Zhang Anao, Padilla Yolanda C, Kim Yeonwoo
The University of Texas at Austin, United States.
The University of Texas at Austin, United States.
J Pediatr Nurs. 2017 Nov-Dec;37:42-50. doi: 10.1016/j.pedn.2017.06.018. Epub 2017 Jul 10.
From a life course perspective, important insights about how social determinants of health operate can be gained by analyzing the various forms that social climate can take in different life periods. For children, a critical aspect of social climate is exposure to bullying. Bullying can serve as a proxy for power imbalance and social exclusion analogous to adult social climate of discrimination and racism.
We used the Year 9 follow-up data of the Fragile Families and Child Wellbeing Study (N=3301) that, for the first time included interviews with the children. We drew on a national sample of children and their families, which allowed us to account for broader contextual variables and represented a broad range of geographic areas and schools. Multinomial logistic regression was used to estimate the effects of exposure to bullying on self-rated health among primarily 9- to 10-year-old children while controlling for socio-demographic and diagnosed health-conditions.
Both frequency and forms of bullying were positively associated with lower odds of reporting excellent, very good or good health. The effect of forms of bullying on children's self-rated health fell on a gradient. Subgroup analysis indicated a significant effect on self-rated health for children who experienced peer rejection but not for those who experienced physical aggression.
The results of the study provide new evidence that the harmful health consequences of power imbalance and discriminatory practices may extend to children in early development. It also accentuates the need to study social determinants of health from both an ecological/contextual and a developmental angle.
Echoing a plethora of nursing literature on the critical role of psycho-social pediatric care, this study further encourages pediatric nurses to expand their assessment and intervention priorities beyond a familial and developmental perspective, and to consider the evident physical health consequence of a child's overall social climate determinants.
从生命历程的角度来看，通过分析社会环境在不同生命阶段可能呈现的各种形式，能够获得有关健康的社会决定因素如何发挥作用的重要见解。对于儿童而言，社会环境的一个关键方面是遭受欺凌。欺凌可作为权力失衡和社会排斥的代表，类似于成人社会中的歧视和种族主义环境。
我们使用了脆弱家庭与儿童福祉研究的九年级随访数据（N = 3301），该数据首次纳入了对儿童的访谈。我们抽取了一个全国性的儿童及其家庭样本，这使我们能够考虑更广泛的背景变量，并涵盖了广泛的地理区域和学校。在控制社会人口统计学因素和已诊断的健康状况的同时，使用多项逻辑回归来估计遭受欺凌对主要为9至10岁儿童自评健康的影响。
欺凌的频率和形式均与报告健康状况为优秀、非常好或良好的较低几率呈正相关。欺凌形式对儿童自评健康的影响呈梯度变化。亚组分析表明，经历同伴排斥的儿童的自评健康受到显著影响，而经历身体攻击的儿童则未受影响。
该研究结果提供了新的证据，表明权力失衡和歧视性做法对健康的有害影响可能会延伸至早期发育阶段的儿童。这也凸显了从生态/背景和发展角度研究健康的社会决定因素的必要性。
呼应了大量关于心理社会儿科护理关键作用的护理文献，本研究进一步鼓励儿科护士将评估和干预重点从家庭和发育角度扩展出去，并考虑儿童整体社会环境决定因素对身体健康的明显影响。
