Pathways to socioeconomic health differences in Armenian adolescents:The role of bullying perpetration

Bullying perpetration might be an alternative way of hierarchy formation among adolescents. It can potentially compensate for the negative health influences of low socioeconomic status (SES), rewarding this unwanted behavior. This study aimed to investigate the role of bullying perpetration in the relationship between SES and health among Armenian adolescents. A nationally representative sample of 3679 adolescents aged 11-15 years (mean = 13.1, standard deviation = 1.6) participated in the Health Behavior in School-aged Children 2013/14 survey in Armenia. Complex samples multiple logistic regression were used to estimate the associations between two SES measures (family socioeconomic position [SEP] and material well-being) and three health outcomes (perceived health status, psychosocial well-being, and psychosomatic symptoms). Bullying perpetration was not associated with less than good health or low psychosocial well-being (P > 0.05) but increased the odds of reporting high psychosomatic symptoms (P < 0.05). Perpetration did not change the SES-health gradient substantially. However, in stratified analyses, socioeconomic inequalities in health were consistently weaker among perpetrators. The largest observed difference was in the relationship between low family SEP and less than good health (OR = 3.60, 95% CI = 2.77-4.67 vs. OR = 1.80, 95% CI = 1.06-3.04), whereas the smallest difference was in the relationship between low family SEP and high psychosomatic symptoms (OR = 1.27, 95% CI = 1.03-1.56 vs. OR = 1.04, 95% CI = 0.61-1.77). Our findings suggest that bullying perpetration, as an alternative hierarchy, may be looked at as a compensatory but vicious strategy in the face of the negative health influences of low SES in Armenian adolescents. For high-SES adolescents, on the other hand, social, emotional, or psychological problems might contribute to bullying perpetration. Consequently, bullying prevention activities in Armenia should focus on both low and high-SES adolescents, considering SES-specific pathways and mechanisms.