OBJECTIVE To examine the unique contribution of bully victimization to sleep loss over worry (SLOW) among adolescents in four Southeast Asian countries, while controlling for loneliness and selected lifestyle factors. METHODS Data was derived from the Global School-Based Student Health Survey (2014-2015). Responses from a total of 13,043 adolescents in four Southeast Asian countries (Bangladesh, Brunei, Indonesia, and Timor Leste) were examined. Weighted frequencies of SLOW, bully victimization, loneliness, and selected lifestyle factors were first calculated, and Pearson's chi-square test was used to compare sample characteristics by severity of SLOW. A multivariate logistic regression analysis was constructed for each country to assess the unique contribution of bully victimization to SLOW, adjusting for demographics, loneliness, and selected lifestyle factors. RESULTS The prevalence of SLOW and bully victimization ranged between 38.0% and 44.6%, and 20.5%-24.9% respectively. Bully victimization and loneliness were consistently and positively linked to SLOW, with greater odds seen among students with severe SLOW who were bullied for 3 days or more (adjusted odds ratios (AORs) and 95% confidence intervals (CIs) Bangladesh: 6.00 [2.57-14.01]; Brunei: 2.48 [1.42-4.32]; Indonesia: 3.36 [2.02-5.59]; Timor Leste: 4.27 [2.15-8.48]) and experienced high level of loneliness (AORs and 95% CIs Bangladesh: 7.03 [3.46-14.29]; Brunei: 4.97 [3.63-6.79]; Indonesia: 8.71 [4.55-16.69]; Timor Leste: 2.97 [2.25-3.93]). Increased odds of severe SLOW were also seen among those engaged in sedentary behavior for 3 h or more per day (AORs and 95% CIs Indonesia: 1.85 [1.40-2.45]; Timor Leste: 1.61 [1.18-2.19]), and among those consuming fast food for three or more days per week (AORs and 95% CIs Brunei: 2.20 [1.26-3.86]; Indonesia: 1.98 [1.19-3.31]). The association of lifestyle factors and SLOW differed across countries. CONCLUSION Given the unique contributions of bully victimization to SLOW, we recommend countries in Southeast Asia to include sleep health as a component of adolescent health promotion, and to include reducing bully and bully victimization in strategies aimed at improving sleep health.

中文翻译：

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欺凌受害是东南亚四个国家青少年的睡眠不足与忧虑（SLOW）相关联。

目的探讨欺凌受害对东南亚四个国家青少年的睡眠不足（SLOW）造成的独特影响，同时控制孤独感和特定的生活方式。方法数据来源于《 2014-2015年全球基于学校的学生健康调查》。调查了来自四个东南亚国家（孟加拉国，文莱，印度尼西亚和东帝汶）的总共13,043名青少年的反应。首先计算SLOW的加权频率，欺凌受害者，孤独感和选定的生活方式因素，然后使用Pearson卡方检验比较SLOW严重程度的样本特征。针对每个国家/地区构建了多变量logistic回归分析，以评估欺凌受害者对SLOW的独特贡献，并根据人口统计学，孤独感，和选定的生活方式因素。结果SLOW和欺负受害者的患病率分别在38.0％和44.6％之间以及20.5％-24.9％之间。欺负受害和孤独感一直与SLOW保持正相关，在SLOW严重且被欺凌3天或更长时间的学生中，发生率更高（调整后的优势比（AOR）和95％置信区间（CI）孟加拉国：6.00 [2.57- 14.01]；文莱：2.48 [1.42-4.32]；印度尼西亚：3.36 [2.02-5.59]；东帝汶：4.27 [2.15-8.48]），经历过高度的孤独感（AOR和95％CI的孟加拉国：7.03 [3.46-14.29] ]；文莱：4.97 [3.63-6.79]；印度尼西亚：8.71 [4.55-16.69]；东帝汶：2.97 [2.25-3.93]）。每天久坐3小时或更长时间的人中，发生严重SLOW的几率也增加了（印度尼西亚的AOR和95％CI的人：1.85 [1.40-2.45]；东帝汶的人：1。61 [1.18-2.19]），以及每周食用快餐三天或以上的人（AOR和95％CI的文莱：2.20 [1.26-3.86]；印度尼西亚：1.98 [1.19-3.31]）。各国之间，生活方式因素与SLOW的关联有所不同。结论鉴于欺负受害者对SLOW的独特贡献，我们建议东南亚国家将睡眠健康作为青少年健康促进的一部分，并在旨在改善睡眠健康的策略中包括减少欺凌和欺凌受害者。