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Asian MSM, transgenders not accessing HIV testing – APCOM

To better understand why MSM and transgender people are not accessing HIV-related health services, the Asia Pacific Coalition on Male Sexual Health (APCOM) is joining other regional development and community partners to convene a consultation on the matter. “It is important that community voices are heard, they have to be central in creating demand and improving the take-up for these vital services,” said Midnight Poonkasetwattana, executive director of APCOM.

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A great concern of many public health professionals is the large numbers of men who have sex with men (MSM) and transgender people in Asia not accessing HIV testing and counselling (HTC). Even with such great concerns, there is very little real data that exists adequately measuring the scale of this problem, or the reasons behind it.

In order to better understand why MSM and transgender people are not accessing these vital health services, the Asia Pacific Coalition on Male Sexual Health (APCOM) is joining other regional development and community partners to convene a consultation on “Regional Meeting on Community-based HIV testing: Challenges and Opportunities” this October in Bangkok, Thailand. Having such information would greatly increase future efforts at regional and country level to ensure that community demand for HIV testing is created, alongside new testing delivery models that will better address community needs.

“It is important that community voices are heard, they have to be central in creating demand and improving the take-up for these vital services and it is hoped this event will provide real insights into how this can be achieved,” said Midnight Poonkasetwattana, executive director of APCOM.

Concerns over poor coverage, access and supportive environments, held by a number of community members, will be high priority for the many community-based organisations attending the consultation.

“Many current testing models still have a lot to achieve in terms of reaching communities and enabling them access to testing services. However, in scaling up we should ensure the rights of people being tested, and that ethical guidelines are in place. Such issues will also be taken up in the consultation,” said Malu S. Marin, regional coordinator of the Coalition of Asia-Pacific Regional Networks on HIV/AIDS (7 Sisters), one of the conveners of the Regional Consultation.

While access to HIV treatment and care services have expanded in Asia and the Pacific region (44 % of people in need had access to treatment in 2011), access to and uptake of HIV testing among key populations (MSM; sex workers; transgender, people who use drugs and their partners) remains low. More than 50% of people living with HIV are not aware of their HIV status. Many individuals learn of their HIV status at the hospital when diagnosed with an opportunistic infection occurring from advanced disease. This late diagnosis drives the steady increase of annual AIDS-related deaths. There are already some examples of effective interventions. In China in 2012, GZTZ used the Internet to mobilize as many as 5,389 MSM into HIV testing, accounting for 83% of the city’s yearly total.

The consultation will have representatives from the government sectors, essential to understand the communities’ views of HTC and their experiences with service providers, and perform a critical analysis of the current HIV testing models in the region.

Figure1. Percentage of key populations (KP) who received an HIV test in the last 12 months and know their results (selected countries)
KAP

“We know people reach HIV treatment, care, and the full range of prevention options through the gateway of HIV Testing and Counseling (HTC). Our colleagues in China, at GZTZ, highlighted to us how innovation, through the use of the Internet, could prove effect in scaling up HIV testing services amongst MSM. We hope this meeting with facilitate more sharing and learning on this important topic,” Poonkasetwattana said.

APCOM hopes to draw attention to more examples, similar to that in China, through the launch of their new Highlight series focusing on evidence-based examples of good practices in the region.

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Coming out as bisexual associated with increased risk of smoking – BU study

Bisexual young people may face unique forms of discrimination and stigma that increase their risk for smoking or other substance use behaviors.

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For many years, lesbian, gay, bisexual, and other non-heterosexual (LGB+) folks have been known to be more likely to smoke than their straight counterparts. But a new, first-of-its-kind Boston University School of Public Health (BUSPH) study paints a more precise picture by looking at LGB+ identities separately and over time, finding that bisexuality is the identity most associated with smoking, especially around the time of coming out.

Published in the journal JAMA Pediatrics, the nationally-representative cohort study followed 7,843 youth and young adults over three years, finding that those who came out as bisexual were twice as likely as consistently-heterosexual participants to start smoking. Coming out as lesbian, gay, or another non-heterosexual identity, or having a consistent LG+ identity, was not associated with being more likely to smoke.

Bisexual young people may face unique forms of discrimination and stigma that increase their risk for smoking or other substance use behaviors.

The study “highlights the importance of moving beyond static measures of sexual identity towards more dynamic measures that capture critical periods of vulnerability,” says Dr. Andrew Stokes, assistant professor of global health at BUSPH and the study’s corresponding author.

“This approach turned out to be really important, because it revealed disparities that would have otherwise been missed if we measured identity at one time point, or grouped all LGB+ identities together,” says study lead author Alyssa Harlow, a doctoral candidate at BUSPH.

Bisexual young people may face unique forms of discrimination and stigma that increase their risk for smoking or other substance use behaviors, Harlow adds.

“For example, they may experience stigma from heterosexual individuals as well as from within the LGB+ community. There’s also prior research that shows that bisexual populations have worse mental health outcomes than LG+ populations,” Harlow says.

The findings point to a need for public health interventions specifically designed to address the unique needs, experiences, and stressors associated with coming out and identifying as bisexual.

For the study, the researchers used data from the first four waves of the American Population Assessment of Tobacco and Health (PATH) study, which surveyed the same 14-29-year-olds three times between 2013 and 2018. (There were too few transgender respondents in this sample for the researchers to include gender identity in their analysis.) The researchers adjusted for other variables including sex, age, race/ethnicity, education level (for participants over 18) and parents’ education level (for participants under 18), and where participants lived (urban/nonurban, and region of the U.S.).

By the third wave, 14% of the respondents had smoked at some point, and 6% were current smokers. The researchers found that the same sexual identity patterns held true both for having smoked at any point in the study period and for being a current smoker.

The researchers found that, compared to a consistent heterosexual identity, coming out as bisexual was associated with being more than twice as likely to smoke. Participants with LG+ identities in the first wave who shifted to a bisexual identity, or vice versa, were twice as likely to smoke.

On the other hand, participants with a consistent LG+ identity throughout the three waves of the study and participants who started out identifying as heterosexual and came out as LG+ were not more likely to smoke than those with a consistent heterosexual identity–while those with a consistent bisexual identity were slightly more likely to smoke.

The researchers say that the study’s unique approach to LGB+ identities–separated and over time–could provide valuable insights for other issues that disproportionately affect the community, including mental health issues and substance use.

But to make that possible, more national surveys need to ask youth about their sexual orientation and gender identity, says study co-author Dielle Lundberg, a research fellow at BUSPH.

“The PATH study is unique because it asks youth about their sexual orientation and gender identity. Most national surveys do not,” Lundberg says. “We must advocate for better data. Whenever national surveys fail to ask about sexual orientation and gender identity, they are directly contributing to health inequities for LGBTQ+ populations.”

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Sexual, gender minorities almost four times more likely to experience violent victimization

LGBTQIA people are almost four times more likely than non-LGBTQIA people to experience violent victimization, which includes rape, sexual assault, and aggravated or simple assault. A plausible cause is anti-LGBTQIA prejudice at home, work or school, which would make LGBTQIA people particularly vulnerable to victimization in numerous areas of their everyday life.

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LGBTQIA people are almost four times more likely than non-LGBTQIA people to experience violent victimization, which includes rape, sexual assault, and aggravated or simple assault.

This is according to a study by the Williams Institute at UCLA School of Law, which also found that LGBTQIA people are more likely to experience violence both from someone known to the victim and at the hands of a stranger.

For this study (“Victimization rates and traits of sexual and gender minorities in the United States: Results from the National Crime Victimization Survey, 2017”), the researchers analyzed data from the 2017 National Crime Victimization Survey in the US. Written by Andrew Flores, Lynn Langton, Ilan H. Mayer and Adam P. Romero, the study was published in Science Advances.

The results showed that, in 2017, LGBTQIA people experienced 71.1 victimizations per 1,000 people, compared to 19.2 victimizations per 1,000 people for non-LGBTQIA people.

LGBTQIA people are more likely to experience violence both from someone known to the victim and at the hands of a stranger.

“We found that the odds of violent victimization among sexual and gender minorities (SGMs) were almost four times that of non-SGMs,” the researchers stated, adding that the higher rates were noticeable “across nearly all of the violent crime subtypes”.

In a statement, Flores said that it may be worth asking why this is happening. And for him, a “plausible cause is anti-LGBTQIA prejudice at home, work or school, which would make LGBTQIA people particularly vulnerable to victimization in numerous areas of their everyday life.”

Other findings included:

  • LGBTQIA people are about six times more likely to experience violence by someone who is known to them and about 2.5 times more likely to undergo it at the hands of a stranger
  • LBTQIA women are five times more likely than non-LBTQIA women to experience violent victimization
  • The risk of violence for GBT men is more than twice that of non-GBT men
  • About half of all victimizations are not reported to police.

For Meyer, the study’s findings “point to the importance of policies and interventions to reduce victimization and the need to consider the unique susceptibility to violence and the high rates of crime experienced by LGBTQIA people.”

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Combined intimate partner violence that includes sexual violence is common & more damaging

All types of intimate partner violence were associated with long-lasting damage to health but combinations that included sexual violence were more common and markedly more damaging to women’s physical and mental health.

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Women who experience sexual violence combined with other forms of intimate partner violence suffer greater damage to their health and are much more likely to attempt suicide, according to a study led by researchers at the University of Bristol’s Centre for Academic Primary Care published in the International Journal of Epidemiology .

Intimate partner violence – psychological, physical or sexual violence perpetrated by a current or former partner – is the most common form of violence experienced by women worldwide.

The study (titled ‘Categories and health impacts of intimate partner violence in the World Health Organization (WHO) multi-country study on women’s health and domestic violence’), conducted in collaboration with the World Health Organization (WHO) and University of Melbourne, found that all types of intimate partner violence were associated with long-lasting damage to health but combinations that included sexual violence were more common and markedly more damaging to women’s physical and mental health.

Researchers analyzed data from the WHO multi-country study on women’s health, which has information from 16 different sites in 11 different countries on over 21,000 women who have ever had a partner. This new analysis assessed different combinations of psychological, physical and sexual intimate partner violence and their impacts on health.

They found that over 15% of ever-partnered women had experienced a combination of intimate partner violence that included sexual violence. Those who had experienced this in the last year were ten times more likely to attempt suicide than those who had not.

Women who had experienced multiple forms of abuse were also more likely to experience difficulty walking, difficulty with daily activities, pain or discomfort, poor memory or concentration, dizziness, and vaginal discharge, and to be taking sleeping pills or painkillers.

All types of intimate partner violence were associated with long-lasting damage to health but combinations that included sexual violence were more common and markedly more damaging to women’s physical and mental health.

Study lead, Dr Lucy Potter a GP and NIHR In-Practice Clinical Research Fellow at the University of Bristol’s Centre for Academic Primary Care, said: “We know intimate partner violence is damaging to health. What this study adds is the recognition of the profound harm caused by multiple forms of abuse, particularly when it includes sexual violence, and how we do not see this when all forms of abuse are lumped together as one experience. Practitioners and policy makers must appreciate the diversity of experience of intimate partner violence to tailor support appropriately.

“We also found that these health impacts persist over a year after the abuse ends. So, effective prevention and early intervention are vital to the health of individuals and families and health systems.”

Senior author, Professor Gene Feder from the University of Bristol’s Centre for Academic Primary Care, said: “Violence against women is a violation of human rights that damages their and their children’s physical and mental health, with substantial health care and societal costs. It is an important cause of ill health among women globally and an indicator for Goal 5 – Gender Equality and Women and Girls’ Empowerment – of the United Nations’ Sustainable Development Goals.

“This study, analyzing the impact of different types and combinations of intimate partner violence, shows the severe health impact when these include sexual or psychological abuse. These types of abuse are often not recognized by health care providers.”

Women who had experienced multiple forms of abuse were also more likely to experience difficulty walking, difficulty with daily activities, pain or discomfort, poor memory or concentration, dizziness, and vaginal discharge, and to be taking sleeping pills or painkillers.

Intimate partner violence is a big issue in the LGBTQIA community.

In 2018, for instance, nearly half of men in same-sex couples suffered some form of abuse at the hands of their partner, according to a study that surveyed 320 men (160 male couples) in Atlanta, Boston and Chicago in the US to measure emotional abuse, controlling behaviors, monitoring of partners, and HIV-related abuse.

Unfortunately, a 2019 study found that domestic and family violence (DFV) and intimate partner violence (IPV) were perceived by community members and professional stakeholders to be a “heterosexual issue that did not easily apply to LGBTQIA relationships.” In particular, many community members held the view that relationships between (LGBTQIA) people could avoid the inherent sexism and patriarchal values of heterosexual, cisgender relationships, and, by implication, avoid DFV/IPV.

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Dieting and weight worries on rise in teens

While girls have consistently been more likely to diet to lose weight, the researchers found a greater increase over the years among boys, who were also becoming more likely to be trying to gain weight.

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Significantly higher numbers of Generation Z boys and girls are dieting to lose weight, and are likely to overestimate their own weight, finds a new UCL-led study.

The research, published in JAMA Pediatrics, found that girls who are trying to lose weight are also more likely to experience depressive symptoms than in previous years.

In 2015, 42% of 14-year-old girls and boys said they currently were trying to lose weight, compared to 30% in 2005.

Lead author Dr Francesca Solmi (UCL Psychiatry) said: “Our findings show how the way we talk about weight, health and appearance can have profound impacts on young people’s mental health, and efforts to tackle rising obesity rates may have unintended consequences.”

An increase in dieting among young people is concerning because experimental studies found that dieting is generally ineffective in the long term at reducing body weight in adolescents, but can instead have greater impacts on mental health.

“We know, for instance, that dieting is a strong risk factor in the development of eating disorders,” Solmi said.

For this study, the research team reviewed data from 22,503 adolescents in the UK, in three different decades, who are part of different cohort studies: the British Cohort Study (of people born in 1970; data was collected in 1986), the Children of the 90s study (born 1991-92, data collected in 2005), and Millennium Cohort Study (born 2000-02, data collected in 2015).

The adolescents were all asked questions about whether they were, or had been, trying to lose weight, whether they had dieted or exercised to lose weight, whether they perceived themselves to be underweight, about the right weight or overweight (which was compared to their actual height and weight measurements), and they filled out questionnaires that gauged depressive symptoms. The researchers found that in 2015, 44% and 60% of all participants had dieted or exercised to lose weight, respectively, compared to 38% and 7% in 1986.

The researchers say other evidence suggests that engagement in vigorous physical activity has remained relatively stable among adolescents over the past few decades.

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Senior author Dr Praveetha Patalay (Centre for Longitudinal Studies and MRC Unit for Lifelong Health & Ageing, UCL) said: “It seems that young people are exercising for different reasons than they did before – more adolescents seem to be thinking of exercise predominantly as a means to lose weight rather than exercising for fun, socialising and feeling healthy. We suspect that recent controversial calls to add ‘exercise-equivalent’ labels on food packaging may exacerbate this.”

While girls have consistently been more likely to diet to lose weight, the researchers found a greater increase over the years among boys, who were also becoming more likely to be trying to gain weight.

Dr Patalay said: “Societal pressures for girls to be thin have been around for decades, but body image pressures on boys may be a more recent trend. Our findings underscore the impact that societal pressures and public health messaging around weight can have on children’s health behaviours, body image and mental health.”

Both girls and boys also became more likely to over-estimate their weight from 1986 to 2005, and even more so by 2015, which the researchers say adds to their concerns that increased efforts to lose weight are not necessarily due to increased obesity rates.

The reported weight-related behaviours and weight misperception were associated with depressive symptoms, and among girls, this relationship was becoming even stronger over the three decades examined in this study. The findings could possibly be part of the explanation for increases in adolescent depressive symptoms that have been observed in recent decades.

Dr Solmi said: “Media portrayals of thinness, the rise of the fitness industry and the advent of social media may all partly explain our results, and public health messaging around calorie restriction and exercise might also be causing unintended harm. Public health campaigns around obesity should consider adverse mental health effects, and ensure they avoid weight stigma. By promoting health and wellbeing, as opposed to focusing on ‘healthy weight’, they could have positive effects on both mental and physical health.”

Weight issues also affect members of the LGBTQIA community.

In 2019, for instance, a study found that Grindr, the most popular dating app for gay, bisexual, two-spirit and queer men, had a negative effect on men’s body image, especially when it came to weight. Aside from the weight stigma, body dissatisfaction stemmed from sexual objectification and appearance comparison. 

Still in 2019, another study found that 44% to 70% of LGBTQ teens reported weight-based teasing from family members, 41% to 57% reported weight-based teasing from peers, and as many as 44% reported weight-based teasing from both family members and peers.

Yet another 2019 study found that Lesbian and bisexual women are at increased risk of being overweight or obese compared to heterosexual women.

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Risky sexual behavior and STIs are rising despite Covid-19 pandemic

A study concluded that the COVID-19 pandemic, despite lockdown and advice on social/physical distancing, did not inhibit risky behaviors and that acute STIs actually increased.

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Neil (not his real name), who claims to be in his 20s, is an “raw fun orgynizer” (or a person who organizes unprotected orgies/group sex through his Romeo, Grindr and Telegram accounts) from Santa Mesa Heights in Quezon City in Metro Manila. He is first to admit that organizing “gatherings” was affected by Covid-19, with the last pre-lockdown “orgynuman” (or an orgy that also involves a drinking session) held in some hotel in Ortigas on February 15.

But things have been “picking up again”, according to him, with the easing of the lockdown. So far, he already organized a gathering on October 28 in Cavite, and another one is scheduled in November in Sta. Mesa. And so “raunchy raw fun is back.”

The effect of Covid-19 on sexual connections is still under-studied; but at least one research found that despite the Covid-19 (SARS-CoV-2) lockdown restrictions, diagnosis of sexually transmitted infections (STIs), including gonorrhoea, secondary syphilis and mycoplasma genitalium (MG), have increased. This is true – at least – in two main STI centers in Milan, Italy. There, compared were the number of confirmed diagnoses of the most common STIs in patients with symptoms for the period 15 March 2020 to 14 April 2020 following social isolation measures (lockdown) adopted to control the epidemic, with the same period in 2019.

The results revealed that despite a reduction in the total number of attendances by over a third (37%, 233 in 2019 vs 147 in 2020), the number of acute bacterial infections, most associated with men who have sex with men (MSM), increased during the observational period, including secondary syphilis and gonorrhoea.

Cases fell, however, in the non-acute cases, such as genital warts and Molluscum Contagiosum.

The study concluded that the COVID-19 pandemic, despite lockdown and advice on social/physical distancing, did not inhibit risky behaviors and that acute STIs actually increased.

While it is unrealistic to prevent people from having sex, even in this extraordinary pandemic, close contact during sexual intercourse inevitably involves an increased risk of SARS-CoV-2 contagion.The findings show the importance of ongoing screening for STIs and the real benefit of having these types of services open and available during these unprecedented times.

Dr Marco Cusini, La Fondazione IRCCS Ca’ Granda Ospedale Maggiore di Milano Policlinico, Milano, Italy, stated: “It was assumed that the lockdown would reduce the opportunity for sexual encounters and STIs. However, I was surprised by the number of new acute infections diagnosed in this short period of time. Gonhorrhea and syphillis are typically more prevalent in people in their 30s, so infection may have increased because the concentration of COVID-19 morbidity and mortality in the elderly made the younger, more active, cohort feel protected and so less risk averse. While it is unrealistic to prevent people from having sex, even in this extraordinary pandemic, close contact during sexual intercourse inevitably involves an increased risk of SARS-CoV-2 contagion.The findings show the importance of ongoing screening for STIs and the real benefit of having these types of services open and available during these unprecedented times.”

While gonorrhoea is still highly susceptible to the mainstay antibiotic treatment option ceftriaxone, the emergence of antimicrobial resistant gonorrhoea remains of concern. Recommended combinations with antibiotics such as azithromycin should be avoided in the light of antibiotic stewardship, necessitating new treatment guidelines. Dr Henry J.C. de Vries of the STI outpatient clinic Health Service Amsterdam presented on The threat of antimicrobial resistant gonorrhoea at 12:00-12:15 CET on Thursday 29th October 2020.

Gonorrhoea is caused by the bacterium Nesisseria gonorrhoeae. Often, but not always, it presents no symptoms in females and is mostly symptomatic in males. Common symptoms in men include urethral discharge and pain upon urination (dysuria), and women may present with odorless vaginal discharge, dysuria and pain during sexual intercourse. Symptoms usually appear between 1-10 days after infection.

Gonorrhoea is on the rise across Europe, in 2017 alone, there were more than 89,000 confirmed cases (240 per day), of which MSM accounted for almost half of all the cases (47%). The UK reported 55% of all cases (75 per 100,000) followed by Ireland (47), Denmark (33), Iceland (29), Norway (27) and Sweden (25).

The first symptoms of syphilis usually develop around 2 or 3 weeks after infection, although they can start later than this. The main symptom is a small, painless sore or ulcer typically on the penis, vagina, or around the anus, although it can sometimes appear in the mouth or on the lips, fingers or buttocks. Secondary syphilis is a progression of the disease and symptoms, however is curable with treatment. In 2018, there were 33,927 confirmed cases in Europe. The highest rate was observed in Malta (17.9 cases per 100,000 population), followed by Luxembourg (17.1), the UK (12.6) and Spain (10.3).

The Milan study may provide a more scientific look at the sexual engagements at the time of Covid-19. But in the Philippines, access to sexual health services have been – and continue to be – hampered by Covid-19. So that the participants in the gatherings of those organized by the likes of Neil are not monitored. And yet checking those commenting on his Telegram GC (group chat), for instance, one would only see the focus on “fun”, not the “risks.”

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Victims of school bullying more prone to develop violent behavior in the future

Being a victim of bullying was detected as a risk factor for developing violent behavior at home against their family as well as at school. Likewise, those people who were violent in public or in class were shown to have higher scores in moral disengagement, meaning that they usually made excuses so that these acts would seem less serious than they really were.

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There is another pandemic that humans have been experiencing for a long time now and for which effective preventive measures have yet to be found: violence. This is shown in various ways in different aspects of life and continues to have serious consequences for society, the economy, our health and human relations.

The onset of violent behavior can be observed from childhood and adolescence, so studying what aspects lead to the development of these kinds of behaviors and which curb them has become a necessary step in their prevention.

A study from the University of Cordoba and the University of Cambridge – titled “Moral disengagement, victimization, empathy, social and emotional competencies as predictors of violence in children and adolescents“, which was published in Children and Youth Services Review – studied possible risk and protection factors for violence and, in this way, verified whether violent behavior can be predicted months or even years before it develops.

Specifically, the study focused on finding out if morality, victimization, empathy and social and emotional skills predict the expression of different violent behaviors in children and adolescents in different contexts, including at school and in a family setting.

“These behaviors refer to, for instance, troubling behavior at home, including physical violence towards parents and siblings, at school, including physical violence towards teaching staff and schoolmates, and other settings, including bad behavior in public,” explains Raquel Espejo Siles, doctoral student at the University of Cordoba who carried out this research during her stay at the Institute of Criminology at the University of Cambridge thanks to one of the ELMER grants from the Diputación de Córdoba (Cordoba’s county government).

Being a victim of bullying was detected as a risk factor for developing violent behavior at home against their family as well as at school.

Siles worked with Izabela Zych, Professor at the Psychology Department at the University of Cordoba and part of the LAECOVI (Study Laboratory on Coexistence and Violence Prevention) research group, whose line of research is this study’s framework.

The study also had the participation of David P. Farrington, Emeritus Professor of Criminology at the University of Cambridge, and Vicente J. Llorent, Professor at the Education Department at the University of Cordoba.

871 students between 10 and 17 years of age at different Andalusian educational centers took part in the research. They filled out two questionnaires, one in June 2017 and one in June 2018.

Interesting conclusions were drawn from the results.

“We found that violence used directly towards people was related to a tendency to make impulsive decisions and to a blind motivation to accomplish one’s aims, without regard for the disadvantages or negative consequences from using violence,” reveals Siles.

What is more, being a victim of bullying was detected as a risk factor for developing violent behavior at home against their family as well as at school. Likewise, those people who were violent in public or in class were shown to have higher scores in moral disengagement, meaning that they usually made excuses so that these acts would seem less serious than they really were.

At school, it was verified that higher scores for social and emotional competencies such as social awareness, self-management, motivation and decision making are protection factors against violence. Therefore, these results support prevention initiatives based on the potential of learning social and emotional skills at home as well as at school.

Enabling teenagers to reassess their goals and the consequences of their violent behavior could have an impact on decreasing violence further down the road. In addition, teaching different strategies to resolve issues in a different way could help them to compare and see the high individual and social price to pay for violent behavior.

The data shows that reducing victimization in a school setting could be effective in decreasing violence in different contexts in the future.

“It is important to prevent violence, both victimization and bullying, since the data found in this study and others indicate that violence is a vicious cycle. Being the aggressor or the victim entails a high risk of developing the opposite role, reinforcing and increasing violence both at school and outside of school,” points out Siles.

According to this research study, enabling teenagers to reassess their goals and the consequences of their violent behavior could have an impact on decreasing violence further down the road. In addition, teaching different strategies to resolve issues in a different way could help them to compare and see the high individual and social price to pay for violent behavior.

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