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square tests, t-tests, analysis of variance (ANOVA) and covariance (ANCOVA). The ANOVA tested the unadjusted associations between bullying roles and desire for cosmetic surgery and the ANCOVA adjusted for covariates (age, parent education and ethnicity) and included sex as a factor. A bullying x sex interaction term was added to the model to test whether any effects were moderated (i.e., sex-specific). These analyses were performed using IBM SPSS 22.0. To examine the potential mechanisms between bullying role and desire for cosmetic surgery, path analyses were performed in Mplus version 7.4 using full information maximum likelihood, which can handle missing data. (54) We first estimated the psychological functioning variable using the scale scores of self-esteem, body esteem and emotional problems (reverse scored). Dummy variables were created (e.g. uninvolved=0, victim=1) to examine the direct effect of each bullying role on desire for cosmetic surgery and the indirect (mediated) effect via psychological functioning. Paths adjusted for covariates were computed for each bullying role separately. To assess model fit, the root-mean square error of approximation (RMSEA), the Comparative Fit Index (CFI) and the Tucker-Lewis index (TLI) were used. RMSEA values less than 0.06 and CFI and TLI values greater than 0.90 indicate an acceptable model. (55-57) Model results are expressed as standardized regression coefficients (β). Results Missing and descriptive data Missing data on desire for cosmetic surgery (2.5%) and the covariates (1.1%) were low. Missing data was highest on the body-esteem scale (15.4%) (table 3) and was related to age (odds ratio (OR) = 0.88, 95% confidence interval (95% CI) = 0.79 to 0.99, p=.034); the odds of missing data was lower in older adolescents. 7 Descriptive data for each bullying role are reported in table 3. The majority of the sample were bullyvictims (39.1%) and victims were most likely to be girls (67.6%). Victims and bully-victims had significantly poorer psychological functioning than bullies and uninvolved adolescents. Victims had the lowest body esteem, self-esteem and had the highest emotional problem scores. Overall, mean interest in cosmetic surgery was low (M=1.79, SD=1.06, range 1-5). Do adolescents in all bullying roles have a greater desire for cosmetic surgery than adolescents uninvolved in bullying? Bullies, victims and bully-victims were significantly more interested in cosmetic surgery than uninvolved adolescents. In the unadjusted model (ANOVA), bullying role significantly predicted desire for cosmetic surgery (F(3,748) = 17.57, p Every child’s path to adulthood—reaching developmental and emotional milestones, learning healthy social skills, and dealing with problems—is different and difficult. Many face added challenges along the way, often beyond their control. There’s no map, and the road is never straight. But the challenges today’s generation of young people face are unprecedented and uniquely hard to navigate. And the effect these challenges have had on their mental health is devastating. Recent national surveys of young people have shown alarming increases in the prevalence of certain mental health challenges— in 2019, one in three high school students and half of female students reported persistent feelings of sadness or hopelessness, an overall increase of 40% from 2009. We know that mental health is shaped by many factors, from our genes and brain chemistry to our relationships with family and friends, neighborhood conditions, and larger social forces and policies. We also know that, too often, young people are bombarded with messages through the media and popular culture that erode their sense of self-worth—telling them they are not good looking enough, popular enough, smart enough, or rich enough. That comes as progress on legitimate, and distressing, issues like climate change, income inequality, racial injustice, the opioid epidemic, and gun violence feels too slow. And while technology platforms have improved our lives in important ways, increasing our ability to build new communities, deliver resources, and access information, we know that, for many people, they can also have adverse effects. When not deployed responsibly and safely, these tools can pit us against each other, reinforce negative behaviors like bullying and exclusion, and undermine the safe and supportive environments young people need and deserve. Introduction from the Surgeon General Protecting Youth Mental Health: The U.S. Surgeon General’s Advisory 4 All of that was true even before the COVID-19 pandemic dramatically altered young peoples’ experiences at home, at school, and in the community. The pandemic era’s unfathomable number of deaths, pervasive sense of fear, economic instability, and forced physical distancing from loved ones, friends, and communities have exacerbated the unprecedented stresses young people already faced. It would be a tragedy if we beat back one public health crisis only to allow another to grow in its place. That’s why I am issuing this Surgeon General’s Advisory. Mental health challenges in children, adolescents, and young adults are real, and they are widespread. But most importantly, they are treatable, and often preventable. This Advisory shows us how. To be sure, this isn’t an issue
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