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Why the pediatric urologist should care about school bullying: an association between bullying and bowel/bladder dysfunction
Christina B. Ching, MD, Haerin Lee, MD, Matthew D. Mason, MD, Douglass B. Clayton, MD, John C. Thomas, MD, John C. Pope, IV, MD, Mark C. Adams, MD, John W. Brock, III, MD, Stacy T. Tanaka, MD, MS.
Vanderbilt University, Nashville, TN, USA.

Background:
Bullying has become a social plague associated with various deleterious outcomes. We sought to determine if there is an association between bullying and bowel and bladder dysfunction (BBD). We hypothesized a higher rate of bullying in our BBD population.
Methods:
We assessed exposure to school bullying with the “Setting the Record Straight” bullying questionnaire in children 8-11 years old being evaluated for BBD in our pediatric urology clinic. BBD was defined as diurnal and/or nocturnal enuresis, urinary tract infections, and/or symptoms of dysuria, frequency, and/or urgency. Children with an obvious anatomic anomaly to explain their symptoms were excluded. BBD was quantified with the Vancouver Symptom Score (VSS). Additionally, children between 8-11 years old at well visits in the primary care setting also completed the same questionnaires. Our goal was to compare the response of the two groups to both questionnaires. Population characteristics such as age, sex, race, and comorbidities were compared as well. Linear regression was used to assess the relationship between VSS and bullying questionnaire scores. Categorical variables were compared with chi-square test while continuous variables were compared using Student’s t-test.
Results:
A total of 113 children (mean 9 years old) in the pediatric urology clinic and 63 children (mean 9 years old) in the primary care setting consented to participate. When evaluating strict score cut-offs for bullying, there was not a significant difference in number of victims of bullying between the urology and primary care groups (3.5% vs. 3.2%, p=1.00); however, there were significantly more perpetrators of bullying in the primary care group (7.9% vs 0.9%, p=0.02). Although the pediatric urology and primary care groups were well matched for age (p=0.45), there were more boys (p<0.0001), non-Caucasians (p<0.0001) and children with comorbidities (p=0.003) in the primary care group. On univariate analysis, male sex, non-Caucasian race, and presence of comorbidity were positively associated with self and peer perceived bullying perpetrator score (p<0.05) but did not play a role in self and peer victimization score. Interestingly, 33% of children seen in the primary care setting met criteria based on VSS score for significant BBD. When looking specifically at the pediatric urology group, there was a significant association between VSS score and self and peer perceived victimization scores (p<0.001 and <0.001) but not for self and peer bullying perpetrator scores (p=0.72 and 0.93). When looking specifically at the primary care group, there was a significant association between VSS score and self and peer bullying perpetrator scores (p=0.01 and 0.001) but not for self and peer perceived victimization scores (p=0.14 and 0.84).
Conclusions:
BBD is prevalent in the community. Although bullying exposure is multi-factorial, we found that VSS score can be associated with both bullying victimization score and bullying perpetrator score.


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