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International Journal of Adolescent Medicine and Health

Editor-in-Chief: Merrick, Joav

Editorial Board: Birch, Diana ML / Blum, Robert W. / Greydanus, MD, Dr. HC (Athens), Donald E. / Hardoff, Daniel / Kerr, Mike / Levy, Howard B / Morad, Mohammed / Omar, Hatim A. / de Paul, Joaquin / Rydelius, Per-Anders / Shek, Daniel T.L. / Sher, Leo / Silber, Tomas J. / Towns, Susan / Urkin, Jacob / Verhofstadt-Deneve, Leni / Zeltzer, Lonnie / Tenenbaum, Ariel

CiteScore 2018: 0.79

SCImago Journal Rank (SJR) 2018: 0.350
Source Normalized Impact per Paper (SNIP) 2018: 0.476

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The association between school bullying victimization and substance use among adolescents in Malawi: the mediating effect of loneliness

Youn Kyoung Kim
  • Corresponding author
  • Louisiana State University, School of Social Work, Baton Rouge, LA 70803, United States of America, Phone: +225-578-3191
  • Email
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Moses Okumu / Eusebius Small
  • University of Texas, Arlington, School of Social Work, Arlington, TX, United States of America
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Silviya Pavlova Nikolova / Cecilia Mengo
Published Online: 2018-06-12 | DOI: https://doi.org/10.1515/ijamh-2017-0229


Background and objectives

Research has shown an increased prevalence of substance use among adolescents in countries in Sub-Saharan Africa. Peer affiliation, bullying, and psychological stress are significantly associated with substance use. This study empirically tested theoretical frameworks linking peer affiliation, bullying victimization, loneliness and substance use (specifically tobacco or alcohol use) among adolescents.

Materials and methods

Data were obtained from the 2009 Malawi Global School-based Health Survey (GSHS) with a representative sample of 2359 students aged 13–17 years in Malawi, Sub-Saharan Africa. Missing data were handled using multiple imputation. The study conducted path analyses using Mplus to test the conceptual models of tobacco use and alcohol use.


The results showed that loneliness partially mediated the association between bullying victimization and tobacco use in the first model, as well as the relationship between bullying victimization and alcohol use in the second model. Results indicated statistically significant indirect paths from bullying victimization to tobacco use and alcohol use through the mediation of loneliness. However, peer affiliation did not directly predict bullying victimization in the two path models; it directly predicted tobacco use only.


These findings have important implications in early intervention for health practitioners in school and mental health settings to prevent feelings of loneliness and substance use among adolescents who have experience with bullying victimization but no experience with depression, alcohol use or tobacco use.

Keywords: adolescents; alcohol use; bullying victimization; loneliness; peer affiliation; substance use; tobacco use


  • [1]

    Volk AA, Veenstra R, Espelage DL. So you want to study bullying? Recommendations to enhance the validity, transparency, and compatibility of bullying research. Aggress Violent Behav. 2017;36:34–43.CrossrefWeb of ScienceGoogle Scholar

  • [2]

    Hong JS, Davis JP, Sterzing PR, Yoon J, Choi S, Smith DC. A conceptual framework for understanding the association between school bullying victimization and substance misuse. Am J Orthopsychiatry. 2014;84(6):696–710.PubMedWeb of ScienceCrossrefGoogle Scholar

  • [3]

    Houbre B, Tarquinio C, Thuillier I, Hergott E. Bullying among students and its consequences on health. Eur J Psychol Educ. 2006;21(2):183–208.CrossrefGoogle Scholar

  • [4]

    Card NA, Stucky BD, Sawalani GM, Little TD. Direct and indirect aggression during childhood and adolescence: a meta-analytic review of gender differences, intercorrelations, and relations to maladjustment. Child Dev. 2008;79(5):1185–229.PubMedCrossrefWeb of ScienceGoogle Scholar

  • [5]

    AlBuhairan F, Abou Abbas O, El Sayed D, Badri M, Alshahri S, de Vries N. The relationship of bullying and physical violence to mental health and academic performance: a cross-sectional study among adolescents in Saudi Arabia. Int J Pediatr Adolesc Med. 2017;4(2):61–5.CrossrefGoogle Scholar

  • [6]

    Okumu M, Mengo C, Ombayo B, Small E. Bullying and HIV risk among high school teenagers: the mediating role of teen dating violence. J Sch Heal. 2017;87(10):743–50.CrossrefGoogle Scholar

  • [7]

    Marschall-Lévesque S, Castellanos-Ryan N, Parent S, Renaud J, Vitaro F, Boivin M, et al. Victimization, suicidal ideation, and alcohol use from age 13 to 15 years: support for the self-medication model. J Adolesc Heal. 2017;60(4):380–7.CrossrefGoogle Scholar

  • [8]

    Liang H, Flisher AJ, Lombard CJ. Bullying, violence, and risk behavior in South African school students. Child Abuse Negl. 2007;31(2):161–71.CrossrefPubMedGoogle Scholar

  • [9]

    Wilson ML, Bovet P, Viswanathan B, Suris JC. Bullying among adolescents in a sub-Saharan middle-income setting. J Adolesc Heal. 2012;51(1):96–8.CrossrefGoogle Scholar

  • [10]

    Peltzer K. Injury and social determinants among in-school adolescents in six African countries. Inj Prev. 2008;14(6):381–8.PubMedWeb of ScienceCrossrefGoogle Scholar

  • [11]

    Cluver L, Bowes L, Gardner F. Risk and protective factors for bullying victimization among AIDS-affected and vulnerable children in South Africa. Child Abuse Negl. 2010;34(10):793–803.Web of ScienceCrossrefPubMedGoogle Scholar

  • [12]

    Harmelen AL, Gibson JL, St Clair MC, Owens M, Brodbeck J, Dunn V, et al. Friendships and family support reduce subsequent depressive symptoms in at-risk adolescents. PLoS One. 2016;11(5):e0153715.Web of SciencePubMedGoogle Scholar

  • [13]

    Kubwalo HW, Muula AS, Siziya S, Pasupulati S, Rudatsikira E. Prevalence and correlates of being bullied among in-school adolescents in Malawi: results from the 2009 Global School-based Health Survey. Malawi Med J. 2013;25(1):12–4.PubMedGoogle Scholar

  • [14]

    Craig W, Harel-Fisch Y, Fogel-Grinvald H, Dostaler S, Hetland J, Simons-Morton B, et al. A cross-national profile of bullying and victimization among adolescents in 40 countries. Int J Public Heal. 2009;54(2):216–24.CrossrefGoogle Scholar

  • [15]

    Olweus D. Bullying at school: basic facts and effects of a school based intervention program. J Child Psychol Psychiatry. 1994;35(7):1171–90.PubMedCrossrefGoogle Scholar

  • [16]

    Hansen TB, Steenberg LM, Palic S, Elklit A. A review of psychological factors related to bullying victimization in schools. Aggress Violent Behav. 2012;17(4):383–7.CrossrefWeb of ScienceGoogle Scholar

  • [17]

    Werth JM, Nickerson AB, Aloe AM, Swearer SM. Bullying victimization and the social and emotional maladjustment of bystanders: a propensity score analysis. J Sch Psychol. 2015;53(4):295–308.Web of ScienceCrossrefPubMedGoogle Scholar

  • [18]

    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(4):419.Web of ScienceCrossrefPubMedGoogle Scholar

  • [19]

    Ttofi MM, Farrington DP, Lösel F. School bullying as a predictor of violence later in life: a systematic review and meta-analysis of prospective longitudinal studies. Aggress Violent Behav. 2012;17(5):405–18.CrossrefWeb of ScienceGoogle Scholar

  • [20]

    Lereya ST, Copeland WE, Costello EJ, Wolke D. Adult mental health consequences of peer bullying and maltreatment in childhood: two cohorts in two countries. Lancet Psychiatry. 2015;2(6):524–31.CrossrefPubMedWeb of ScienceGoogle Scholar

  • [21]

    Kubwalo HW, Muula AS, Siziya S, Pasupulati S, Rudatsikira E. Prevalence and correlates of being bullied among in-school adolescents in Malawi: Results from the 2009 Global School-Based Health Survey. Malawi Med J. 2913;25(1):12–14.Google Scholar

  • [22]

    Carbone-Lopez K, Esbensen F-A, Brick BT. Correlates and consequences of peer victimization: gender differences in direct and indirect forms of bullying. Youth Violence Juv Justice. 2010;8(4):332–50.Web of ScienceCrossrefGoogle Scholar

  • [23]

    Maniglio R. Bullying and other forms of peer victimization in adolescence and alcohol use. Trauma, Violence, Abus. 2016;18(4):457–73.Web of ScienceGoogle Scholar

  • [24]

    Taylor JE, Conard MW, Koetting O’Byrne K, Haddock CK, Poston WS. Saturation of tobacco smoking models and risk of alcohol and tobacco use among adolescents. J Adolesc Heal. 2004;35(3):190–6.CrossrefGoogle Scholar

  • [25]

    Mbongwe B, Tapera R, Phaladze N, Lord A, Zetola NM, Clark M. Predictors of smoking among primary and secondary school students in Botswana. PLoS One. 2017;12(4):e0175640.PubMedWeb of ScienceGoogle Scholar

  • [26]

    Wormington SV, Anderson KG, Tomlinson KL, Brown SA. Alcohol and other drug use in middle school: the interplay of gender, peer victimization, and supportive social relationships. J Early Adolesc. 2012;33(5):610–34.Web of ScienceGoogle Scholar

  • [27]

    Luk JW, Wang J, Simons-Morton BG. Bullying victimization and substance use among U.S. adolescents: mediation by depression. Prev Sci. 2010;11(4):355–9.CrossrefWeb of SciencePubMedGoogle Scholar

  • [28]

    Wormington SV, Anderson KG, Schneider A, Tomlinson KL, Brown SA. Peer victimization and adolescent adjustment: does school belonging matter? J Sch Violence. 2016;15(1):1–21.CrossrefWeb of SciencePubMedGoogle Scholar

  • [29]

    Hong JS, Espelage DL. A review of research on bullying and peer victimization in school: an ecological system analysis. Aggress Violent Behav. 2012;17(4):311–22.Web of ScienceCrossrefGoogle Scholar

  • [30]

    Lazarus RS. Coping theory and research: past, present, and future. Psychosom Med. 1993;55:234–47.CrossrefPubMedGoogle Scholar

  • [31]

    Dyal SR, Valente TW. A systematic review of loneliness and smoking: small effects, big implications. Subst Use Misuse. 2015;50(13):1697–716.PubMedCrossrefWeb of ScienceGoogle Scholar

  • [32]

    McKay MT, Konowalczyk S, Andretta JR, Cole JC. The direct and indirect effect of loneliness on the development of adolescent alcohol use in the United Kingdom. Addict Behav Rep. 2017;6:65–70.PubMedCrossrefGoogle Scholar

  • [33]

    Enders CK, Bandalos DL. The relative performance of full information maximum likelihood estimation for missing data in structural equation models. Struct Equ Modeling. 2001;8:430–57.CrossrefGoogle Scholar

  • [34]

    Jelicic H, Phelps E, Lerner RM. Use of missing data methods in longitudinal studies: the persistence of bad practices in developmental psychology. Dev Psychol. 2009;45:1195–9.Web of SciencePubMedCrossrefGoogle Scholar

  • [35]

    Siddique J, Belin TR. Multiple imputation using an iterative hot-deck with distance-based donor selection. Stat Med. 2008;27:83–102.PubMedWeb of ScienceCrossrefGoogle Scholar

  • [36]

    Ford P, Clifford A, Gussy K, Gartner C. A systematic review of peer-support programs for smoking cessation in disadvantaged groups. Int J Environ Res Public Heal. 2013;10:5507–22.CrossrefGoogle Scholar

  • [37]

    PhotoVoice. Photography for social change [Internet]. London: PhotoVoice; 2017 [cited 2017 March 20]. Available from: https://photovoice.org.

  • [38]

    Baer AL, Glasgow JN. Take the bullies to task: using process drama to make a stand. English J. 2008;97:79–86.Google Scholar

  • [39]

    Burton B. Dramatising the hidden hurt: acting against covertbullying by adolescent girls. Research in Drama Educ. 2010;15:255–70.CrossrefGoogle Scholar

  • [40]

    Dennis K. Acting up: theatre of the oppressed as critical ethnography. Int J of Qualitative Methods. 2009;8:65–96.CrossrefGoogle Scholar

  • [41]

    Graves K, Frabutt J, Vigliano D. Teaching conflict resolution skills to 80 middle and high school students through applied theatre and role play. J Sch Violence. 2007;6(4):59–79.Google Scholar

  • [42]

    Brazq C, Bekemeier B, Springer C, Huebner CE. Our community in focus: the use of photovoice for youth-driven substance abuse assessment and health promotion. Heal Promotion and Practice. 2011;12(4):502–11.CrossrefGoogle Scholar

  • [43]

    Lopez ED, Eng E, Robinson N, Wang CC. Photovoice as a community-based participatory research methods. In: Israel BA, Eng E, Schulz AJ, Parker EA, editors. Methods in community-based participatory research for health. San Francisco, CA: Jossey-Bass; 2005. pp. 326–48.Google Scholar

  • [44]

    Helm S, Lee W, Hanakahi V, Gleason K, McCarthy K, Haumana. Using photovoice with youth to develop a drug prevention program in a rural Hawaiian community. Indian Alsk Native Ment Health Res. 2015;22(1):1–26.CrossrefGoogle Scholar

  • [45]

    Simantov E, Schoen C, Klein JD. Health-compromising behaviors: why do adolescents smoke or drink? Arch Pediatr Adolesc Med. 2000;154(10):1025–33.CrossrefPubMedGoogle Scholar

  • [46]

    Griffin KW, Scheier LM, Acevedo B, Grenard JL, Botvin GJ. Long-term effects of self-control on alcohol use and sexual behavior among urban minority young women. Int J Env Res Public Heal. 2012;9(1):1–23.Google Scholar

About the article

Received: 2017-12-30

Accepted: 2018-04-01

Published Online: 2018-06-12

Citation Information: International Journal of Adolescent Medicine and Health, 20170229, ISSN (Online) 2191-0278, DOI: https://doi.org/10.1515/ijamh-2017-0229.

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