حذف صبحانه با مزاحمت سایبری و قربانی زورگویی مدرسه همراه است. یک مطالعه مبتنی بر مدرسه مقطعی

Breakfast skipping is a health concern that has well-known negative consequences physically and psychologically. It is therefore important to understand why children skip breakfast. The purpose of this study was to establish whether the experience of bullying and cyberbullying impacts upon breakfast skipping and to further evaluate whether the inability for youths to cope with bullying victimization affects their mental health (depression), and in turn predicts breakfast skipping. Data were obtained from the Eastern Ontario 2011 Youth Risk Behaviour Survey, a cross-sectional regional school-based survey of middle and high school students (11–20 years old) across the five counties of Eastern Ontario, Canada (N = 3035). Self-reported data about children's experiences of bullying victimization, breakfast eating habits, socio-economical status, depression, and other risk behaviours were analysed. Approximately half of the participants (50.4%) reported not eating breakfast on a regular basis: 26.3% and 24.1% reported often (usually eat breakfast three times or more per week) and frequent (usually eat breakfast twice a week or less) breakfast skipping behaviour, respectively. Victims of both cyberbullying and school bullying presented greater likelihood of often (adjusted relative risk ratio (RR) = 1.55; 95% confidence interval (CI) = 1.17–2.06) and frequent (RR = 1.97; 95% CI = 1.28–3.03) breakfast skipping. Mediation analysis further showed that depression fully mediated the relationship between school bullying victimization and frequent breakfast skipping. Moreover, depression partially mediated the associations between both cyberbullying and school bullying with frequent breakfast skipping. These findings highlight the potential interrelationships between cyberbullying, school bullying and depression in predicting unhealthy breakfast skipping behaviour in children.

Breakfast skipping has become increasingly widespread amongst children and adolescents (Siega-Riz et al, 1998, Storey et al, 2009, Vereecken et al, 2009 and Woodruff et al, 2008), and population-based research data are required to provide a clearer understanding of the possible underlying factors that contribute to and perpetuate breakfast skipping in children and adolescents. A body of research has shown that breakfast skipping in adolescents is associated with various health-risk behaviours, such as smoking, frequent alcohol consumption, marijuana use, infrequent exercise and behavioural disinhibition (Isralowitz, Trostler, 1996 and Keski-Rahkonen et al, 2003). Studies also reported associations of breakfast skipping with socio-economic status (SES), family structure, and the development of overweight and obesity (Levin et al, 2012, Niemeier et al, 2006, O'Dea, Caputi, 2001, Rampersaud et al, 2005, Timlin et al, 2008 and Vereecken et al, 2009). Breakfast skipping has also been reported as a possible indicator of disordered eating (Rampersaud et al., 2005), both sub-clinically (Melve & Baerheim, 1994) and clinically (Fernandez-Aranda et al., 2007). Body weight and body image concerns are not the only reasons students skip breakfast. While not being offered breakfast may be a reason for not eating breakfast in younger children, a body of research has reported a variety of other reasons amongst adolescents. In addition to dieting in order to lose weight, Shaw (1998) has reported in a follow-up telephone survey that common reasons given for skipping breakfast were lack of time and lack of appetite in the morning. This supports the need to investigate other determinants as they may offer new insights into how to prevent or reduce breakfast skipping. One such determinant is the experience of bullying. Children and adolescents spend a large amount of their time with friends and peers and many children experience instances of bullying or victimization during their childhood years (Guerra, Williams, & Sadek, 2011). According to Coping Theory, adolescents engage in high risk behaviours to cope with increased negative effects, which may result from such victimization (Lazarus, 1993), one such behaviour may include breakfast skipping. Bullying is usually defined as aggression that is intentionally carried out by one or more individuals and repeatedly targeted towards a person who cannot easily defend him or herself (Olweus, 1993). School bullying (bullying on school property) is a major public health concern. Despite the efforts of schools to prevent or stop bullying, bullying is still highly prevalent worldwide (Perren et al, 2010 and Schneider et al, 2012). Beyond the school property, a new form of bullying has rapidly emerged with the advent of technology. Cyberbullying is defined as the use of email, cell phones, text messages, and Internet sites to threaten, harass, embarrass, or socially exclude (Hinduja & Patchin, 2009). Like school bullying, cyberbullying has also been associated with mental health problems. Several negative consequences have been identified amongst victims of cyberbullying, including increased anxiety and emotional distress (Juvonen, Gross, 2008 and Ybarra et al, 2006), feelings of loneliness, insecurity and humiliation (Breguet, 2007). Victims of cyberbullying may also suffer from low self-esteem, frustration and sadness, and serious distress, including major depression, self-harm, and suicide (Hay, Meldrum, 2010, Patchin, Hinduja, 2010 and Schneider et al, 2012). Previous research has mostly focused on the association between bullying and eating disorders, or unhealthy eating psychopathology (Farrow, Fox, 2011, Kaltiala-Heino et al, 2000 and Libbey et al, 2008). To the best of our knowledge, there have been no previous reports of a specific association between breakfast skipping and bullying victimization. The objective of this study was to begin to explore the prevalence and associations between cyberbullying and school bullying victimization with breakfast skipping. By doing so we seek to gain a better understanding of the links that may exist between these public health issues. Using a large and diverse sample of Canadian middle and high school students, we sought to establish whether the experience of bullying may impact upon breakfast skipping and to further evaluate whether bullying victimization might impact mental health (depression), and in turn lead to breakfast skipping. Indeed, bullying victimization is deemed to increase children's depressive symptoms (Hawker, Boulton, 2000, Perren et al, 2010 and Schneider et al, 2012), and depression is often related to eating behaviour (Frost, Goolkasian, Ely, & Blanchard, 1982), particularly breakfast skipping (Lien, 2007). We therefore sought to establish whether elevated levels of depression might be the means through which bullying may impact upon breakfast intake. Understanding how bullying impacts upon nutritional behaviour will allow for more targeted interventions to help protect children who are subjected to bullying. It was hypothesized that cyberbullying and school bullying victimization would predict a higher likelihood of breakfast skipping and that depression would mediate these relationships.

Results Sample characteristics More than half (55.4%) of the participants in the study were girls. Overall, students who were in lower grades were oversampled and there were significant differences between boys and girls in the distribution of grade. For example, while 25.6% and 21.9% of boys and girls respectively were in grade 7, 12.8% and 15.4% of boys and girls respectively were in grade 12. Therefore, gender was controlled for in further analyses. Overall, 24.6% of participants considered themselves overweight, and the distribution of body weight perception significantly varied between genders. Girls were more likely to perceive themselves as overweight, whereas boys were more likely to consider themselves underweight (Table 1). Approximately three quarter of fathers and mothers of the participants had attended a least high school (73.6% and 77.2%, respectively). Table 1. Sample characteristics. Sample Boys Girls Total 3035 (100) 1354 (44.6) 1681 (55.4) Age  Mean age (SD) 14.3 (1.8) 14.2 (1.8) 14.3 (1.8) Grade***  Grade 7 715 (23.6) 347 (25.6) 368 (21.9)  Grade 8 630 (20.7) 271 (21.4) 359 (20.8)  Grade 9 446 (14.7) 199 (14.7) 247 (14.7)  Grade 10 438 (14.4) 197 (14.5) 241 (14.3)  Grade 11 373 (12.3) 167 (12.3) 206 (12.3)  Grade 12 433 (14.3) 173 (12.8) 260 (15.4) Tobacco usea 490 (16.1) 213 (15.7) 277 (16.5) Alcohol usea 1681 (55.4) 775 (57.2) 906 (53.9) Body weight perception*  Underweight 402 (13.2) 209 (15.4) 193 (11.5)  About the right weight 1886 (62.1) 864 (63.8) 1022 (60.8)  Overweight 747 (24.6) 281 (20.8) 466 (27.7) Educational level of father*  Attended university 672 (22.1) 338 (25.0) 334 (19.9)  Attended college 760 (25.0) 348 (25.7) 412 (24.5)  Attended high school 804 (26.5) 329 (24.3) 475 (28.3)  Did not attended high school 38 (1.3) 16 (1.2) 22 (1.3)  I don’t know 761 (25.1) 323 (23.8) 438 (26.0) Educational level of mother  Attended university 924 (30.4) 440 (32.5) 484 (28.8)  Attended college 780 (25.7) 354 (26.1) 426 (25.3)  Attended high school 640 (21.1) 244 (18.0) 396 (23.6)  Did not attended high school 21 (.7) 11 (.8) 10 (.6)  I don’t know 670 (22.1) 305 (22.5) 365 (21.7) Depression** 753 (25.0) 234 (17.5) 519 (31.1) Data are shown as No. (%) unless otherwise specified. p value of difference between boys and girls: *p < .05; **p < .01; ***p < .001. a Values indicate the percentage of respondents answering “Yes” for each item. “No” responses are not shown. Table options Prevalence of breakfast skipping Approximately half of the participants (50.4%) reported not eating breakfast on a regular basis: 26.3% and 24.1% reported often (usually eat breakfast three times or more per week) and frequent (usually eat breakfast twice a week or less) breakfast skipping behaviour, respectively. Girls were more likely to frequently skip breakfast than boys (27.8% vs. 19.6%; p < .01). Breakfast skipping behaviour also showed an increase with student's grade, as older grade-level students skipped breakfast more frequently than their younger peers ( Table 2). Participants who perceived themselves as overweight were more likely to frequently skip breakfast than those who perceived themselves as about the right weight or underweight ( Table 2). Children of parents with lower levels of education (father and/or mother did not attend high school) were more likely to frequently skip breakfast than those of more educated parents. Table 2. Prevalence and correlates of breakfast eating habit. Eat breakfast every day No. (%) Often breakfast skippinga No. (%) Frequent breakfast skippingb No. (%) Sample (N = 3035) 1505 (49.6) 793 (26.3) 733 (24.1) Grade***  Grade 7 (n = 715) 412 (57.6) 169 (23.6) 134 (18.7)  Grade 8 (n = 630) 331 (52.5) 160 (25.4) 139 (22.1)  Grade 9 (n = 446) 218 (48.9) 116 (26.0) 112 (25.1)  Grade 10 (n = 438) 193 (44.1) 133 (30.4) 112 (25.6)  Grade 11 (n = 373) 157 (42.1) 106 (28.4) 110 (29.5)  Grade 12 (n = 433) 194 (44.8) 113 (26.1) 126 (29.1) Gender**  Male (n = 1354) 749 (55.3) 340 (25.1) 265 (19.6)  Female (n = 1681) 756 (45.0) 457 (27.2) 468 (27.8) Tobacco use (n = 490) c,*** 146 (29.8) 137 (28.0) 207 (42.2) Alcohol use (n = 1681) c,*** 699 (41.6) 477 (28.4) 505 (30.0) Educational level of father*  Attended university (n = 672) 372 (55.4) 172 (25.6) 128 (19.0)  Attended college (n = 760) 409 (53.8) 196 (25.8) 155 (20.4)  Attended high school (n = 804) 338 (42.0) 237 (29.5) 229 (28.5)  Did not attended high school (n = 38) 16 (42.1) 7 (18.4) 15 (39.5)  I don’t know (n = 761) 370 (48.6) 185 (24.3) 206 (27.1) Educational level of mother**  Attended university (n = 924) 513 (55.5) 243 (26.3) 168 (18.2)  Attended college (n = 780) 392 (50.3) 207 (26.5) 181 (23.2)  Attended high school (n = 640) 262 (40.9) 177 (27.7) 201 (31.4)  Did not attended high school (n = 21) 7 (33.3) 4.0 (19.0) 10 (47.6)  I don’t know (n = 670) 331 (49.4) 166 (24.8) 173 (25.8) Body weight perception*  Underweight (n = 402) 203 (50.5) 110 (27.4) 89 (22.1)  About the right weight (n = 1886) 968 (51.3) 490 (26.0) 428 (22.7)  Overweight (n = 747) 334 (44.7) 197 (26.4) 216 (28.9) Depression (n = 753)*** 272 (36.1) 203 (27.0) 278 (36.9) Cyberbullying (n = 525) c,*** 184 (35.0) 150 (28.6) 191 (36.4) School bullying (n = 766) c,** 340 (44.4) 210 (27.4) 216 (28.2) Both bullying forms (n = 319) c,*** 104 (32.6) 94 (29.5) 121 (37.9) p value of association with breakfast skipping: *p < .05; **p < .01; ***p < .001. a Eating breakfast three times or more per week. b Eating breakfast two times or less per week. c Values indicate the percent of respondents answering “Yes” for each item. “No” responses are not shown. Table options Prevalence of bullying victimization Figure 1 displays the prevalence of bullying victimization by gender. A total of 17.3% of students were victims of cyberbullying and 25.2% were victims of school bullying, while 10.5% were victims of both cyberbullying and school bullying. The majority of victims of cyberbullying (60.8%) were also victims of school bullying; 41.6% of victims of school bullying were also victims of cyberbullying. Girls were twice as likely as boys to be victims of cyberbullying (22.4% vs. 10.9%; p < .001) and both forms of bullying (13.5% vs. 6.8%; p < .001). Students who were in lower grades were more likely to be victims of school bullying, whereas those in higher grades were more likely to be victims of cyberbullying or both forms of bullying victimization. Full-size image (25 K) Fig. 1. Prevalence of bullying victimization by gender. Figure options Association between bullying victimization and breakfast skipping Table 3 presents associations between bullying victimization with breakfast skipping using multinomial logistic regression analyses. Victims of both cyberbullying and school bullying presented greater likelihood of often breakfast skipping (RR = 1.80; 95% CI = 1.33–2.43) and frequent breakfast skipping (RR = 2.66; 95% CI = 1.76–4.04). Results were similar when adjusting for grade, gender, body weight perception, and tobacco and alcohol use, as victims of both cyberbullying and school bullying presented greater likelihood of often breakfast skipping (RR = 1.55; 95% CI = 1.17–2.06) and frequent breakfast skipping (RR = 1.97; 95% CI = 1.28–3.03). There were also significant associations between either form of bullying alone and breakfast skipping. Table 3. Associations of cyberbullying and school bullying victimization with breakfast skipping amongst schoolchildren. Model Often breakfast skippinga Frequent breakfast skippingb Cyberbullying 1 1.66 (1.43–1.94)*** 2.53 (1.75–3.66)** 2 1.57 (1.40–1.76)*** 2.27 (1.61–3.21)** 3 1.44 (1.33–1.55)*** 1.90 (1.37–2.64)** School bullying 1 1.23 (1.02–1.47)* 1.43 (1.26–1.63)** 2 1.25 (1.06–1.48)* 1.48 (1.26–1.72)** 3 1.18 (1.00–1.39) 1.28 (1.08–1.53)* Both forms of bullying 1 1.80 (1.33–2.43)** 2.66 (1.76–4.04)** 2 1.71 (1.28–2.28)** 2.42 (1.57–3.71)** 3 1.55 (1.17–2.06)* 1.97 (1.28–3.03)* Results shown as Relative Risk Ratio (95% confidence interval). Eat breakfast everyday was used as reference category. Model 1: unadjusted. Model 2: adjusted for grade and gender. Model 3: adjusted for grade, gender, educational level of father, educational level of mother, body weight perception, and tobacco and alcohol use. *p < .05; **p < .01; ***p < .001. a Eating breakfast three times or more per week. b Eating breakfast two times or less per week. Table options Mediation analysis Often breakfast skipping was not significantly associated with depression (Path B) while controlling for school bullying (B = .22, t = 1.50, p = .194), cyberbullying (B = .20, t = 1.36, p = .233), and both forms of bullying (B = .20, t = 1.43, p = .212), and therefore did not meet criteria necessary to test for mediation. With respect to frequent breakfast skipping, criteria for steps 1, 2 and 3 were all met ( Fig. 2); however, step 4 criteria differed by type of bullying victimization. Depression fully mediated the association between school bullying victimization and frequent breakfast skipping as the latter was reduced to non-significant when controlling for depression ( Fig. 2a). Depression partially mediated the association between both cyberbullying victimization and being a victim of both types of bullying with frequent breakfast skipping ( Fig. 2b and c). Sobel tests confirmed the partial meditational relationships of frequent breakfast skipping with cyberbullying (z = 6.50, p < .001) and both types of bullying (z = 6.37, p < .001). Full-size image (40 K) Fig. 2. Results of the mediational analyses on the relationship between bullying victimization and breakfast skipping. Binary (Path A) and multinomial (Path B and Path C) logistic regression were performed, all models controlling for grade, gender, SES, body weight perception, and tobacco and alcohol use; Paths B and C analyses compared “often breakfast skipping vs. eat breakfast everyday” and “frequent breakfast skipping vs. eat breakfast everyday,” but only the latter group of comparison met criteria necessary to test for mediation, and is therefore presented; Sobel test evaluating the indirect effect of bullying victimization on frequent breakfast skipping through depression was significant for cyberbullying (z = 6.29, p < .001) and both types of bullying (z = 6.31, p < .001). Coefficient level of significance: *p < .05; **p < .01; ***p < .001.