The Epidemiological Study On The Exposure To Violence Among Rural Middle School Students

PARTⅠExposure to Violence and Risk Factors among Rural Middle School Students in ChinaObjective:The aim of this study was to estimate the prevalence of exposure to violence and features of violence among rural middle school students in China,and to identify risk factors,which may modify such exposure.The objectives were mainly focused on the fellow aspects.First,it was to estimate the prevalence of exposure to violence,including age prevalence and gender prevalence.Second,it was to describe the features of violence,including types,spots,reason and consquence,ect. Third,it was to identify the possible risk factors,including demographic, behavior and social-psychological facotrs.Finally,it was to provide the basic study data with the interference of violence.Methods:It was a cross-sectional study.A survey using a face-to-face interview was conducted among 3620 middle school students randomly selected from a rural county.Database was established by epidata 3.0. Desciptive statatistic methods were used to analysis the prevalence and features of violence.Chi-square test was used to test the prevalence difference between each group.Logistic regression models were used to assess the possible demographic,behavior and social-psychological risk factors of exposure to violence.Results:Of the 3620 middle school students interviewed,41.0%reported to have experienced victimization during their lifetimes and 33.8%in past year.Among these victims,27.4%reported to have experienced emotional violence,30.6%physical and 3.2%sexual violence during their lifetimes.21.5%reported to have experienced emotional violence, 24.3%physical and 2.0%sexual violence in past year.Males were more likely than females to be victims in both lifetime (51.3%vs 31.2%,x~2=151.54,P＜0.01)and past year(42.9%vs 25.3%, x~2=125.06,P＜0.01).Female students from junior high school were more likely than those from senior high school to be victims in both lifetime (34.8%vs 27.7%,x~2=11.11,P＜0.01)and past year(29.6%vs 21.1%,x~2=18.06,P＜0.01),but males only in past year(45.8%vs 39.8%, x~2=6.50,P＜0.05).The major assaulters were from classmates or schoolmates(40.4%), teachers(21.3%),and strangers(20.0%).Most violence occurred at school(55.7%),followed by on the way to home(17.2%)and playing places(12.2%).As a result,67.9%reported to be harmed in mental health, and 30.7%in physical health.The percent of victims who seek for supports only accounted for 31.8%.Multiple logistic analyses indicated that the students aged at 15-16 years had increasing risk of exposure to violence in both lifetime (OR=1.34,P＜0.01)and last year(OR=1.57,P＜0.01),for the students aged at 13-14 years,only in last year(OR=1.48,P＜0.01).Female students had lower risk of exposure to violence(OR=0.49,P＜0.01 and OR=0.51, P＜0.01 respectively).Victimization was significantly more likely to occur in students,which often surf at internet-clubs(OR=1.39,P＜0.01 and OR=1.27,P＜0.05 respectively),and play electronic games(OR=1.50, P＜0.05 and OR=1.49,P＜0.05 respectively),and smoke(OR=1.82, P＜0.05 and OR=2.03,P＜0.05 respectively),and bully others(OR=3.78, P＜0.01 and OR=3.28,P＜0.01 respectively).Students who were often exposed to frequent quarrelling between parents had the higher odds ratios(OR=1.34,P＜0.05 and OR=1.39,P＜0.05 respectively).Students whose academic performances were at middle levels had higher risk of exposure to violence(OR=l.41,P＜0.01 and OR=1.44,P＜0.05 respectively).Respondents with lower self-esteem were also founded to have the higher odds ratios(OR=1.48,P＜0.01,OR=1.24,P＜0.05 and OR=1.63,P＜0.01,OR=1.36,P＜0.01 respectively).Conclusions:Exposure to violence is prevalent in rural middle school students though the prevalence of exposure to violence in rural middle school student might be lower than that in urban.The major assaulters were from classmates or schoolmates,teachers, and strangers.Most violence occurred at school,followed by on the way to home and playing places.The possible risk factors associated with exposure to violence mainly included demographic factors(13-14 and 15-16 years old,males), behavior factors(surfing at internet-clubs,playing electronic games, smoking,bullying,academic performance at middle level),and social-psychological factors(exposure to frequent quarrelling between parents,and self-esteem at low and middle level).Violence prevention projects target at risk factors should be developed and launched among rural middle school students. PARTⅡA Study on Exposure to Violence and Behavior Problems among Rural Middle School StudentsObjective:First,it was to analysis the prevalence of behavior problems.Second, it was to explore the relationship between exposure to violence and behavior problem,and to provide study data with the behavior interference of violence among rural middle school students.Methods:A cross-section study was conducted in 3620 middle school students randomly selected from rural area.A constructed data instrument and Achenbach Children Behavior Checklist(CBCL)were used to measure the exposure to violence and behavior problems respectively.Database was established by epidata 3.0.Desciptive statatistic methods were used to analysis the prevalence of exposure to violence and of behavior problems.Chi-square test was used to test the prevalence difference between each group.Logistic regression models were used to assess the possible behavior risk factors of exposure to violence.Results:Of the 3620 respondents,the prevalence of exposure to violence in past year was 33.8%(1225/3620).Males(42.9%)were more likely than females(25.3%)to be victimized,and the difference was significant (x~2=125.06,P＜0.01).The prevalence of behavior problems averaged 14.3%(519/3620),and students victimized reported significantly more behavior problems than those no-victimized(22.4%vs 10.95,x~2=99.206, P＜0.01).Similarly,males or females victimized also reported significantly more behavior problems than that no-victimized(19.8%vs 8.7%;x~2=45.551,P＜0.01 and 26.1%vs 11.3%;x~2=65.161,P＜0.01 respectively).The prevalence of behavior problem factors was significantly higher in students victimized than those no-victimized.After controlling factors,such as demographic factors,family background,academic performance et al,the result of multiple regression indicted that behavior problem factors related to exposure to violence were somatic complaints(OR=2.16,95%CI:1.57-2.97),social problems (OR=1.88,95%CI:1.18-2.99),thought problems(OR=1.94, 95%CI:1.05-3.60),delinquent behavior(OR=2.29,95%CI:1.27-4.16),aggressive behavior(OR=3.85,95%CI:1.70-8.69)in total sample,and somatic complaints(OR=2.13,95%CI:1.26-3.58),social problems (OR=2.25,95%CI:1.05-4.80),delinquent behavior(OR=2.84, 95%CI:1.41-5.71)in males,and somatic complaints(OR=2.29, 95%CI:1.54-3.41),thought problems(OR=2.72,95%CI:1.09-6.75),delinquent behavior(OR=2.81,95%CI:1.05-7.51),aggressive behavior (OR=16.72,95%CI:3.66-76.35)in females.Conclusion:The prevalence of behavior problems in respondents victimized was significantly higher than those no-victimized.There was strong relationship between exposure to violence and behavior problems in rural middle school students,and the possible behavior problem factors were somatic complaints,social problems,thought problems,delinquent behavior,aggressive behavior.So the project targeted at adolescent violence prevention and interference should focus on those having behavior problems. PARTⅢBehavior Problems and Exposure to Violence:The Mediating Role of Self-esteem in Rural Middle School StudentsObjective:To test a model in which self-esteem mediated the effects by behavior on exposure to violence in a sample of rural middle school students.Methods:A cross-section study was conducted in 3620 rural middle school students randomly selected from rural area.A constructed data instrument and Achenbach Children Behavior Checklist(CBCL)and Rosenberg self-esteem scale were used to measure the exposure to violence and behavior problems and self-esteem respectively.Relationship and Hierarchical regression analyses were used to test the relationship between variables.Sobel Z-test was used to explore whether self-esteem partially mediated the effects by behavior on exposure to violence with significant difference.Results:Hierarchical regression analyses provided evidence that the addition of self-esteem reduced the links between behavior and exposure to violence(βfrom 0.232 to 0.226).Sobel Z-test predicted that self-esteem partially mediated the effects by behavior on exposure to violence with significant difference(βfrom 0.232 to 0.226,Sobel-Z value=2.340, P＜0.05).Emotion violence,physical violence,and sexual violence were tested by the same model respectively,and the results showed that self-esteem partially mediated the effects by behavior on emotion violence with significant difference(βfrom 0.225 to 0.200,Sobel-Z value=1.992,P＜0.05),but not on physical or sexual violence.Conclusion:Self-esteem partially mediated the effects by behavior on exposure to violence(verbal violence)among rural middle school students.