Journal of Pediatric Nursing 59 (2021) 55–62

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Journal of Pediatric Nursing

journal homepage: www.pediatricnursing.org

What Types of Delinquent Activities are Bullies, Victims, and Bully/

Victims in Urban Neighborhoods Most Likely Involved in?
Jun Sung Hong a,⁎, Ji-Kang Chen b, Shu-Chen Wang c, Jeoung Min Lee d, Carl L. Algood e,f, Dexter R. Voisin g
a
School of Social Work, Wayne State University, Detroit, MI, United States of America
b
Department of Social Work, The Chinese University of Hong Kong, Hong Kong, SAR, China
c
National Academy for Educational Research, Research Center for Education Systems and Policy, Taiwan
d
School of Social Work, Wichita State University, Wichita, KS, United States of America
e
School of Social Work, University of Maryland, Baltimore, MD, United States of America
f
Walter Reed National Military Medical Center, Bethesda, MD, United States of America
g
Factor-Inwentash Faculty of Social Work, University of Toronto, Ontario, Canada

a r t i c l e i n f o a b s t r a c t

Article history: Purpose: The current study explores which types of delinquent activities bullies, victims, and bully/victims are
Received 24 September 2020 most at risk of from a sample of urban African American adolescents.
Revised 29 December 2020 Design and methods: The research design was cross-sectional, which includes a sample of low-income African
Accepted 29 December 2020 American adolescents in Chicago's Southside. The study participants included 523 adolescents. Descriptive statis-
tics, latent class analysis, and logistic regression analysis were conducted.
Keywords:
Results: Bullies, victims, and bully/victims are all at a heightened risk of theft, threatening behavior, and assaultive
African American
Bullying
behavior. Irrespective of bullying status, delinquency is a serious problem for urban adolescents who are bullies,
Delinquent behavior victims, or bully/victims.
Urban Conclusions: Investigating the types of delinquent activities bullies, victims, and bully/victims are most likely to be
Victimization involved in is important.
Implications for practice: Evidence-based treatment plans require assessment tools that are tailored for urban
African American adolescents. Nurses are advised to consider interventions that promote resilience.
© 2021 Elsevier Inc. All rights reserved.

Introduction
Adolescent bullying is a significant concern, and numerous studies
have addressed the prevalence, antecedents, and psychosocial and
health outcomes of bullying (Gini & Pozzoli, 2009, 2013; Ttofi et al.,
2011). Although the prevalence rate of bullying varies, studies estimate
that between 5% to 20% of youth are identified as bullies, about 20% to
30% are victims, and about 5% to 20% are bully/victims (Cho & Lee,
2018a; Ttofi et al., 2011; Wolke et al., 2013). Bullying and peer victimi-
zation are serious concerns for racial minority adolescents, although re-
search findings on bullying involvement among these adolescents have
been largely inconsistent. To illustrate, according to Goldweber et al.'s
(2013) study findings, African American adolescents are most likely to
be identified as either victims or bully/victims (i.e., victims who become
bullies) whereas other studies showed that they are more likely to be
identified as perpetrators of bullying (Fitzpatrick et al., 2007; Nansel
et al., 2001; Wang et al., 2009). For instance, Wang et al. (2009) found
⁎ Corresponding author at: School of Social Work, Wayne State University, 5447
Woodward Avenue, Detroit, MI 48202, United States of America.
E-mail address: fl4684@wayne.edu (J.S. Hong).
that African Americans were more likely to be involved in more bullying
perpetration and less victimization.
Serious consequences of bullying have also been documented, and
many studies showed that involvement in bullying (as a victim, perpe-
trator, or bully/victim) is correlated with delinquent activities, another
serious issue that heavily affects racial minority adolescents. Despite a
decrease in the number of adolescents in the juvenile justice system, a
disproportionate number of minority youth in the juvenile justice sys-
tem continues to be a challenge. In 2008, minority youth represented
13.3% of the United States population, yet represented 36.9% of all
cases juvenile courts handled (Leiber & Peck, 2014). More recently,
the 2018 statistics on demographic data of delinquency cases handled
by courts, which were compiled by the U.S. Department of Justice,
Office of Juvenile Justice and Delinquency Prevention (2019) docu-
mented a total of 755,510 cases from ages 10 to 17. Of these cases,
consisting of juveniles between ages 12 to 17, African Americans com-
prised 258,500 cases (Hockenberry & Puzzanchera, 2020).
Both involvements in bullying and delinquency are public concerns,
and the association between the two has been well documented in the
research literature. The present study aims to extend the bullying-
delinquency research by exploring which types of delinquent activities

https://doi.org/10.1016/j.pedn.2020.12.019
0882-5963/© 2021 Elsevier Inc. All rights reserved.
J.S. Hong, J.-K. Chen, S.-C. Wang et al.
bullies, victims, or bully/victims are most likely to participate in, from a
sample of African American adolescents in urban neighborhoods.
Bullying as a precursor to delinquency
A substantial body of empirical research has established that in-
volvement in bullying, as a bully, victim, or bully/victim is predictive
of delinquent behaviors and activities (Aldridge et al., 2018; Barboza,
2015; Bender & Lösel, 2011; Higgins et al., 2012; Kim, Lee, Cho,
Peguero, & Misuraca, 2019; Walters & Espelage, 2017, 2019; Wong &
Schonlau, 2013). Such linkage has been supported by theories, such as
the General Strain Theory, which purports that strainful events and re-
lationships (e.g., bullying victimization) correlate positively to delin-
quency (Hay et al., 2010) and Self-Control Theory, which asserts that
individuals with low self-control (e.g., bullies) are highly at risk of devi-
ant and delinquent behavior (Cho & Lee, 2018b). However, little is
known about the specific types of delinquent activities that bullies, vic-
tims, and bully/victims are at the most risk of participating in. This line
of research inquiry is important for many reasons. Adolescents in urban
neighborhoods frequently encounter bullying and peer aggression in
their school and in their neighborhoods where violence-prevention
programs are scarce or absent because of limited resources. Also, due
to structural inequality and a lack of protection, urban adolescents are
at a heightened risk of various kinds of delinquent and criminal activi-
ties in their neighborhoods, ranging from theft of property to illegal sex-
ual activities. The odds of engaging in such activities are likely to be
significantly higher when they experience or are exposed to bullying.
However, it is unclear whether youth identified as bullies, victims, or
bully/victims are prone to certain types of delinquent activities. Investi-
gating the types of delinquent activities adolescents identified as bullies,
victims, and bully/victims most likely engage in can unravel some of the
complexities of the bullying-delinquency relationship by identifying
motives for delinquent activities of bullies, victims, and bully/victims.
Subtypes of bullying and the types of delinquent activities
Extant studies show variations in the types of delinquent activities
bullies, victims, and bully/victims are involved in. However, an impor-
tant question is whether bullying perpetration might influence an indi-
vidual in such ways as to reinforce violent behaviors. According to two
longitudinal study findings, bullies are shown to engage in more serious
and violent forms of delinquent activities (Bender & Lösel, 2011;
Sigfusdottir et al., 2010). Such findings appear to support Ttofi et al.'s
(2012) argument of a persistent underlying violent tendency, which is
continuity of violent behaviors. In other words, adolescents who exhibit
one form of violent behavior (e.g., bullying) are likely to continue to en-
gage in other forms of violent behavior (e.g., violent delinquency).
These findings also highlight the importance of early intervention re-
search in focusing on children's bullying and aggressive behavior early
on before it develops into a more serious form of violence (Ttofi et al.,
2012). On the other hand, Walters and Espelage's (2019) study, which
comprised a sample of 1001 U.S. middle school students, found that
bullies engaged in all types of delinquent activities, ranging from non-
violent (i.e., theft, truancy) to violent (i.e., threatening) behaviors.
Victims of bullying may resort to certain types of delinquent behav-
iors, such as alcohol and tobacco use in an effort to cope with psycholog-
ical problems that are linked to bullying. The self-medication
hypothesis, for example, explains that alcohol and tobacco use provides
relief from psychological suffering (Khantzian, 1997). Less violent forms
of delinquent behaviors, such as drug-related delinquent activities
(e.g., using or selling drugs) are also reported outcomes of bullying vic-
timization (Aldridge et al., 2018). Victims of bullying also might resort
to other forms of delinquent activities to lessen psychological distress,
such as illegal sexual activities, which include engaging in sex in ex-
change for money or drugs. As research literature on child maltreatment
has shown, youth are likely to turn to illegal sexual activities in an effort
56
Journal of Pediatric Nursing 59 (2021) 55–62
to cope with victimization (e.g., Kramer & Berg, 2003; Roe-Sepowitz,
2012; Wilson & Widom, 2010). Although research, to date, has yet in-
vestigated how bullying victimization might correlate with illegal sex-
ual activities, victims of bullying might be most at risk of turning to
illegal sexual activities as a means of self-medicating.
Youth who are both a victim and perpetrator of bullying (or bully/
victims), on the other hand, report greater problematic behaviors
(Espelage & Holt, 2006; Haynie et al., 2001), less favorable attitude to-
wards school (Stein et al., 2007), and are supportive of retaliatory be-
haviors (O'Brennan et al., 2009) than either bullies or victims, making
them vulnerable to all types of delinquent activities. According to
Haynie et al.'s (2001) research, bully/victims were found to score less fa-
vorably than either bullies or victims on all the psychosocial and behav-
ioral variables. In Liang et al.'s (2007) study, bully/victims were found to
show comparable violent, anti-social, and risk-taking behavior profiles
to bullies as well as comparable tobacco use profiles to victims. Other
studies also suggest that bully/victims are most likely at risk of
experiencing all types of delinquency, ranging from non-violent behav-
iors such as defiance, alcohol/drug use, and disruptive behaviors to vio-
lent behaviors such as aggression and physical fights (Cook et al., 2010;
Kelly et al., 2015).
The study hypotheses
Using a convenience sample of urban African American adolescents
in four neighborhoods in Chicago's Southside, we propose and test the
following four hypotheses: (a) guided by Ttofi et al.'s (2012) persistent
underlying violent tendency argument, bullies-only are particularly at
risk of exhibiting threatening and assaultive behaviors; (b) guided by
the self-medication hypothesis, victims-only are particularly at risk of il-
legal sexual activities; (c) bullies, victims, and bully/victims are at risk
of theft; (d) bully/victims are at risk of both violent and non-violent
types delinquent activities.
Method
Participants and setting
Cross-sectional research that includes a purposive sample of low-
income African American adolescents was conducted between August
of 2013 and January of 2014 in four low-income neighborhoods located
in Chicago's Southside: Englewood, Woodlawn, Southshore, and
Kenwood. Data were collected by the last author, and the study was ap-
proved by the Institutional Review Board at the last author's prior insti-
tution. The range of average annual median incomes in these
neighborhoods was from $24,049 to $35,946 (Chicago's average annual
income was $43,628), and single female-headed households were be-
tween 28.9% and 32.3% (Chicago's average percentage of the single
female-headed household was 13.9%). Study participants were re-
cruited in three high schools, one youth church group, two community
youth programs, and four public venues, such as parks, fast food outlets,
and movie theaters. The number of individuals enrolled in the study and
the number of those approached at each site was 579/606 in schools,
38/42 in community centers, 44/49 in churches, and 39/56 in public
venues (56/39). The overall response rate of the 753 adolescents who
were asked to participate in the research was 87%. In the present
study, adolescents were eligible for the study if they self-identified as
African American and were under eighteen years of age who provided
informed assent, and had a caregiver who also provided informed con-
sent. The total number of participants in the present study was 523.
Flyers describing the study were posted at each of these locations,
and trained research assistants introduced the study to potential partic-
ipants in these locations. Each participant was provided with a detailed
letter that describes the study, along with parental consent forms, and
those who returned signed consent forms were enrolled in the study.
Youth recruited in public venues were only asked to participate if a
J.S. Hong, J.-K. Chen, S.-C. Wang et al.
caregiver was present to provide consent. Questionnaires were admin-
istered in small groups when possible.
All participants were proctored by the research assistants who were
comprised of undergraduate and graduate students. The adolescents
filled out the self-administered questionnaire, and those who were re-
cruited from schools, youth community programs, and churches were
provided the questionnaire in those respective locations in spaces
assigned by the venue. Those recruited in public venues (e.g., parks,
fast food venues) were given the questionnaire in a quiet space at or
near those venues. Questionnaires were only administered if a caregiver
was present to provide consent and the questionnaire could be admin-
istered immediately. The questionnaire lasted up to 45 min to finish,
and those who completed the questionnaire were each given $10.
The analytic sample consists of 532 adolescents. Among them, 237
(44.5%) were males and 295 (55.5%) were females, and the mean age
was 15.5 years (SD = 1.10). In terms of the family structure, 164
(30.8%) of the participants lived with both parents, and concerning gov-
ernment assistance, 397 (74.7%) of their families receive governmental
assistance. Regarding the different types of delinquent activities, 194
(36.5%) had engaged in theft, 121(22.7%) were involved in an assault,
112 (21.0%) had exhibited threatening behavior, and 39 (7.4%) had par-
ticipated in illegal sex. Also, for bullying perpetration, 181 (34.0%)
threatened to hit/hurt, 151 (28.4%) teased others, 151 (28.3%) excluded
others, and 94 (17.7%) spread rumors. For bullying victimization, 214
(40.3%) reported being called names, 213 (40.0%) reported being
made fun of, 187 (35.1%) reported being picked on, and 136 (25.6%) re-
ported being hit and pushed.
Measures
Subtypes of bullying
The subtypes of bullying included four categories: bullies-only,
victims-only, bullies/victims, and uninvolved. Bullies-only was mea-
sured with the University of Illinois Bully Scale developed by Espelage
and Holt (2001). Students are asked how often in the past 30 days
they did the following to other students at school: teased other stu-
dents, threatened to hurt or hit another student, spread rumors about
other students, and excluded others from my cliques of friends. Re-
sponse options were “Never”, “1 or 2 times”, “3 or 4 times”, “5 or 6
times”, and “7 or more times” on a 5-point scale (1–5). The construct
validity of this scale was supported via exploratory and confirmatory
factor analysis (Espelage & Holt, 2001). Higher scores indicated more
self-reported bullying. The scale correlated moderately with the Youth
Self-Report Aggression Scale (r = 0.65) (Achenbach, 1991), suggesting
that it was somewhat unique from general aggression. Concurrent va-
lidity of this scale was established with significant correlations with
peer nominations of bullying (Espelage et al., 2003). Due to skewed dis-
tribution, each item of this scale was dichotomized (0 = never involve,
and 1 = involves in at least one time).
Victims-only was measured with the four-item University of Illinois
Victimization Scale developed by Espelage and Holt (2001). Participants
were asked how often the following have happened to them in the past
30 days: “Other students called me names,” “Other students made fun of
me,” “Other students picked on me,” and “I got hit and pushed by other
students.” Responses options consisted of “Never”, “1 or 2 times”, “3 or 4
times”, “5 or 6 times”, or “7 or more times”. For the five items, the inter-
nal reliability score was 0.906. The construct validity of this scale is sup-
ported by exploratory and confirmatory factor analysis (Espelage &
Holt, 2001). Scores have converged with the peer nominations of vic-
timization (Espelage & Holt, 2001), and higher scores indicated more
self-reported peer victimization. Due to skewed distribution, each
item of this scale was dichotomized (0 = never happened and 1 = hap-
pened at least one time).
57
Journal of Pediatric Nursing 59 (2021) 55–62
Types of delinquent behaviors
Types of delinquent behaviors include illegal sexual activities, theft,
assault, and threatening behavior. Illegal sexual activities were measured
with two items, “How many times in the past 12 months have you had
sex with someone in exchange for drugs?” and “How many times in the
past 12 months have you had sex with someone in exchange for some-
thing other than drugs?” Response for both items was (write-in)
______times. We categorized this scale into 0 = never have, and 1 =
have this behavior at least one time.
Theft was measured with five items including, “Take something not
belonging to you worth under $50”; “Taken something from a store
without paying for it”; “Taken a car that didn't belong to someone in
your family without permission of the owner”; “Taken an expensive
part of a car without the permission of the owner (for example, radio,
tire, rims)”; “Taken an inexpensive part of a car without the permission
of the owner (for example, antenna, emblems)”; “Taken something not
belonging to you worth over $50”. Response options were 0 = 0 times,
1 = 1–2 times, 2 = 3–5 times, 3 = 6–8 times, 4 = 9–11 times, and 5 =
12 or more times. Due to skewed distribution, the variable was catego-
rized as 0 = never engaged, and 1 = engage in one or more times.
Assault was measured with two items including, “set fire to someone
else's property on purpose” and “hurt someone badly enough for them
to need bandages or a doctor”. Response options were 0 = 0 times, 1 =
1–2 times, 2 = 3–5 times, 3 = 6–8 times, 4 = 9–11 times, and 5 = 12 or
more times. We dichotomized the variable into 0 = 0 times and 1 = one
or more times, because of highly skewed distribution.
Threatening behavior was measured with two items, “gotten some-
thing by telling a person something bad would happen to him/her if
you did not get what you wanted” and “used a knife or gun or some
other thing (such as a bat, pipe, razor, taser, mace) to get something
from a person”. Response options were 0 = 0 times, 1 = 1–2 times,
2 = 3–5 times, 3 = 6–8 times, 4 = 9–11 times, and 5 = 12 or more
times. We dichotomized the variable as 0 = 0 times and 1 = one or
more times.
Covariates
Covariates for the study included age (fill-in-the-blank), sex (male/
female), government assistance (“Are you currently receiving free or re-
duced lunch and/or SNAP benefits (Link Card)?”; no/yes), and family
structure (“Please check all of the individuals who live in your household
(check all that apply)”; two parents, mother only, father only, adoptive
parent, legal guardian, brother(s), sister(s), grandmother, grandfather,
other relatives (e.g., aunts, uncles, cousins), fictive/play parents, others:
(please specify:_____). We dichotomized the family structure variable
as 0 = other family structures, and 1 = two-parent family.
Analytic techniques
Descriptive statistics were first conducted using Stata 15 (StataCorp.,
2017). Next, Latent Class Analysis (LCA), using MPlus 8 (Muthén &
Muthén, 2017), was mainly conducted to classify adolescent partici-
pants into a discrete cluster based on their self-reported items on bully-
ing and victimization experiences. Specifically, LCA is a probabilistic,
model-based method, and person-centered approach to classifying a
group of individuals into homogenous subgroups and their most rele-
vant latent classes, according to the profiles of a group of items or vari-
ables and the estimated posterior probabilities of class membership
(Collins & Lanza, 2010; Edwards & MacCallum, 2013). In this study, sev-
eral common indices of model fit were computed. For example, Akaike's
information criterion (AIC), Bayesian information criterion (BIC), and
sample-size-adjusted BIC (SSA BIC) were used to determine the good-
ness of fit and the lowest value of them indicated the best fit (Bray
et al., 2014; Collins & Lanza, 2010; Edwards & MacCallum, 2013;
Nylund et al., 2007). Lo-Mendell-Rubin adjusted likelihood ratio test
(LMR) and sample-sized-adjusted LMR (SSA LMR) were indicators
supporting the fit of the model with the correct number of classes and
J.S. Hong, J.-K. Chen, S.-C. Wang et al. Journal of Pediatric Nursing 59 (2021) 55–62

Table 1 Table 2
Descriptive statistics. Fit indices for the latent class analyses.

Variable n % M(SD) Range Number of BIC AIC SSA BIC LMR SSA LMR Likelihood
classes (p-value) (p-value) ratio χ2
Types of delinquent activities
Threatening (at least one time) 112 21.0 1 5094.24 5060.17 5068.85 – – 817.38
Assault (at least one time) 121 22.7 2 4001.77 3929.35 3947.80 0 0 468.47
Illegal sex (at least one time) 39 7.4 3 3867.50 3756.75 3784.97 0 0 276.62
Theft (at least one time) 194 36.5 4 3824.51 3675.43 3713.42 0 0 172.76
Bullying perpetration 5 3866.50 3679.08 3726.84 0.07 0.07 158.34
Teasing (at least one time) 151 28.4
Note: AIC = Akaike's information criterion; BIC = Bayesian information criterion; SSA
Excluding (at least one time) 151 28.3
BIC = sample-size-adjusted Bayesian information criterion. LMR = Lo-Mendell-Rubin ad-
Threatening to hit/hurt (at least one time) 181 34.0
justed likelihood ratio; SSA LMR = sample-sized-adjusted Lo-Mendell-Rubin adjusted
Spreading rumors (at least one time) 94 17.7
likelihood ratio.
Bullying victimization
Being called names (at least one time) 214 40.3
Being made fun of (at least one time) 213 40.0
Being picked on (at least one time) 187 35.1
very little probabilities of bullying others and being victimized, labeled
Being hit and pushed (at least one time) 136 25.6
Age 15.5 (1.1) 12–17
as non-victims and uninvolved group. Two hundred and fifty partici-
Sex pants (47.80%) belonged to Class 4.
Male 237 44.5
Female 295 55.5
Government assistance Logistic regression analysis
No 135 25.3
Yes 397 74.7 Logistic regression analyses were conducted to estimate the associa-
Family structure tions of these four classes with specified types of delinquency. Table 3
Two-parent family 164 30.8
Others 368 69.2
shows the results of three classes compared to the reference group
(i.e., uninvolved class). After adjusting for all covariates, we found that
Note: N = 532.
compared with adolescents in uninvolved group (class 4), members in
bullies/victims group (class 1), victims-only group (class 2), and
bullies-only group (class 3) are more likely to report engaging in threat-
a nonsignificant p-value indicates additional class fails to result in a sig- ening and assaultive behavior. Specifically, compared to uninvolved
nificant improvement in fit (Nylund et al., 2007). Entropy value was an group, adolescents in bullies/victims group (B = 2.29, SE = 0.30,
indicator to determine a good separation of the identified groups, and AOR = 9.88, CI = 5.49–17.77, p < .001), victims-only group (B =
the value was over 0.80 suggested well separation (Ramaswamy et al., 0.74, SE = 0.32, AOR = 2.10, CI = 1.12–3.98, p < .05), and bullies-
1993). Once the optimal number of classes was determined, logistic re- only group (B = 1.23, SE = 0.37, AOR = 3.41, CI = 1.64–7.11,
gression analysis was conducted using Stata to examine the hypotheses p < .01) were 9.88, 2.10, and 3.41 times more likely to involve in threat-
in this study (Table 1). ening behavior, respectively. The odds of engaging in assaultive behav-
ior were 8.99, 4.27, and 8.87 times higher for bullies-victims (B = 2.20,
Results SE = 0.31, AOR = 8.99, CI = 4.87–16.62, p < .001), victims-only (B =
1.45, SE = 0.32, AOR = 4.27, CI = 2.30–7.93, p < .001), and bullies-
Latent class analyses only groups (B = 2.18, SE = 0.37, AOR = 8.87, CI = 4.33–18.17,
p < .001), respectively. In addition, compared with adolescents in unin-
A latent class analysis was first conducted to examine if the patterns volved group, involving in theft behavior is more likely to be associated
of bullying and victimization can be empirically identified. We included with bullies/victims (B = 2.36, SE = 0.29, AOR = 10.55, CI =
four items of bullying and four items of victimization behavior in this 6.03–18.46, p < .001), only victims (B = 1.18, SE = 0.26, AOR = 3.26,
data and examined data fit with models that specified 1 to 5 classes. CI = 1.95–5.46, p < .001), and only bullies (B = 1.88, SE = 0.33,
Table 2 showed the results of the LCA on discrete classes with different AOR = 6.57, CI = 3.43–12.58, p < .001). There was no significant differ-
patterns of bullying and victimization. As presented, in comparison to ence between groups regarding engaging in illegal sexual behavior (for
other model solutions, the four-class model solution provided a better bullies/victims group: B = 0.59, SE = 0.44, AOR = 1.81, CI = 0.76–4.30,
fit to the data because it has relatively lower AIC, BIC, and SSA BIC values, p > .05; for victims-only group: B = −0.35, SE = 0.54, AOR = 0.70,
and significant LMR and SSA LMR. The entropy of the four-class model CI = 0.24–2.04, p > .05; for bullies-only group: B = 0.88, SE = 0.52,
was 0.85, suggesting satisfied classification and separation. Also, the AOR = 2.42, CI = 0.88–6.65, p > .05).
LMR and SSA LMR indicated that the five-class model did not signifi-
cantly improve on the fit of the four-class model, which suggested Discussion
that the four-class model solution is more parsimonious. Thus, a four-
class model was selected. The current study investigated which particular types of delinquent
Fig. 1 showed that the item probability distribution for each latent activities adolescents identified as bullies, victims, or bully/victims are
class. As presented in Fig. 1, Class 1 showed a higher probability of en- most likely to participate in. The study utilized data from a convenience
dorsing bullying items and higher probabilities of endorsing victimiza- sample of African American adolescents located in Chicago's Southside.
tion items, which was labeled as bullies/victims group. Class 1 consists Somewhat contrary to our proposed hypotheses, we found that adoles-
of 100 participants (19.12%) in the sample. Class 2 is characterized by cents who are bullies, victims, or bully/victims are all at an elevated risk
much higher probabilities of being exposed to all types of bullying and of theft, threatening behavior, and assaultive behavior. Our results con-
relatively lower probabilities of engaging in bullying behavior, labeled firmed the findings of numerous studies, which reported that adoles-
as a victims-only group. 117 participants (22.37%) belonged to this cents involved in bullying, as a victim, perpetrator, or bully/victim all
group. Class 3 is characterized by relatively lower probabilities of en- have an increased risk of both non-violent (e.g., theft) and violent
dorsing victimization items and much higher probabilities of endorsing types of delinquent behaviors (e.g., threatening and assaultive behav-
bullying behavior items, labeled as a bullies-only group. Fifty-six partic- iors) (Aldridge et al., 2018; Barboza, 2015; Bender & Lösel, 2011; Cook
ipants (10.71%) were identified as this class. Class 4 is characterized by et al., 2010; Haynie et al., 2001; Higgins et al., 2012; Kelly et al., 2015;

58
J.S. Hong, J.-K. Chen, S.-C. Wang et al. Journal of Pediatric Nursing 59 (2021) 55–62

1
0.9 Bullies/Victim(Class 1)
0.8
0.7
0.6 Victims-only(Class 2)
0.5
0.4 Bullies-only (Class 3)
0.3
0.2
0.1 Uninvolved (Class 4)
0

Fig. 1. Item probability profile plots for each class. Note: N = 523. The eight response items for the four latent classes are listed along the x-axis. The probability of endorsing each item is
provided by class membership. The predicted probabilities (reported on the y-axis) indicate the probability of endorsing the (dichotomized) response option for those participants within
that particular latent class.

Kim, Lee, Cho, Peguero, & Misuraca, 2019; Liang et al., 2007; Walters &
Espelage, 2017, 2019; Wong & Schonlau, 2013).
Although bullying perpetration was positively associated with
threatening and assaultive behaviors, which is consistent with Ttofi
et al.'s (2012) persistent underlying violence tendency, it was also related
to non-violent delinquency (e.g., theft). As Farrington and Baldry (2010)
argued, bullies tend to be high on deficient interpersonal characteristics
(e.g., manipulative, lying), deficient affective characteristics (e.g., low
level of guilt, low empathy or remorse), and impulsive or irresponsible,
which might explain their likelihood of participation in various kinds of
risky and deviant behaviors. Also, for adolescents in Chicago's Southside,
as the Social Disorganization Theory (Shaw & McKay, 1932) might ex-
plain that bullies tend to be embedded in a disorganized neighborhood,
characterized by impoverished economic and social conditions, which
would limit the neighborhood's ability to supervise adolescent's behav-
ior, increasing their exposure to all types of delinquent behaviors.
Bullying victimization was also positively related to both violent
(threatening behavior and assaultive behavior) and non-violent
(e.g., theft) types of delinquent activities, which was also consistent
with past study findings (Rusby et al., 2005; Wong & Schonlau, 2013).
This finding appears to support the “victim-offender overlap,” a well-
documented phenomenon in the criminological research literature in
which victimization experiences can produce negative behavioral out-
comes such as delinquency (Huber, 2014; Jennings et al., 2012). Popp
and Peguero (2011) also argued that victims of bullying may experience
weakened social bond, which frees them from societal constraints and
allow them to be involved in delinquent behavior. However, we also
found that the victims-only group was not at an increased risk of illegal
sexual activity, which did not support the self-medication hypothesis.
Victims might choose not to seek out illegal sexual activities in fear of
suffering from re-victimization and trauma.
Both violent and non-violent types of delinquent activities were
found to be significant for bully/victims, which was consistent with
our hypothesis. This finding confirms other research findings that
bully/victims tend to be the highest-risk group (Kennedy, 2018), as
they are more likely to exhibit behavior problems (Dukes et al., 2009;
Haynie et al., 2001; Stein et al., 2007), depressive symptoms (Haynie
et al., 2001; Toblin et al., 2005), dysfunctional behaviors (Dukes et al.,
2009), emotional dysregulation and hyperactivity (Toblin et al., 2005)
than bullies or victims, all of which likely increase their risk of various
types of delinquent activities. Although our findings did not fully sup-
port our hypotheses, they seem to suggest that irrespective of bullying
status, delinquency is a serious problem for urban adolescents who
are bullies, victims, or bully/victims.

Table 3
Logistic regression analysis for the classes of bullying and victimizations associated with types of delinquent activities.

Threatening Assault Illegal sex Theft

B (SE) AOR (95% CI) B (SE) AOR (95% CI) B (SE) AOR (95% CI) B (SE) AOR (95% CI)

Bullies/victims vs. 2.29 (0.30) 9.88*** (5.49, 2.20 (0.31) 8.99*** (4.87, 0.59 (0.44) 1.81 (0.76, 4.30) 2.36 (0.29) 10.55*** (6.03,
noninvolved 17.77) 16.62) 18.46)
Victims only vs. noninvolved 0.74 (0.32) 2.10* (1.12, 3.98) 1.45 (0.32) 4.27*** (2.30, 7.93) −0.35 0.70 (0.24, 2.04) 1.18 (0.26) 3.26*** (1.95, 5.46)
(0.54)
Bullies only vs. noninvolved 1.23 (0.37) 3.41** (1.64, 7.11) 2.18 (0.37) 8.87*** (4.33, 0.88 (0.52) 2.42 (0.88, 6.65) 1.88 (0.33) 6.57*** (3.43, 12.58)
18.17)
Sex (Girls) −0.10 0.90 (0.56, 1.44) −0.62 0.54** (0.34, 0.86) −1.76 0.17*** (0.07, −0.66 0.52** (0.34, 0.79)
(0.24) (0.24) (0.44) 0.41) (0.21)
Age 0.21 (0.11) 1.23 (1.00, 1.51) −0.06 0.94 (0.77, 1.15) 0.43 (0.17) 1.53* (1.09, 2.16) 0.17 (0.09) 1.19 (0.99, 1.43)
(0.10)
Government assistance (yes) −0.11 0.90 (0.53, 1.52) 0.01 (0.26) 1.01 (0.60, 1.69) 0.07 (0.42) 1.07 (0.47, 2.46) −0.66 0.52** (0.32, 0.82)
(0.27) (0.24)
Family structure −0.20 0.82 (0.50, 1.37) −0.12 0.89 (0.55, 1.45) 0.47 (0.36) 1.59 (0.78, 3.23) 0.37 (0.22) 1.45 (0.94, 2.25)
(two-parent) (0.26) (0.25)
Likelihood ratio χ2 (df = 7) 70.58, p < .001 77.93, p < .001 39.26, p < .001 116.71, p < .001
McFadden's pseudo R2 0.1328 0.1412 0.1468 0.1735

Note: B = unstandardized coefficients. SE = standard errors. AOR = adjusted odd ratios. CI = confidence interval.
* p < .05, ** p < .01, ***p < .001.

59
J.S. Hong, J.-K. Chen, S.-C. Wang et al.
Implications for nursing practice
Our findings have major implications for nursing practice and policy.
The association between bullying and victimization and delinquent be-
havior has received wide empirical support, and anti-bullying programs
have been widely implemented in U.S. school districts. Yet, the effec-
tiveness of the existing anti-bullying efforts has been reported to be
modest (Evans et al., 2014). A recent review of the effectiveness of
school-based bullying prevention programs reported that up to 45% of
the study findings showed no program effects on bullying perpetration
and 30% suggested no program effects on victimization (Evans et al.,
2014).
Nurses play a critical role in providing the necessary care and sup-
port for adolescents who are involved in bullying (Hendershot et al.,
2006; Kub & Feldman, 2015). They typically provide services in the diag-
nosis and treatment of adolescents who are at risk of delinquency and
suggestions for an effective alternative to incarceration for adolescents
in the juvenile justice system (Burriss et al., 2011). In particular, acute
care pediatric nurses are relevant to adolescent bullying and delin-
quency prevention, as acute care consists of promotive, preventive, cu-
rative, rehabilitative, or palliative actions whose effectiveness is
contingent upon time-sensitive and rapid approach (World Health
Organization, 2013). Pediatric nurses in acute care settings are called
upon to identify adolescents at risk of violent behavior through assess-
ment and referral to intervention programs (see Copeland-Linder
et al., 2012).
Evidence-based treatment for addressing bullying and delinquency
requires effective assessment tools. However, the assessment of adoles-
cents in an urban school likely differs from adolescents in suburban
schools. In urban schools where limited resources remains a persistent
problem, delinquent activities are likely to occur in youth who are in-
volved in bullying perhaps due to chronic exposure to deviant and crim-
inal activities in the neighborhoods due to the absence of “capable
guardians,” such as a parent, teacher or a school official (Felson, 1995)
who can effectively intervene. Despite our findings that involvement
in bullying is positively correlated with delinquent activities, it is also
important for practitioners to recognize that African American youth
are most likely to be identified as being aggressive and disruptive not
only in the self-reports but also by their peers and teachers
(e.g., Graham & Juvonen, 2002). Also, as mentioned earlier, the rate of
delinquency of African American adolescents is reportedly high due to
the overrepresentation of these youth in the juvenile justice system,
which is likely a reflection of the inherent biases in the current juvenile
justice system (Mallett, 2018). Although this argument is outside the
purview of this study, it is a very important consideration when
assessing the behavior of urban African American adolescents who are
identified as bullies, victims, or bully/victims and whether they are at
an increased risk of delinquency.
As mentioned previously, there are possibilities of racial and cultural
differences in adolescents' perceptions of bullying and victimization,
which likely affect their responses. As indicated in Sawyer et al.'s
(2008) research, which examined racial differences in the way youth re-
port being victims of “bullying” on self-report measures, cultural differ-
ences in the perceptions of bullying and victimization are likely to affect
their willingness to report their experiences in bullying. Nurses and
other practitioners are encouraged to identify and utilize culturally rel-
evant bullying measures in the assessment. For example, practitioners
might consider roasting, an African American oral tradition defined as
making fun of someone using clever metaphors (e.g., Smitherman,
1977, 2000), in their assessment of African American adolescents' bully-
ing experiences (see Rivers Jr., 2015).
For urban African American adolescents in low-resourced, inner-city
neighborhoods, exposure to and experiences in bullying and the associ-
ated adverse outcomes support an urgent need for practitioners to pro-
mote positive youth development. In an effort to effectively prevent and
respond to bullying, there has also been a growing recognition of a need
60
Journal of Pediatric Nursing 59 (2021) 55–62
to focus on resilience, which can facilitate positive response to a variety
of challenges (Hinduja & Patchin, 2017). Resilience, a complex construct,
is defined as “the attainment of positive outcomes, adaptations, or de-
velopmental milestones in spite of significant adversity, risk or stress”
(Moore & Woodcock, 2017, p. 689). Nurses are strongly encouraged to
consider resilience-based interventions that promote optimism by fos-
tering positive current and future-oriented attitude and behaviors
(Moore & Woodcock, 2017). Resilience-based interventions, which
build on strengths rather than problem-focused treatment to address
the problem (Luthar & Cicchetti, 2000), would not only lessen adoles-
cents' involvement in bullying and victimization, but also negative out-
comes that are linked to such involvement.
In addition to viable assessment tools and resilience-based interven-
tions, nurses need to be aware of some of the policies that have resulted
in the disproportionate representation of African American youth in
school discipline and incarceration (Bell, 2015). Such examples are
“zero tolerance” and “disproportionate minority confinement” which
were designed to address bullying and delinquency. However, nurses
and practitioners are urged to work with school officials to address
the possible biases that are inherent in these policies and how they
can exacerbate, rather than inhibit negative behaviors associated with
involvement in bullying.
Limitations
Our findings also are likely to have been impacted by several limita-
tions. The study was correlational as it relied on a cross-sectional study
design. We were unable to make causal inferences to the relationship
between involvement in bullying and delinquent activities. Although a
longitudinal dataset would establish causal inferences, our study find-
ings remain important as they demonstrate a significant relationship
between involvement in bullying as bullies-only, victims-only, and
bullies/victims and various types of delinquent activities. Variables for
illegal sexual activities, threatening behavior, and assaultive behavior
in our study each relied on only two items, which precluded a more
in-depth understanding of the types of delinquent activities that
might be differentially associated with the subtypes of bullying involve-
ment. However, other studies have relied on two-item measures for
various forms of delinquent activities (e.g., Zhang et al., 2017). For ex-
ample, Zhang et al.'s (2017) study, which investigated the association
between youth gang involvement and self-reported delinquency,
assessed drug-related delinquency with two items (i.e., engaged in ille-
gal drug use and involvement in drug dealing). Further, it is worth men-
tioning that the subscales of delinquent activities are suggested over an
all-inclusive index of delinquent activities (Sweeten, 2012). Also, cer-
tain types of delinquent activities such as illegal sexual activities have
been largely understudied as potential outcomes of adolescents' in-
volvement in bullying. In addition, we were unable to investigate
whether certain types of delinquent behaviors, such as delinquency re-
lated to substance use (e.g., manufacturing and distribution of illegal
drugs and drug-related theft) might be associated with involvement
in bullying among the study participants. This limitation is based on
the data that were available in the dataset. Also, measures for our
study were derived from youth self-reports exclusively, which might
have introduced unmeasured biases. This is a serious concern because
of the ways in which there are racial and ethnic differences in adoles-
cents' reports of bullying and victimization on self-report measures. As
argued by Sawyer et al. (2008), racial, ethnic, and cultural factors
might influence the way youth perceive bullying.
Conclusion
These limitations aside, our findings point to the importance of mov-
ing beyond a narrow understanding of whether bullying predicts delin-
quency by investigating what types of delinquent activities bullies,
victims, and bully/victims are most likely to be involved in. Future
J.S. Hong, J.-K. Chen, S.-C. Wang et al.
studies need to build on our findings with a longitudinal research design
with a variety of measures of delinquent activities, which can provide
nurse practitioners with a viable tool for bullying and delinquency pre-
vention. Nurses' role in adolescent bullying and delinquency prevention
is even more crucial today as the chaotic COVID-19 pandemic in, 2020
and the associated racial disparities in health care have negatively im-
pacted adolescent mental health, especially in urban neighborhoods. Al-
though it appears that COVID-19 mitigation measures might have
decreased youths' opportunities for engaging in bullying and delinquent
behaviors due to restrictions in public areas (see Buchanan et al., 2020),
risks compounded by COVID-19 (e.g., growing rates of poverty and un-
employment, barriers to healthcare, and a lack of educational opportu-
nities) can fuel trauma, psychological distress, and delinquent
behaviors (see Buchanan et al., 2020). Because of a lack of availability
of mental health services in light of the COVID-19 pandemic, adoles-
cents identified as victims or bully/victims might resort to delinquent
behaviors in an effort to cope with victimization. Among bullies, the in-
creasing lack of capable guardians (e.g., availability of parents and
teachers who provide supervision) can trigger delinquent behavior as
these youth may act with impunity. That being said, future studies
might uncover how the relationship between bullying and delinquency
might be impacted by external factors, such as barriers to healthcare, ra-
cial discrimination, and diminished educational opportunities—all of
which have intensified during the COVID-19 pandemic.
Author statements
Dr. Jun Sung Hong conceived the study; wrote the Literature Review,
Discussion, Practice Implications, and Limitations section; edited the en-
tire manuscript.
Dr. Ji-Kang Chen conceived the analyses for the study, wrote the
Analyses and Results sections, and created the Tables and Figures.
Dr. Shu-Chen Wang conducted the statistical analyses and created
the Tables and Figures.
Dr. Jeoung Min Lee contributed to a part of the Introduction.
Dr. Carl L. Algood contributed to a part of the Introduction.
Dr. Dexter R. Voisin collected the data and assisted in drafting the
Methods section.
Ethical statements & Conflict of Interest
The study was approved by the Institutional Review Board of the last
author's previous institution. The last author collected the data for the
study and takes responsibility for the integrity of the data. The authors
assume responsibility for the accuracy of the data analysis. The authors
declare that there is no conflict of interest. There were no ethical issues
with regard to human participants/animals in the study. Informed con-
sent was obtained prior to the data collection.
Declaration of Competing Interest
None
Acknowledgements
This study was funded by the Center for Health Administration Stud-
ies and the STI/HIV Intervention Network at the University of Chicago in
the United States of America, which were awarded to Dr. Dexter R.
Voisin.
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