This month’s OBSSR Director’s Spotlight focuses on “back to school” and discusses the impact of school health and bullying on youth. Courtney F. Aklin, Ph.D., Acting Director of the National Institute of Nursing Research (NINR), and Alison N. Cernich, Ph.D., Acting Director of the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), co-authored this spotlight on the significant activities and accomplishments of coordinated research efforts at NIH.
September is back-to-school season, a time of transition for students, teachers, and administrators across the nation. Some students are starting school for the first time, while others are entering a new grade level or transitioning to middle or high school. Along with the inevitable change, one constant remains: school is where students will spend many of their waking hours, building routines and relationships with peers, educators, and administrators. Given the centrality of school settings in many students’ lives, schools are an ideal location to support and promote children’s mental and physical health.
Although they can serve as safe havens and promote positive health outcomes for students, schools can also be host to bullying, particularly among older children. A recent national survey found that 10% of elementary schools, 28% of middle schools, and 15% of high schools reported at least one bullying incident per week.
Alarmingly, cyber bullying incidents were reported among 37% of middle schools and 25% of high schools. Bullying is a pervasive issue in the United States, and youth who experience and/or perpetrate bullying are subject to negative emotional and physical health outcomes such as self-harm, depression, anxiety, poor sleep, and physical injury. As such, it is important to understand the social and behavioral predictors and consequences of bullying to reduce its impact and address its short- and long-term health effects on children and adolescents.
In December 2023, the NIH held a workshop titled “Understanding and Addressing the Health Impacts of Online Abuse and Harassment” that explored gaps and challenges to strengthen the evidence base on technology-facilitated violence across the life course and sought to enhance agency coordination and increase access to support services, particularly for youth who experienced online bullying. By involving experts and prioritizing trauma-informed, survivor-centered approaches, the workshop aimed to better equip schools, mental health providers, and communities to protect adolescents from digital abuse.
This effort aligns with NIH’s implementation of the bipartisan Children and Media Research Advancement (CAMRA) Act, passed by Congress as part of the bipartisan omnibus law. The Act allocates $15 million in the first year of a multi-year NIH initiative to study how technology and media influence cognitive, physical, and socio-emotional development in infants, children, and adolescents.
Research supported by NICHD aims to reduce the prevalence of bullying, victimization, and witnessing as well as to improve responses to bullying (i.e., positive bystander actions by students and more positive responding by teachers). In one part of the study, researchers assessed whether behaviors that damage social reputation or relationships such as exclusion, manipulation, or gossip (i.e., relational peer victimization) affected academic engagement. The results show that effects of relational peer victimization extend negatively into the classroom, with a decrease in attentiveness and active participation in class for those who experienced peer victimization.
School climate is also a critical factor that shapes peer relationships, and the behavior of bullying bystanders is shaped by factors including teacher–teacher and student–teacher connectedness (i.e., engagement), safety, and environment. Schools with higher levels of engagement and safety are more likely to have upstander behavior—bystanders who intervene when they observe bullying behavior. Programs to increase upstander behavior can positively impact peer relationships and well-being in schools.
Recognizing the critical role that the school context can play in lifelong health and well-being, NINR in 2024 announced a School Health Strategic Imperative focused on leveraging nursing science to address research gaps in the field of school health.
In June 2025, as part of its 40th anniversary celebration, NINR hosted a virtual meeting in collaboration with OBSSR titled “Advancing Nursing Research to Support Healthy School Environments for All.” The event featured invited speakers and discussion among school health researchers and practitioners with a focus on the critical role of the school nurse and nursing research.
In addition to highlighting the direct school environment and the link between education and health outcomes, discussions featured the critical role that the broader context surrounding schools (e.g., neighborhoods and communities) plays in youth health and well-being. Through these discussions, it became clear that multidisciplinary team science, which brings evidence to practice through trusted partnerships with families and communities, is needed to advance the science and practice of school health and ensure healthy environments that support youth development. Through its Healthy School Environments initiative, NINR is committed to working with our NIH and federal partners to bring nursing’s holistic, solution-focused approach and the critical role of the school nurse to this pressing public health challenge.
Further acknowledging the key role of schools in promoting health, NICHD and OBSSR are supporting research to determine the impact of school-based health centers (SBHCs), which co-locate a primary care clinic on a primary or secondary school campus (5R01HD109190). This study will compare services offered among different SBHCs, as well as estimate effects on access to health care, cost, and health and educational outcomes.
Schools are essential for ensuring all children can thrive academically, emotionally, and physically and are safe from bullying. NIH’s school health portfolio of research is prolific and rigorous, but gaps remain.
OBSSR is committed to working with NIH institutes, centers, and offices to support new and innovative approaches to advance the state of the science for determining best practices in bullying prevention and broader health promotion within schools.
