96424 • Cyberbullying and Harassment

Table of Contents

96424 • Cyberbullying and Harassment

How to Receive Credit

Course Overview

Audience

Accreditations & Approvals

Designations of Credit

Individual State Nursing Approvals

Individual State Behavioral Health Approvals

Special Approvals

Course Objective

Learning Objectives

Faculty

Faculty Disclosure

Division Planners

Division Planners Disclosure

Director of Development and Academic Affairs

Director Disclosure Statement

About the Sponsor

Disclosure Statement

Implicit Bias in Health Care

1. INTRODUCTION

2. INTERNET AND DIGITAL COMMUNICATION TRENDS

CELL PHONE/SMARTPHONE USE

SOCIAL NETWORKING

THE DIGITAL DIVIDE

3. DEFINING CYBERBULLYING

4. ONLINE AND DIGITAL MEDIUMS FOR HARASSMENT

E-MAIL

CHATROOMS/ONLINE GAMES

BLOGS

INSTANT/TEXT MESSAGING

SOCIAL NETWORKING

WEBSITES

5. FORMS OF CYBERBULLYING

6. PREVALENCE OF CYBERBULLYING

CHILDREN AND ADOLESCENTS

SEXUAL VICTIMIZATION

RACIAL DISCRIMINATION

COLLEGE STUDENTS

ADULTS

INTERNATIONAL PREVALENCE

7. SIMILARITIES AND DIFFERENCES BETWEEN ONLINE AND OFFLINE BULLYING/HARASSING

8. PROFILE OF CYBERBULLIES

9. PROFILE OF CYBERBULLYING VICTIMS

HELP-SEEKING

10. POTENTIAL INDICATORS OF CYBERBULLYING

11. THEORETICAL FRAMEWORKS USED TO UNDERSTAND CYBERBULLYING

STRAIN THEORY

DISINHIBITION THEORY

SOCIAL PRESENCE THEORY

12. ONLINE DATING AND CYBERHARASSMENT

13. DIGITAL TECHNOLOGY AND INTIMATE PARTNER VIOLENCE

14. PSYCHOSOCIAL CONSEQUENCES OF CYBERBULLYING

15. RISKY INTERNET BEHAVIORS

16. PREVENTION AND INTERVENTIONS

EDUCATION ON INTERNET SAFETY AND RISKY INTERNET BEHAVIORS

PROSOCIAL SKILLS TRAINING

EDUCATION ABOUT CYBERBULLYING AND HARASSMENT

COMMUNITY ADVOCACY AND COLLABORATION

CRISIS INTERVENTION AND COUNSELING

17. CONCLUSION

18. RESOURCES

Works Cited

Evidence-Based Practice Recommendations Citations

96424 • Cyberbullying and Harassment

Alice Yick Flanagan, PhD, MSW

www.netce.com

Copyright © 2023 NetCE, All rights reserved.

The goal of this course is to discuss a newer form of abuse—cyberbullying and cyberharassment. The course will review how perpetrators employ different digital mediums to harass their victims and the terminologies that have been linked to these harassing behaviors. The scope of cyberbullying and harassment and at what point online and offline harassment converge and diverge will also be explored. Risk factors, consequences of cyberbullying, how dating and domestic violence have been transformed by technology, theories to explain this phenomenon, and prevention and educational efforts will also be discussed.

96424 • Cyberbullying and Harassment

Education Category. Psychiatric / Mental Health

Release Date. 12/01/2023

Expiration Date. 11/30/2026

How to Receive Credit

To complete this course for continuing education credit please go to http://www.netce.com/course/2717 in your browser.

For assistance with receiving continuing education credit, please contact us at help@netce.com.

Course Overview

The goal of this course is to discuss a newer form of abuse—cyberbullying and cyberharassment. The course will review how perpetrators employ different digital mediums to harass their victims and the terminologies that have been linked to these harassing behaviors. The scope of cyberbullying and harassment and at what point online and offline harassment converge and diverge will also be explored. Risk factors, consequences of cyberbullying, how dating and domestic violence have been transformed by technology, theories to explain this phenomenon, and prevention and educational efforts will also be discussed.

Audience

This course is designed for physicians, nurses, social workers, psychologists, therapists, mental health counselors, and other members of the interdisciplinary team who may intervene in cases of cyberbullying and harassment.

Accreditations & Approvals

In support of improving patient care, TRC Healthcare/NetCE is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team. NetCE has been approved by NBCC as an Approved Continuing Education Provider, ACEP No. 6361. Programs that do not qualify for NBCC credit are clearly identified. NetCE is solely responsible for all aspects of the programs. As a Jointly Accredited Organization, NetCE is approved to offer social work continuing education by the Association of Social Work Boards (ASWB) Approved Continuing Education (ACE) program. Organizations, not individual courses, are approved under this program. Regulatory boards are the final authority on courses accepted for continuing education credit. Continuing Education (CE) credits for psychologists are provided through the co-sponsorship of the American Psychological Association (APA) Office of Continuing Education in Psychology (CEP). The APA CEP Office maintains responsibility for the content of the programs. NetCE is accredited by the International Accreditors for Continuing Education and Training (IACET). NetCE complies with the ANSI/IACET Standard, which is recognized internationally as a standard of excellence in instructional practices. As a result of this accreditation, NetCE is authorized to issue the IACET CEU. NetCE is recognized by the New York State Education Department's State Board for Social Work as an approved provider of continuing education for licensed social workers #SW-0033. This course is considered self-study, as defined by the New York State Board for Social Work. NetCE is recognized by the New York State Education Department's State Board for Mental Health Practitioners as an approved provider of continuing education for licensed mental health counselors #MHC-0021. This course is considered self-study by the New York State Board of Mental Health Counseling. NetCE is recognized by the New York State Education Department's State Board for Mental Health Practitioners as an approved provider of continuing education for licensed marriage and family therapists. #MFT-0015.This course is considered self-study by the New York State Board of Marriage and Family Therapy. Materials that are included in this course may include interventions and modalities that are beyond the authorized practice of licensed master social work and licensed clinical social work in New York. As a licensed professional, you are responsible for reviewing the scope of practice, including activities that are defined in law as beyond the boundaries of practice for an LMSW and LCSW. A licensee who practices beyond the authorized scope of practice could be charged with unprofessional conduct under the Education Law and Regents Rules.

Designations of Credit

This activity was planned by and for the healthcare team, and learners will receive 5 Interprofessional Continuing Education (IPCE) credit(s) for learning and change. NetCE designates this enduring material for a maximum of 5 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. NetCE designates this continuing education activity for 5 ANCC contact hour(s). NetCE designates this continuing education activity for 6 hours for Alabama nurses. NetCE designates this continuing education activity for 3 NBCC clock hour(s). Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 5 MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit. Completion of this course constitutes permission to share the completion data with ACCME. Social workers participating in this intermediate to advanced course will receive 5 Clinical continuing education clock hours. Successful completion of this CME activity, which includes participation in the evaluation component, enables the learner to earn credit toward the CME and/or Self-Assessment requirements of the American Board of Surgery's Continuous Certification program. It is the CME activity provider's responsibility to submit learner completion information to ACCME for the purpose of granting ABS credit. Successful completion of this CME activity, which includes participation in the activity with individual assessments of the participant and feedback to the participant, enables the participant to earn 5 MOC points in the American Board of Pediatrics' (ABP) Maintenance of Certification (MOC) program. It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABP MOC credit. Through an agreement between the Accreditation Council for Continuing Medical Education and the Royal College of Physicians and Surgeons of Canada, medical practitioners participating in the Royal College MOC Program may record completion of accredited activities registered under the ACCME's "CME in Support of MOC" program in Section 3 of the Royal College's MOC Program. NetCE is authorized by IACET to offer 0.5 CEU(s) for this program. AACN Synergy CERP Category B. NetCE designates this continuing education activity for 5 credit(s).

Individual State Nursing Approvals

In addition to states that accept ANCC, NetCE is approved as a provider of continuing education in nursing by: Alabama, Provider #ABNP0353, (valid through July 29, 2025); Arkansas, Provider #50-2405; California, BRN Provider #CEP9784; California, LVN Provider #V10662; California, PT Provider #V10842; District of Columbia, Provider #50-2405; Florida, Provider #50-2405; Georgia, Provider #50-2405; Kentucky, Provider #7-0054 through 12/31/2025; South Carolina, Provider #50-2405; West Virginia RN and APRN, Provider #50-2405.

Individual State Behavioral Health Approvals

In addition to states that accept ASWB, NetCE is approved as a provider of continuing education by the following state boards: Alabama State Board of Social Work Examiners, Provider #0515; Florida Board of Clinical Social Work, Marriage and Family Therapy and Mental Health Counseling, CE Broker Provider #50-2405; Illinois Division of Professional Regulation for Social Workers, License #159.001094; Illinois Division of Professional Regulation for Licensed Professional and Clinical Counselors, License #197.000185; Illinois Division of Professional Regulation for Marriage and Family Therapists, License #168.000190;

Special Approvals

This activity is designed to comply with the requirements of California Assembly Bill 1195, Cultural and Linguistic Competency.

Course Objective

While incidents of cyberbullying are becoming more common, the solution is not necessarily to avoid the Internet and other digital technologies; rather, more Internet safety education and prevention information are needed to raise awareness. The purpose of this course is to provide health and mental health professionals with the information necessary to identify and intervene in cases of cyberbullying and harassment to minimize the negative effects to patients and to improve professionals' ability to educate the public to prevent cyberbullying.

Learning Objectives

Upon completion of this course, you should be able to:

1. Discuss Internet and cell phone usage among different segments of the population.

2. Define cyberbullying, cyberharassment, and cyberstalking.

3. Identify various online platforms and how they may be used to harass or bully.

4. Discuss the prevalence of cyberbullying and harassment among children, adolescents, young adults, and adults.

5. Analyze the general profiles of cyberbullying perpetrators and victims, including possible indicators of cyberbullying.

6. Utilize theoretical frameworks used to explain cyberbullying.

7. Evaluate the health, psychosocial, social, behavioral, and academic impacts of cyberbullying and harassment.

8. Identify risky Internet behaviors.

9. Apply different prevention, educational, and clinical interventions for cyberbullying.

Faculty

Alice Yick Flanagan, PhD, MSW, received her Master’s in Social Work from Columbia University, School of Social Work. She has clinical experience in mental health in correctional settings, psychiatric hospitals, and community health centers. In 1997, she received her PhD from UCLA, School of Public Policy and Social Research. Dr. Yick Flanagan completed a year-long post-doctoral fellowship at Hunter College, School of Social Work in 1999. In that year she taught the course Research Methods and Violence Against Women to Masters degree students, as well as conducting qualitative research studies on death and dying in Chinese American families.

Previously acting as a faculty member at Capella University and Northcentral University, Dr. Yick Flanagan is currently a contributing faculty member at Walden University, School of Social Work, and a dissertation chair at Grand Canyon University, College of Doctoral Studies, working with Industrial Organizational Psychology doctoral students. She also serves as a consultant/subject matter expert for the New York City Board of Education and publishing companies for online curriculum development, developing practice MCAT questions in the area of psychology and sociology. Her research focus is on the area of culture and mental health in ethnic minority communities.

Faculty Disclosure

Contributing faculty, Alice Yick Flanagan, PhD, MSW, has disclosed no relevant financial relationship with any product manufacturer or service provider mentioned.

Division Planners

John M. Leonard, MD

Mary Franks, MSN, APRN, FNP-C

Margaret Donohue, PhD

Division Planners Disclosure

The division planners have disclosed no relevant financial relationship with any product manufacturer or service provider mentioned.

Director of Development and Academic Affairs

Sarah Campbell

Director Disclosure Statement

The Director of Development and Academic Affairs has disclosed no relevant financial relationship with any product manufacturer or service provider mentioned.

About the Sponsor

The purpose of NetCE is to provide challenging curricula to assist healthcare professionals to raise their levels of expertise while fulfilling their continuing education requirements, thereby improving the quality of healthcare.

Our contributing faculty members have taken care to ensure that the information and recommendations are accurate and compatible with the standards generally accepted at the time of publication. The publisher disclaims any liability, loss or damage incurred as a consequence, directly or indirectly, of the use and application of any of the contents. Participants are cautioned about the potential risk of using limited knowledge when integrating new techniques into practice.

Disclosure Statement

It is the policy of NetCE not to accept commercial support. Furthermore, commercial interests are prohibited from distributing or providing access to this activity to learners.

Implicit Bias in Health Care

The role of implicit biases on healthcare outcomes has become a concern, as there is some evidence that implicit biases contribute to health disparities, professionals' attitudes toward and interactions with patients, quality of care, diagnoses, and treatment decisions. This may produce differences in help-seeking, diagnoses, and ultimately treatments and interventions. Implicit biases may also unwittingly produce professional behaviors, attitudes, and interactions that reduce patients' trust and comfort with their provider, leading to earlier termination of visits and/or reduced adherence and follow-up. Disadvantaged groups are marginalized in the healthcare system and vulnerable on multiple levels; health professionals' implicit biases can further exacerbate these existing disadvantages.

Interventions or strategies designed to reduce implicit bias may be categorized as change-based or control-based. Change-based interventions focus on reducing or changing cognitive associations underlying implicit biases. These interventions might include challenging stereotypes. Conversely, control-based interventions involve reducing the effects of the implicit bias on the individual's behaviors. These strategies include increasing awareness of biased thoughts and responses. The two types of interventions are not mutually exclusive and may be used synergistically.

1. INTRODUCTION

In the last few decades, Internet and digital technologies have become a fundamental part of communication for many. It is customary to instantaneously connect and communicate with people using a variety of online social networking platforms and/or messaging services. Unfortunately, these digital mediums may be utilized as vehicles to bully and harass others. Cyberbullying and cyberharassment refer to the use of electronic communication to frighten, intimidate, and/or threaten another individual, with the potential to inflict emotional distress [1]. This definition is based on the concepts of power imbalances, intent, and repetition found in "traditional" bullying but within the context of electronic communications [47]. The prevalence of victimization of cyberbullying varies due to differing definitions, data collection methods, and constant technologic changes and advancements. Addressing cyberbullying and cyberharassment can be a challenge due to the anonymity of the perpetrator, and it can be extremely rampant given the easy access to and prevalence of Internet-enabled devices. A negative comment or crude photo of someone can be disseminated very rapidly and can be read and seen around the world [3].

Many adults may be categorized as what is termed "digital immigrants," meaning they did not grow up in the digital world and are trying to learn and adapt to this new environment [4]. Digital immigrants (typically born before 1980) may employ technology but tend to be less familiar with its potential, although they do acknowledge its importance for some tasks [5]. On the other hand, those born after 1980 are generally considered "digital natives," as they were raised using digital technology and have no difficulty speaking and utilizing new technologic mediums with ease and familiarity [4]. Digital natives tend to use technology for numerous tasks and adapt as the tools change; they are well versed in operating multiple tasks, depend on graphics to communicate, and thrive on instant gratification [5,130]. It is likely that many health and mental health practitioners fall into the category of "digital immigrants," and some clients, particularly adolescents and young adults, are "digital natives." Consequently, it is vital for practitioners to build their knowledge of Internet technologies and applications in order to meet the unique needs of their younger clients.

2. INTERNET AND DIGITAL COMMUNICATION TRENDS

In order to understand the pervasive social, psychologic, and cultural impact of the Internet on the lives of individuals, it is important to obtain a brief glimpse of Internet and digital technology usage and consumption. According to the U.S. Census, 85.3% of all households in the United States had some sort of Internet subscription in 2018 [41]. Access to broadband Internet has increased over the years, but the adoption rate has leveled off, mainly due to the increasing use of smartphones. In 2021, 77% of households in the U.S. had broadband Internet [6]. In addition, 85% of households that included minor children had an Internet subscription, versus 73% of those without a minor living in the home [7]. In 2021, 93% of American adults use the Internet [6]. Among adults, individuals 18 to 29 years of age are the most likely to utilize the Internet (100%), while adults 65 years of age and older are the least likely (75%) [6]. Among adolescents 13 to 17 years of age, 97% report using the Internet daily, including 46% who indicate they are online "almost constantly" [111]. In addition, 35% of teens say they are connected to some form of social media platform "almost constantly" [111]. There is no doubt that Internet technology has become a ubiquitous part of the American landscape. Although data published in the last several years is among the most current, the Internet landscape changes so rapidly that obtaining accurate data is nearly impossible.

CELL PHONE/SMARTPHONE USE

Cell phones, and increasingly, smartphones, are an integral part of the fabric of individuals' lives. As of 2021, 97% of American adults own cell phones and 85% have smartphones, up from 64% of adults who owned a smartphone in 2015 [8,9]. In 2021, 15% use their smartphones as their sole access the Internet, as they do not have broadband at home [8]. Among adolescents, 95% own a smartphone, an increase of 30% compared with 2014-2015 [111].

Of the 3,181 adults 18 years of age and older who participated in the Pew American Trends Panel in 2015, more than three-quarters (76%) of adults in the United States, including 93% of young adults (18 to 29 years of age), 82% of adults 30 to 49 years of age, and 55% of adults 50 years of age or older, indicated that the phone is a way to deal with boredom [9]. In addition, approximately 31% of smartphone users indicated that they use a phone as way to avoid others around them [9]. Among adolescents 13 to 17 years of age, approximately 88% had access to a smartphone or cell phone in 2015, while 12% reported not having access to either [11]. In a focus group study of Australian adolescents and their usage of cell phones, interesting themes emerged [10]. While it is not surprising they were attached to their cell phones, these adolescents expressed that the number of calls they received on their cell phone was associated with how valued or loved they felt. When they could not use their cell phones, they felt disconnected. This speaks to how cell phones and smartphones have become entrenched in individuals' social and personal lives. Not surprisingly, 71% of parents indicated they were concerned that their children might be spending too much time on their devices [161].

Of the 64% of adults with smartphones in 2015, 97% reported using their phones to send and receive text messages, 93% to make voice or video calls, 88% to access email, and 74% to visit social networking sites [9]. Among adolescents 13 to 17 years of age with either a smartphone or cell phone, 90% exchange texts, a significant increase from 38% in 2008 [11]. With the increase in smartphone usage and the availability of messaging apps and social networking sites, the number of texts sent by adolescents has decreased from an average of 111 per day in 2010 to 30 in 2015, although the amount of communication has actually increased [11,12].

SOCIAL NETWORKING

A huge number of individuals are using online social networking sites like Facebook, Instagram, Snapchat, Twitter, LinkedIn, and TikTok (previously Music.ly). In 2021, 72% of adults were using social networking sites, with those 18 to 29 years of age the leading users at 84% [13]. As of 2021, an estimated 69% of Americans 18 years of age and older used Facebook, 81% used YouTube, 40% used Instagram (owned by Facebook), 31% used Pinterest, 28% used LinkedIn, and 23% reported using Twitter [201]. Users between 18 to 29 years of age most frequently use these sites, and those 65 years of age or older comprise the lowest percentage of users [201].

In terms of usage, a 2017 study of African American college students found that 95% had a YouTube account, 82.2% a Facebook account, and 77.8% a Twitter account [162]. Almost a half (45.5%) checked their Facebook account at least once per day and 18.6% checked two to three times per day. Additionally, parental supervision of social networking sites is not as strict as one might think. In 2016, only 60% of parents with adolescents 13 to 17 years of age reported checking their teen's social media profile(s) [15].

THE DIGITAL DIVIDE

Although the use of the Internet and digital technology is growing and changing rapidly, it is important to remember that there is also the digital divide. The term "digital divide" refers to the social inclusion/exclusion and equality/inequality of Internet access, which is influenced by socioeconomic differences among various groups, including racial/ethnic minorities [16]. Extent of access can be categorized based on three factors: access to the Internet, frequency of Internet use, and scope of Internet use [17]. Socioeconomic status plays a role in each of these factors, as it is necessary to have the economic resources to purchase a computer or digital device, to pay for service, and to allot time to use the Internet recreationally [17]. Although structural factors are key determinants to the digital divide, digital literacy, which is related to level of education, also plays a role [163]. According to 2015 U.S. Census data, the Internet access racial gap has decreased. The percentage of African Americans with Internet access at home increased from 56.9% in 2012 to 64.9% and the proportion of Hispanics who reported home access increased from 58.3% in 2012 to 70.9%; this is compared with 79.3% of whites with home access in 2015 [7]. Data from the Pew Research Center show that 80% of white households have Internet broadband while only 71% and 65% of African American and Hispanic households, respectively, have broadband Internet [6]. This divide does not expand to include Asian Americans, who have greater access to the Internet at home (88.5%) than whites [7]. The growing use of cell phones/smartphones and mobile devices to access the Internet may be responsible for closing this gap. In 2019, ethnic minorities are higher users of smartphones as their only access to the Internet, with 23% of African Americans and 25% of Latinos having only smartphone Internet access, compared with 12% of white users [8]. They also appear to take fuller advantage of their cell phone features compared to white cell phone users [7]. Among those with a household income of $25,000 or less, 11% access the Internet through a smartphone [41]. An estimated 43% of adults who fall in the lower income bracket do not have broadband Internet and 41% do not own a laptop or a desktop computer [202].

3. DEFINING CYBERBULLYING

The terminology used to discuss cyberbullying is complex. For the purposes of consistency and clarity, the term "cyberbullying" will be used throughout this course, as opposed to the terms "cyberharassment" or "cyberabuse," as the term cyberbullying is the most frequently used in the research literature [98]. In this course, cyberharassment and cyberabuse will be considered subtypes of cyberbullying. Although bullying is often considered a part of school violence, the term has been used to describe activities occurring in the workplace and outside of the school setting. The classic definition of bullying includes three major dimensions of bullying: intent to harm, repetition, and power imbalance [203]. The parties include the victim, the perpetrator(s), and the bystander(s) [204].

As discussed, cyberbullying is defined as the use of electronic communication disseminated via the Internet and other digital technologies to frighten, intimidate, and/or threaten another individual with resultant emotional distress [1,131,132,205]. Cyberbullying can further be defined as having five dimensions [164,165,204]:

- Interpersonal aggression

- Asymmetrical situation (power imbalance)

- Intentional aggression

- Repetition

- Technology used as a vehicle for the aggression

The terms cyberharassment, cyberabuse, and cyberstalking (or online harassment, online abuse, and online stalking) are often used interchangeably, which may be confusing.

In general, stalking typically involves two or more unwanted contacts. The mechanisms of stalking may be classified into four different categories [19]:

- Purely online: Stalking occurs completely online.

- Crossover: Stalking takes place solely online for weeks, but it then transitions to offline (e.g., face-to-face contact or postal contact by the perpetrator), though online activities may continue.

- Proximal with online: Stalking is initiated offline but evolves to include online contact.

- Purely offline: Stalking occurs completely offline.

Examples of cyberstalking include but are not limited to [19,133,204]:

- Obtaining information on the Internet about the victim in order to harass or intimidate online or offline

- Sending or posting false information or messages about the victim

- Impersonating someone online

- Posting personal information about the victim online

- Sending computer viruses to the victim

- Tracking the victim using hidden webcams or global positioning systems (GPS)

- Monitoring the victim's Internet and computer use using spyware

- Contacting the victim using fake online profiles

Some experts have defined cyberharassment as involving the use of electronic communications to convey sexually lewd or inappropriate behaviors, while cyberbullying does not. However, for the purposes of this course, bullying, harassment, and abuse will refer to repeatedly inflicting negative behaviors on another individual causing physical, psychologic, or emotional discomfort or injury [20]. These negative behaviors may or may not be sexually inappropriate.

In addition, some have argued that repetition of the negative behavior is not necessarily a key criterion in the definition of cyberbullying [134,135,165]. For many adolescents, this criterion does not necessarily apply [206]. For example, an offensive behavior or threat can be sent or posted online once but then distributed or posted to larger audiences, because the Internet provides a mechanism to disseminate information quickly to a vast number of people [21,99]. In these cases, the perpetrator's behavior is not repetitious, but the intent is for mass distribution (i.e., repetition of views or forwards).

Another key dimension of cyberbullying is the intent to trigger harm or negative feelings in the victim(s) [134,204].

In one focus group study, adolescents felt that the intent of the cyberbullying perpetrator was to hurt the victim [22]. The authors indicated that the motivations for the perpetrator varied and included just wanting to have fun (at the expense of the victim), not liking the victim, having had an argument with the victim, or in some cases, merely wanting to display technologic prowess. In a focus groups with teachers, parents, and students, another theme was peer pressure; cyberbullying was being perpetrated because "everyone else was doing it" [99].

The power imbalance (or an asymmetrical situation) between the victim and perpetrator is a vital component in the definition of traditional bullying [21; 134; 164; 165; 204; 206]. For example, power differentials in offline bullying might encompass the bully having larger physical stature or greater social status, such as popularity. However, this is not necessarily the case in online harassment. In cases of cyberbullying, the perpetrator may hold the power by having technologic skills and/or the content (e.g., a photo or video) to inflict harm [23,135,206]. Consequently, some have said that online technology itself can create a power imbalance between the perpetrator and victim. Essentially, bullying and harassment have become democratized; it allows everyone to participate.

Finally, literature has typically used the term "cyberbullying" to connote the behaviors of youths and adolescents, and many organizations define cyberbullying as bullying using electronic means instigated by a minor against a minor, while cyberharassment and cyberstalking is instigated by an adult toward a minor or another adult [14]. However, as stated earlier, this curriculum will be employing the collective term "cyberbullying" in its broadest sense to encompass a wide range of negative behaviors such as aggression disseminated through electronic communications and this appears to be the consensus in the empirical literature [98]. How researchers measure the different types of aggression and the specific vehicle of the electronic communication employed are inconsistent in research studies [98]. Its victims and perpetrators can include adults, adolescents, and children, although there is an emphasis on youths in this curriculum.

In summary, there remains no single consensus definition of cyberbullying. Having multiple and potentially conflicting definitions makes it challenging to research the subject. Even the basic components of harm, repetition, and power imbalance are not always included in definitions [204]. In a concept analysis, researchers suggested that cyberbullying be generally described as "using information and communication technologies to repeatedly and intentionally harm, harass, hurt and/or embarrass a target" [47].

4. ONLINE AND DIGITAL MEDIUMS FOR HARASSMENT

There are many different forms of online, digital, and electronic mediums that are used to bully or harass someone. The most common mediums include social media sites, e-mail, text, and instant messaging [24,25,136]. In a 2016 nationally representative sample of 4,500 students 12 to 17 years of age, 34% of students indicated that they were a victim of cyberbullying at some point, with 17% of the incidents occurring within the previous 30 days. It was reported that the incident was usually through social media and included mean, hurtful comments or spreading of rumors [18].

E-MAIL

E-mail is a form of electronic communication involving the transmission of messages over the Internet. Cyberbullying can occur when inappropriate messages, photos, pornography, or computer viruses are e-mailed to the victim.

CHATROOMS/ONLINE GAMES

A chatroom is a virtual community in which a group of individuals "dialogue" and share information with each other asynchronously (i.e., non-real time). A perpetrator can use this forum to spread rumors or negative or personal information about a victim to the group. Once one of the most common areas in which cyberbullying occurred, chatrooms have been replaced by social networking websites as the most common tool of cyberbullying.

Persons engaged in online gaming may harass other players regarding their performance, extending bullying to other aspects of their online persona or block them from participating in future games [166]. There are several online games (e.g., Fortnite, Minecraft, League of Legends) with an interactive component, allowing players to have discussions and interactions in game. When someone harasses an individual when playing games in the cyber world, this is called "griefing" [100]. In a 2015 study of 2,315 Taiwanese high school students, online game use predicted cyberbullying victimization and perpetration [137]. In a 2019 study, 6% to 21% of participants reported engaging in cyberbullying and 6% to 31% reported being victims of cyberbullying on online gaming platforms in the past six months [166]. In one study, being male and viewing violent content in online games were predictive of being both a victim and a perpetrator of cyberbullying in online game settings [207]. Spending long hours playing online games was also a risk factor of being bullied online but not of bullying others.

BLOGS

Blogs are analogous to website journals. Entries might include commentary, information about events, graphics, videos, or images, all of which are posted by an individual and viewed in chronologic order. Cyberbullying occurs when an individual posts negative, private, and/or false information about the victim and others are encouraged to enter the blog to read the commentaries.

INSTANT/TEXT MESSAGING

Instant and text messaging are forms of synchronous (i.e., real-time) communication whereby individuals communicate through text using computers or other devices, such as phones. When mean, hurtful, threatening, or humiliating messages are sent from one party to another, this may be considered cyberbullying. Text wars or attacks can occur when a large group of people gangs up on a victim or victims. During these "wars" massive amounts of text messages are sent to the victim.

SOCIAL NETWORKING

Social networking is a form of online communication that consists of three uses of web-based services [27]:

- Individuals construct a public or semi-public profile within a bounded system.

- Individuals articulate a list of other users with whom they share a connection.

- Users can view and traverse their list of connections and those made by others within the system.

In a 2020 study of 180,919 children 11 to 15 years of age in 42 countries, problematic social media use was related to perpetrating cyberbullying (38% to 86%) and/or cyberbullying victimization (19% to 45%) [167]. Cyberbullying on social networking sites can occur in a similar manner as via e-mails, blogs, text messaging, and websites. A survey study of adolescents found that 17% had reported being cyberbullied, with online social network sites being the most common platform [138]. Interestingly, there are several studies that show that the largest group involved in cyberbullying on social networking sites is bystanders—those who witness the bullying of others. A 2011 study found that 88% of adolescents in the United States have witnessed bullying/harassment on a social networking site [101]. In a survey study with 200 university students in Malaysia, Facebook was the most utilized social media application for cyberbullying. Participants reported that physical appearance was most often the target in cyberbullying victims [208].

WEBSITES

It has become relatively easy for anyone to create a personal website. A cyberbully may create pages with threatening or hurtful information about a victim on a specific website. In some cases, the perpetrator may post personal information and photos without the consent of the victim. This information then becomes public domain, with the possibility of reaching millions of viewers. This act of placing harmful, insulting, or threatening comments on a website has been called "trolling" [100,139]. The goal of trolling is to cause disruption and contention on websites and online threads [209].

These forms of electronic communication all share the same attribute of reproducibility. A perpetrator can easily harm another individual repeatedly by simply clicking a button, which then spreads the negative behavior (i.e., gossip) to a group of individuals in his/her address book [102].

5. FORMS OF CYBERBULLYING

There are many different forms of cyberbullying, but some of the most commonly encountered are [28; 29; 102; 134; 140; 141; 142; 143; 168; 169; 209; 210]:

- Flaming: Sending messages that are rude or vulgar in nature about a person via an online group, e-mail, or instant/text message

- Outing: Posting or sending content about a person that is sensitive and/or private (also referred to as "doxxing")

- Swatting: A form of doxxing whereby the public release of information and reporting false emergencies instigates a law enforcement response (usually to the victim's home)

- Exclusion: Deliberately and cruelly excluding someone from an online group

- Cyberstalking: Harassment via the Internet involving threats and intimidation

- Online harassment: Repeatedly sending offensive messages online

- Impersonating: Pretending to be the victim and posting messages or personal photos in a false profile

- Denigrating: Sending or posting untrue and cruel statements about a particular person. This can include e-mail or text insults about another peer's physical characteristics, such as looks or weight. Girls are the more frequent target of insults than boys, and the insults often focused on weight (e.g., calling someone a "whale" or "ugly pig") and promiscuity or sexuality (e.g., calling someone a "whore" or "slut").

- Masquerading: Posing as someone else for the purpose of sending information via the Internet that makes that individual look bad. Some perpetrators manage to steal victims' passwords in order to access computers or cell phones and pretend to be that person. Adolescents report that it is not difficult to obtain a password, and exchanging password information is often a sign of friendship.

- Online grooming: An individual targets a minor and gradually gains his/her trust to ultimately prepare him/her for abuse.

- Internet polling: Creating and disseminating an online survey with embarrassing or denigrating questions and publishing the results.

- Trickery: The perpetrator gains the trust of the victim, who then shares embarrassing information. That information is published online by the perpetrator.

- Happy slapping: Publishing a video that displays someone being physically hurt or humiliated.

View the following video, produced by Internet Safety 101, for an overview of the problem of cyberbullying.

To see this media go to http://www.NetCE.com/activities/ using a browser that supports Adobe Flash.

For more information, visit Enough is Enough's Internet Safety 101 website at https://internetsafety101.org.

In a systematic review of journal articles published between 2017 and 2022, adolescents most often used flaming, harassment, denigration, impersonation, outing, and trickery [211].

Online sexual solicitation is another form of cyberbullying, whereby perpetrators identify victims online and entice them to perform sexual acts on- or offline[29]. Other approaches include bombing (using a software program to send the victim thousands of e-mails, resulting in the e-mail account failing and ultimately being blocked) and tricking a victim into disclosing sensitive and personal information in order to disseminate the information to other people via the Internet[30,31]. In one study of 1,241 high school students, 10% admitted to filming someone being humiliated or attacked[30].

Online grooming involves an adult using technology to target a minor for an inappropriate and/or abusive relationship. In some cases, the goal is to obtain sexual photos and other materials. Some will go further and prepare the minor to perpetrate the abuse to someone else [212]. The prevalence of online grooming has been estimated between 9% and 19%[213].

In some cases, perpetrators will assume a new online identity for the purpose of bullying. In a study conducted with 365 sixth to ninth graders in Canada, researchers found that one-third of the adolescents admitted to taking on different personalities when they were online, and almost one-quarter pretended to be a different gender [32]. About 19% said they told people online that they had a different physical appearance than in real life, and 15% disclosed assuming another person's identity online. In another study, adolescents admitted to engaging in a variety of cyberbullying behaviors, including sending insulting e-mails, targeting strangers in chatrooms, and impersonating others online [22].

Some cyberbullies are very sophisticated in terms of their Internet skills, and some have been known to target institutions or companies by releasing worms that compromise computer systems [33]. This can cause computer and network systems to shut down, ultimately hurting a company's productivity and yielding financial losses. Others use their skills to access private customer information from companies for dissemination or criminal activity.

Another behavior that can develop into or be a part of cyberbullying is "sexting." However, not all sexting is cyberbullying. Sexting involves disseminating sexually explicit photos, e-mails, and texts by cell phone or online [34]. According to a study conducted by the Pew Internet and American Life Project, sexting may take place between romantic partners or it may occur between individuals who are not in a romantic relationship, but one of whom hopes to develop a romantic relationship [35]. When sexting takes place in the context of an established romantic relationship, it is considered analogous to sex, according to the teens surveyed. It may begin before or after sexual intercourse is initiated in the relationship.

If sexting data are sent in either of these scenarios, it may be shared with others outside the relationship without the consent of one of the individuals. If this occurs, it can be classified as cyberbullying under some contexts.

In a study of 1,034 ethnic minority 10th graders, 21% of participants had sent a nude or semi-nude photo or video [103]. Nearly one-third (31%) had received sexually explicit content. It is estimated that approximately 15% to 40% of youths are involved in sexting (depending on how sexting is defined) [104]. Research indicates that sexting is often done outside the context of a romantic relationship and among groups rather than simply between two individuals [144]. Generally, individuals are more likely to receive a sext than to sending a sext. Boys are more likely than girls to request and forward a sexually explicit video, photo, or message [170].

View the CBS News Segment "Don't Ask for Nude Photos:" Recalibrating Teen Sexting Culture

To see this media go to http://www.NetCE.com/activities/ using a browser that supports Adobe Flash.

6. PREVALENCE OF CYBERBULLYING

It is not clear whether the prevalence of cyberbullying has increased or decreased over the years. Some speculate that as the forms of electronic communication increase there is a greater opportunity for cyberbullying [105]. However, the prevalence is very difficult to monitor due to the varying definitions of cyberbullying, the different timeframes used, and the different study populations researchers employ [102,155,171].

CHILDREN AND ADOLESCENTS

Some scholars argue that there is a curvilinear relationship between age and cyberbullying—it peaks around adolescence (between the ages of 13 and 15 years) and then decreases with age [100]. However, the speculation that there is an "age out" effect with cyberbullying is controversial. The statistics regarding college students and cyberbullying seem to contradict this hypothesis.

Estimates of cyberbullying victimization rates among adolescents range from 3% to 72% [155]. In a survey of Internet users 10 to 17 years of age, 19% indicated that they bullied someone via the Internet or were a victim themselves in the previous year [2]. In a 2007 study, 48.8% of adolescents disclosed being a victim of cyberbullying, with almost one-third having received an abusive text message [36]. On the other hand, 21.4% of adolescents in the study admitted to having bullied someone using technology, typically text messages. Other reported forms of cyberbullying included receiving threatening online messages, having e-mails forwarded to others without consent, having an embarrassing photo posted without consent, or being the target of a malicious rumor that was spread online [37]. Girls are generally more likely to be victims of harassment or abuse online compared to boys (38% vs. 26%). Furthermore, adolescents who use social networking sites are more likely to be victims of cyberbullying compared to those who do not use social networking sites (39% vs. 22%) [37]. Data obtained from ten studies conducted between 2007 and 2016 yielding a sample size of 20,000 youths throughout the United States indicate that 28% have experienced cyberbullying victimization and 16% disclosed to having cyberbullied someone [106]. In a separate 2016 study, 34% of adolescents disclosed being a victim of cyberbullying at some point, with 17% of the incidents occurring within the previous 30 days [18]. In a 2018 survey conducted by the Pew Research Center, 59% of adolescents in the United States reported they had directly experienced at least one type of cyberbullying [172]. Almost one-third stated they had someone spread false rumors about them online. One study found a lifetime prevalence cyberbullying victimization of 9.6% for young adolescents and 1.1% for cyberbullying perpetration [214]. A separate study found higher prevalence rates, with one-fifth of the study sample disclosing to having been a victim, perpetrator, or witness of cyberbullying [215]. Again, the differences in these prevalence rates are due to differences in definitions and measures of cyberbullying.

SEXUAL VICTIMIZATION

In a very early study focusing on online sexual victimization, almost 20% of surveyed adolescents had received an online sexual solicitation within the last year, and 3% stated that they received a sexual solicitation that was characterized as aggressive, whereby the perpetrator attempted to contact the youth by mail or phone to meet [38]. In a 2008 survey study examining social networking sites and victimization, 15% of participants 10 to 15 years of age reported that they had received some sort of sexual solicitation via social networking sites [39]. In a 2012 national study in the United States, 23% of youths indicated that they experienced exposure to pornography online and 9% reported an unwanted sexual solicitation online [107]. In a study conducted in Taiwan, 13% of 11th grade students had experienced unwanted online sexual solicitation [108]. The rate of solicitation was higher among boys than girls (15.9% vs. 10.2%) [108]. In a study of 3,897 adolescents in Spain, 39.5% reported online sexual victimization. Among victims, half reported online sexual harassment and one-quarter were exposed to unwanted sexual content [156].

Online sexual harassment can also be perpetrated by former or current partners. In a study with 462 girls (median age: 15 years), 90% reported that they had engaged in sexting when they did not want to. Reasons given for complying with partner's requests to sext included proving love and avoiding conflict [173]. Revenge porn is another example of sexual online harassment often perpetrated by a former or current partner. Typically, this involves posting sexually explicit images or videos of a victim without her/his consent. In some cases, perpetrators may attempt to extort money or sexual favors from the victim ("sextortion") [174]. In a 2022 systematic review and meta-analysis, a pooled sample of 33,247 participants was analyzed [216]. Researchers found that 8.8% of participants had their image- or video-based sexts shared without their consent, and 7.2% had been threatened with sext distribution.

RACIAL DISCRIMINATION

Online racial discrimination, another form of cyberbullying, is also a concern [40]. A study of 340 minority adolescents conducted using three surveys between 2010 to 2013 measured online racial discrimination by asking whether participants had experienced being shown a racist image online; seeing jokes about people of their race or ethnic group online; hearing things online that were untrue about people in their race or ethnic group; or witnessing people saying mean or rude things about another person's ethnic group online. The researchers found that an average of almost 48% of African American, Latino/a, Asian, and bi-racial students had experienced online racial discrimination at least once within the previous 12 months through a social networking site; 21% of participants experienced online discrimination specifically through Twitter and YouTube. Text messaging accounted for 20% of online racial discrimination [40]. Perceived anonymity may be a partial motivator for perpetrators. A 2017 survey study showed that nearly 25% of black adults had been the victims of online harassment due to their race or ethnicity, compared with 10% of Hispanic adults, and 3% of white adults. These populations noted Facebook as being the most prominent medium of harassment [92].

COLLEGE STUDENTS

The most common digital mechanisms for online victimization are texts, phone calls, and social media [162]. In a 2014 online survey study with 297 undergraduate and graduate students at a university, 51.5% indicated that they had engaged in a cyberbullying behavior [109]. In another study, 10% to 15% of college students had received repeated e-mails or text messages from a spouse, boy/girlfriend, or partner that were insulting, threatening, or harassing [42]. The two most frequent types of online harassment among college students, according to a 2010 study, were sexual harassment and online pestering [43]. Approximately 24% of the participants reported having received inappropriate sexually oriented messages or unwanted material of a sexual nature, while 28% had been pestered or irritated by a person online to the point they no longer wanted to be friends. In these cases, 17% stated they requested the person who was sending messages not contact them any longer, but the contact did not stop [43]. A 2010 survey study of with 439 college students indicated that 38% of respondents knew someone who had been a victim of cyberbullying; 21.9% had been victims of cyberbullying themselves; and 8.6% had cyberbullied another person [44]. A study of 1,653 university students in Spain found that one-third disclosed to having had their suggestive photos or videos distributed without their consent [217]. The study also found a relationship between dropping out of university and experiences with cyberbullying.

Cyberbullying perpetration or victimization in high school is likely to continue after graduation and into college. Furthermore, perpetrators tend to continue using the same preferred digital vehicle even as they get older [175].

ADULTS

Although much of the research regarding cyberbullying focuses on youths, adults are also at risk. A 2017 Pew survey of 4,248 adults found that 41% of Americans have been harassed online, 66% have witnessed others being harassed online, and 18% have been victims of physical threats and/or sexual harassment [81]. Common reasons for cyberbullying included different political views (14%), physical appearance (9%), race or ethnicity (8%), and gender (8%). Age is also a factor, with 67% of adults 18 to 29 years of age experiencing cyberbullying and harassment, compared with 49% of individuals 30 to 49 years of age and 22% of individuals 50 years of age or older [81]. This survey was conducted again in 2021, and similar rates were found for adults; however, the difference in 2021 was that respondents reported more severe forms of cyberharassment [218]. For example, 25% of adults reported experiencing stalking, sexual harassment, physical threats, and sustained harassment, compared with 18% in 2017 [218].

INTERNATIONAL PREVALENCE

Cyberbullying is not a phenomenon confined to the United States; rather, it has become a global social issue. A cross-cultural comparison of youths from Canada and China and their experiences with cyberbullying found that one-quarter of Canadian 7th grade students had been victims of cyberbullying, and the prevalence was slightly higher for the Chinese students (33%) [3]. However, these differences were not statistically significant. Meanwhile, 15% of the Canadian students and 7% of the Chinese students admitted to have bullied someone using online communication mediums [3]. In another large-scale Canadian study conducted in high schools in Quebec, a total of 8,194 individuals 14 to 20 years of age participated. A total of 22.9% reported experiencing cyberbullying in the last 12 months [110]. Girls in this study experienced significantly more cyberbullying than boys [110].

A 2018 cross-comparison study examined differences in cyberbullying prevalence rates in more than 12,000 9th and 10th graders in Germany, Greece, Iceland, the Netherlands, Poland, Romania, and Spain [177]. In total, 21% reported being the victim of cyberbullying in the past year. However, there was significant variability in prevalence across countries. In this study, Romania reported the highest rate (37%) while Spain and Iceland reported the lowest (13%).

In a study of young Australians (younger than 25 years of age) who had self-identified as cyberbullying victims, almost half (49%) stated they were victims when they were 10 to 12 years of age, 52% at 13 to 14 years of age, and 29% at 15 to 16 years of age [48]. The data also demonstrated that they were victimized multiple times. The most common vehicles of harassment were e-mail (21%), online chatrooms (20%), social networking sites (20%), and cell phones (19%) [48]. In the European Union, cyberbullying victimization ranges from 2.8% to 31.5%, and cyberbullying perpetration rates are 3% to 30.6% [219]. In a systematic study of European Union and Asian countries, with a pooled sample of 188,003, the overall prevalence rate of cyberbullying was 15.8%. The lowest rates were found in Greece (5.8%), while the highest rates (38.3%) were in Greenland [220].

Sociocultural context may play a role in shaping bullying behaviors both offline and online and help-seeking behaviors. It has been suggested that in collective cultures (e.g., Asian cultures) in which there is an emphasis on the collective unit and preserving harmony, social conformity becomes an important dimension in bullying. In Japan, for example, bullying typically involves an entire class or a small group of students "ganging up" on a victim. Bystanders will tend not to intervene because the collective unit is where they derive their identity. In these cultures, the bullying behavior usually involves indirect bullying tactics, such as spreading rumors and social exclusion [49].

Cultural differences in how individuals view themselves relative to the external environment may also play a role in cyberbullying [112]. In Japan, as in most Asian countries, there is an emphasis on an interdependent self-construal—viewing oneself and others within a broader context [112]. In Western cultures, individuals tend to be primed with independent self-construals—viewing oneself and others from one's own perspective [112]. In a longitudinal study of college students in the United States and Japan, researchers analyzed two time periods to determine if there were changes in cyberbullying behaviors. Cyberbullying behaviors were highest and increased over time with the U.S. college and the U.S. sample had lower interdependent self-construals and higher cyberbullying reinforcements compared with their Japanese counterparts [112].

There also appear to be cultural differences in help-seeking behaviors, with cultures with stronger respect for authority figures (e.g., China) displaying more confidence in these figures' ability to protect them. It is possible that a culture's ingrained respect for authority and hierarchy may make the involvement of authority figures such as teachers and school administrators an effective preventive measure for cyberbullying [113].

7. SIMILARITIES AND DIFFERENCES BETWEEN ONLINE AND OFFLINE BULLYING/HARASSING

When one thinks of a conventional bully, an image of a bigger or stronger person dominating a weaker victim comes to mind. While this may be true in offline cases, this is not necessarily the case in cyberbullying. According to some experts, the issue of physical or social power is not necessarily the primary issue of the cyberbully; there may not necessarily be an obvious power imbalance between the perpetrator and victim [21,141]. However, context specific skills, such as having more technologic prowess, may be considered the key form of power in some cases of cyberbullying [23,178]. Without very specific online skills, victims may feel they cannot escape from the bullying [179].

A second difference is that online perpetrators are more often unknown to their victims; he/she can be invisible and anonymous [3]. This can make tracing the identity of the cyberbully difficult, and more difficult to hold them accountable [33,178]. Furthermore, as noted, this anonymity may play a role in the continuation of cyberbullying, as the perpetrator does not necessarily witness the negative results of the bullying and may be less likely to feel remorse or regret [33,180]. Studies are demonstrating the role of anonymity in cyberbullying. For example, one study found that 59% of comments posted anonymously were uncivil compared to 29% of those posted by an individual with an identifier [114]. In a longitudinal study with 146 college students, researchers found that when the perpetrator perceived there was anonymity, rates of cyberbullying increased [115]. Perceived anonymity tends to support positive attitudes toward cyberbullying. In a focus group study, one young boy related [50]:

I think cyberbullying is much worse than verbal bullying because you cannot tell anyone about it and then no one really knows what's going on. And the person who is doing it does not feel as guilty because they are not saying it to your face.

Some argue that the motives behind cyberbullying and traditional bullying may be different [221]. Online, recreational bullying seems to be a common reason; this was less often the case off line. This may mean that perpetrators in cyberspace do not have a good grasp on the ramifications of their actions. Conversely, revenge is a much more common motive for offline bullying than in cyberbullying, perhaps because the perpetrators in offline bullying are in closer proximity to the victim.

Offline bullying is confined to a particular time and place; however, with cyberbullying, the harassing messages can be disseminated very rapidly to a very wide audience in multiple geographic regions over an extended period of time [3,178,180]. This makes it very difficult to locate the source of the cyberbullying, but it is easier for the victim to document the harassment as the messages can easily be saved [3]. However, there does appear to be growing evidence of an overlap of traditional (offline) bullying and cyberbullying [143].

8. PROFILE OF CYBERBULLIES

In studies of children and adolescents 10 to 17 years of age, boys have been found more likely to be perpetrators of cyberbullying [46,51]. Female teen perpetrators tend to spread rumors online, while male adolescent cyberbullies tend to post photos or videos that are hurtful to the victim [116]. Age also seems to be correlated with cyberbullying, as it increases with age to a certain point [52]. The peak frequency in cyberbullying tends to occur between 13 and 15 years of age—spiking in the 8th grade and declining in the 11th grade [30,53]. This seems to be confirmed in a 2023 study that found the prevalence of cyberbullying experiences decreased from middle to late childhood, and then increased again in early adolescence [222]. It appears that younger children are more likely to be bullies in the traditional sense (offline), but older youths are more likely to be bullies online; however, it is not clear what dynamics explain this difference [46,52]. In part, it may be correlated with increased access to the Internet and cell phones with less parental supervision as children age. In addition, having been a victim of cyberbullying is a strong predictor for becoming a perpetrator [181,182,183].

There are some evidence that cyberbullies are simply looking for fun—often to entertain themselves and those in their circles [158,221]. However, other studies indicate that cyberbullies tend to be more aggressive and generally break more rules than non-bullies of the same age [51]. Not surprisingly, there is a strong correlation of cyberbullying with substance abuse and being either a victim or perpetrator of traditional offline bullying [26]. Socially, perpetrators tend to have poor relationships and emotional bonds with their parents, less supervision from their parents, and are more likely to associate with peers who are delinquent [54].

It is not surprising that empathy plays a role in cyberbullying. Those with higher levels of empathy toward cyberbully victims tend to have more negative attitudes toward cyberbullying in general and believe that their peers also disapprove of cyberbullying activities [117]. Because perpetrators are not empathetic toward their victims, they underestimate the harmful consequences of their behaviors and tend to view their behaviors more as innocent pranks or jokes rather than cyberbullying [118].

There is also some evidence that perpetrators of cyberbullying/harassment score higher levels of psychopathology compared to their non-perpetrating counterparts. In a 2014 study with undergraduate and graduate students, personality traits of Machiavellianism, subclinical narcissism, and subclinical psychopathy (called the "Dark Triad") were correlated with engaging in cyberbullying behaviors [109]. A 2015 study examining the Dark Triad and its relationship to cyberbullying among college students found that psychopathy (i.e., a lack of empathy and focus on thrill-seeking behavior) was the most influential predictor to cyberbullying [159].

There is also another segment of cyberbullies termed "social climber bullies" [55]. These are upper social class students who do well in school and who have leadership positions in school clubs and extracurricular activities. They know they can get away with bullying because teachers and school administrators do not suspect them. Social climber bullies tend to bully students who are "wannabees" (i.e., who want to be part of the in-crowd) and "losers" (i.e., outside of the in-crowd) because they are less likely to report the bullying.

9. PROFILE OF CYBERBULLYING VICTIMS

There are two major categories of cyberbullying victims: passive and proactive [180]. The majority of cyberbullying victims are categorized as passive. They tend to be described as isolated, lonely, insecure, and lacking self-esteem. When victimized, these individuals typically withdraw. Conversely, proactive cyberbullying victims respond to bullying with retaliatory bullying [180].

In general, girls and women tend to be the victims of cyberbullying, especially specific types of bullying. For example, girls are more likely to have had a rumor spread online about them than boys [37].

Cyberbully victims also tend to be victims in other areas of their lives, such as traditional bullying. Not surprisingly, victims of cyberbullying tend to use the Internet more and in riskier ways than non-victims [52,184]. A study of 935 adolescents between 12 and 17 years of age found that those with active profiles on social networking sites were more likely to experience online bullying than those without profiles [56]. Similarly, adolescents who are daily users of the Internet and who use social networking sites such Facebook, Twitter, and YouTube are more likely to report having been harassed online [37]. Individuals who used webcams at least once or twice a week or who used message boards most days of the week were 1.75 times and 1.67 times more likely, respectively, to report having been cyberbullied repeatedly in the past year [57].Those who have created online content, such as developing their own blogs, building websites for themselves or for others, uploading photos, or posting to community boards, are more likely to experience online harassment compared to those who do not create their own content [37]. This is not surprising, as motivated perpetrators will seek out contact and other personal information online to be used to harass their victims [56].

A meta-analysis found that victims of cyberbullying tended to be female and to experience high levels of depression, stress, and/or loneliness [160]. They also tend to have low self-esteem, lower levels of empathy, and more anxiety [171]. In addition, they tended to experience other forms of victimization offline, were frequent Internet users, had problem behaviors, lived in a negative family environment, and were less committed to school. A 2020 Chinese study found that cyberbully victims are more often male and younger [185]. They are more likely to experience parental conflict and have higher deviant peer affiliations. In a 2021 study, those at low risk for cyberbully victimization were more likely to be satisfied in school, have high self-esteem and self-control, and have good parental and friendship supports [223].

HELP-SEEKING

Although cyberbullying can have devastating effects on victims, many are reluctant to seek help. Adolescents have stated they would not necessarily seek help from school staff if they were being cyberbullied due to [32,118]:

- Fear of being stigmatized as an informant

- Fear of retaliation from the perpetrator

- Concern of getting friends into trouble

- Belief that it is not a school problem

- Concern that parents would restrict their Internet activities

- Feelings of shame (i.e., unwillingness to admit to being not well liked by peers)

A study of children who sought help from a Canadian organization's cyberbullying helpline found that the decision to seek parental assistance in online stalking incidences was contingent on whether the individual believed the stalker's threats were real and credible [50]. The children expressed concern that they might be punished if they were to involve their parents, and for the most part, they felt that their parents and adults in general were unable to understand the online environment and cyberbullying [50,186]. Other victims minimized cyberbullying, making light of its effects. Some felt that getting help from adults was a sign of weakness [187]. In a survey study involving more than 500 university students, the majority reported they were more likely to go to their parents for assistance with cyberbullying and they would not be likely to report it to the police [224]. Interestingly, in one study, young adults who experienced cyberabuse or aggression and who are able to identify the perpetrator were less likely to get technological assistance and/or legal assistance [225].

10. POTENTIAL INDICATORS OF CYBERBULLYING

Signs that youths may be victims or perpetrators of bullying on the Internet have been identified. Parents, counselors, and other health professionals should be aware of [78,79,144,188,226]:

- Signs of depression or anxiety, particularly when the Internet is not available or is inaccessible for periods of time

- Signs of depression or anxiety when e-mails or instant/text messages arrive

- Hopelessness or talk of suicide

- Avoiding use of the Internet and/or devices, when it was an activity that was previously enjoyed

- Academic difficulties or behavioral problems offline (e.g., not being on time at school, dropping grades, relationships suffering)

- Withdrawal from friends and family

- General aggressive behaviors

- Viewing pornographic material on the computer

- Sacrificing normally enjoyed offline activities to participate in Internet activities

- Attempting to maintain level of secrecy about online activities (e.g., quickly turning computer off when parent is walking by, deleting browsing history, turning monitor screen off when someone walks by)

- Is online or uses devices at all hours, including night

- Attempting to hide devices or switching screens off quickly when someone walks by

- Refusing to talk about what they are doing or who they are engaging with online

- Beginning to display behavioral issues at home or at school

11. THEORETICAL FRAMEWORKS USED TO UNDERSTAND CYBERBULLYING

STRAIN THEORY

Strain theory was introduced by Robert Merton in the early 1930s in his study of wealth. He asserted that whenever a gap or discrepancy between individuals' aspirations and reality exists, frustration will ensue, and individuals will be more likely use illegitimate means to accomplish their goals [58]. In the 1990s, Agnew expanded this theory to apply more broadly to economic aspirations. Agnew argued that people who experience strain are more likely to experience frustration or anger and are then more vulnerable to engaging in criminal or deviant behavior [59]. Sources of strain could stem from three sources: positively valued goals that are not achieved; loss of positively valued stimuli (e.g., loss of a job, loss of a romantic relationship); and presentation of negative stimuli (e.g., history of family violence) [59]. Although social institutions or persons (e.g., parents) can prevent deviant behavior, it is argued that repeated strains could weaken the bonds of these social control mechanisms [119]. It is important to note that strain and deviance are not causal; deviant behavior is a coping mechanism when strain develops [59].

Since the 1990s, strain theory has been applied to other behaviors, and it has been posited that there may be a relationship between strain and cyberbullying or traditional bullying. In one study of 1,963 middle school students, a variety of strains were measured, including receiving a poor grade, breaking up with a girl/boyfriend, and having a quarrel with a family member, and level of frustration and anger was also recorded [58]. The authors found that strain and anger/frustration were correlated to traditional bullying and cyberbullying even after taking into account gender, race, and age. Therefore, strain theory may be helpful in explaining the causes of cyberbullying. Using the Korean Youth Panel Survey, which includes 3,449 8th grade students, researchers tested strain theory by hypothesizing that youths who were bullied in the traditional manner were more likely to be perpetrators of cyberbullying [120]. This hypothesis was confirmed, and the authors found that other strains, such as parental, academic, and financial strains, also increased the odds of being a perpetrator of cyberbullying.

One study tested strain theory with 3,195 junior high and high school students [145]. Cyberbullying victimization and the strain of not feeling safe on the way to school or back to school was correlated with using both soft and hard drugs as well as carrying a weapon. Another study found that experiencing or having experienced cyberbullying is a strain that predisposes an individual to future cyberbullying perpetration [189]. Some have hypothesized that the stress of the COVID-19 pandemic would also contribute to cyberbullying perpetration [227]. A study of 194 adults in the United States with a mean age of 37 years found that those who had personal experiences or who knew of others who were infected with COVID-19 were more at risk of cyberbullying.

DISINHIBITION THEORY

Disinhibition theory maintains that the Internet can promote an abandonment of some inhibitions, leading to greater disclosure, less restraint, greater expressiveness, and less empathy. These types of behaviors have been classified as the "online disinhibition effect," which can fall into one of two categories: benign disinhibition (e.g., self-disclosures) or toxic disinhibition (e.g., foul language, pornography, violence, bullying) [60]. Some have also termed this phenomenon "toxic online disinhibition," defined as the loss of capacity for empathy and dulled awareness and processing of social cues [190].

The following characteristics of the Internet may facilitate online disinhibition [60]:

- Dissociative anonymity: A person can remain relatively anonymous online, with no name or a false name.

- Invisibility: For the most part, the Internet, and particularly websites, blogs, and other text-based platforms, lends itself to the person's invisibility. In online communication, there is no concern about nonverbal cues and messages sent.

- Asynchronicity: People can interact and communicate with each other in non-real time; there is no feedback loop that discourages negative behavior.

- Solipsistic introjections: Because there are no immediate social and nonverbal cues online, one assigns a "voice" and "image" to another person. This process may be conscious or unconscious.

- Dissociative imagination: It is easier for a person to dissociate online fiction and offline fact.

- Minimization of authority: There is often minimal or no sense of who the authority figure is online. If there is an authority figure, his/her presence is minimized by social cues present in face-to-face interaction, such as attire, height, and body language.

Although this is interesting, studies testing disinhibition theory's application to cyberbullying have not necessarily yielded findings to support these assumptions. In an anonymous online survey of youths 12 to 17 years of age, approximately two-thirds who were victims of cyberbullying stated they knew who the perpetrator was and half knew the bully from school [57]. Therefore, anonymity associated with the Internet does not appear to be the driving force in the cyberbullying in this age group.

In another survey of 7th, 8th, and 9th grade Taiwanese students, instant messaging was the technology most often used for cyberbullying purposes [61]. Students who used instant messaging were more likely to be victims and perpetrators of cyberbullying. If the anonymity component of cyberbullying were a true motivating factor, instant or text messaging would not be the best tool, as it requires login identification. In addition, users of instant messaging often must first have approved the conversation and participants [61]. In this study, among those who experienced cyberbullying, only 25% did not know the identity of the cyberbully, and among those who witnessed a cyberbullying event, 43% stated they did not know who the bully was. Because the majority of people do seem to know the identity of the perpetrator, the role of anonymity in promoting greater disinhibition is called into question. In a 2020 longitudinal study, a program designed to challenge college students' views about anonymity on the Internet was found to decrease perceived levels of anonymity and levels of toxic online disinhibition [191]. Two months after completing the program, researchers found that anonymity perceptions helped to reduce cyberbullying perpetration.

Finally, in a study with 2,407 Chinese adolescents between 11 and 16 years of age, high levels of online disinhibition predicted perpetration experiences of cyberbullying [228]. However, when high levels of empathy were introduced in the analysis, this relationship was no longer significant.

SOCIAL PRESENCE THEORY

Social presence theory is somewhat similar to disinhibition theory in that it asserts that Internet technologies might encourage certain types of behaviors due to the lack of nonverbal and social cues. An individual's sense of social presence decreases in the online medium, and therefore, deindividuation increases [62]. Because online interactions are more impersonal, communication can more easily become aggressive or abusive [62]. For example, it is simple to cut and paste information and e-mail it to a large audience without having to witness the fallout [37]. In a survey of 146 undergraduate students, researchers found that aggressor-perceived anonymity was positively related with cyberbullying [146]. In other words, the more anonymous these students perceived the Internet being, the more likely they would cyberbully.

12. ONLINE DATING AND CYBERHARASSMENT

According to a 2019 survey, about 30% of adults in the United States have used an online dating site or app [63]. In the United States, 54% believe that relationships that begin on a dating site or app are just as successful as those that begin in person [63]. Popular online dating sites/apps include Tinder, Bumble, Match.com, OkCupid, Plenty of Fish, and Grindr [64]. However, many consider safety to be an issue when using these services. In a small sample of Internet dating service users, more than 80% used various safety precautions when dating, such as meeting at a public location; telling a friend of the meeting; never leaving or going home with someone they met; never giving out a home address; never giving out a phone number; and reporting people who violate dating rules to the dating service [65].

In a 2012 qualitative study conducted, researchers interviewed online dating site users via email and texting [121]. Participants indicated that the use of deceit contributed to the riskiness of online dating. One participant admitted to having two different profiles, individualizing use of the profile to match the type of women he wanted to target. Interesting, although participants acknowledged that there were dangers in online dating, it was generally acknowledged only within the overall context of the danger of the Internet. Participants also contextualized that any danger was rooted in other people behaving badly [121].

Patterns of use may vary among online dating websites, but researchers have found a theme of control. Implementing mechanisms to control how the situation will play out in an offline environment surfaced as a prominent theme that touches indirectly on online dating safety [66]. Participants in one study described the process of how they negotiated the transition from online dialoguing to the first face-to-face meeting with the person they had been conversing with on the Internet, and common characteristics included meeting during the day in public places and ensuring that there is an easy exit strategy (e.g., meeting for coffee).

There have been few studies about cyberbullying and online dating. In a 2001 study of female adult customers of online dating sites, 26.8% stated they experienced receiving unsolicited obscene e-mails and 15.6% stated they experienced flaming [65]. In this study, the cybervictimization did not necessarily translate into offline harassment or victimization. In a study with 433 university students, more than half of the participants disclosed to having experienced dating abuse via the Internet in the past six months, with jealousy and control being primary motivating factors [147]. In a survey study with 424 sixth graders, almost 15% disclosed having perpetrated cyber dating abuse at least once [192]. In a study of 798 seventh graders, 32% had experienced online dating violence perpetration and 51% had experienced victimization [229]. The theme of control and the desire to monitor a dating partner's activity also arose in a study of high school students [148]. Participants in this study reported using social media as a form of electronic intrusion to monitor the whereabouts of their partner. There is also a relationship between cyberbullying and online dating victimization—those who have been victims of cyberbullying are four times more likely to also be a victim of online dating abuse [179]. A study of 696 young adults found that the average age when digital dating abuse behaviors started was 16 years [230].

Youths also use online mechanisms to date or engage in romantic relationships [29]. A study of youths 11 to 14 years of age found that adolescents used the Internet as a developmental platform for romantic and sexual experiences, building friendships and romantic relationships. Adolescents rely on their devices to feel connected to their friends and to their partners. Victims of online dating violence may feel that they cannot escape their abuser because they are reliant on their device for connection to others [179].

As young as 13 years of age, youths described their online sexual and romantic relationships as intense and committed. Sexual encounters ranged from cybersex or cybering, which refers to having blatant sexual conversations, to flashing, which is displaying nudity via a webcam or video message. The online environment appears to make younger individuals overly confident, and their sexual activities were often detached, impersonal, and anonymous [29].

Over the years, as dating websites have become more popular, states have attempted to enact statutes to protect users. For example, some states require dating websites to have criminal background checks in place [122]. In addition, it is now common for dating websites to have educational information for users about how to protect themselves when making arrangements to meet offline [122].

13. DIGITAL TECHNOLOGY AND INTIMATE PARTNER VIOLENCE

Many U.S. states are just beginning to effectively address the growth of technologies and their role in intimate partner violence. However, domestic violence victims who typically can resort to prosecuting their perpetrators and filing civil protection orders have had a more challenging time when the violence and stalking takes place online [123]. As of 2017, all 50 states and the District of Columbia have laws regarding bullying. Of those, 23 states specifically address "cyberbullying" and 48 states included electronic harassment [93]. However, those states that did not address specific terms such as "cyberbullying" and "cyberstalking" in their statutes may leave domestic violence victims finding themselves in a predicament [93,123].

Domestic violence has been defined as "a pattern of assaultive and coercive behaviors, including physical, sexual, and psychologic attacks, and economic coercion that adults or adolescents use against their intimate partners" [67,68]. Domestic violence can include any behavior that is meant to "intimidate, manipulate, humiliate, isolate, frighten, terrorize, coerce, threaten, blame, hurt, injure, or wound someone" [94]. Stalking is common among domestic violence perpetrators as a means to threaten and control victims. The three technologies most frequently used to stalk are smartphones, mobile phones, and social media [149].

A 2017 report by the Centers for Disease Control and Prevention (CDC) examining intimate partner violence indicated that 15.8% of women experienced stalking within her lifetime [69]. Of these women, 75.8% reported receiving unwanted text messages, phone calls, and voice messages, and 13.6% reported receiving unwanted emails and messages on social media [69]. The report showed that 61.5% of female stalking victims were stalked not by a stranger but by a current or former intimate partner [69].

Men also are victims of stalking; in fact, a survey study involving 689 men and women found that women were more likely to cyberstalk than men [133]. In the CDC report, an estimated 5.3% of men reported a lifetime prevalence of being stalked [69]. Of these men, 72.1% indicated receiving unwanted text messages, phones calls, and voice messages and 13.2% received unwanted emails, instant messages, and social media messages [69].

In a 2009 study conducted by the Technology Safety Project of the Washington State Coalition Against Domestic Violence, a program designed to educate the community, domestic violence victims, and domestic violence advocates about the role of technology in domestic violence and promoting technology safety, one-quarter of the women had the browser history on their computer monitored, and 23.6% stated that they had received threatening e-mails repeatedly [71]. An additional 18% indicated that someone monitored their e-mails. However, a 2017 report by the National Network to End Domestic Violence notes that abusers often use electronic means to spy or eavesdrop on their victims. These researchers found that 97% of abusers used social media and other programs to stalk, harass, and control their victims, showing the growing use of technology in domestic violence and abuse [70].

The increasing sophistication of digital technology has affected how perpetrators control and monitor their victims' movement through the use of GPS, wireless video cameras, and tracking apps [193; 231]. Similarly, Internet technology has been used by perpetrators to determine and track victims' plans and movements. If a victim is not technologically sophisticated, she or he can inadvertently provide more information than she or he intends to the abuser. For example, abusers can monitor victims' e-mails by simply looking at website browser histories and reading deleted e-mails or browsing through deleted files [72; 231]. Abusers may also disrupt victims' messaging system by bombarding with messages or assuming victims' identities to send messages to others [194]. Increasingly sophisticated and easily accessible software, hardware, and spyware programs allow abusers to monitor a victim's computer or smartphone without his or her knowledge. If one of these programs is installed, alerts reporting the victim's computer activity, including e-mails sent and websites visited, may be sent to the abuser [72,231]. Keystroke loggers, hardware devices plugged into the keyboard, may also be used to record everything typed, such as e-mails and passwords [72,194].

Perpetrators often employ online and digital technology to control victims' communications, to threaten and harass, and to target the victim's network [232]. For example, behaviors to control the victim's communication includes demanding to have joint accounts, deleting certain contacts on the victim's device, looking at retroactive posts, and blocking certain communications. Targeting the victim's network includes pretending to be the victim on the device, threatening the victim's friends and family members on the device, and encouraging friends and family members to criticize the victim online. However, victims also use technology to access support and information, obtain evidence, monitor the perpetrator, and counterstrike. Not only can victims access information about how to better safeguard themselves, but they can let their friends and family know what is going on. Some start building their legal case by collecting photos and posts.

As digital technology has advanced, there have been concerted efforts to protect domestic violence victims from online crimes. In Ohio, for example, a "do not track" legislation was brought forth that allowed Internet and smartphone users the ability to prevent anyone from tracking their personal information and whereabouts. This type of legislation may be used by domestic violence victims to protect their safety [124].

14. PSYCHOSOCIAL CONSEQUENCES OF CYBERBULLYING

Undoubtedly, cyberbullying has deleterious consequences. There has been some research that shows that the severity of the negative effects may vary by the means by which the cyberbullying is performed. For example, posting negative or invasive photos or video has the most serious consequences. Online cyberbullying is associated with more negative emotional repercussions than cyberbullying by phone or text message, as the message is often more widely spread and causes more humiliation [125].

Evidence Based Practice Recommendation

According to the U.S. Preventive Services Task Force, bullying (either as perpetrators or as victims) is a possible risk factor for suicide attempt in children and adolescents.

https://jamanetwork.com/journals/jama/fullarticle/2797145

Last Accessed: November 29, 2023

Level of Evidence: Expert Opinion/Consensus Statement

Many psychosocial effects of cyberbullying have been noted in victims. Youths who experience bullying of any kind often face academic problems, perhaps in part because they are distressed and preoccupied. Teachers will often report that victims' grades drop precipitously, and some will have other academic problems, such as cutting classes, increased detentions, and carrying weapons to school [54,73]. This may be the result of no longer viewing school as a safe place. Poor academic performance and behavioral problems have been found to continue for years after experiences of cyberbullying [150]. Adult victims have reported sleep problems, job dissatisfaction, and health and mental health issues [165]. The most significant psychologic effects appear to be depression and anxiety [233]. Depression is also associated with cyberbullying victimization, with victims reporting increased sadness, anger, and anxiety [74,233]. These negative ramifications appear to apply in many countries and cultures [125]. Situational characteristics (e.g., level of social support, emotional intelligence, coping skills, empathy) can moderate psychosocial consequences [165]. Those with higher levels of interpersonal emotional competence are better able to ameliorate the psychologic distress of cyberbullying better than those with lower levels [195].

In one study, youths who reported receiving an unwanted sexual solicitation online were 3.5 times more likely to experience major depression symptoms [75]. In terms of gender, boys were 2.5 times and girls were two times as likely to disclose experiencing major depression if they had experienced unwanted online sexual solicitations. Similar negative psychologic effects have been reported in adolescents experiencing online racial discrimination. High school students who experienced online racial discrimination are at greater risk for depression and anxiety, with girls reporting more symptoms compared to boys [40].

Issues of self-esteem seem to be a problem for both perpetrators and victims of cyberbullying, even after controlling for age, race, and gender [76]. Coupled with increased depression and anxiety, it is not surprising that suicide resulting from cyberbullying and victimization has become a social problem [234]. In a study of 2,000 middle school youths, suicidal ideation was higher among those who were either victims or perpetrators of bullying or cyberbullying [77]. Being a victim is a slightly stronger predictor of suicidal thoughts and attempts; victims of cyberbullying were 1.9 times more likely and perpetrators of cyberbullying were 1.5 times more likely to have attempted suicide. The adverse psychosocial consequences stemming from cyberbullying may be due to the fact that victims feel that because of online anonymity, there is no safe haven [100].

Not surprisingly, biophysical mechanisms that influence stress and anxiety levels are activated in cases of cyberbullying. Cyberbullying victims and bystanders experience increased levels of cortisol secretion [151]. In a longitudinal study of high school students, adolescents who were cyberbullying witnesses, perpetrators, and victims (all three roles) were 1.47 times more likely to use several substances over time than those who had only witnessed cyberbullying [196].

15. RISKY INTERNET BEHAVIORS

Risky and safe Internet behaviors have become an issue in most households given parental concerns that children might fall prey to online predators or be exposed to inappropriate material. Many parents are attempting to take on an active role in the monitoring of their teen's online behavior. In one study, parents monitored their teen's online activity through checking websites that the teen had visited (61%), checking their teen's social media profile(s) (60%), looking through phone records (48%), using parental controls to monitor (48%), using parental controls to restrict use (16%), and tracking location through use of GPS/phone apps (16%) [15]. Although there is technology available to monitor children, parents of younger teens tend to rely more on personal engagement than technologic solutions [15].

Internet technology has also changed the face of developing friendships in youth. In 2015, 57% of adolescents had met a friend online and 29% had made five or more friends online; however, only 20% of those friends made online have been met in person [95]. Boys were more likely to report making friends online (61%) compared with girls (52%) [95]. Social media and gaming sites are the most common platforms for teens to meet new people, with 36% of all adolescents making friends on Facebook or Twitter and 21% making new friends while online gaming [95]. A study surveyed 251 adolescent girls, 14 to 17 years of age, and found that 30% had met an online "friend" offline without fully confirming the other person's identity [80].

In a study with 147 teens and young adults (15 to 24 years of age), participants were asked to complete a survey about experiences with cybervictimization. A content analysis of the participants' Facebook profiles found that greater numbers of Facebook friends predicted victimization [126]. Having a strong presence on Facebook and a wide social network increases one's online profile and can increase the risk of meeting a stranger and of victimization [126,197]. In another study, persons who frequented online games and chatrooms were more likely to be victims and perpetrators of online sexual solicitation than those who were not involved in online gaming or chatrooms [108]. Parental rules regarding Internet use, including how long adolescent children can be online, oversight of activities, and checking accessed sites, were not predictors of whether or not adolescents would have an offline meeting with someone they met online [82].

However, children who are online are not necessarily in grave danger from online predators [83]. Rather, because of a lack of familiarity with technology, general concern with adolescents' sexuality, and parental fears about losing control, the media and parents have created a moral panic with little data to justify the fear. In a 2008 study, researchers found that none of the youths in the study who posted personal information online were exposed to sexual predators [83]. However, other risky Internet behaviors, such as interacting online with a stranger, chatting online about sex, seeking pornography, and accepting strangers to friends lists, make adolescents more vulnerable. Essentially, there is no single risky Internet behavior that places youths at risk; engaging in a cluster of Internet risky behaviors increases vulnerability [84]. For example, students who post photos online were also more likely to visit sex websites, chat online about sex, and seek information about sex online.

In general, scholars and researchers maintain that the skills acquired by using the Internet and conversing in online social networking sites can assist in facilitating youths' confidence, communication skills, team building, and other skills that are necessary in a highly technologic world. Therefore, it is not realistic to merely prohibit the use of online technologies. Instead, prevention and educational efforts for health professionals, parents, adolescents, and young adults should focus on risky behaviors and skills to recognize, refuse, and report online predators [84].

Parents, adolescents, and children should also be educated about the types of Internet behaviors that are considered risky, including [45; 95; 235]:

- Posting a full name on publicly accessible Internet profiles, such as discussion forums, message boards, social media platforms, blogs, and/or chat rooms

- Posting contact information (e.g., phone numbers, e-mail addresses, city and state) on the Internet

- Posting photos of oneself on the Internet

- Posting what is considered a provocative or sexy picture of oneself on the Internet

- Sharing passwords, even with close friends

- Creating what might be considered a provocative user name or e-mail address

- Making one's profile visible to all Internet users

- Creating a gender-specific e-mail address

- Inviting strangers to one's social networking site

- Accepting strangers to one's social networking site

- Entering a sex chatroom

- Agreeing to meet someone offline after minimal Internet exchanges

- Downloading pornographic images from pornographic websites

- Talking with a stranger about sensitive topics (e.g., sex, relationships)

- Returning an e-mail from a stranger

- Posting one's plans on the Internet (e.g., plans for the day or a specific time)

- Using a webcam to talk to a stranger on the Internet

- Accepting file transfers or links from a stranger

- Posting rude or offensive comments

- Visiting forbidden and/or pornographic websites

The following video, Risky Youth Behavior, was produced by Internet Safety 101 to explore adolescents' online behaviors and perspective on online sexuality.

To see this media go to http://www.NetCE.com/activities/ using a browser that supports Adobe Flash.

For more information, visit Enough is Enough's Internet Safety 101 website at https://internetsafety101.org.

16. PREVENTION AND INTERVENTIONS

A three-tiered model may be used to provide a framework in developing prevention and intervention approaches specific to cyberbullying [152,180,198]:

- Tier 1: A common definition and policy for cyberbullying is shared by all relevant stakeholders (e.g., victim, perpetrator, parents, educators). Practitioners learn the jargon associated with social media and how to use these apps in order to build credibility.

- Tier 2: Prevention and intervention strategies are developed for those who may be at-risk for cyberbullying or are victims of cyberbullying. For example, educational groups are started that teach empathy and assertiveness skills to at-risk youth. Practitioners involve parents to address the issue appropriately with their children (not simply take away devices).

- Tier 3: Interventions are developed for those who have been affected by cyberbullying or those who perpetrating cyberbullying. For example, a crisis intervention strategy is offered to meet the mental health needs of victims of cyberbullying. If a victim requires transfer to a new school, practitioners help to negotiate the process. A restorative justice perspective may be taken, when appropriate, when there is an attempt to reconcile the victim and perpetrator.

EDUCATION ON INTERNET SAFETY AND RISKY INTERNET BEHAVIORS

Education is a key component in the prevention of cyberbullying, and education about Internet safety can occur on several different levels—with parents, youths, and young adults. Parents often education on definitions of cyberbullying, different applications and how they are used, and how to best communicate with their children about Internet activity [236]. Although the majority of individuals practice Internet safety behaviors to some extent, in one study 25% of young women reported having posted a sexy or provocative photo of themselves on the Internet in the last 12 months and 25% talked to someone online they did not know about sex, relationships, and other personal topics [45]. Approximately 10% of the sample indicated they had met someone offline after a few online exchanges. Of course, while the majority of users have not engaged in risky Internet behaviors, those who have may be targeted for more education regarding what constitutes risky behavior and how to avoid victimization.

In an in-depth study with 48 high school students, participants were asked to identify factors that would be important in helping to prevent cyberbullying [127]. The majority felt that there should be more explicit discussions in order to raise awareness about the Internet environment. For example, when an individual engages in an online conversation, he or she should understand that they are "talking" to a stranger who may or may not have represented him/herself accurately. One interesting point is that the participants discussed the importance of others raising their awareness of risky Internet behaviors but not their own [127]. This may speak to the fact that youths do not necessarily see themselves in danger (feeling "invincible"). These points should be addressed in educational materials and programs for the prevention of cyberbullying.

Parental supervision and monitoring is also vital. Three dimensions of effective parental monitoring have been identified: control, solicitation, and disclosure [128]. Parental control refers to efforts on behalf of the parents to restrict their children's behaviors through rules. Parental solicitation pertains to parents' efforts to obtain information by questioning their friends, teachers, and coaches. Disclosure refers to a child's willingness to honestly tell parents about his or her behaviors [128]. Parent/child digital contracts may be used to outline parental monitoring expectations and to incorporate discussion of healthy and positive technology use [199]. Resources for digital contracts are available at https://mediatechparenting.net/contracts-and-agreements.

Overall, studies indicate there is a discrepancy in reports by parents and children about parental supervision and monitoring of the Internet. Parents tend to report that they have more rules for Internet usage, while children report fewer parental rules [85]. Parents may underestimate how often their children use the Internet and engage in risky Internet behaviors in part because they are less competent with technology and less informed about the Internet [85]. At the same time, another study found that the more parents try to restrict their children's online activity, the more risky online activities they engage in [128].

With this in mind, there are safety tips parents may implement in order to minimize the chances of online victimization of their child or children [78]:

- Place the computer in an area where there is a lot of traffic to prevent youths from being completely isolated, minimizing their ability to freely explore on the Internet.

- Specify where laptops, smart phones, and tablets may be used.

- Implement a schedule for Internet use.

- Encourage computer and Internet use when a responsible adult is present.

- Use screensavers of important people to prevent the person using the computer from falling into a trance-like state.

Practitioners should encourage parents to get involved with the social media platforms their children use [153]. Parents may also monitor and check their children's phones' security settings [153].

Parents, counselors, and other helping professionals cannot effectively advocate for Internet safety and avoidance of risky behaviors if they themselves are not familiar with various technologies. It is important to experience social networking sites, blogs, chatrooms, and other online technologies firsthand. Professionals and parents must also acknowledge that the Internet is not simply a venue to locate information; it has become a place for youths and young adults to socialize [86]. Just as individuals have been socialized to recognize cues when situations are perceived to be unsafe or to not frequent certain locations during certain times, this now extends to the Internet.

PROSOCIAL SKILLS TRAINING

Using cognitive behavioral techniques, cyberbullying education can focus on an individual level or group format. Topics such as social skills, an ethics of caring, conflict resolution, impulse control, and promotion and facilitation of empathy and personal responsibility should be the focus of educational curricula [32,33]. In a 2014 study, adolescents were asked to identify solutions for cyberbullying; the strongest suggestions were to provide counseling/support services; to establish an anonymous helpline to report cyberbullying; to develop a more respectful school culture; to suspend or expel perpetrators of cyberbullying; and to develop strong anti-cyberbullying policies [32,97]. Although youths indicated a wish to report witnessed or experienced cyberbullying, fear of reprisal was a major barrier. Therefore, they felt a mechanism to report cyberbullying and harassment that protected anonymity was vital [32,97]. Other suggestions included interventions to help youths develop a healthy and positive self-esteem and self-concept.

Imparting social skills, such as fostering empathy and self-efficacy, is also an important theme in cyberbullying prevention [200]. Educators, parents, and practitioners often assume that adolescents and young adults understand and know how to extend empathy and fairness, but this is not always the case. These individuals may benefit from education on how to respond to cyberbullying in a non-aggressive, empathetic, and thoughtful manner [200]. Adolescents who intervened or who were merely bystanders in cyberbullying situations score high on empathic levels, but adolescents who score high on social self-efficacy are more likely to intervene compared to those who scored low on social self-efficacy, who were more likely to engage in passive bystanding behaviors [87]. Social self-efficacy is defined as one's perception of oneself and perceived competence in navigating social situations and being assertive and proactive in interpersonal relationships. In other words, regardless of adolescents' ability to empathize with victims, perceived ability to do something effective predicts whether they will intervene. Furthermore, adolescents benefit from training in how to help friends or what steps to take to intervene as a bystander [237]. Thus, adolescents who score low on self-efficacy may not necessarily know what they can do to help, may be afraid of retaliation, or may be afraid of doing the wrong thing and exacerbating the situation [87]. Therefore, adolescents should be taught assertiveness skills for a variety of situations in order to minimize the pressure to conform to group norms. For example, prevention programs that emphasize peer support, peer mediation, and peer mentoring might be beneficial [87]. For example, researchers who conducted a recent study with Turkish adolescents found that those adolescents who were less empathic were more at risk for engaging in cyberbullying. Their study results demonstrated that the combined effect of affective (i.e., experiencing someone else's feelings) and cognitive (i.e., taking another's perspective) empathy played a vital role in influencing adolescents' participation in cyberbullying. In an experimental study that used a cognitive-behavioral model for empathy training, at two-month follow-up, adolescents who participated in the training maintained increased empathy levels and had reduced cyberbullying perpetration and victimization experiences [238]. Consequently, some experts recommend empathy training in an attempt to reduce participation in cyberbullying [125]. Teaching both affective empathy ("My friend's negative feelings as a result of experiencing cyberbullying do affect me.") as well as cognitive empathy ("I can understand why my friend who experienced cyberbullying is upset.)" is vital [125].

However, certain dimensions of empathy may be more predictive of perpetrating cyberbullying. For example, in a study with 72 young adults, lack of emotional congruence (defined as the correspondence between the person who perceives the actual emotional experience and the target's actual emotional experience) was predictive of cyberbullying [154]. As such, it may be worthwhile to develop online exercises or games to enhance individuals' emotional congruence. Furthermore, it takes time to develop prosocial skills. Some experts assert that a minimum of four sessions is needed, while others recommend anywhere from one to six months [237,239].

EDUCATION ABOUT CYBERBULLYING AND HARASSMENT

Due to the rapidly changing nature of the Internet and digital technology, parents, educators, practitioners, and youths will require continual education regarding cyberbullying and harassment, how it occurs, and its impact. The etiquette that applies to interacting offline should also be applied to interacting online, and individuals of all ages should have a clear understanding of how to behave properly on the Internet. Sanctions should be imposed when inappropriate behaviors occur on school grounds and at home [88]. Educators and parents may employ an Internet use contract and/or a cell phone use contract to explicitly delineate what is appropriate and inappropriate in terms of Internet and cell phone behaviors [88]. These contracts should be reviewed by all parties and be placed by the computer as reminders.

Because cyberbullying is often perceived to be anonymous, perpetrators believe they can get away with the offense and victims believe they have no recourse. However, there are steps that can be taken to address these behaviors. Victims of cyberbullying should not erase messages, as they can serve as evidence. The police, Internet service providers, and/or telephone companies may use these messages and the associated data to track the origination of the message [33]. This can allow victims to gain some sense of control over the situation.

Overall, the prevention of cyberbullying must be viewed as a several-prong approach, with education at many levels. It should be ongoing, not merely implemented after an instance occurs [240]. Collaboration with teachers, school counselors, school administrators, and students is key to making education effective [129]. Cyberbullying among youths may be related to poor parental monitoring and poor parent/child emotional bonding [54,87]. However, this does not mean that parents should be the sole target for prevention education. Instead, educators, youths, practitioners, and parents should all learn about Internet safety. It should not be assumed that adults are the most effective teachers regarding cyberbullying. Student mentors can be highly effective in disseminating information about cyberbullying, Internet risky behaviors, and positive online interactive skills [96,200].

Education on digital citizenship is also important [240]. Discussions about what constitutes citizenship and the characteristics of a "good citizen" offline and online, and how civic virtues of respect and care can be promoted online are beneficial [241].

COMMUNITY ADVOCACY AND COLLABORATION

Social workers, counselors, physicians, nurses, educators, lawyers, and other professionals can work collaboratively with parents and community leaders to develop policies and interventions that deal directly with cyberbullying and harassment [186]. Policies that establish appropriate Internet behavior etiquette and codes of conduct and consequences for violating these codes must be clearly communicated to all parties. Training should involve local community leaders, school administrators, teachers, and other professionals and should focus on different forms of technology and how they are used to cyberbully. Because many administrators may be digital immigrants, as discussed, they must be empowered to make a difference despite lacking technologic savvy [4].

CRISIS INTERVENTION AND COUNSELING

In cases of identified cyberbullying, victims may benefit from crisis intervention and counseling [89]. The seven-stage crisis intervention model is often used with these clients.

Stage 1

The first stage involves assessing the client's level of danger. Depending upon the type of cyberbullying the victim experienced, the victim's level of distress may vary. Determine the severity of the distress and if the victim is at risk of hurting himself/herself. Equally important is assessing the victim's risk of being hurt by the perpetrator.

Stage 2

Establishing rapport is the next step. Frequently, victims are ashamed about the cyberbullying or harassment, feeling that they are to blame. Others are reluctant to disclose the cyberbullying and harassment, believing that their parents may impose strict monitoring and supervision or that the repercussion from the perpetrators will be severe. Adults may feel embarrassed. The goal in this stage is to provide a supportive and safe environment in which the victim can tell his/her story about the cyberbullying.

Stage 3

Next, it is important to identify the major problems to address. Practitioners can assist cyberbullying victims by first evaluating his or her emotional status and determining the extent of the psychologic, emotional, and social impact of the cyberbullying. This will inform the treatment plan by illuminating specific areas that should be addressed.

Stage 4

The fourth stage involves exploring feelings. Questions should be posed about victims' feelings and perceptions of how safe they feel at home and at school [79]. Victims can be asked to define what cyberbullying and harassment mean to them and what types of losses they have experienced (e.g., loss of safety, control, certainty, and/or trust) [90].

Stage 5

Exploring alternatives is stage 5. It is important that victims feel that the counseling process is collaborative. Victims should voice their feelings or thoughts about the various alternative solutions that may be implemented.

Stage 6

In stage 6, develop a concrete, solutions-focused action plan. Crisis intervention is based on a problem-solving orientation, whereby the situation is immediately assessed. The type of assistance is decided upon, and a concrete plan of action is implemented. The specific action plan will vary depending upon the type, extent, and severity of the cyberbullying.

Stage 7

Finally, it is essential to follow-up with the victim. When the immediate stress from the crisis has stabilized, reinforce proactive techniques used by the victim to promote adaptation and coping [91]. It is important to reassure victims that fear is a normal response and the fear and anxiety experienced might last for a while, which is normal. Fear can be used in a positive manner to serve as a protective mechanism, ultimately empowering victims to be more proactive in taking online safety precautions [90]. When instances of cyberbullying occur, it is recommended that it is documented fully [129].

Art-based therapeutic modalities have also been suggested to assist cyberbullying victims and perpetrators [186]. Role playing and psychodramas, for example, can be used to teach and practice assertiveness to victims, to teach empathy to perpetrators, and to model appropriate responses to bystanders. Art-based therapies can facilitate discussion of experienced trauma and expressions of anger and frustration.

17. CONCLUSION

Due to the seeming invisibility and anonymity of the Internet, cyberbullying and harassment have become serious social concerns. The solution is not necessarily to avoid the Internet and other digital technologies; rather, more Internet safety education and prevention information are needed to raise awareness for youths, adults, parents, and practitioners. Adults, including helping professionals, who are not confident and do not feel well-versed in new digital technologies must acknowledge that the Internet is a new space for individuals to connect and converse, both positively and negatively. Having the knowledge and skills to help cyberbullying victims is necessary in this new era.

18. RESOURCES

Cartoon Network

Stop Bullying: Speak Up Campaign

An initiative started by the Cartoon Network, Stop Bullying: Speak Up seeks to empower all kids to take part in the growing movement to help bring an end to bullying by offering online tools, documentaries, and parental guides.

https://www.cartoonnetwork.com/stop-bullying

Common Sense Media

A cyberbullying toolkit and other educational materials for safe media use.

https://www.commonsensemedia.org

University of New Hampshire

Crimes Against Children Research Center: Technology/Internet Victimization

The Center conducts research and offers resources about crimes against children for the public, policy makers, law enforcement personnel, and other child welfare practitioners.

http://www.unh.edu/ccrc/internet-crimes

Cyberbullying Research Center

Clearinghouse that provides current resources and information about cyberbullying among adolescents.

https://cyberbullying.org

eSafety

An education program about online safety in Australia.

https://esafety.gov.au/key-issues

Embrace Civility

Organization focused on cyberbullying and harassment and safe Internet use.

http://www.embracecivility.org

Federal Bureau of Investigation

Protecting Your Kids on the Internet

Government publication focused on education for parents regarding safe Internet use for children.

https://www.fbi.gov/scams-and-safety/protecting-your-kids

GetNetWise

A public service sponsored by Internet industry corporations and public interest organizations to help ensure that Internet users have safe, constructive, and educational or entertaining online experiences.

http://www.getnetwise.org

National Center for Missing and Exploited Children

NetSmartz

An interactive educational program that provides educational resources to help children be safe online.

https://www.missingkids.org/NetSmartz

Privacy Rights Clearinghouse

A nonprofit consumer organization to provide consumer information and advocacy. One of the main goals is to raise consumers' awareness of how technology affects personal privacy, including information about stalking.

https://privacyrights.org

SafeKids.com

Provides educational resources on Internet safety for youths.

http://www.safekids.com

StopBullying.gov

Provides information and resources from various government agencies.

https://www.stopbullying.gov

National Network to End Domestic Violence

Technology Safety

Information and toolkits for victim service agencies and survivors of intimate partner violence and sexual assault.

https://www.techsafety.org

U.S. Department of Justice

Computer Crime and Intellectual Property Section

Government site focused on cybercrime.

https://www.justice.gov/criminal-ccips

Virtual Global Taskforce

An organization focused on building partnerships to protect children from online abuse.

http://virtualglobaltaskforce.com

Works Cited

1. Patchin JW, Hinduja S. Bullies move beyond the schoolyard: a preliminary look at cyberbullying. Youth Violence Juv Justice. 2006;4(2):148-169.

2. Ybarra ML, Mitchell KJ. Youth engaging in online harassment: associations with caregiver-child relationships, Internet use, and personal characteristics. J Adolesc. 2004;27(3):319-336.

3. Li Q. A cross-cultural comparison of adolescents' experience related to cyberbullying. Educ Res. 2008;50(3):223-234.

4. Premsky M. Digital natives: digital immigrants. On the Horizon. 2001;9(5):1-6.

5. Herther NK. Digital natives and immigrants. Online. 2009;33(6):14-21.

6. Pew Research Center. Internet/Broadband Fact Sheet. Available at https://www.pewresearch.org/internet/fact-sheet/internet-broadband. Last accessed July 7, 2023.

7. U.S. Census Bureau. Computer and Internet Access in the United States: 2015. Available at https://www.census.gov/library/publications/2017/acs/acs-37.html. Last accessed July 31, 2023.

8. Pew Research Center. Mobile Fact Sheet. Available at https://www.pewresearch.org/internet/fact-sheet/mobile. Last accessed July 31, 2023.

9. Pew Research Center. U.S. Smartphone Use in 2015. Available at https://www.pewresearch.org/internet/2015/04/01/us-smartphone-use-in-2015. Last accessed July 31, 2023.

10. Walsh SP, White KM, Young RM. Over-connected? A qualitative phenomenon of the relationship between Australian youths and their mobile phones. J Adolesc. 2008;31(1):77-92.

11. Pew Research Center. Teens, Social Media and Technology Overview, 2015. Available at https://www.pewresearch.org/internet/2015/04/09/teens-social-media-technology-2015. Last accessed July 31, 2023.

12. The Nielson Company. U.S. Teen Mobile Report: Calling Yesterday, Texting Today, Using Apps Tomorrow. Available at https://www.nielsen.com/us/en/insights/article/2010/u-s-teen-mobile-report-calling-yesterday-texting-today-using-apps-tomorrow. Last accessed July 31, 2023.

13. Pew Research Center. Social Media Fact Sheet. Available at https://www.pewresearch.org/internet/fact-sheet/social-media. Last accessed July 31, 2023.

14. StopCyberbullying.org. What Is It? Available at http://www.stopcyberbullying.org/what_is_cyberbullying_exactly.html. Last accessed July 31, 2023.

15. Pew Research Center. How Parents Monitor their Teen's Digital Behavior. Available at https://www.pewresearch.org/internet/2016/01/07/how-parents-monitor-their-teens-digital-behavior. Last accessed July 31, 2023.

16. Guillén MF, Suárez SL. Explaining the global digital divide: economic, political, and sociological drivers of cross-national Internet use. Soc Forces. 2005;84(2):681-708.

17. Wasserman IM, Richmond-Abbott M. Gender and the Internet: causes of variation in access, level, and scope of use. Soc Sci Q. 2005;86(1):252-270.

18. Cyberbullying Research Center. New National Bullying and Cyberbullying Data. Available at https://cyberbullying.org/new-national-bullying-cyberbullying-data. Last accessed July 31, 2023.

19. Sheridan LP, Grant T. Is cyberstalking different? Psychology, Crime & Law. 2007;13(6):627-640.

20. Olweus D. A profile of bullying at school. Educ Leadersh. 2003;60(6):12-19.

21. Mitchell KJ, Wolak J, Finkelhor D. Trends in youth reports of sexual solicitations, harassment and unwanted exposure to pornography on the Internet. J Adolesc Health. 2007;40(2):116-126.

22. Vandebosch H, Van Cleemput K. Defining cyberbullying: a qualitative research into the perceptions of youngsters. Cyberpsychol Behav. 2008;11(4):499-503.

23. Hinduja S, Patchin JW. Cyberbullying Fact Sheet: What You Need To Know About Online Aggression. Available at https://cyberbullying.org/cyberbullying_fact_sheet.pdf. Last accessed July 31, 2023.

24. Stopbullying.gov. What is Cyberbullying? Available at https://www.stopbullying.gov/cyberbullying/what-is-it/index.html. Last accessed July 31, 2023.

25. Bullyingstatistics.org. Cyber Bullying Statistics. Available at http://www.bullyingstatistics.org/content/cyber-bullying-statistics.html. Last accessed July 31, 2023.

26. Ybarra ML, Espelage DL, Mitchell KJ. The co-occurrence of Internet harassment and unwanted sexual solicitation victimization and perpetration: associations with psychosocial indicators. J Adolesc Health. 2007;41(6 Suppl 1):S31-S41.

27. Boyd DM, Ellison NB. Social network sites: definition, history, and scholarship. J Comput Mediat Commun. 2008;13(1):210-230.

28. Endcyberbullying.org. 5 Different Types of Cyberbullying. Available at https://www.endcyberbullying.org/5-different-types-of-cyberbullying. Last accessed July 31, 2023.

29. Mishna F, McLuckie A, Saini M. Real-world dangers in an online reality: a qualitative study examining online relationships and cyber abuse. Soc Work Res. 2009;33(2):107-118.

30. Calvete E, Orue I, Estévez A, Villardón L, Padilla P. Cyberbullying in adolescents: modalities and aggressors' profile. Comput Human Behav. 2010;26(5):1128-1135.

31. Reeckman B, Cannard L. Cyberbullying. Youth Studies Australia. 2009;28(2):41-49.

32. Cassidy W, Jackson M, Brown KN. Sticks and stones can break my bones, but how can pixels hurt me? Students' experiences with cyber-bullying. Sch Psychol Int. 2009:30(4):383-402.

33. Strom PS, Strom RD. Cyberbullying by adolescents: a preliminary assessment. Educ Forum. 2005;70(1):21-36.

34. O'Donovan E. Sexting and student discipline. District Administration. 2010;46(3):60-64.

35. Lenhart A. Teens and Sexting. Available at https://www.pewresearch.org/internet/2009/12/15/teens-and-sexting. Last accessed July 31, 2023.

36. Raskauskas J, Stoltz AD. Involvement in traditional and electronic bullying among adolescents. Dev Psychol. 2007;43(3):564-575.

37. Anderson M. A Majority of Teens Have Experienced Some Form of Cyberbullying. Available at https://www.pewresearch.org/internet/2018/09/27/a-majority-of-teens-have-experienced-some-form-of-cyberbullying. Last accessed July 31, 2023.

38. Finkelhor D, Mitchell KJ, Wolak J. Online Victimization: A Report on the Nation's Youth. Available at http://www.unh.edu/ccrc/pdf/jvq/CV38.pdf. Last accessed July 31, 2023.

39. Ybarra ML, Mitchell KJ. Instant messaging may put young people at risk of harassment. Nurs Stand. 2008;22(31):17.

40. Tynes BM, Giang MT, Williams DR, Thompson GN. Online racial discrimination and psychological adjustment among adolescents. J Adolesc Health. 2008;43(6):565-569.

41. Martin M. Computer and Internet Use in the United States, 2018. Available at https://www.census.gov/library/publications/2021/acs/acs-49.html. Last accessed November 27, 2023.

42. Finn J. A survey of online harassment at a university campus. J Interpers Violence. 2004;19(4):468-483.

43. Kennedy MA, Taylor MA. Online Harassment and Victimization of College Students. Available at http://www.cjcj.org/uploads/cjcj/documents/online_harassment.pdf. Last accessed July 31, 2023.

44. Macdonald CD, Roberts-Pittman B. Cyberbullying Among College Students: Prevalence and Demographic Differences. Available at https://www.researchgate.net/publication/241123159_Cyberbullying_Among_College_Students_Prevalence_and_Demographic_Differences. Last accessed July 31, 2023.

45. Burke S, Yick-Flanagan A, Oomen-Early J, Walker A. Using Social Networking Sites to Explore Cyberabuse Among U.S. Women. Paper presented at: American Public Health Association 138th Annual Meeting and Expo; November 6, 2010; Denver, CO.

46. Mishna F, Khoury-Kassabri M, Gadalla T, Daciuka J. Risk factors for involvement in cyberbullying: victims, bullies and bully-victims. Children and Youth Services Review. 2012;34(1): 63-70.

47. Peter I-K, Petermann F. Cyberbullying: a concept analysis of defining attributes and additional influencing factors. Computers in Human Behavior. 2018;86:350-366.

48. Price M, Dalgleish J. Cyberbullying experiences, impacts and coping strategies as described by Australian young people. Youth Studies Australia. 2010;29(2):51-59.

49. Hokoda A, Lu H-HA, Angeles M. School bullying in Taiwanese adolescents. Journal of Emotional Abuse. 2006;6(4):69-90.

50. Mishna F, Saini M, Solomon S. Ongoing and online: children and youth's perceptions of cyber bullying. Child Youth Serv Rev. 2009;31:1222-1228.

51. Ybarra ML, Mitchell KJ. Prevalence and frequency of Internet harassment instigation: implications for adolescent health. J Adolesc Health. 2004:41(2):189-195.

52. Kiriakidis SP, Kavoura A. Cyberbullying: a review of the literature on harassment through the internet and other electronic means. Fam Community Health. 2010;33(2):82-93.

53. Williams KR, Guerra NG. Prevalence and predictors of internet bullying. J Adolesc Health. 2007;41(6):S14-S21.

54. Ybarra ML, Diener-West M, Leaf PJ. Examining the overlap in Internet harassment and school bullying: implications for school intervention. J Adolesc Health. 2007;41(6 Suppl 1):S42-S50.

55. Willard NE. Cyberbullying and Cyberthreats: Responding to the Challenge of Online Social Cruelty, Threats, and Distress. Champaign, IL: Research Press; 2007.

56. Mesch GS. Parental mediation, online activities and cyberbullying. Cyberpsychol Behav. 2009;12(4):387-393.

57. Juvonen J, Gross EF. Extending the school grounds? Bullying experiences in cyberspace. J Sch Health. 2008;78(9):46-54.

58. Patchin JW, Hinduja S. Traditional and nontraditional bullying among youth: a test of general strain theory. Youth Soc. 2011;43(2):727-751.

59. Agnew R. Foundation for a general strain theory of crime and delinquency. Criminol. 1992;30(1):47-87.

60. Suler J. The online disinhibition effect. Cyberpsychol Behav. 2004;7(3):321-326.

61. Huang Y, Chou C. An analysis of multiple factors of cyberbullying among junior high school students in Taiwan. Comput Human Behav. 2010;26(6):1581-1590.

62. Whitty MT. Liberating or debilitating? An examination of romantic relationships, sexual relationships and friendships on the Net. Comput Human Behav. 2008;24(5):1837-1850.

63. Pew Research Center. 10 Facts About Americans and Online Dating. Available at https://www.pewresearch.org/fact-tank/2020/02/06/10-facts-about-americans-and-online-dating/. Last accessed July 31, 2023.

64. Pew Research Center. Online Dating and Relationships. Available at https://www.pewresearch.org/internet/2013/10/21/main-report. Last accessed July 31, 2023.

65. Jerin R, Dolinsky B. You've got mail! You don't want it: cyber-victimization and on-line dating. Journal of Criminal Justice and Popular Culture. 2001;9(1):15-21.

66. Couch D, Liamputtong P. Online dating and mating: the use of the Internet to meet sexual partners. Qual Health Res. 2008;18(2):268-279.

67. Bent-Goodly TB. Eradicating domestic violence in the African American community. Trauma Violence Abuse. 2001;2(4):316-330.

68. Schechter S, Ganley A. Domestic Violence: A National Curriculum for Family Preservation Practitioners. San Francisco, CA: Family Violence Prevention Fund; 1995.

69. Smith SG, Chen J, Basile KC, et al. The National Intimate Partner and Sexual Violence Survey (NISVS): 2010–2012 State Report. Available at https://www.cdc.gov/violenceprevention/pdf/NISVS-StateReportBook.pdf. Last accessed July 31, 2023.

70. National Network to End Domestic Violence. Technology-Facilitated Stalking: What You Need to Know. Available at https://nnedv.org/latest_update/technology-facilitated-stalking. Last accessed July 31, 2023.

71. Finn J, Atkinson T. Promoting the safe and strategic use of technology for victims of intimate partner violence: evaluation of the Technology Safety Project. J Fam Violence. 2009;24(1):53-59.

72. Southworth C, Finn J, Dawson S, Fraser C, Tucker S. Intimate partner violence, technology, and stalking. Violence Against Women. 2007;13(8):842-856.

73. Beran T, Li Q. The relationship between cyberbullying and school bullying. Journal of Student Wellbeing. 2007;1(2):15-33.

74. Ybarra ML. Linkages between depressive symptomatology and Internet harassment among young regular Internet users. Cyberpsychol Behav. 2004;7(2):247-257.

75. Ybarra ML, Leaf PJ, Diener-West M. Sex differences in youth-reported depressive symptomatology and unwanted Internet sexual solicitation. J Med Internet Res. 2004;6(1):e5.

76. Patchin JW, Hinduja S. Cyberbullying and self-esteem. J Sch Health. 2010;80(12):614-621.

77. Hinduja S, Patchin JW. Bullying, cyberbullying, and suicide. Arch Suicide Res. 2010;14(3):206-221.

78. Delmonico DL, Griffin EJ. Cybersex and the e-teen: what marriage and family therapists should know. J Marital Fam Ther. 2008;34(4):431-444.

79. Diamanduros T, Downs E, Jenkins SJ. The role of school psychologists in the assessment, prevention, and intervention of cyberbullying. Psychol Sch. 2008;45(8):693-704.

80. Noll JG, Shenk CE, Barnes JE, Haralson KJ. Association of maltreatment with high-risk Internet behaviors and offline encounters. Pediatrics. 2013;2012-1281.

81. Pew Research Center. Online Harassment 2017. Available at https://www.pewresearch.org/internet/2017/07/11/online-harassment-2017. Last accessed July 31, 2023.

82. Liau AK, Khoo A, Ang PH. Factors influencing adolescents' engagement in risky Internet behavior. Cyberpsychol Behav. 2005;8(6):513-520.

83. Wolak J, Finkelhor D, Mitchell KJ, Ybarra ML. Online "predators" and their victims: myths, realities and implications for prevention and treatment. Am Psychol. 2008;63(2):111-128.

84. Dowell EB, Burgess AW, Cavanaugh DJ. Clustering of Internet risk behaviors in a middle school student population. J Sch Health. 2009;79(11):547-553.

85. Liau A, Khoo A, Ang P. Parental awareness and monitoring of adolescent Internet use. Curr Psychol. 2008;27(4):217-233.

86. Hertz M, David-Ferdon C. Electronic Media and Youth Violence: A CDC Issue Brief for Educators and Caregivers. Available at https://stacks.cdc.gov/view/cdc/7032. Last accessed July 31,2023.

87. Gini G, Albiero P, Benelli B, Altoè G. Determinants of adolescents' active defending and passive bystanding behavior in bullying. J Adolesc. 2008;31(1):93-105.

88. Hinduja S, Patchin JW. Preventing Cyberbullying: Top Ten Tips for Teens. Available at https://cyberbullying.org/preventing-cyberbullying-top-ten-tips-for-teens. Last accessed July 31, 2023.

89. Roberts AR. Contemporary Perspectives on Crisis Intervention and Prevention. Englewood Cliffs, NJ: Prentice Hall; 1991.

90. Alexy EM, Burgess AW, Baker T, Smoyak SA. Perceptions of cyberstalking among college students. Brief Treat Crisis Interv. 2005;5(3):279-289.

91. Woolley N. Crisis theory: a paradigm of effective intervention with families of critically ill people. J Adv Nurs. 1990;15(2):1402-1408.

92. Pew Research Center. One in Four Black Americans Have Faced Online Harassment Because of Their Race or Ethnicity. Available at http://www.pewresearch.org/fact-tank/2017/07/25/1-in-4-black-americans-have-faced-online-harassment-because-of-their-race-or-ethnicity. Last accessed July 31, 2023.

93. Cyberbullying Research Center. State Cyberbullying Laws. Available at https://cyberbullying.org/state-cyberbullying-laws-a-brief-review-of-state-cyberbullying-laws-and-policies. Last accessed July 31, 2023.

94. U.S. Department of Justice. Domestic Violence. Available at https://www.justice.gov/ovw/domestic-violence. Last accessed July 31, 2023.

95. Pew Internet Research. Teens, Technology and Friendships. Available at https://www.pewresearch.org/internet/2015/08/06/teens-technology-and-friendships/. Last accessed July 31, 2023.

96. Hinduja S, Patchin J. Preventing Cyberbullying: Top Ten Tips for Educators. Available at https://cyberbullying.org/responding-to-cyberbullying-top-ten-tips-for-educators. Last accessed July 31, 2023.

97. Faucher C, Jackson M, Cassidy W. Cyberbullying among university students: gendered experiences, impacts, and perspectives. Education Research International. 2014;2014: 698545.

98. Mehari KR, Farrell AD, Le AH. Cyberbullying among adolescents: measures in search of a construct. Psychol Violence. 2014; 4(4):399-415.

99. Compton L, Campbell MA, Mergler A. Teacher, parent and student perceptions of the motives of cyberbullies. Soc Psychol Educ. 2014;17(3):383-400.

100. Slonje R, Smith PK, Frisén A. The nature of cyberbullying, and strategies for prevention. Comput Human Behav. 2013;29(1):26-32.

101. Lenhart A, Madden M, Smith A, Purcell K, Zickuhr K, Rainie L. Teens, Kindness and Cruelty on Social Network Sites: How American Teens Navigate the New World of "Digital Citizenship."Washington, DC: Pew Research Center Internet & American Life Project; 2011.

102. Kowalski RM, Giumetti GW, Schroeder AN, Lattanner MR. Bullying in the digital age: a critical review and meta-analysis of cyberbullying research among youth. Psychol Bull. 2014;140(4):1073-1137.

103. Peskin F, Markham CM, Addy RC, et al. Prevalence and patterns of sexting among ethnic minority urban high school students. Cyberpsychol Behav Soc Netw. 2013;16(6):454-459.

104. Ringrose J, Gill R, Livingstone S, Harvey L. A Qualitative Study of Children, Young People and "Sexting:" A Report Prepared for the NSPCC. Available at https://eprints.lse.ac.uk/44216/1/__Libfile_repository_Content_Livingstone%2C%20S_A%20qualitative%20study%20of%20children%2C%20young%20people%20and%20%27sexting%27%20%28LSE%20RO%29.pdf. Last accessed July 31, 2023.

105. Slonje R, Smith PK. Cyberbullying: another main type of bullying? Scand J Psychol. 2008;49:147-154.

106. Patchin JW. Summary of Our Research (2004–2016). Available at https://cyberbullying.org/summary-of-our-cyberbullying-research. Last accessed July 31, 2023.

107. Jones LM, Mitchell KJ, Finkelhor D. Trends in youth Internet victimization: findings from three youth Internet safety surveys 2000–2010. J Adolesc Health. 2012;50(2):179-186.

108. Chang FC, Chiu CH, Miao NF, et al. Predictors of unwanted exposure to online pornography and online sexual solicitation of youth. J Health Psychol. 2014;21(6):1107-1118.

109. Gibb ZG, Devereux PG. Who does that anyway? Predictors and personality correlates of cyberbullying in college. Comput Human Behav. 2014;38:8-16.

110. Cénat JM, Hébert M, Blais M, et al. Cyberbullying, psychological distress and self-esteem among youth in Quebec schools. J Affect Disord. 2014;169(1):7-9.

111. Pew Research Center. Teens, Social Media and Technology, 2022. Available at https://www.pewresearch.org/internet/2022/08/10/teens-social-media-and-technology-2022. Last accessed November 27, 2023.

112. Barlett CP, Gentile DA, Anderson CA, et al. Cross-cultural differences in cyberbullying behavior: a short-term longitudinal study. J Cross Cult Psychol. 2014;45(2):300-313.

113. Li Q. A cross-cultural comparison of adolescents' experience related to cyberbullying. Educ Res. 2008;50:223-234.

114. Santana D. Virtuous or vitriolic: the effect of anonymity on civility in online newspaper reader comment boards. Journalism Practice. 2014;8(1):18-33.

115. Barlett CP, Gentile DA, Chew C. Predicting cyberbullying from anonymity. Psychol Pop Media Cult. 2016;5(2):171-180.

116. D'Auria JP. Cyberbullying resources for youth and their families. J Pediatr Health Care. 2014;28(2):e19-e22.

117. Doane AN, Pearson MR, Kelley ML. Predictors of cyberbullying perpetration among college students: an application of the theory of reasoned action. Comput Human Behav. 2014;36:154-162.

118. Baas N, de Jong MDT, Drossaert CHC. Children's perspectives on cyberbullying: insights based on participatory research. Cyberpsychol Behav Soc Netw. 2013;16:248-253.

119. Bao W, Haas A, Chen X, Pi Y. Repeated strains, social control, social learning, and delinquency: testing an integrated model of strain theory in China. Youth Soc. 2014;46(3):402-424.

120. Jang H, Song J, Kim R. Does the offline bully-victimization influence cyberbullying behavior among youths? Application of general strain theory. Comput Human Behav. 2014;31:85-93.

121. Couch D, Liamputtong P, Pitts M. What are the real and perceived risks of online dating? Perspectives from online daters. Health Risk Soc. 2012;14(7-8):697-714.

122. O'Day RD. Rapists, sexual offenders, and child molesters: who is your romantic "match?" Why dating websites should perform criminal background checks. Valparaiso University Law Review. 2013;48(1):329-368.

123. Shimizu A. Domestic violence in the digital age: towards the creation of a comprehensive cyberstalking statute. Berkeley Journal of Gender, Law & Justice. 2013;28(1):116-137.

124. Congressional Documents and Publications. Brown Joins Domestic Violence Advocate to Outline Need for "Do Not Track" Internet and Smartphone Privacy Legislation: "Do Not Track" Bill Would Safeguard Consumers from Companies that Track Users' Whereabouts, Give Domestic Violence Victims Additional Safeguard Against GPS-Enabled Smartphone Stalking. Available at https://www.brown.senate.gov/newsroom/press/release/brown-joins-domestic-violence-advocate-to-outline-need-for-do-not-track-internet-and-smartphone-privacy-legislation. Last accessed July 24, 2023.

125. Nixon CL. Current perspectives: the impact of cyberbullying on adolescent health. Adolesc Health Med Ther. 2014;1(5):143-158.

126. Dredge R, Gleeson J, Garcia X. Presentation of Facebook and risk of cyberbullying victimization. Comput Human Behav. 2014;40:16-22.

127. Parris LN, Varjas K, Meyers J. The Internet is a mask: high school students' suggestions for preventing cyberbullying. West J Emerg Med. 2014;15(5):587-592.

128. Sasson H, Mesch G. Parental mediation, peer norms and risky online behavior among adolescents. Comput Human Behav. 2014;33:32-38.

129. Simmons KD, Bynum YP. Cyberbullying: six things administrators can do. Education. 2014;134(4):452-456.

130. Teo T. Do digital natives differ by computer self-efficacy and experience? An empirical study. Interactive Learning Environments. 2016;24(7):1725-1739.

131. El Asam A, Samara M. Cyberbullying and the law: a review of psychological and legal challenges. Comput Human Behav. 2016;65:127-141.

132. Barlett CP, Helmstetter K, Gentile DA. The development of a new cyberbullying attitude measure. Comput Human Behav. 2016;64:906-913.

133. Smoker M, March E. Predicting perpetration of intimate partner cyberstalking: gender and the Dark Tetrad. Comput Human Behav. 2017;72:390-396.

134. Hutson E. Cyberbullying in adolescence. ANS Adv Nurs Sci. 2016;39(1):60-70.

135. Vranjes I, Baillien E, Vandebosch H, Erreygers S, De Witte H. The dark side of working online: towards a definition and an emotion reaction model of workplace cyberbullying. Comput Human Behav. 2017;69:324-334.

136. Whittaker E, Kowalski RM. Cyberbullying via social media. J Sch Violence. 2015;14(1):11-29.

137. Chang FC, Chiu CH, Miao NF, Chen PH, Lee CM, Chiang JT. Predictors of unwanted exposure to online pornography and online sexual solicitation of youth. J Health Psychol. 2016;21(6):1107-1118.

138. Carter JM, Wilson FL. Cyberbullying: a 21st century health care phenomenon. Pediatr Nurs. 2015;41(3):115-125.

139. Fernando DL. Trolling and the First Amendment: protecting Internet speech in the era of cyberbullies and Internet defamation. University of Illinois Journal of Law, Technology & Policy. 2016;6(1):135.

140. Nandhini BS, Sheeba JI. Online social network bullying detection using intelligence techniques. Procedia Comput Sci. 2015;45: 485-492.

141. Rachoene M, Oyedemi T. From self-expression to social aggression: cyberbullying culture among South African youth on Facebook. Communicatio: South African Journal for Communication Theory and Research. 2015;41(3):302-319.

142. Smith R, Morgan J, Monks C. Students' perceptions of the effect of social media ostracism on wellbeing. Comput Human Behav. 2017;68:276-285.

143. Wachs S, Junger M, Sittichai R. Traditional, cyber and combined bullying roles: differences in risky online and offline activities. Societies. 2015;5(1):109-135.

144. Van Ouytsel J, Walrave M, Vandebosch H. Correlates of cyberbullying and how school nurses can respond. NASN Sch Nurse. 2015;30(3):162-170.

145. Baker T, Pelfrey WV. Bullying victimization, social network usage, and delinquent coping in a sample of urban youth: examining the predictions of general strain theory. Violence Vict. 2016;31(6):1021-1043.

146. Barlett CP, Gentile DA, Chew C. Predicting cyberbullying from anonymity. Psychol Pop Media Cult. 2016;5(2):171-180.

147. Borrajo E, Gamez-Guadix M, Calvete E. Cyberdating abuse: prevalence, context, and relationship with offline dating aggression. Psychol Rep. 2015;116(2):565-585.

148. Reed LA, Tolman RM, Ward LM, Safyer P. Keeping tabs: attachment anxiety and electronic intrusion in high school dating relationships. Comput Human Behav. 2016;58:259-268.

149. Woodlock D. The abuse of technology in domestic violence and stalking. Violence Against Women. 2017;23(5):584-602.

150. Wright M. Adolescents' cyber aggression perpetration and cyber victimization: the longitudinal associations with school functioning. Soc Psychol Educ. 2015;18(4):653-666.

151. González-Cabrera J, Calvete E, León-Mejía A, Pérez-Sancho C, Peinado JM. Relationship between cyberbullying roles, cortisol secretion and psychological stress. Comput Human Behav. 2017;70:153-160.

152. Davis N, Schmidt C. Cyberbullying and cyber abuse intervention: the three-tiered model for schools. Journal of Creativity in Mental Health. 2016;11(3-4):366-377.

153. Bass PF. Living life online: talking to parents about social media. Contemp Pediatr. 2016;33(5):21-24.

154. Pfetsch JS. Empathic skills and cyberbullying: relationship of different measures of empathy to cyberbullying in comparison to offline bullying among young adults. J Genet Psychol. 2017;178(1):58-72.

155. Selkie EM, Fales JL, Moreno MA. Cyberbullying prevalence among us middle and high school-aged adolescents: a systematic review and quality assessment. J Adolesc Health. 2016;58(2):125-133.

156. Montiel I, Carbonell E, Pereda N. Multiple online victimization of Spanish adolescents: results from a community sample. Child Abuse Negl. 2016;52:123-134.

157. Forssell R. Exploring cyberbullying and face-to-face bullying in working life: prevalence, targets and expressions. Comput Human Behav. 2016;58:454-460.

158. Kyriacou C. A psychological typology of cyberbullies in schools. Psychology of Education Review. 2016;40(2):24-27.

159. Goodboy AK, Martin MM. The personality profile of a cyberbully: examining the Dark Triad. Comput Human Behav. 2015;49:1-4.

160. Guo S. A meta-analysis of the predictors of cyberbullying perpetration and victimization. Psychol Sch. 2016;53(4):432-453.

161. Pew Research Center. Parenting Children in the Age of Screens. Available at https://www.pewresearch.org/internet/2020/07/28/parenting-children-in-the-age-of-screens. Last accessed November 6, 2020.

162. Lee EB. Cyberbullying: prevalence and predictors among African American young adults. Journal of Black Studies. 2017;48(1):57-73.

163. Martin M. Deconstructing the Digital Divide: Identifying the Supply and Demand Factors That Drive Internet Subscription Rates. Available at https://www.census.gov/library/working-papers/2019/demo/SEHSD-WP2019-15.html. Last accessed July 31, 2023.

164. Alfandari R. Approaching the study of cyberbullying towards social workers from a systems perspective. Aggression and Violent Behavior. 2019;48:60-64.

165. Jenaro C, Flores N, Frías CP. Systematic review of empirical studies on cyberbullying in adults: what we know and what we should investigate. Aggression and Violent Behavior. 2018;38:113-122.

166. Huang CL, Yang SC, Hsieh LS. The cyberbullying behavior of Taiwanese adolescents in an online gaming environment. Children and Youth Services Review. 2019;106:104461.

167. Craig W, Boniel-Nissim M, King N, et al. Social media use and cyber-bullying: a cross-national analysis of young people in 42 countries. J Adolesc Health. 2020;66(6S):S100-S108.

168. Calabro SM. From the message board to the front door: addressing the offline consequences of race- and gender-based doxxing and swatting. Suffolk University Law Review. 2018;51(1):55-75.

169. Dulovics M, Kamenská J. Analysis of cyber-bullying forms by aggressors in elementary and secondary schools. New Educational Review. 2017;49(3):126-137.

170. Ojeda M, Del R, Hunter S. Longitudinal relationships between sexting and involvement in both bullying and cyberbullying. Journal of Adolescence. 2019;77:81-89.

171. Ansary NS. Cyberbullying: Concepts, theories, and correlates informing evidence-based best practices for prevention. Aggression and Violent Behavior. 2020;50:101343.

172. Pew Research Center. A Majority of Teens Have Been the Target of Cyberbullying, with Name-Calling and Rumor-Spreading Being the Most Common Forms of Harassment. Available at https://www.pewresearch.org/internet/2018/09/27/a-majority-of-teens-have-experienced-some-form-of-cyberbullying/pi_2018-09-27_teens-and-cyberbullying_0-01. Last accessed July 31, 2023.

173. Thomas S. "What should I do?" Young women's reported dilemmas with nude photographs. Sexuality Research & Social Policy. 2017;15(2):192-207.

174. O'Connor K, Drouin M, Davis J, Thompson H. Cyberbullying, revenge porn and the mid-sized university: victim characteristics, prevalence and students' knowledge of university policy and reporting procedures. Higher Education Quarterly. 2018;72(4):344-359.

175. Watts LK, Wagner J, Velasquez B, Behrens PI. Cyberbullying in higher education: a literature review. Computers in Human Behavior. 2017;69:268-274.

176. Oksanen A, Oksa R, Savela N, Kaakinen M, Ellonen N. Cyberbullying victimization at work: social media identity bubble approach. Computers in Human Behavior. 2020;109:106363.

177. Athanasiou K, Melegkovits E, Andrie EK, et al. Cross-national aspects of cyberbullying victimization among 14–17-year-old adolescents across seven European countries. BMC Public Health. 2018;18:800-815.

178. D'Souza N, Forsyth D, Tappin D, Catley B. Conceptualizing workplace cyberbullying: toward a definition for research and practice in nursing. Journal of Nursing Management. 2018;26(7):842-850.

179. Hinduja S, Patchin JW. Digital Dating Abuse: A Brief Guide for Educators and Parents. Available at https://cyberbullying.org/digital-dating-abuse.pdf. Last accessed July 31, 2023.

180. Payne AA, Hutzell KL. Old wine, new bottle? Comparing interpersonal bullying and cyberbullying victimization. Youth & Society. 2017;49(8):1149-1178.

181. Quintana-Orts C, Rey L. Forgiveness and cyberbullying in adolescence: does willingness to forgive help minimize the risk of becoming a cyberbully? Computers in Human Behavior. 2018;81:209-214.

182. Pabian S, Vandebosch H. An investigation of short-term longitudinal associations between social anxiety and victimization and perpetration of traditional bullying and cyberbullying. Journal of Youth and Adolescence. 2016;45:328-339.

183. Chu XW, Fan CY, Liu QQ, Zhou ZK. Cyberbullying victimization and symptoms of depression and anxiety among Chinese adolescents: examining hopelessness as a mediator and self-compassion as a moderator. Computers in Human Behavior. 2018;86:377-386.

184. Chen L, Ho SS, Lwin MO. A meta-analysis of factors predicting cyberbullying perpetration and victimization: from the social cognitive and media effects approach. New Media & Society. 2017;19(8): 1194-1213.

185. Ding Y, Li D, Li X, Xiao J, Zhang H, Wang Y. Profiles of adolescent traditional and cyber bullying and victimization: the role of demographic, individual, family, school, and peer factors. Computers in Human Behavior. 2020;111:106439.

186. Elbedour S, Alqahtani S, El Sheikh Rihan I, Bawalsah JA, Booker-Ammah B, Turner JF Jr. Cyberbullying: roles of school psychologists and school counselors in addressing a pervasive social justice issue. Children and Youth Services Review. 2020;109:104720.

187. Dennehy R, Meaney S, Cronin M, Arensman E. The psychosocial impacts of cybervictimisation and barriers to seeking social support: young people's perspectives. Children and Youth Services Review. 2020;111:104872.

188. Hinduja S, Patchin JW. Cyberbullying Warning Signs: Red Flags that a Child is Involved in Cyberbullying. Available at https://cyberbullying.org/cyberbullying-warning-signs.pdf. Last accessed July 31, 2023.

189. Lianos H, McGrath A. Can the general theory of crime and general strain theory explain cyberbullying perpetration? Crime & Delinquency. 2018;64(5):674-700.

190. Wright MF, Wachs S. Does empathy and toxic online disinhibition moderate the longitudinal association between witnessing and perpetrating homophobic cyberbullying? Int Journal of Bullying Prevention. 2020; [Epub ahead of print].

191. Barlett CP, Heath JB, Madison CS, DeWitt CC, Kirkpatrick SM. You're not anonymous online: the development and validation of a new cyberbullying intervention curriculum. Psychology of Popular Media. 2020;9(2):135-144.

192. Peskin MF, Markham CM, Shegog R, et al. Prevalence and correlates of the perpetration of cyber dating abuse among early adolescents. Journal of Youth and Adolescence. 2017;46(2):358-375.

193. Melander L. College students' perceptions of intimate partner cyber harassment. Cyberpsychology, Behavior and Social Networking. 2010;13:263-268.

194. Fernet M, Lapierre A, Hébert M, Cousineau M-M. A systematic review of literature on cyber intimate partner victimization in adolescent girls and women. Computers in Human Behavior. 2019;100:11-25.

195. Urano Y, Takizawa R, Ohka M, Yamasaki H, Shimoyama H. Cyber bullying victimization and adolescent mental health: the differential moderating effects of intrapersonal and interpersonal emotional competence. Journal of Adolescence. 2020;80: 182-191.

196. Yoon Y, Lee JO, Cho J, et al. Association of cyberbullying involvement with subsequent substance use among adolescents. J Adolesc Health. 2019;65(5):613-620.

197. Peluchette JV, Karl K, Wood C, Williams J. Cyberbullying victimization: do victims' personality and risky social network behaviors contribute to the problem? Computers in Human Behavior. 2015;52:424-435.

198. Byrne E, Vessey JA, Pfeifer L. Cyberbullying and social media: information and interventions for school nurses working with victims, students, and families. Journal of School Nursing. 2018;34(1):38-50.

199. Abreu RL, Kenny MC. Cyberbullying and LGBTQ youth: a systematic literature review and recommendations for prevention and intervention. Journal of Child & Adolescent Trauma. 2018;11(1):81-97.

200. Florang JE. Cyberbullying: new approaches for school counselors. Journal of School Counseling. 2020;18(1):1-24.

201. Pew Research Center. Social Media Use in 2021. Available at https://www.pewresearch.org/internet/2021/04/07/social-media-use-in-2021. Last accessed November 27, 2023.

202. Vogel EA. Digital Divide Persists Even as Americans with Lower Incomes Make Gains in Tech Adoption. Available at https://www.pewresearch.org/short-reads/2021/06/22/digital-divide-persists-even-as-americans-with-lower-incomes-make-gains-in-tech-adoption. Last accessed November 27, 2023.

203. Olweus D, Limber SP. Some problems with cyberbullying research. Current Opinion in Psychology. 2018;19:139-143.

204. Zhang W, Huang S, Lam L, Evans R, Zhu C. Cyberbullying definitions and measurements in children and adolescents: summarizing 20 years of global efforts. Frontiers in Public Health. 2022;10.

205. Campbell M, Xu J. Children and adolescents' understanding of traditional and cyberbullying. Children and Youth Services Review. 2022;139:1-7.

206. Menin D, Guarini A, Mameli C, Skrzypiec G, Brighi A. Was that (cyber)bullying? Investigating the operational definitions of bullying and cyberbullying from adolescents' perspective. International Journal of Clinical and Health Psychology. 2021;21(2).

207. Huang J, Zhong Z, Zhang H, Li L. Cyberbullying in social media and online games among Chinese college students and its associated factors. International Journal of Environmental Research and Public Health. 2021;18(9).

208. Kee DMH, Lutf Al‐Anesi MA, Lutf Al‐Anesi SA. Cyberbullying on social media under the influence of COVID-19. Global Business and Organizational Excellence. 2022;41(6):11-22.

209. Al-Ameedi RTK, Al-Ghizzy MJD. Investigating cyberbullying in electronic communication: a descriptive study. International Journal of English Language Studies. 2022;4(4):97-106.

210. Xu Y, Trzaskawka P. Towards descriptive adequacy of cyberbullying: interdisciplinary studies on features, cases and legislative concerns of cyberbullying. International Journal for the Semiotics of Law. 2021;34:929-943.

211. Yemima CK. The forms of cyberbullying behavior among teenage students: a systematic literature review. Jurnal Bimbingan Dan Konseling Terapan. 2023;7(2):151-160.

212. Bergen E, Davidson J, Schulz A, et al. The effects of using identity deception and suggesting secrecy on the outcomes of adult-adult and adult-child or -adolescent online sexual interactions. Victims and Offenders. 2014;9(3):276-298.

213. Gandolfi CE, Mosillo M, Del Castillo G, et al. Online grooming: an analysis of the phenomenon. Journal of Preventive Medicine and Hygiene. 2019;60:E220.

214. Nagata JM, Trompeter N, Singh G, et al. Social epidemiology of early adolescent cyberbullying in the United States. Academic Pediatrics. 2022;22(8):1287-1293.

215. Patchin JW, Hinduja S. Cyberbullying among tweens in the United States: prevalence, impact, and helping behaviors. Journal of Early Adolescence. 2022;42(3):414-430.

216. Patel U, Roesch R. The prevalence of technology-facilitated sexual violence: a meta-analysis and systematic review. Trauma, Violence & Abuse. 2022;23(2):428-443.

217. Bernardo AB, Galve-González C, Cervero A, Tuero E. Cyberbullying in first-year university students and its influence on their intentions to drop out. Higher Education Research & Development. 2023;42(2):275-289.

218. Pew Research Center. The State of Online Harassment. Available at https://www.pewresearch.org/internet/2021/01/13/the-state-of-online-harassment. Last accessed November 27, 2023.

219. Henares-Montiel J, Benítez-Hidalgo V, Ruiz-Pérez I, Pastor-Moreno G, Rodríguez-Barranco M. Cyberbullying and associated factors in member countries of the European Union: a systematic review and meta-analysis of studies with representative population samples. International Journal of Environmental Research and Public Health. 2022;19:7364.

220. Hasan M, Fatima Y, Cleary A, et al. Geographical variations in the prevalence of traditional and cyberbullying and its additive role in psychological and somatic health complaints among adolescents in 38 European countries. Journal of Psychosomatic Research. 2023;164:111103.

221. Graf D, Yanagida T, Runions K, Spiel C. Why did you do that? Differential types of aggression in offline and in cyberbullying. Computers in Human Behavior. 2022;128:107107.

222. Tian L, Huang J, Huebner ES. Profiles and transitions of cyberbullying perpetration and victimization from childhood to early adolescence: multi-contextual risk and protective factors. Journal of Youth & Adolescence. 2023;52(2):434-448.

223. Yoo C. What are the characteristics of cyberbullying victims and perpetrators among South Korean students and how do their experiences change? Child Abuse & Neglect. 2021;113(5).

224. Sheikh MMR, Hossan MR, Menih H. Cyberbullying victimization and perpetration among university students in Bangladesh: prevalence, impact and help-seeking practices. Journal of School Violence. 2023;22(2):198-214.

225. Mumford EA, Rothman EF, Maitra P, Sheridan-Johnson J. U.S. young adults' professional help-seeking in response to technology-facilitated abuse. Journal of Interpersonal Violence. 2023;38(11-12):7063-7088.

226. Exceptional Parent. Cyberbullying: recognizing the signs and helping your child. Exceptional Parent. 2021;51(12):54-55.

227. Barlett CP, Rinker A, Roth B. Cyberbullying perpetration in the COVID-19 era: an application of general strain theory. Journal of Social Psychology. 2021;161(4):466-476.

228. Wang X, Qiao Y, Li W, Dong W. How is online disinhibition related to adolescents' cyberbullying perpetration? Empathy and gender as moderators. Journal of Early Adolescence. 2022;42(5):704-732.

229. Cutbush S, Williams J, Miller S, Gibbs D, Clinton-Sherrod M. Longitudinal patterns of electronic teen dating violence among middle school students. Journal of Interpersonal Violence. 2021;36(5/6):NP2506-NP2526.

230. Ellyson AM, Adhia A, Lyons VH, Rivara FP. Prevalence, age of initiation, and patterns of co-occurrence of digital dating abuse behaviors nationwide. Children & Youth Services Review. 2021;122:105921.

231. Afrouz R. The nature, patterns and consequences of technology-facilitated domestic abuse: a scoping review. Trauma, Violence, & Abuse. 2023;24(2):913-927.

232. Boethius S, Åkerström M, Hydén M. The double-edged sword: abused women's experiences of digital technology. European Journal of Social Work. 2023;26(3):506-518.

233. Saleem S, Khan NF, Zafar S, Raza N. Systematic literature reviews in cyberbullying/cyber harassment: a tertiary study. Technology in Society. 2022;70(C).

234. Giumetti GW, Kowalski RM. Cyberbullying via social media and well-being. Current Opinion in Psychology. 2022;45.

235. Paluckaitė U, Žardeckaitė-Matulaitienė K. Students' engagement in risky online behaviour: the comparison of youth and secondary schools'. Health and Health Psychology. 2016;266-273.

236. Heyeres M, Carter M-A, Lui SM, Low-Lim A, Teo S, Tsey K. Cyberbullying prevention and treatment interventions targeting young people: an umbrella review. Pastoral Care in Education. 2021;39(2):125-151.

237. Yosep I, Hikmat R, Mardhiyah A. Nursing intervention for preventing cyberbullying and reducing its negative impact on students: a scoping review. Journal of Multidisciplinary Healthcare. 2023;26(16):261-273.

238. Salem AAMS, Al-Huwailah AH, Abdelsattar M, et al. Empathic skills training as a means of reducing cyberbullying among adolescents: an empirical evaluation. International Journal of Environmental Research and Public Health. 2023;20(3).

239. Chen Q, Chan KL, Guo S, Chen M, Lo CK-M, Ip P. Effectiveness of digital health interventions in reducing bullying and cyberbullying: a meta-analysis. Trauma, Violence & Abuse. 2023;24(3):1986-2002.

240. Hendry BP, Hellsten L-AM, McIntyre LJ, Smith BRR. Recommendations for cyberbullying prevention and intervention: a Western Canadian perspective from key stakeholders. Frontiers in Psychology. 2023;14.

241. Waters S, Russell WB, Hensley M. Cyberbullying, social media, and character education: why it matters for middle school social studies. Clearing House. 2020;93(4):195-204.

Evidence-Based Practice Recommendations Citations

1. U.S. Preventive Services Task Force. Screening for depression and suicide risk in children and adolescents: U.S. Preventive Services Task Force recommendation statement. JAMA. 2022;328(15):1534-1542. Available at https://jamanetwork.com/journals/jama/fullarticle/2797145. Last accessed November 29, 2023.