There were Keywords: Abuse, Adolescents, Pakistan. World Health Organisation WHO defines violence as "the intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community that either results in or has a high likelihood of resulting in injury, death, psychological harm, maldevelopment or deprivation". A growing number of reports describe such exposure. In the United States, for example, violence against adolescents is a major cause of morbidity and mortality among this age group.
There are also some reports from India and South Korea which reveal bullying as a significant predictor of suicidal ideation among Asians. In a study, exposure to three different types of violence exposure to aggression among peers at school, physical punishment at school, and exposure to community violence was independently associated with poor school achievement among adolescents. The current study, therefore, was planned to assess the proportion of various types of abuses and to identify whether it is associated with school performances and psychological stress among adolescents from three major cities of Pakistan.
Subjects and Methods The cross-sectional, analytical school survey was conducted from March to September , comprising adolescent students at six schools in Karachi, Lahore and Quetta. Since it was a pilot study, the sample size was calculated using the WHO calculator. The final sample size calculated was Seven high schools of the three major cities were approached using convenience sampling to participate in the baseline lifestyle survey.
However, permission to interview the adolescents was not given by one school and it was subsequently excluded. The study was conducted with adolescents in grade 9 and 10 in the remaining six schools. All students in the selected classes from whom consent was obtained and who were present at their schools during the survey were included. Prior to the survey, the rationale of the study was explained to the adolescents and they could choose not to participate. The questionnaires were administered by a team of 3 medical students who helped the subjects in filling them out.
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The questionnaire was distributed, to two or three sections in each school, with each section containing students on an average. For confidentiality, the questionnaires were anonymously self-completed by the students. A draft of the questionnaire was produced and the questions were piloted among adolescents attending private secondary schools that were not included in the study sample.
Ambiguous questions or questions which were misinterpreted were re-phrased and the piloting continued until the research team was satisfied that the questions were clearly understandable by the students and were culturally appropriate. Before conducting interviews, all study participants and school administrations were assured of the confidentiality and anonymity, and efforts were made to ensure the privacy of the information.
We used the following questions for the outcome of interest and some of the explanatory variables: "During the past 12 months, how many times were you in a physical fight? As we were interested in any history of physical fight and injury, the variables were recoded to a binary version with responses of zero for 0 times and one for any number of times.
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Further questions asked included: "During the past 12 months, have you ever been verbally abused by? As we were interested in any history of having been verbally abused, physically abused, bullied, we recoded the variable to a binary variable with responses of 0 for no one and 1 for all other categories. For assessing psychological stress we used question: "What stress do you have? Lastly, we assessed school performance by asking, "Have you got on well at school? The students were given ample time to complete the questionnaire.
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All the data was managed by medical students who were trained prior to the task. The results were analysed using SPSS Frequencies and percentages were calculated to evaluate the different types of violence among adolescents. P-value less than 0. Those having poor school performance were Association between exposure to various types of violence and measures of poor school performance and psychological stress were worked out Table.
It is astounding how violence-related events are increasing among adolescents globally. Adolescents reported experiencing high levels of violence like physical abuse, verbal abuse, physical fight, serious injury and being bullied. The findings are consistent with earlier literature from Pakistan 16 and elsewhere. In Goa, India, frequent physical or verbal abuse among adolescents by parents or other family members was reported to be Our study found that the prevalence of being engaged in a physical fight among school-going adolescents was In Namibia, In southern Turkey, 2.
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The results of our study also pointed out that during the preceding 12 months, more than two-fifth We inquired only about being bullied, and failed to ask about participation in bullying. The differences between school systems and school environments may also account for the differences. In line with previous studies, the results of our study showed that involvement in bullying had serious implications on school performance and psychological stress. However, despite the presence of a clear relationship between involvement in bullying and psychological problems, it cannot be stated that bullying behaviours were causes of disturbances or vice versa because of the cross-sectional nature of our study.
To clarify this, further longitudinal studies are needed. There is a strong need for bullying prevention programmes in schools in Pakistan.
Poor school performance, as asked by how often the respondent got on well at school, was significantly associated with violence-related behaviours i. Respondents who stated that they never or sometimes got on well at school were more likely to report that they had been involved in at least one form of violence-related behaviour over the preceding year compared to those who responded that they mostly or always got on well at school. In this study, psychological stress was also associated with an increased risk of violence-related behaviours like physical abuse, verbal abuse, injury and bullying, which was also reported earlier.
These are reactive rather than proactive approaches. The assumption underlying the counseling approach is that students who repeatedly get into trouble need specific attention and services. Counseling often involves parents and teachers. Mediation of conflicts, on the other hand, is incident- rather than person-based: the goal is to negotiate and resolve conflicts in a constructive manner as soon as they happen.
Mediation and conflict resolution programs provide opportunities for modeling and rehearsing critical negotiation and resolution tactics. Various school personnel can be in charge of the counseling and mediation. In some schools, the administrators e.
Yet the qualifications and training of personnel might be critical factors, determining the success or failure of these approaches. The most recent national data from the school year includes a short section on school actions and reactions related to discipline issues. Of these, about 90 percent of the schools had zero-tolerance policies for firearms. Schools are sincere in their efforts to confront the antecedents of violence and alleviate students' fears, and they have implemented a variety of thoughtful programs.
But do these programs work? At this time, only a handful of violence prevention approaches have been evaluated, and even fewer have been determined to be effective or promising. Proper evaluation research is costly and typically deemed a luxury by funders and program developers. As a result, large amounts of both federal and state monies are spent to support school violence programs with little or no data on their potential effectiveness.
Given the lack of data on program effectiveness, school and district administrators have few guidelines to help them make informed choices among the myriad of alternatives. Instead, they are likely to make decisions based on such factors as the availability of program materials and training, cost, ease of implementation, and public relations issues such as how visible a particular tactic might be. Thus, popular methods such as physical surveillance and zero-tolerance policies regarding guns and violent behavior may be convenient, but they are not necessarily the most effective approaches to prevent the development of violent behavior.
School safety is clearly one of our national priorities. We owe it to our children to make sure that the methods we use to promote school safety will work. We cannot justify large amounts of taxpayer money for programs that feel good or that appear to be working according to the testimonials of a few administrators, teachers, or parents. Instead, rigorous program evaluation studies are needed. With the most promising approaches, longer-term evaluations must also be conducted. While we are waiting for evaluations to be conducted, decisionmakers can make meaningful choices by matching their goals with the primary goals of the various approaches.
School-based violence prevention approaches can address 1 outbursts of violent behavior e. However, the methods that address these primary goals can conflict with one another and have unintended effects. For example, the fears and anxieties of students cannot necessarily be reduced if the primary goal is to increase physical safety by means of increased surveillance.
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Hence, choices need to be made between psychological safety and physical safety; proactive strategies and reactive strategies; targeted and whole school approaches; punitive and instructional methods; and, finally, between incident-based and person-based interventions. Poll Release, March 6, , on School Safety. Cerio, and R. New York: Alfred University. Indicators of School Crime and Safety, Washington, DC: U. Department of Education, U. Department of Justice. Gottfredson, E. Chez, D.
Cantor, S. Crosse, and I.
Hamburg, and K. Williams Eds. Violence in American Schools. New York: Cambridge University Press. Overpeck, R. Pilla, W. Ruan, B. Simons-Morton, and P. New York: W. Freeman and Company. Graham Eds. New York: Guilford Press.
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Proctor, and D. Juvonen and S. The Plight of the Vulnerable and Victimized.
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