinquent behavior

• Included studies were randomized trials (69 studies).
• Studies were conducted primarily in Europe (31 studies) and North America (17 studies from the United States, 2 from Canada). Remaining studies were from Australia (3 studies), China (4 studies), South Africa (3 studies), Brazil (2 studies), Chile, Indonesia, Israel, Iran, New Zealand, Turkey, and Zambia (1 study each).
• Studies from the United State and Canada primarily focused on students in elementary schools (10 studies), middle schools (5 studies), or both (2 studies). Only one study was conducted in high school and one study evaluated students in preschool or kindergarten.
• Participants in U.S. studies included Black or African American students (median 16.0%; 14 studies) and Hispanic or Latino students (median 25.5%; 14 studies).
• Seven U.S. studies reported student participation in free or reduced lunch program (median 40%; 7 studies).

Effectiveness Review

• Logic Model – Effectiveness Review
• Text Description – Effectiveness Review

When starting an effectiveness review, the systematic review team develops an analytic framework. The analytic framework illustrates how the intervention approach is thought to affect public health. It guides the search for evidence and may be used to summarize the evidence collected. The analytic framework often includes intermediate outcomes, potential effect modifiers, potential harms, and potential additional benefits.

A summary evidence table for this Community Guide review is not available because the CPSTF finding is based on the following published systematic review:

Fraguas D, Diaz-Caneja CM, Ayora M, Duran-Cutilla M, Abregu-Crespo R, et al. Assessment of school anti-bullying interventions: a meta-analysis of randomized clinical trials. JAMA Pediatrics 2021;175(1):44-55.

The number of studies and publications do not always correspond (e.g., a publication may include several studies, or one study may be explained in several publications).

Effectiveness Review

Subset of Studies Conducted in the United States and Canada

Brown EC, Low S, Smith BH, Haggerty KP. Outcomes from a school-randomized controlled trial of steps to respect: a bullying prevention program. School Psychology Review 2011;40 (3):423-33.

Cappella E, Hamre BK, Yeon Kim H, Henry DB, Frazier SL, et al. Teacher consultation and coaching within mental health practice: classroom and child effects in urban elementary schools. Journal of Consulting and Clinical Psychology 2012;80(4):597-610.

Conduct Problems Prevention Research Group. The effects of a multiyear universal social emotional learning program: the role of student and school characteristics. Journal of Consulting and Clinical Psychology 2010;78(2):156-68.

Connolly J, Josephson W, Schnoll J, Simkins-Strong E, Pepler D, et al. Evaluation of a youth-led program for preventing bullying, sexual harassment, and dating aggression in middle schools. Journal of Early Adolescence 2015;35(3):403-34.

Crean HF, Johnson DB. Promoting Alternative Thinking Strategies (PATHS) and elementary school aged children’s aggression: results from a cluster randomized trial. American Journal of Community Psychology 2013;52(1-2):56-72.

DeRosier ME, Marcus SR. Building friendships and combating bullying: effectiveness of S.S.GRIN at one-year follow-up. Journal of Clinical Child & Adolescent Psychology 2005;34(1):140-50.

DeRosier ME. Building relationships and combating bullying: effectiveness of a school-based social skills group intervention. Journal of Clinical Child & Adolescent Psychology 2004;33(1):196-201.

Espelage DL, Rose CA, Polanin JR. Social-emotional learning program to promote prosocial and academic skills among middle school students with disabilities. Remedial and Special Education 2016;1-10.

Espelage DL, Rose CA, Polanin JR. Social-emotional learning program to reduce bullying, fighting, and victimization among middle school students with disabilities. Remedial and Special Education 2015; 36(5):299-311.

Espelage DL, Low S, Polanin JR, Brown EC. The impact of a middle school program to reduce aggression, victimization, and sexual violence. Journal of Adolescent Health 2013;53(2):180-6.

Frey KS, Snell JL, Van Schoiack Edstrom L, MacKenzie EP, Broderick CJ. Reducing playground bullying and supporting beliefs: an experimental trial of the Steps to Respect program. Developmental Psychology Journal 2005;41(3):479-90.

Green JG, Holt MK, Oblath R, Robinson E, Storey K, et al. Engaging professional sports to reduce bullying: an evaluation of the Boston vs. Bullies Program. Journal of School Violence 2020.

Jenson JM, Brisson D, Bender KA, Williford AP. Effects of the Youth Matters Prevention Program on patterns of bullying and victimization in elementary and middle school. Social Work Research 2013;37(4):361-72.

Meraviglia MG, Becker H, Rosenbluth B, Sanchez E, Robertson T. The Expect Respect Project. Creating a positive elementary school climate. Journal Interpersonal Violence 2003;18(11):1347-60.

Ostrov JM, Godleski SA, Kamper-DeMarco KE, Blakely-McClure SJ, Celenza L. Replication and extension of the Early Childhood Friendship Project: effects on physical and relational bullying. School Psychology Review 2015; 44(4):445-63.

Sanchez E, Robertson TR, Lewis CM, Rosenbluth B, Bohman T, et al. Preventing bullying and sexual harassment in elementary schools the Expect Respect Model. Journal of Emotional Abuse 2001;2 (2-3):157-80.

Santos RG, Chartier MJ, Whalen JC, Chateau D, Boyd L. Effectiveness of school-based violence prevention for children and youth: a research report. Healthcare Quarterly 2011;14 (2):80-91.

Swaim RC, Kelly K. Efficacy of a randomized trial of a community and school-based anti-violence media intervention among small-town middle school youth. Prevention Sciences 2008;9(3):202-14.

Yeager DS, Trzesniewski KH, Dweck CS. An implicit theories of personality intervention reduces adolescent aggression in response to victimization and exclusion. Child Development 2012; 84 (3):970-88.

Subset of included studies conducted outside of the United States and Canada

Athanasiades C, Kamariotis H, Psalti A, Baldry AC, Sorrentino A. Internet use and cyberbullying among adolescent students in Greece: The “TABBY” project. Hellenic Journal of Psychology 2015;12:14-39.

Baldry AC, Farrington DP. Evaluation of an intervention program for the reduction of bullying and victimization in schools. Aggressive Behavior 2004;30:1-15.

Barkoukis V, Lazuras L, Ourda D, Tsorbatzoudis H. Psychosocial risk factors for adolescent cyberbullying: evidence from a school-based intervention. Aggressive Behavior 2016;42:114-22.

Bonell C, Allen E, Opondo C, Warren E, Elbourne DR, et al. Examining intervention mechanisms of action using mediation analysis within a randomised trial of a whole-school health intervention. Journal of Epidemiology and Community Health 2019;73(5):455-64.

Bonell C, Allen E, Warren E, McGowan J, Bevilacqua L, et al. Effects of the Learning Together Intervention on bullying and aggression in English secondary schools (INCLUSIVE): a cluster randomised controlled trial. Lancet 2018;392(10163):2452-64.

Boulton MJ, Boulton L. Modifying self-blame, self-esteem, and disclosure through a cooperative cross-age teaching intervention for bullying among adolescents. Violence and Victims 2017;32(4):609-26.

Boulton MJ, Flemington I. The effects of a short video intervention on secondary school pupils’ involvement in definitions of and attitudes towards bullying. School Psychology International 1996;17:331.

Bowes L, Aryani F, Ohan F, Haryanti RH, Winarna S, et al. The development and pilot testing of an adolescent bullying intervention in Indonesia – the ROOTS Indonesia Program. Global Health Action 2019;12(1):e1656905.

Calvete E, Orue I, Fern ndez-Gonz lez L, Prieto-Fidalgo A. Effects of an incremental theory of personality Intervention on the reciprocity between bullying and cyberbullying victimization and perpetration in adolescents. PLoS One 2019;14(11):e0224755.

Chen LM, Sung YH, Cheng W. How to enhance teachers’ bullying identification: a comparison among providing a training program, a written definition, and a definition with a checklist of bullying characteristics. Asia-Pacific Education Researcher 2017; 26(6):351-59.

Cross D, Shaw T, Hadwen K, Cardoso P, Slee P, et al. Longitudinal impact of the cyber friendly schools program on adolescents’ cyberbullying behavior. Aggressive Behavior 2016;42:166-80.

Cross D, Monks H, Hall M, Shaw T, Pintabona Y, et al.Three-year results of the Friendly Schools whole-of-school intervention on children’s bullying behaviour. British Educational Research Journal 2011; 37(1):105-29.

DeSmet A, Bastiaensens S, Van Cleemput K, Poels K, Vandebosch H, et al. The efficacy of the Friendly Attac serious digital game to promote prosocial bystander behavior in cyberbullying among Young adolescents: a cluster-randomized controlled trial. Computers in Human Behavior 2018;78:336-47.

Farmer VL, Williams SM, Mann JI, Schofield G, McPhee JC, et al. Change of school playground environment on bullying: a randomized controlled trial. Pediatrics 2017;139(5):e20163072.

Fekkes M, Pijpers FIM, Verloove-Vanhorick SP. Effects of antibullying school program on bullying and health complaints. Archives of Pediatrics and Adolescent Medicine 2006;160(6):638-44.

Fonagy P, Twemlow SW, Vernberg EM, Nelson JM, Dill EJ, et al. A cluster randomized controlled trial of child-focused psychiatric consultation and a school systems-focused intervention to reduce aggression. Journal of Child Psychology and Psychiatry 2009;50(5):607-16.

Giannotta F, Settanni M, Kliewer W, Ciairano S. Results of an Italian school-based expressive writing intervention trial focused on peer problems. Journal of Adolescence 2009; 32(6):1377-89.

Gradinger P, Yanagidaa T, Strohmeiera D, Spiel C. Prevention of cyberbullying and cyber victimization: evaluation of the ViSC Social Competence Program. Journal of School Violence 2015;14 (1): 87-110.

Gusm es J, Sa udo A, Valente JY, Sanchez ZM. Violence in Brazilian schools: analysis of the effect of the #Tamojunto Prevention Program for Bullying and Physical Violence. Journal of Adolescence 2018;63:107-117.

Holen S, Waaktaar T, Lerv g A, Ystgaard M. Implementing a universal stress management program for young school children: are there classroom climate or academic effects? Scandinavian Journal of Educational Research 2013;57(4):420-44.

Hormaz bal-Aguayo I, Fern ndez-Vergara O, Gonz lez-Calder n N, Vicencio-Rojas F, Russell-Guzm n J, et al. Can a before-school physical activity program decrease bullying victimization in disadvantaged children? The Active-Start Study. International Journal of Clinical and Health Psychology 2019;19(3):237-42.

Hunt C. The effect of an education program on attitudes and beliefs about bullying and bullying behaviour in junior secondary school students. Child and Adolescent Mental Health 2007;12(1):21-6.

Ju Y, Wang S, Zhang W. Intervention research on school bullying in primary schools. Frontiers of Education in China 2009; 4(1):111-22.

Kaljee L, Zhang L, Langhaug L, Munjile K, Tembo S, et al. A randomized-control trial for the Teachers’ Diploma Programme on psychosocial care, support and protection in Zambian government primary schools. Psychology, Health & Medicine 2017; 22(4):381-92.

Karasimopoulou S, Derri V, Zer voudaki E. Children’s perceptions about their health-related quality of life: effects of a health education-social skills program. Health Education Research 2012;27(5):780-93.

K rn A, Voeten M, Little TD, Alanen E, Poskiparta E, et al. Effectiveness of the KiVa Antibullying Program: Grades 1 3 and 7 9. Journal of Educational Psychology 2013;105(2):535 51.

K rn A, Voeten M, Little TD, Poskiparta E, Kaljonen A, et al. A large-scale evaluation of the KiVa Antibullying Program: Grades 4-6. Child Development 2011;82(1):311-30.

Kathard H, Walters F, Frieslaar, K, Mhlongo T, Rhoode, M, et al. Classroom intervention to change peers’ attitudes towards children who stutter: a feasibility study. South African Journal of Communication Disorders 2014; 61(1).

Knowler C, Frederickson N. Effects of an emotional literacy intervention for students identified with bullying behaviour. Educational Psychology 2013;33(7):862-83.

Mallick R, Kathard H, Borhan A, Pillay M, Thabane L. A Cluster randomised trial of a classroom communication resource program to change peer attitudes towards children who stutter among grade 7 students. Trial 2018;19(1), 664.

Meyer N, Lesch E. An analysis of the limitations of a behavioural programme for bullying boys from a subeconomic environment. Southern African Journal of Child and Adolescent Mental Health 2000; 12(1):59-6.

Midthassel UV, Bru E, Idsoe T. Is the sustainability of reduction in bullying related to follow-up procedures? Journal Educational Psychology 2008;28 (1):83-95.

Moore B, Woodcock S, Dudley D. Developing wellbeing through a randomised controlled trial of a martial arts based intervention: an alternative to the anti-bullying approach. International Journal of Environmental Research and Public Health 2018;16(1):81-99.

Mu oz-Fern ndez N, Ortega-Rivera J, Nocentini A, Menesini E, S nchez-Jim nez V. The efficacy of the “Dat-e Adolescence” prevention program in the reduction of dating violence and bullying. International Journal of Environmental Research and Public Health 2019; 16(3),408-29.

Naidoo S, Satorius BK, De Vries H, Taylor M. Verbal bullying changes among students following an educational intervention using the integrated model for behavior change. Journal of School Health 2016; 86(11):813-22.

Nieh HP, Wu WC. Effects of a collaborative board game on bullying intervention: a group-randomized controlled trial. Journal of School Health 2018;88(10):725-33.

Nocentini A, Menesini E, Pluess M. The personality trait of environmental sensitivity predicts children’s positive response to school-based antibullying intervention. Clinical Psychological Science 2018;1-12.

Nocentini A, Menesini E. KiVa Anti-bullying program in Italy: evidence of effectiveness in a randomized control trial. Prevention Science 2016;17(8):1012-23.

Pfetsch J, Schultze-Krumbholz A, F llgraf, F. Does the information about classroom norms change the individual injunctive norms about cyberbullying? A minimal intervention study. International Journal of Developmental Science 2018;1(2):1-11.

Schechtman Z, Ifargan M. School-based integrated and segregated interventions to reduce aggression. Aggressive Behavior 2009;35(4):342-56.

Shams H, Garmaroudi G, Nedjat S, Yekaninejad MS. Effect of education based on socio-ecological theory on bullying in students: an educational study. Electronic Physician Journal 2018; 10(7):7046-53.

Sorrentino A, Baldry AC, Farrington DP. The efficacy of the Tabby Improved Prevention and Intervention Program in reducing cyberbullying and cybervictimization among students. International Journal of Environmental Research and Public Health 2018;15(11):2536.

Stelko-Pereira AC, Williams LC. Evaluation of a Brazilian school violence prevention program (Viol ncia Nota Zero). Pensamiento Psicol gico 2016;14(1):63-76.

Stevens V, De Bourdeaudhuij I, Van Oost P. Bullying in Flemish schools: an evaluation of anti-bullying intervention in primary and secondary schools. British Journal of Educational Psychology 2000; 70(2): 195-210.

Tanr kulu T, K nay H, Ar cak OT. Sensibility development program against cyberbullying. New Media and Society 2015;17(5):708-19.

Trip S, Bora C, Sipos-Gug S, Tocai I, Gradinger P, et al. Bullying prevention in schools by targeting cognitions, emotions, and behavior: evaluating the effectiveness of the REBE-ViSC Program. Journal of Counseling Psychology 2015; 62(4):732-40.

Tsiantis ACJ, Beratis IN, Syngelaki EM, Stefanakou AA, Asimopoulos C, et al. The effects of a clinical prevention program on bullying, victimization, and attitudes toward school of elementary school students. Behavioral Disorders 2013;38(4):243-57.

van den Berg YHM, Segers E, Cillessen AHN. Changing peer perceptions and victimization through classroom arrangements: a field experiment. Journal of Abnormal Child Psychology 2012;40(3):403-12.

W jcik M, He ka AM. Meeting the needs of young adolescents: ABBL Anti-Bullying Program during middle school transition. Psychological Reports 2018;122(3):1043-67.

Yan H, Chen J, Huang J. School bullying among left-behind children: the efficacy of art therapy on reducing bullying victimization. Frontiers in Psychiatry. 2019;10(40):1-7.

A search strategy for this Community Guide review is not available because the CPSTF finding is based on the following published systematic review:

Fraguas D, Diaz-Caneja CM, Ayora M, Duran-Cutilla M, Abregu-Crespo R, et al. Assessment of school anti-bullying interventions: a meta-analysis of randomized clinical trials. JAMA Pediatrics 2021;175(1):44-55.

David-Ferdon C, Vivolo-Kantor AM, Dahlberg LL, Marshall KJ, Rainford N, et al. A Comprehensive Technical Package for the Prevention of Youth Violence and Associated Risk Behaviors. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention. 2016.

Diliberti M, Jackson M, Correa S, Padgett Z. Crime, Violence, Discipline, and Safety in U.S. Public Schools: Findings From the School Survey on Crime and Safety: 2017 18 (NCES 2019-061). U.S. Department of Education. Washington, DC: National Center for Education Statistics. Retrieved [November 3, 2021] from https://nces.ed.gov/pubs2019/2019061.pdf

Doumas DM, Midgett A. Witnessing cyberbullying and internalizing symptoms among middle school students. European Journal of Investigation in Health, Psychology and Education 2020;10(4):957-66.

Fraguas D, Diaz-Caneja CM, Ayora M, Duran-Cutilla M, Abregu-Crespo R, et al. Assessment of school anti-bullying interventions: a meta-analysis of randomized clinical trials. JAMA Pediatrics 2021;175(1):44-55.

Gladden RM, Vivolo-Kantor AM, Hamburger ME, Lumpkin CD. Bullying Surveillance Among Youths: Uniform Definitions for Public Health and Recommended Data Elements, Version 1.0. Atlanta, GA; National Center for Injury Prevention and Control, Centers for Disease Control and Prevention and U.S. Department of Education; 2014.

Hahn R, Fuqua-Whitley D, Wethington H, Lowy J, Crosby A, et al. Effectiveness of universal school-based programs to prevent violent and aggressive behavior: a systematic review. American Journal of Preventive Medicine 2007;33(2S):S114 29.

National Academies of Sciences, Engineering, and Medicine. Preventing Bullying Through Science, Policy, and Practice. Washington, DC: The National Academies Press, 2016.

Singham T, Viding E, Schoeler T, et al. Concurrent and longitudinal contribution of exposure to bullying in childhood to mental health: the role of vulnerability and resilience. JAMA Psychiatry 2017;74(11):1112-9.

Wolke D, Lereya ST Long-term effects of bullying. Archives of Disease in Childhood 2015;100:879-85.

The following considerations for implementation are drawn from studies included in the existing evidence review, the broader literature, and expert opinion.

• Violence and violence prevention efforts in school settings should be considered within the broader context of violence and drivers of violence in the community (David-Ferdon et al. 2016).
• CPSTF recommendations complement guidance on school anti-bullying interventions available in CDC’s A Comprehensive Technical Package for the Prevention of Youth Violence and Associated Risk Behaviors. This technical package from CDC’s Division of Violence Prevention represents a select group of strategies based on the best available evidence to help communities and states sharpen their focus on prevention activities with the greatest potential to prevent youth violence and its consequences
• Program planners may find it helpful to conduct assessments of school and community violence prevention needs, resources, and readiness in selecting appropriate interventions for implementation.
  • Assessing Prevention Capacity & Implementing Change: An evidence-informed and evidence-based Bullying Prevention Capacity Assessment and Change Package
• Several publicly available resources provide implementation guidance:
  • StopBullying.gov. This website from the U.S. Department of Health and Human Services provides definitions and prevention guidance from various government agencies on what bullying is, what cyberbullying is, who is at risk, and how you can prevent and respond to bullying.
  • Protecting Youth Mental Health: The U.S. Surgeon General’s Advisory outlines a series of recommendations to improve youth mental health across eleven sectors, including young people and their families, educators and schools, and media and technology companies.
  • STRYVE Action Council – Safe States Alliance. The Striving to Reduce Youth Violence Everywhere (STRYVE) Action Council is a multidisciplinary consortium of organizations collaborating across sectors and systems to build safe, healthy, inclusive, and equitable communities that allow youth from every background to thrive. STRYVE leverages the work of its partners to prevent injuries and violence in communities.
  • National Center on Safe Supportive Learning Environments offers resources and technical assistance to states, districts, schools, institutions of higher learning, and communities focused on improving school climate and conditions for learning.
  • Children’s Safety Network provides technical assistance to state and jurisdiction health departments to increase their capacity to address childhood injuries and violence.
  • Health Alliance for Violence Intervention (HAVI) supports connections between communities and systems of care including violence intervention specialists, doctors, health administrators, and researchers, and provides resources to enhance new and existing network programs.

Healthy People 2030

Healthy People 2030 includes the following objectives related to this CPSTF recommendation.

• Reduce the number of young adults who report 3 or more adverse childhood experiences — IVP-D03
• Reduce physical fighting among adolescents — IVP-11
• Reduce the rate of minors and young adults committing violent crimes — AH-10
• Reduce the rate of adolescent and young adult victimization from violent crimes — AH-R11
• Reduce bullying of lesbian, gay, or bisexual high school students — LGBT-05
• Reduce bullying of transgender students — LGBT-D01
• Increase the proportion of schools with policies and practices that promote health and safety — EH-D01