Children who are bullied, or who bully others, or who are bullies and victims of being bullied are at a greater risk for a broad range of health issues including family violence, and intentional self-harm, according to a new U.S. study.

In a survey of 5,807 middle-school and high-school students from almost 138 Massachusetts public schools, researchers found that those involved in bullying in any way are more likely to contemplate suicide and engage in self-harm, compared to other students.

Children who are bullies are more likely to suffer abuse from a family member, or witness to home violence, compared to other students who were not bullies or victims.

A bully is defined as a person who is habitually cruel or overbearing, especially to smaller or weaker people. In schools it is defined also as repeatedly teasing, hitting, threatening, kicking or excluding other students. Social media has also become a weapon used against others by bullies.

After adjusting for other factors, the odds ratio of a middle school student being physically hurt by a family member, for example, was 2.9 for victims of bullying, 4.4 for bullies, and 5.0 for those who were both bullies and victims, compared to other students. The odds ratio for witnessing violence at home was, respectively, 2.6, 2.9, and 3.9.

The odds ratio for a high school student to be physically hurt by a family member was 2.8 for victims, 3.8 for bullies, and 5.4 for bully-victims, compared to students who were not involved in bullying; for witnessing violence at home, the odds ratio for high school students was 2.3, 2.7 and 6.8, respectively.

Previous research has linked bullying with poor grades, substance use and mental health issues. This report concludes that the health risks and home environment for teens involved in bullying are much worse than for kids who have no experience with bullying.

"The results underscore the importance of primary prevention programs, as well as comprehensive programs and strategies that involve families," researchers from the U.S. Centers for Disease Control and Prevention said.

A successful prevention program should include school officials, staff members, students and parents, with access to health and mental health services an essential component, they added, while noting that classroom programs alone are ineffective.

The findings are published in the April 22 issue of the CDC's Morbidity and Mortality Weekly Report.

The statistics revealed by the study are not surprising in today’s hyper society, but are very different from 20 years ago. More population in the schools, media glorification on television and in the movies, plus new media tools boost the opportunities children have to bully as well as present a different interpretation of what is considered acceptable behavior by children and young adults.

Of the students surveyed, middle school students (44 percent) were more likely than high school students (30.5 percent) to have some involvement in bullying.

Researchers found that 26.8 percent of middle-school students reported being bullied compared to 15.6 percent of high-school students. But fewer middle-school students (7.5 percent) than high-school students (8.4 percent) reported being bullies themselves.

In both age ranges, more males than females admitted to bullying, and more females said they were victims than males.

Among high school students, 6.5 percent reported being bully-victims. A little less than 10 percent of middle school students said they were bully-victims. Health risks were greater for bully-victims than for those who saw themselves as just bullies or just victims, the report said.

The majority of students in both age ranges -- 56 percent of middle school students and 69.5 percent of high school students -- said they were neither bullies nor victims.

The researchers cited several limitations in the study, including a low response rate and its reliance on self-reporting. Recall is not always accurate and may be subject to bias, experts say.

The CDC has launched a program, Striving to Reduce Youth Violence Everywhere, to help communities promote safe environments for students.

Programs such as Rachel’s Challenge offer schools and students ways to inspire, and empower students.

Rachel’s Challenge programs are age specific for K-12. Programs generally include school assemblies, student and staff training, community presentations and follow along strategies to sustain the impact of the initial motivation to improve the educational environment. More information about Rachel’s Challenge can be found on their website at http://www.rachelschallenge.org