Violence Prevention: School-based Anti-bullying Interventions

Findings and Recommendations

The Community Preventive Services Task Force (CPSTF) recommends school-based anti-bullying interventions to reduce bullying experiences and improve mental health among students. Systematic review evidence shows that when interventions are implemented in schools, students report fewer episodes of bullying perpetration, fewer episodes of bullying victimization, and fewer mental health symptoms such as anxiety and depression.

The full CPSTF Finding and Rationale Statement and supporting documents for Violence Prevention: School-based Anti-bullying Interventions are available in The Community Guide Collection on CDC Stacks.

Intervention

School-based anti-bullying interventions aim to prevent bullying experiences among students inside and outside of school. Interventions provide group education sessions for students, training and consultation to school staff, or both. Student sessions may enhance interpersonal and emotional skills. School staff may be trained to deliver student sessions and implement evidence-based anti-bullying policies and practices. Interventions may focus on traditional face-to-face bullying, cyberbullying, or both.

About The Systematic Review

CPSTF uses recently published systematic reviews to conduct accelerated assessments of interventions. The following published review was selected and evaluated:

Fraguas D, Diaz-Caneja CM, Ayora M, Duran-Cutilla M, Abregu-Crespo R, et al. Assessment of school anti-bullying interventions: a meta-analysis of randomized clinical trials. JAMA Pediatrics 2021;175(1):44-55.

The published review included 69 studies overall (search period through February 2020). The CPSTF abstracted supplemental information for the subset of 19 studies conducted in the United States or Canada.

Study Characteristics

Studies were randomized trials (69 studies)
Conducted primarily in Europe (31) and North America (17 U.S., 2 Canada). Remaining studies from Australia (3), China (4), South Africa (3), Brazil (2), and one each from Chile, Indonesia, Israel, Iran, New Zealand, Turkey, and Zambia
U.S. and Canadian studies primarily focused on elementary schools (10), middle schools (5), or both (2). Only one in high school and one in preschool or kindergarten
U.S. study participants included Black or African American students (median 16.0%; 14 studies) and Hispanic or Latino students (median 25.5%; 14 studies)
Seven U.S. studies reported student participation in free or reduced lunch program (median 40%)

Summary of Results

Sixty-nine studies were included in the published review.

Students reported small reductions in both bullying perpetration (35 studies) and victimization (32 studies)
Student assessments of mental symptoms including anxiety, depression, and well-being improved (20 studies)
Studies addressing cyberbullying found small reductions in combined measures of cyberbullying perpetration and victimization (5 studies)

Summary of Economic Evidence

A systematic review of economic evidence has not been conducted.

Applicability

Findings applicable to primary and middle school students in the United States.

Evidence Gaps

Which activities and combinations increase intervention effectiveness?
How effective are interventions for groups at increased risk for bullying and cyberbullying including students who self-identify as LGBQI+, have disabilities, or are overweight (Fraguas et al. 2019; National Academy of Sciences 2016)?
How effective are school-based anti-bullying interventions when implemented in the following settings?
- High schools
- Charter or private schools
- Rural communities
- Communities with lower incomes
What are the effects of school-based anti-bullying interventions on the following outcomes?
- Specific mental and behavioral health outcomes (e.g., depression)
- Educational outcomes and attainment
- Bystander action
- Number of students who witness bullying perpetration on others
- Risk behaviors
- Other forms of violence and delinquent behavior

Implementation Considerations and Resources

Violence and violence prevention efforts in school settings should be considered within the broader context of violence and drivers of violence in the community.

CPSTF recommendations complement guidance on school anti-bullying interventions available through CDC’s violence prevention activities.

Program planners may find it helpful to conduct assessments of school and community violence prevention needs, resources, and readiness in selecting appropriate interventions. Assessing Prevention Capacity & Implementing Change provides guidance.

Several publicly available resources provide implementation guidance:

StopBullying.gov from U.S. Department of Health and Human Services provides definitions and prevention guidance
Protecting Youth Mental Health: The U.S. Surgeon General’s Advisory outlines recommendations to improve youth mental health
STRYVE Action Council — Safe States Alliance is a multidisciplinary consortium collaborating to build safe, healthy communities
National Center on Safe Supportive Learning Environments offers resources for improving school climate
Children’s Safety Network provides technical assistance to state health departments
Health Alliance for Violence Intervention (HAVI) supports connections between communities and systems of care

Crosswalks

Healthy People 2030 icon Healthy People 2030 includes the following objectives related to this CPSTF recommendation.