Bullying first emerged as an important topic of research in the 1980s in Norway (Olweus), and a recent meta‐analysis shows that these forms of aggression remain prevalent among young people globally . Prominent researchers in the field have defined bullying as any aggressive behavior that incorporates three key elements, namely: (1) an intention to harm, (2) repetitive in nature, and (3) a clear power imbalance between perpetrator and victim . There are many negative outcomes associated with bullying perpetration, such as: suicidal ideation , weapon carrying , drug use , and violence and offending in later life . Bullying victimization too is associated with negative outcomes such as: suicidal ideation , anxiety, low self‐esteem and loneliness (Hawker& Boulton). Therefore, school bullying is an important target for effective intervention, and should be considered a matter of public health concern.The objective of this review is to establish whether or not existing school‐based antibullying programs are effective in reducing school‐bullyng behaviors. This report also updates a previous meta‐analysis conducted by Farrington and Ttofi. This earlier review found that antibullying programs are effective in reducing bullying perpetration and victimization and a primary objective of the current report is to update the earlier analysis of 53 evaluations by conducting new searches for evaluations conducted and published since 2009.bully*; victim*; bully‐victim; school; intervention; prevention; program*; evaluation; effect*; and anti‐bullying. Searches were conducted on several online databases including, Web of Science, PscyhINFO, EMBASE, EMBASE, DARE, ERIC, Google Scholar, and Scopus. Databases of unpublished reports, such as masters' and doctoral theses  were also searched.Systematic searches were conducted using Boolean combinations of the following keywords: Results from systematic searches were screened thoroughly against the following inclusion criteria. To be included in this review, a study must have: (1) described an evaluation of a school‐based antibullying program implemented with school‐age participants; (2) utilized an operational definition of school‐bullying that coincides with existing definitions; (3) measured school‐bullying perpetration and/or victimization using quantitative measures, such as, self‐, peer‐, or teacher‐report questionnaires; and (4) used an experimental or quasi‐experimental design, with one group receiving the intervention and another not receiving the intervention.n = 45; i.e., randomized controlled trials/RCTs) and nonrandomized  methodologies. All of these studies included measures of bullying outcomes before and after implementation of an intervention. The remaining 14 effect sizes were estimated from evaluations that used age cohort designs. Two models of meta‐analysis are used to report results in our report. All mean effects computed are presented using both the multivariance adjustment model (MVA) and random effects model (RE). The MVA model assigns weights to primary studies in direct proportion to study level sampling error as with the fixed effects model but adjusts the meta‐analytic standard error and confidence intervals for study heterogeneity. The RE model incorporates between‐study heterogeneity into the formula for assigning weights to primary studies. The differences and strengths/limitations of both approaches are discussed in the context of the present data.Of the 19,877 search results, 474 were retained for further screening. The majority of these were excluded, and after multiple waves of screening, 100 evaluations were included in our meta‐analysis. A total of 103 independent effect sizes were estimated and each effect size was corrected for the impact of including clusters in evaluation designs. Included evaluations were conducted using both randomized  and bullying victimization , under a random effects model of meta‐analysis. Mean effects were similar across both models of meta‐analysis for bullying perpetration  and bullying victimization . Under both computational models, primary studies were more effective in reducing bullying perpetration than victimization overall. Effect sizes varied across studies, with significant heterogeneity between studies for both bullying perpetration  and bullying victimization  outcomes. Analyses suggest that publication bias is unlikely. Between‐study heterogeneity was expected, given the large number of studies included, and thus, the number of different programs, methods, measures and samples used.Our meta‐analysis identified that bullying programs significantly reduce bullying perpetration (RE: odds ratio [OR] = 1.309; 95% confidence interval [CI]: 1.24–1.38; We conclude that overall, school‐based antibullying programs are effective in reducing bullying perpetration and bullying victimization, although effect sizes are modest. The impact of evaluation methodology on effect size appears to be weak and does not adequately explain the significant heterogeneity between primary studies. Moreover, the issue of the under‐/over‐estimation of the true treatment effect by different experimental designs and use of self‐reported measures is reviewed. The potential explanations for this are discussed, along with recommendations for future primary evaluations. Avenues for future research are discussed, including the need further explain differences across programs by correlating individual effect sizes with varying program components and varying methodological elements available across these 100 evaluations. Initial findings in the variability of effect sizes across different methodological moderators provide some understanding on the issue of heterogeneity, but future analyses based on further moderator variables are needed. Intervention and prevention programs targeting school bullying perpetration and victimization are effective, yet more research is needed to understand variability in effectiveness.The main findings of our review are that bullying programs were effective in reducing bullying perpetration outcomes by roughly 18–19% and bullying victimization by roughly 15–16%. There are substantial variations in effects, and the reasons for these variations require further research.1.2Bullying is defined as aggressive behaviors that occur repeatedly over time between two or more individuals. Typically, there is a clear power imbalance between victims and bullies, either socially or physically. Furthermore, bullying behaviors are those that are committed intentionally to harm the victim.What is the aim of this review?The aim of this review is to summarise findings from studies of the effectiveness of school‐based antibullying programs in reducing both bullying perpetration and victimization will be reported. The review summarizes 100 studies, with the largest number being from the United States.1.3To be included in this review, primary studies must have evaluated a specific intervention program that targeted bullying perpetration and/or victimization outcomes in school‐aged children, that is, typically between four and 18 years old. Studies must have used two experimental groups of children, one that received the intervention, and one that did not, and applied quantitative measures of bullying behavior (perpetration and/or victimization) that coincided with our operational definition of bullying.Our final meta‐analytic review includes 100 studies of the effectiveness of antibullying programs. The largest number of studies came from the United States, with most other studies from Canada and Europe.1.4Antibullying programs are effective in reducing bullying perpetration outcomes by roughly 18–19% and bullying victimization by roughly 15–16%.Variability in the effectiveness of antibullying programs was associated with differences in methodological designs, types of programs and geographical regions. Interventions evaluated using age cohort designs collectively gave the largest overall effect for both bullying perpetration and bullying victimization.Limitations of the results are similar to those of previous reviews; for example, the reliance of self‐reported measurements of bullying may suggest the change is in reports of bullying perpetration/victimization and not behavioral change.1.5The findings indicate that school‐based bullying intervention and prevention programs can be effective in reducing both bullying perpetration and victimization, although the effect is, overall, modest.The effectiveness of antibullying programs is an important finding with implications for public health and educational policy. However, our review did identify that there are variations in the effectiveness of intervention programs. Future research is needed to explore the reasons for these variations.1.6This report forms an update of an earlier review  an intention to harm, (2) repetitive in nature, and (3) a clear power imbalance between perpetration and victim  and online bullying  and bullying victimization . Their review had a major impact on the field of bullying intervention and prevention, and in the 9 years that have passed since its publication there has been a wealth of new research.It is hoped that this new evidence base will assist policy‐makers and practitioners working in the field of bullying prevention. Farrington and Ttofi's  review cTherefore, the aim of the present report is to conduct systematic searches for new evaluations of antibullying programs, and also update earlier analysis by including their 53 evaluations.4The initial stage of any meta‐analysis involves conducting a thorough and systematic search of all the existing and relevant literature Describe an evaluation of a school‐based antibullying program implemented with school‐age participants ;(2)Utilize an operational definition of school‐bullying that coincides with existing definitions Measure school‐bullying perpetration and/or victimization using quantitative measures, such as, self‐, peer‐, or teacher‐report questionnaires; and(4)Use an experimental or quasi‐experimental design, with one group receiving the intervention and another (control group) not receiving the intervention. Nonrandomized studies had to measure outcomes before and after the intervention.As a result, the present systematic review excludes studies that evaluate the effectiveness of intervention programs targeting alternative forms of bullying, such as cyber‐bullying  was also searched. A full list of databases searched is provided in Table Searches were conducted on several online databases, including, but not limited to: Web of Science,Databases of unpublished reports  were also searched to include gray literature in our review. This should help to minimize potential publication bias linked to larger or significant effect sizes ; (2) reviewed several different antibullying programs ; or (3) did not report empirical quantitative data from an evaluation of a specific antibullying program .The initial wave of screening excluded 258 of these primary studies. At this stage, studies were excluded because they: (1) did not evaluate a specific antibullying program  of participants this was recorded. Second, some studies did not report the age in years of participants, but we were able to record the school grade of included samples . Where reported, the % of females and males included in the sample was extracted.The total sample size and also the We also coded descriptive information about the publication of the evaluation. Specifically, the type of publication and the publication year was recorded. The former represents a categorical moderator reflected whether or not the evaluation was published via the following channels, in order of hypothesized negative correlation with bias: (1) peer‐reviewed journal article; (2) chapter in an edited book/book; (3) governmental report or similar; (4) correspondence; and (5) unpublished masters or doctoral theses.Correspondence was included to reflect data obtained from multiple evaluations of the Olweus Bullying Prevention Program (OBPP) sent to the second (M. M. T.) and third (D. P. F.) authors in preparation of their earlier Campbell review. Where evaluation data had been published in multiple formats, we favored the category associated with the least potential bias. For example, Domino  reported5.2Included studies were further categorized according to several aspects of the research design used. We coded information regarding both the measures  and research design.In relation to measurements of bullying, we recorded the timeframe  in which participants were asked to report on experiences of bullying, the type of report used , and data collection points . We also noted whether the measure was a continuous scale or a global item and whether bullying perpetration, victimization, or both, outcomes were measured.As for the research design, we recorded information regarding the unit of allocation , the number of “clusters” included, whether groups were matched at baseline, and the number of experimental or control groups. For example, Elledge et al.  includedInformation about the evaluation methodology was also extracted from primary reports. The types of evaluation methodologies included in the present report are now described in further detail.5.2.1In order to optimize the comparability of effect sizes, primary studies included in a meta‐analysis should use the same, or at least conceptually similar, research designs Wilson, . Followi(1)Randomized controlled trials (RCTs);(2)Before‐after/quasi‐experimental‐control designs (BA/EC);(3)Other quasi‐experimental designs; and(4)Age cohort designs.Each of these methodologies varied on four key elements: as randomization of participants (or clusters of participants); use of experimental and control groups; and administration of quantitative bullying measures before and after intervention.For example, all studies coded as RCT had to include random assignment to experimental conditions  but did not have to use before and after measures of bullying outcomes. RCTs are considered to be the “gold standard” of experimental evaluations  designs, are conceptually similar to RCTs, but they do not involve random assignment to experimental conditions. Instead, participants or clusters of participants may be assigned to the intervention or control group on a self‐selected basis  serve as the experimental group  in the other quasi‐experimental design category because they are poorly controlled and vulnerable to selection effects. Additionally, the four studies included in the earlier review that used an “other quasi‐experimental” design were excluded from the present systematic review.Studies employing RCTs, BA/EC, and age cohort designs were included in the present systematic and meta‐analytic review. Because of the potential threat to internal validity, we excluded studies  were recorded, such as work with peers, parental involvement, teacher training and whole‐school‐approach. Therefore, a brief description of each antibullying program based on this information is provided in Table In addition to specific program elements included in interventions, we also coded for possible sources of bias in evaluations and intervention development. Conflict of interest (COI) has previously been reported to impact evaluation results of many interventions and is a growing area of interest  were coded as “high.” Thus, programs that were less specific and included many other outcomes in addition to bullying measures were considered “low.” A third category was created  to include studies that did multiple other outcomes in addition to bullying outcomes, but these additional variables were bullying‐related.5.4We also extracted several pieces of statistical information from primary studies that was required for the estimation of effect sizes. Statistics for bullying behaviors, for example, means and standard deviations or sample sizes and percentage of bullies and/or victims, were extracted for experimental and control groups at baseline and immediately postintervention timepoints.We also coded bullying data for additional follow‐up timepoints where this information was reported by primary studies. Data was extracted and recorded separately for independent samples  allocation sequence (AS); (2) Allocation concealment (AC); (3) Baseline equivalence on outcomes (BE); (4) Baseline equivalence on participant characteristics (BC); 5) Incomplete outcome data (ID); (6) Contamination protection (CP); and (7) Selective outcome reporting (SOR). The applicability of these categories for each of the methodological designs included in the present report is outlined in Table  Incomple6n = 40) are new bullying prevention and intervention programs.In total, 67 different school‐based antibullying programs were evaluated by primary studies included in our updated meta‐analysis. Descriptions of each of these interventions is provided in the following section of this report. These narrative reviews of included antibullying programs are based on the best available information provided by the primary studies. Twenty‐one of the evaluated antibullying programs were included (only) in the previous meta‐analysis  to reduce bullying episodes through developing in bullies an awareness of their own and others' behavior; (b) to enhance children's capacity to offer support to the victims of bullying; (c) to enhance responsibility and involvement on the part of bystanders; and (d) to improve the quality of interpersonal relationships in the class group  so that they knew how to deal with other children and how to facilitate interactions among other children. Teachers and other professionals  took part in these sessions as well. The overall aim of this phase of the antibullying program was to help peer supporters to enhance their listening and communication skills since they would be the mediators in the interactions among children.During the fourth phase of the program, peer supporters worked in their classes with the assistance and close monitoring of their teachers. The teachers in each class organized “circle meetings” during which the needs of specific children involved in bullying (target children) were identified. Target children were contacted and, after their consent and cooperation, were offered help by the peer supporters. Peer supporters were not only assigned to specific tasks involving the target children but were also supervised by the teachers so that they were given constant feedback on their on‐going work in the class.During the final phase of the Befriending Intervention, the leading group of peer supporters were involved in training other children in the class, so that more children could be involved in the program (in the transmission of training and passing on the roles).6.5This program targeted male youth, from a low socio‐economic area, predominately inhabited by individuals of color, involved in bullying. The program was based on the findings of an in‐depth needs assessment within three schools and targeted a specific number of male students aged sixteen who (based on the results of the questionnaire that had been administered) were “considered to be a serious threat to the harmonious functioning of everyday school life” , was “directed towards the individual and peer group, and aimed to enhance awareness about violence and its negative effects”  and as agents delivering the intervention to students. Teachers were given information and strategies to help them recognize bullying incidents among their students and how to effectively deal with these behaviors  research methodology in education; (2) knowledge of school bullying; (3) components of action research; and (4) intervention skills, such as brainstorming and role‐playing. Second, a 5‐week intervention program was designed and implemented by teachers in classrooms. Components that targeted both victims and bullies specifically were also incorporated into the intervention.6.11The Confident Kids program is an antibullying intervention designed for early adolescent males who were experiencing anxiety as a result of being bullied at school ; graded exposure; adaptive coping strategies; improving social skills; and self‐esteem. A final session targeted relapse prevention and provided a general overview of the skills learned throughout the program. Parents participated in sessions that ran parallel to the student program. Group discussions targeted the strategies being taught to student participants and also possible parent factors that could influence effectiveness of intervention for their children, for example, parental anxiety.6.12Cyberprogram 2.0 is a cyberbullying intervention program that also incorporates elements on school bullying .To illustrate the consequences of bullying and cyberbullying for all those involvedTo develop coping strategies in order to reduce bullying and cyberbullying behaviors.Developing positive social and emotional skills, such as empathy, active listening, anger management, conflict resolution strategies, and diversity tolerance.A wide range of activities and techniques are used, such as, role‐playing, brainstorming, case studies, and guided discussion. The Cyberprogram 2.0 intervention followed a specific methodological framework, employing four key components for implementation. They are as follows: (1) inter‐session constancy: intervention was delivered in weekly 1‐h sessions; (2) spatial‐temporal constancy: intervention was delivered in the same place and at the same time each week; (3) constancy of adult facilitator: intervention was implemented by the same adult, who same psycho‐pedagogical training, each week; and (4) constancy in the session structure: sessions being with group instruction and activities. There is then a following reflection phase that is led by the adult.6.13Vsi Vaiku Linija], in Lithuania, and Nicolaus Copericus University, in Poland, were also involved.Daphne III was an international antibullying initiative implemented and developed in association with numerous organizations. In this study , school antibullying programs were coordinated in Cyprus by the Association for the Psychosocial Health of Children and Adolescents (APHCA). Other influential “partners” included the Cyprus Ministry of Health, mental health services, Department of Child and Adolescent Psychiatry, Ministry of Education and Culture, and Educational Psychology services. Organizations from other European countries included: Child Line  developed by Gargallo (2000)  awareness‐raising; (2) self‐reflection; and (3) commitment to new behaviors , small‐group and whole‐class discussions were conducted  that aimed to increase students' awareness of the bullying problem. Corresponding materials included a real snap‐shot from the playground, a story entitled “A new friend” and students' own drawings. In line with the second theoretical axis (self‐reflection), two instructional hours involving classroom discussions were conducted. These discussions placed emphasis on the participant roles that students took in the bullying process. Corresponding materials involved each students' completion of open‐ended sentences. Through this activity students were intended to reflect on critical issues around the causes, benefits, feelings, and consequences of adopting different roles. In line with the final axis (commitment to new behaviors), three instructional hours of small‐group and whole‐class discussions were conducted concerning different ways of approaching or solving the peer‐conflict situation and the formulation of class rules. Corresponding materials involved an open‐ended comic‐strip for group completion to find a solution to the bullying situation presented in the relevant story.6.29This antibullying program was implemented in Greek elementary schools during the academic year 2011/2012 . Class activities included group discussions, games and the formation and signing of class antibullying rules  classes. Results of the needs assessment survey were then employed by the action group to tailor the INCLUSIVE intervention to target specific needs. The action groups also utilized this information to review and improve schools' existing policies, procedures and schemes .In relation to the core components of the INCLUSIVE intervention, all school staff were provided with introductory training in restorative practices by their affiliated expert facilitator. A minimum of twenty school staff were also required to attend intensive training provided by a specialist training provider. Restorative practices, such as “Circle Time,” were taught to staff to improve school climate and student‐staff communication. This technique involves teachers and staff sitting together in a circle discussing various emotional, social, and curricular issues. Each member of the circle is considered a valued contributor, and all inputs are treated equally. Circle time aims to support student communication and promote positive relationships. Another restorative technique used in the INCLUSIVE program was “formal conferencing,” which aimed to deal with serious bullying and aggressive incidents directly. Formal conferencing involves bringing together teachers, parents and students to establish appropriate punishment and ways in which the harm caused can be repaired. This approach emphasizes a nonjudgmental and inclusive environment so that both victims and perpetrators of bullying and/or aggression are involved.Year 8 students also completed 5–10 h of social and emotional skills training throughout the process of the INCLUSIVE intervention. These lessons were based on the Gatehouse Project curriculum and could be delivered as either stand‐alone modules or integrated into existing academic curriculums. Modules covered included: (1) Establishing respectful relationships; (2) Emotion management; (3) Understanding and creating trusting relationships; (4) Exploring others' needs and avoiding conflict; and (5) Maintaining and repairing relationships.6.31The name of this project is an acronym of the expression “Kiusaamista Vastaan” which means “against bullying.” The word “kiva” in Finnish means “nice” and this is why this acronym was chosen for the specific antibullying initiative in Finland. Regarding the overall perspective of the program, the KiVa project included a universal and an indicated intervention  aiming in this way to enhance students' attitudes against bullying. Also, students received their own personal user ID, which they could use as a password before the completion of each web‐based questionnaire on bullying. KiVa included 20‐h student lessons, which were carried out by student teachers. The lessons involved discussions, group work, short films about bullying, and role‐playing exercises. After each lesson, a class rule was adopted, based on the central theme of the lesson.A unique feature of the KiVa program was the use of an antibullying computer game. The game involved five levels and the teacher always activated the next level of the game after the relevant lesson was completed. Students were able to begin using the game after the third lesson; the second level of the program was played after the fifth lesson, and so on until the end of the school year. Each level of the computer game included three components that were named as “I know,” “I can,” and “I do.” In the first component, students were informed about basic facts on bullying. In the second component, the “I can”‐component, students moved around in the virtual school and faced different challenging bullying incidents. Finally, the third component was used to encourage students to make use of their knowledge and skills in real life situations.Another important element of the KiVa project was the teacher training. Teachers were also provided with vests that they could use during playtime while supervising the school yard. This simple technique aimed to enhance teachers' visibility in the schoolyard and to signal that bullying was taken seriously in the school. Also, all teachers carrying out the KiVa program could seek advice from a web‐based discussion forum, where they could share experiences and ideas about bullying with other colleagues.Within the school framework, the program also facilitated the use of a peer support group for victims of bullying. The classroom teacher was expected to arrange a group with 2–4 classmates—those who were pro‐social and had high status in the class—who were expected to provide support to victimized students, thus sustaining healthy peer relationships. An interesting element in the KiVa program is that it incorporated both punitive and nonblame approaches when dealing with perpetrators of bullying. Half of the school teams were instructed to use more punitive approaches  while the rest of the school teams were instructed to use no‐blame approaches in their discussions with children . There was also co‐operative group work among experts when dealing with children involved in bullying.Finally, the KiVa program involved parents. A parents' guide was sent to the home and provided information about bullying and advice on how parents could be involved to reduce this problem. Information nights for parents were also organized and provided.6.32The Lead Peace intervention is based on a resiliency conceptual framework Resnik, , thus, aThe core curriculum targets factors on three levels: (1) environmental ; (2) personal ; and (3) behavioral . The program aims to reduce risky health and social behaviors  in order to promote positive and reduce risky behaviors. The curriculum is implemented for 3 years, and can be delivered in two “doses”: (1) Lead Peace program (basic)—includes 15–20 intervention lessons each year; or (2) Lead Peace plus program—includes 30 intervention lessons, 15–20 additional community service hours, and health education and family outreach activities.6.33The Lunch Buddy mentoring program was a school‐based antibullying program that aimed to reduce bullying victimization in elementary school children  a short version implemented over four 90‐min lessons that take place in one school day; and (2) a long version that is implemented over 15‐weekly 45‐min lessons , or NoTrap!, is a web‐based antibullying program that has been developed, implemented and refined over several studies  and a folder with information for parents and families. The program also included: (1) CD‐program that was used for assessing and analyzing the data obtained at the pre‐test period, so that school‐specific interventions could then be implemented; (2) a video on bullying; (3) the Revised Olweus Bully/Victim Questionnaire and (4) the book “Bullying at school: what we know and what we can do.”The antibullying measures mainly targeted three different levels of intervention: the school, the classroom and the individual. At the school level, the intervention included:Meetings among teachers to discuss ways of improving peer‐relations; staff discussion groups.Parent/teacher meetings to discuss the issue of bullying.Increased supervision during recess and lunchtime.Improvement of playground facilities so that children have better places to play during recess time.Questionnaire surveys.The formation of a coordinating group.At the classroom level the intervention included:Students were given information about the issue of bullying and were actively involved in devising class rules against bullying.Classroom activities for students included role‐playing situations that could help students learn how to deal better with bullying.Class rules against bullying.Class meetings with students.Meetings with the parents of the class.At the individual level the intervention included:Talks with bullies and their parents and enforcement of nonhostile, nonphysical sanctions.Talks with victims, providing support and providing assertiveness skills training to help them learn how to successfully deal with bullying; also, talks with the parents of victims.Talks with children not involved to make them become effective helpers.An interesting feature of the OBPP is that it offered guided information about what schools should do at both the intervention and the maintenance period. The Olweus program demands significant commitment from the school during the 'introductory period' which covers a period of about 18 months. Later the methodology acquired by the staff and the routines decided by the school may be maintained using less resources … Yet, even for the maintenance period, the program offers a point by point description of what the school should do to continue its work against bullying in accordance with Olweus methodology . Also, at the school level training was offered to the whole school staff, with additional training provided to the coordinators and key personnel. These were responsible for coordinating the overall antibullying initiative in their school. The program also included cooperation among experts and teachers  who worked with children involved in bullying.6.37The Positive Action Program is a generalized school‐based “well‐being” program  self‐concept; (2) social and emotional positive actions for managing oneself responsibly; (3) positive actions relating to a healthy body and mind; (4) honesty with oneself; (5) getting along with others; and (6) continuous self‐improvement . It involved a cognitive‐behavioral approach to the problem of bullying and victimization by building up prosocial behavior. The program was universal: it did not involve specific work with perpetrators or victims of bullying. However, it included both teacher and parent training and a 2‐h classroom discussion with students about violence problems. The program offered curriculum materials that aimed to increase awareness in relation to the problem of bullying and placed emphasis on specific issues such as classroom management and classroom rules against bullying.6.40The program was delivered in a period of 3 years, and it consisted of two main parts. During the 1st two years it was delivered more at the school level whereas the 3rd year was more at the class and individual level  was an antibullying program that aimed to educate elementary school students about bullying and conflict resolution  ignore, (2) say stop, (3) walk away, and (4) get help. The show took approximately 45 min and aimed to increase children's awareness about which behaviors could be categorized as bullying and to show various strategies that children who were bullied and/or who witnessed bullying could use to discourage it  was a school‐based program that aimed to help children enhance their social skills. S.S. GRIN was designed as a social‐skills training intervention for peer‐rejected, victimized, and socially anxious children. It could be applied to an array of problems that are social in nature  not just bullying  of participants. The program followed this format from days 2–5, however, on day 1, all participants completed the introductory lesson together. The school‐bus antibullying program primarily utilized DVD materials from the “Take a Stand” content. These video clips depicted cartoon characters engaging in different bullying scenarios.Stop, Help, and Tell, that bystanders can take if they witness bullying.On day 1  an overview of school bullying and related issues, including bystander intervention, was provided to participants. The associated DVD clip depicted a male character physically bullying another child in the playground while other students watched. Participants then discussed the clip in groups, and were introduced to the “Three Steps to Stop Bullying Chart.” This technique involves three steps, Stop, Help, and Tell concepts were revisited. The school's social worker or principal led discussion groups by posing questions to the students concerning the feelings and emotions experienced by the victim of bullying, potential coping strategies that the victim could use, and possible bystander behaviors. Participants also shared their previous experiences with similar situations. Furthermore, using the Stop, Help, and Tell paradigm, participants brainstormed potential ways to tell a bully to stop behaving in a certain manner, ways to help the victim and appropriate trusted adults that they can tell about the situation.On each subsequent day, a new DVD clip was shown to participants and the 6.49The Second Step: Student Success Through Prevention is a middle school Social‐Emotional Learning (SEL) program that aims to reduce bullying, peer victimization, physical aggression, homophobic name‐calling and sexual violence  empathy and communication—five lessons; (2) bullying—two lessons; (3) emotion regulation —three lessons; (4) problem‐solving—two lessons; and (5) substance abuse prevention—four lessons.Each lesson has clearly outlined learning objectives to reduce problem behaviors and increase prosocial behaviors. For example, lessons on bullying target the peer context by increasing knowledge, improving attitudes, and encouraging bystander intervention in order to reduce bullying perpetration and victimization. Students are educated about the differences between types of bullying, importance and responsibilities of bystanders in preventing bullying and a number of positive bystander behaviors are modeled. The 7th grade Second Step curriculum involves a similar lesson structure, with some slight changes. The intervention is delivered over 13 weekly lessons, and cyber‐bullying and sexual harassment issues are incorporated into bullying modules.6.50Wurf  assessed6.51The antibullying intervention in Czechoslovakia was inspired by the OBPP and borrowed elements from it, such as the Olweus videocassette on bullying  talking about bullying, their views about this phenomenon and their personal experiences of bullying. The video also involved a number of bullying scenes  received the program in 45‐min sessions twice a week, while senior students  completed one 45‐min session per week. Program developers provided each participating teacher with detail manuals for implementing the program with each grade and grade‐specific student workbooks. Role‐playing and modeling tasks covered many themes, including: social problem solving; conflict management; dealing with strong emotions; and resisting peer pressure. Teachers were also supervised once a month during the 1st year of implementation, and students were encouraged to practice skills both at school and at home.6.54Lishak  implemen6.55STT was a program specifically designed to support “chronic victims” of bullying , while the fourth session dealt with issues of body language: teaching children how to modify their nonverbal behavior in a way that would protect them from being victimized. During the fifth session children learned how to be assertive while in the next two sessions children were taught how to deal with the bully. The eighth session signaled the end of the program.6.56This evaluation compared the effects of two intervention packages with a treatment‐as‐usual condition , a manualized protocol that aims to address mental health issues of children with disruptive behavioral problems, internalizing problems, or poor academic performance. SPC was a school‐level intervention focused on individual children. Three child psychiatry residents, supervised biweekly by a senior child psychiatrist, delivered mental health consultation following the SPC manual for 4 h/week. The psychiatric residents attended weekly school resource meetings and consulted directly with teachers, parents and other school personnel, through classroom observations and meetings, providing 140 consultations for 65 students in year 1 and 97 consultations for 45 students in year 2.The second experimental condition involved the implementation of CAPSLE (“Creating a Peaceful School Learning Environment”), a manualized psychodynamic approach addressing the cocreated relationship between bullies, victims and bystanders. In contrast to SPC, CAPSLE represents a whole‐school intervention approach. It aimed to modify the educational and disciplinary school climate. A CAPSLE team drawn from school staff in the pilot project led implementation in the two intervention years using a training manual. In year 1, teachers received a day of group training, students received nine sessions of self‐defense training, and the CAPSLE team consulted with school staff monthly. Year 2 started with a school‐wide half‐day refresher self‐defense course, and consultation continued with counselors, teachers and adult/peer mentor programs. In year 3 (the maintenance phase), self‐defense training continued as in year 2.CAPSLE includes several antibullying materials that can be used by teachers such as a Teacher Discipline Manual (used in the teacher training), a Student Workbook, Buttons and Magnets and Patches (used as a way of reinforcing of desirable student behavior), Parent Warning Notes (notifying parents about specific problem behavior of the child) as well as antibullying videos that can be used during the physical education lessons (and videos that can be used by parents). CAPSLE also includes the Gentle Warrior Program, a 12‐week curriculum specifically designed for physical education teachers. For CAPSLE, intervention fidelity was assessed using a teacher self‐report measure that required teachers to state the frequency with which various CAPSLE program components were implemented.6.57This intervention program combined elements of standardized CBT and DVD bullying‐related materials in order to reduce bullying perpetration and victimization among elementary school children  The Deepest Hurt, that depicts girls role‐playing various scenarios of relational aggression; and (3) The Broken Toy, a dramatization of the damage bullying can cause. Following the videos, students engaged in group discussions led by the counselor about the issues illustrated in each DVD.In addition, students in the CBT + media experimental group watched three DVDs that highlighted the issues outlined in the weekly lessons. The DVDs that were shown are as follow: (1) 6.58This intervention was based on the curriculum activities and the whole school approach because it tried to involve all people in a school  increasing staff awareness; (2) fostering socially responsible beliefs; and (3) teaching social‐emotional skills so as to promote healthy relationships . Teachers, counselors, and administrators received additional training in how to coach students involved in bullying, based on behavioral skills training, cooperative learning and role‐playing.The student curriculum comprised skills and literature‐based lessons delivered by third‐ through sixth‐grade teachers during a 12–14‐week period. The intervention consisted of 10 semi‐scripted skills lessons with topics such as joining groups, distinguishing reporting from tattling and being a responsible bystander.Finally, with regard to the parent intervention, administrators informed parents about the program and the school's antibullying policy and procedures. Parents could also benefit from other resources such as letters provided to them and newsletters describing whole‐school antibullying activities undertaken at school.6.61The SIM  Self‐awareness; (2) Self‐management; (3) Social‐awareness; (4) Relationship skills; (5) Decision making; (6) Problem solving; and (7) Leadership. Trained teachers taught TTL lessons during normal class periods on a weekly basis. Participating teachers were trained on the skill‐based curriculum by the developers of the TTL program. During training, teachers were taught about specific learning objectives and goals of the intervention program, and also about the lesson plans and activities involved in “Take the LEAD.” Information evenings for parent were also held as part of the TTL intervention and aimed to raise parents' awareness of key social‐emotional issues.Each of the sixteen TTL lessons involved specific learning objectives and goals. Lessons involved a combination of knowledge and skill development and an application component, so that participants were given the opportunity to apply skills in real‐world settings. For example, the “Communication skills” lesson aimed to “explore elements of communication that enhance interpersonal skills and foster positive relationships Domino, , p. 432.6.63The Toronto antibullying program was inspired by the OBPP  a 10‐page family guide, sent to children's homes, which provided brief information about the multi‐media program and its relation to the antibullying initiative; and (2) a 10‐page staff guide, which included general information about bullying and how to support student change, classroom activities and information on how to work with parents. Teachers were not provided with any training.6.65The Utrecht Healthy Schools program was a comprehensive educational program that targeted adolescent health behaviors  impulses and group dynamics; (2) reflection; and (3) action. The first phase, entitled “impulses and group dynamics,” consisted of six lessons and the main aim was to enhance students' competence in dealing with critical situations by teaching them how to look at social situations from different perspectives using vignette stories, discussions and role‐plays. The second phase, action, consisted of six lessons during which the trainer asked students to define how they wanted to benefit from the remaining lessons. The trainer collected students' individual ideas, evaluated them and—along with the students—put them in practice in alignment with the global goal of the program: enhancing pupils' social competence. The third phase of the program was flexible and it could involve several projects suggested by pupils such as a movie production, a work of art, the organization of a party, and so on. This flexibility was allowed and was, in fact, a main feature of ViSC because organizing such projects “involves a variety of critical situations, in which alternative, nonaggressive response options can be probed, rehearsed, and evaluated for success”  and proposed that four factors inhibit the development of antisocial development in children. These were: (1) bonding or attachment to family, schools and positive peers; (2) belief in the shared values or norms of the above‐mentioned social units; (3) external constraints or consistent standards against antisocial behavior; and (4) social, cognitive and emotional skills that can be seen as protective tools for children to solve problems and perform adequately in social situations. The Youth Matters curriculum addressed each of these four core areas.6.69The Zero antibullying program is based on the idea that bullying is predominately a version of proactive aggression , primary evaluations (n = 53) discovered by Farrington and Ttofi (n = 13). Next, a detailed explanation is provided about studies which were excluded from the current review and justifications for this decision.In addition to the newly identified studies  Menard and Grotpeter  was a coTen studies (published both before and since 2009) were identified as reporting the effectiveness of an antibullying program from the same sample, or were repeat publications of earlier studies , design label , and the program heading . Results of these moderator analyses analogous to the analysis of variance (ANOVA) are presented in Sections 8.5.1 to 8.5.7 of the present report.7.4.1The primary moderator chosen for further analysis was evaluation method. Specifically, whether the evaluation was conducted using a RCT, quasi‐experimental with before and after measures (BA/EC) or age cohort (AC) design.Overall, in relation to bullying perpetration outcomes, 36 evaluations used RCT designs, 31 used BA/EC designs and 14 used age cohort designs. However, due to some evaluations reporting data for multiple independent samples, a total of 40 effect sizes were estimated for bullying perpetration outcomes from RCT designs. A further 36 were estimated from BA/EC designs and 14 effect sizes came from evaluations using age cohort designs.For bullying victimization outcomes, overall, 33 evaluations used RCT designs that gave 37 independent effect sizes for bullying victimization and 37 evaluations used BA/EC designs and gave 42 independent effect sizes. Similar to perpetration outcomes, 14 evaluations used age cohort designs to evaluate the effect of antibullying programs on bullying victimization outcomes.7.4.2Evaluations included in the present analysis were conducted in many different countries around the world. However, there were only a few countries in which multiple evaluations of antibullying programs had been published.Specifically, in the following countries only one evaluation was included in the present report: Austria ; Canada (n = 6); Cyprus (n = 3); Finland (n = 6); Germany (n = 5); Greece (n = 2); Italy (n = 11); Netherlands (n = 3); Norway (n = 8); Spain (n = 3); UK (n = 4); and United States (n = 26). With respect to bullying victimization outcomes, these countries were as follows: Australia (n = 3); Canada (n = 7); Cyprus (n = 3); Finland (n = 6); Germany (n = 4); Greece (n = 2); Italy (n = 10); the Netherlands (n = 3); Norway (n = 7); Spain (n = 3); UK (n = 6); and United States (n = 28).So, of the 100 evaluations included in our meta‐analysis of school‐based antibullying programs, the majority  were conducted in one of 12 different countries. With respect to bullying perpetration outcomes, these countries were as follows: Australia (7.4.3n = 67) and bullying victimization (n = 72) outcomes. Two evaluations were published in chapters of edited books and both reported effects of a program on both bullying victimization and perpetration. No evaluations identified were published as entire books. Moreover, 12 unpublished dissertations were identified that published evaluation data for bullying perpetration and bullying victimization outcomes. Data was also retrieved for both outcomes from three governmental reports. Four of the effect sizes included in the present report were estimated from data emailed to authors (M. M. T. and D. P. F.) in preparation of the previous Campbell report  studies in comparison to 2009 (n = 39) studies for bullying victimization outcomes.We also categorized included evaluations according to whether they were included in the previous report , or only included in the present report . In relation to bullying perpetration outcomes, 37 studies were coded as 2009 studies and 53 studies were coded as 2016 studies. Similarly, more studies were coded as 2016  and those conducted in Norway  were included in the moderator analysis separately. There was one evaluation of the OBPP conducted in Malaysia is included in the overall category (n = 12).Additionally, multiple evaluations of the OBPP were included in our meta‐analysis. Overall, 12 independent evaluations of this intervention were included in our analysis in relation to bullying perpetration and victimization outcomes. These are included in our moderator analysis as a collective subgroup and also as further subgroups. Evaluations of the OBPP conducted in the United States  yet the unit of analysis was individual students. A number of evaluations  assigned classes to experimental conditions yet the unit of analysis was individual students. Less than 10 evaluations  included assigned students to experimental and control conditions. One study randomly assigned districts to experimental conditions, and information was not available for five studies in relation to bullying perpetration outcomes and four studies in relation to bullying victimization.The majority of RCT and BA/EC evaluations assigned schools to experimental conditions  were considered low COI, and 14 were categorized as possible COI. Information concerning COI was unavailable for 4 evaluations in relation to bullying perpetration outcomes.In the present report, 40 studies were categorized as high COI. A large number of studies (perpetration 7.4.7n = 11) of studies included in our analysis were coded as low on the program specificity variable. The vast majority of evaluations were considered highly specific . Additionally, 18 studies were categorized as medium in relation to specificity, where extra outcome variables were measured but these variables were related to bullying .Overall, a small number . However, because of this, it is likely that there will be some attrition in primary studies. The incomplete outcome data item referred to the risk associated with differential attrition between experimental groups and/or ways in which attrition and missing cases were dealt with by primary studies. Twelve studies were categorized as high risk on the incomplete outcome data item. Additionally, 48 studies were low risk and 29 were unclear risk.7.5.6This item assesses the risk associated with any bias which may arise if outcome measurements are not conducted blindly. In other words, if the individual, or individuals, who administer and collect the measurement instruments are aware of the experimental conditions of participants at the time of measurement. Overall, 27 studies were categorized as high risk on the BOA item. Twenty studies were low risk and 43 were unclear risk.7.5.7Risk of contamination occurs when there is a possibility that experimental and control participants may interact or encounter one another during the course of the evaluation. Thus, the effects of the intervention may “spill over” to control students and impact the results of the evaluation. In our analysis, 35 studies were categorized as high risk on the CP item, 47 studies were low risk, and 9 were unclear risk.7.5.8SOR occurs when the outcomes reported in an evaluation study differ from the outcomes of interest proposed originally. For example, if a trial protocol proposed different outcomes than those actually reported in the publication of the trial results. Two studies were categorized as high risk on the SOR item. Eighty‐four studies were low risk, and three were unclear risk.8After accounting for missing information, studies excluded because of their methodology , and studies with overlapping samples, a total of 41 studies were excluded from the meta‐analysis. Thus, a total of 100 studies were eligible for inclusion in our meta‐analysis. Table 8.1d and Odds Ratios.A meta‐analysis aims to estimate comparable effect sizes from multiple primary studies. The choice of effect size depends on how statistical information is reported by primary studies  effect size was estimated. The ORs for before and after intervention time‐points were calculated independently. The CMA™ software that we used to analyze effect sizes in the present report did not allow us to enter raw data for before and after time‐points for primary studies that reported dichotomous outcomes separately. Thus, we were unable to use this software to calculate a pre‐post intervention estimate for these studies. Hence, these calculations were carried out manually,d was estimated for primary studies when results were reported in the form of continuous data. Cohen's d is estimated as the difference between experimental and control means divided by the pooled standard deviation  and the random effects model , and has been used in several meta‐analyses from both the behavioral sciences  computing the mean effect and variance for each subgroup; and (2) comparing the mean effects between subgroups  and the within‐studies (QW) variance.Comparing the mean effect sizes for subgroups involves a method that is analogous to a one‐way ANOVA in primary research . Similar to a one‐way analysis of variance, this approach partitions the variance and compares the variability between‐groups. The following formula is used to estimate the j − 1 and the statistical significance is determined using a χ2 distribution. As QB is estimated using the weights assigned to observed effect sizes, the value will vary between the fixed effects model and the random effects model. QB is not reported for comparisons of subgroups with very unequal numbers of studies . Under the MVA model, the heterogeneity between groups is estimated by dividing the fixed effects QB by Q/df. The present report presents results from moderator analysis under both the random effects and MVA models.The degrees of freedom for the between‐studies heterogeneity is estimated as 8.5CMA™ version 3 software was used to conduct meta‐regression analysis to explore the relationship between continuous moderator variables and perpetration and victimization outcomes. Weighted regression analysis  or BA/EC designs (n = 44 effect sizes). We estimated the remaining 14 effect sizes from age cohort designs.In total, 100 studies were included in our meta‐analysis of the effectiveness of school‐based antibullying programs. From these evaluations, we were able to estimate 103 independent effect sizes. These are presented for bullying perpetration and bullying victimization outcomes in Tables 9.1z = 13.4; p < .001; I2 = 81.42) and the random effects model .Overall, we found that antibullying programs significantly reduced bullying perpetration under both computational models of meta‐analysis. The effect sizes for each evaluation are presented in Table This result indicates that participants in primary studies who received an antibullying intervention were less likely to report engaging in bullying others after completing the program in comparison to control students who did not partake in the program.Analysis of the funnel plot Figure  suggests9.2z = 12.06; p < .001; I2 = 78.327) and the random effects model .Overall, we found that antibullying programs significantly reduced bullying victimization under both computational models of meta‐analysis. The effect sizes for each evaluation are presented in Table This result suggests that students who participated in an antibullying program were significantly less likely to report being bullied by others after receiving the intervention in comparison to students who did not receive the intervention.Q = 460.97) and adjusted effect sizes . However, this difference is negligible. Based on these results, it was reasonable to assume that publication bias was not likely.The funnel plot in Figure 9.3Q) is the between‐study spurious variance that occurs partly because of true variation in effect sizes, but also as a result of random error  and bullying victimization  outcomes. Multiple moderator analyses were conducted to explore possible explanations for this heterogeneity.In the present meta‐analysis, there was significant heterogeneity between studies for both bullying perpetration  or under the MVA model . Similarly, risk of bias scores did not significantly predict bullying victimization effect sizes under a random effects meta‐regression  or the MVA model .For perpetration outcomes, risk of bias was not associated with effect size under a random effects model of meta‐regression  and bullying victimization  under a random effects model. Similarly, AC studies were associated with the largest effect sizes under the MVA model also  and victimization OR = 1.289; 95% CI, 1.29–1.35; p < .001).Primary studies employing age cohort designs associated with the largest effect sizes for both bullying perpetration  and BA/EC evaluations  for bullying perpetration outcomes. Moreover, the differences between RCT evaluations  and BA/EC evaluations  were marginal for bullying victimization outcomes under the MVA model.Under the MVA model of meta‐analysis, mean effect sizes were the same for RCT evaluations , followed by RCTs  under a random effects model. However, the result was the opposite for bullying perpetration outcomes under a random effects model .In relation to bullying victimization outcomes, before‐after/experimental‐control designs gave the second largest mean effect size  further moderator analysis was not conducted.9.5.2Mean effects for bullying perpetration and bullying victimization outcomes are presented graphically in Figures Evaluations conducted in Greece were associated with the largest effect sizes for bullying perpetration outcomes, followed by Norway, Italy, United States, and Finland under the MVA model of meta‐analysis. Evaluations conducted in Italy were associated with the largest mean effect sizes in relation to bullying victimization, followed by Spain, Norway, United States, and Finland under the MVA model of meta‐analysis. Additionally, evaluations conducted in Germany and the UK gave significant mean effects when computed using the MVA model.p < .05) and evaluations conducted in Finland and the United States were nearly statistically significant  under the random effects model.Under the random effects model, Greek evaluations were similarly associated with the largest effect sizes for bullying perpetration, followed by Spanish and Norwegian evaluations. Evaluations conducted in Italy and the United States were also associated with significant mean effects for reductions in bullying perpetration. In relation to bullying victimization, evaluations conducted in Spain and Italy were associated with very similar mean effect sizes and were the largest of the 12 effect sizes, followed by evaluations conducted in Norway. Evaluations conducted in Australia were also associated with significant mean effects in reducing bullying victimization  were compared to evaluations published via peer‐reviewed journal article.However, additional analysis was conducted to examine any potential differences between peer reviewed and nonpeer reviewed evaluations. Therefore, the above categories were collapsed, and evaluations reported by dissertation, chapter, correspondence and governmental reports (perpetration p < .001) mean effect size than peer‐reviewed evaluations . However, under the random effects model, both groups gave similar effect sizes for bullying perpetration outcomes, and the difference between peer‐reviewed (see Table p < .001) was not statistically significant .Under the MVA model, non‐peer‐reviewed evaluations gave a larger  than peer‐reviewed evaluations . Yet, there was a marginal difference under the random effects model between peer‐reviewed (see Table p = .007) and the difference was not statistically significant .For bullying victimization outcomes, similar results were obtained. Under the MVA model, non‐peer‐reviewed evaluations gave statistically significant larger mean effect sizes  under the MVA model and OR = 1.411  under the random effects model for bullying perpetration outcomes. Across both computational models these summary effects were larger than those for studies labeled “2016” on bullying perpetration for the MVA model  and the RE model . Moderator analysis analogous to the ANOVA showed that this difference was statistically significant  under fixed effects and mixed effects analysis .The mean summary effect size for “2009” studies on the year of publication moderator was OR = 1.487  under the MVA model than the mean summary effect size for studies labeled “2016” . Moderator analysis analogous to the ANOVA found that this difference was statistically significant  but the difference between odds ratios was marginal. However, under the random effects model the minimal difference between the “2009” studies  was not statistically different to the mean summary effect size for “2019” studies .In relation to bullying victimization, the mean summary effect size for studies labeled “2009” was larger .In relation to school‐bullying perpetration outcomes, the OBPP was associated with the largest mean effect sizes. In addition, evaluations of the OBPP in Norway were associated with larger summary effect sizes than evaluations of OBPP conducted in the United States. However, the difference was not statistically significant for school‐bullying perpetration outcomes when moderator analysis analogous to the ANOVA was conducted  were also observed for the BPYS and NoTrap! programs but these effects were not statistically significant in relation to reduction in bullying perpetration outcomes. Negative effects were found for two antibullying programs, the fairplayer manual and ViSC, although these effects were not statistically significant.In relation to school‐bullying victimization outcomes, NoTrap! was associated with the largest mean effect size, followed by the BPYS Program, and then the OBPP. Our analysis identified that other antibullying programs were also significantly effective in reducing school‐bullying victimization, for example, Steps to Respect and KiVa.Qb = 74.95; df = 1; p < 0.001). Our analysis also identified negative effects of the Second Step program in relation to bullying victimization outcomes. Evaluations of the ViSC program also had a negative effect on bullying victimization, although this effect was not statistically significant.Again, effect sizes for the OBPP varied between evaluations conducted in Norway and evaluations conducted in the United States for bullying victimization outcomes. Moreover, our analysis found that the difference in the magnitude of these effect sizes was statistically significant . Under the random effects model, evaluations that assigned students to experimental conditions were associated with the largest effect size for bullying perpetration outcomes when all designs were included, and for RCT evaluations and BA/EC evaluations individually. However, the mean effect size for many of the subgroups were not collectively statistically significant overall under the random effects model.In relation to bullying perpetration outcomes, under the MVA model, studies that assigned participants in classes were associated with the largest effect sizes. However, the difference between the mean effect for all evaluations that used classes or schools as the unit of allocation were verging on statistically significance .Similarly, under the MVA model, evaluations conducted using a RCT design, and assigned classes to conditions, were associated with the largest effect size for bullying perpetration, although the mean group for this subgroup was not statistically significant. Moreover, moderator analysis analogous to the ANOVA found that the difference in the mean effect size for RCT designs that assigned classes to experimental and control conditions were not statistically different to RCT designs that assigned schools to experimental and control conditions .In relation to BAEC designs, evaluations that assigned students to experimental conditions were associated with the largest mean effect size, although the effect was not statistically significant. However, the difference between the mean effect for BAEC evaluations that assigned classes and those that assigned schools to conditions was statistically significant under the MVA model . This pattern was observed when all designs were included, and for the subgroup of RCT evaluations and the subgroup of BA/EC evaluations. Thus, when participants were assigned in classes the mean effect size for these RCT evaluations were significantly associated with larger effect sizes  for reductions in bullying victimization than RCT evaluations that assigned schools. Yet the difference between the mean effect sizes for BA/EC evaluations that assigned classes were not statistically significant  than BA/EC evaluations that assigned schools to experimental conditions.For bullying victimization outcomes, studies where the unit of allocation was classes of participants were associated with the largest effect sizes, followed by schools and individual students under the MVA model. The difference between studies that allocated classes and studies that allocated schools was statistically significant , low‐risk (L), and possible‐risk (P). Moderator analysis analogous to the ANOVA was conducted so as to assess the differences between evaluations on each level. Studies categorized as possible‐risk on COI variable were excluded from subgroup comparisons to establish the differences between evaluations that were clearly high‐risk and evaluations that were clearly low‐risk. Table QB = 50.129; df = 1; p < .001) and the random effects model . This suggests that evaluations considered to have high COI were associated with larger overall effect sizes for bullying perpetration. Similarly, high‐risk COI studies were significantly associated with slightly larger effect sizes for bullying victimization in comparison to low‐risk COI studies when compared under both the MVA model  and the random effects model .Moderator analyses found that the difference between high‐risk and low‐risk studies on COI variable was statistically significant for bullying perpetration outcomes under both the MVA model (9.5.7p < .001) and the random effects model (p = .036).The majority of evaluations included in our meta‐analysis were of highly specific intervention programs, that is, those that targeted bullying behaviors and no other outcomes. Consistently across computational model and both perpetration and victimization outcomes these subgroups were associated with the largest mean effect sizes. These results are presented in Table 1010.1Overall, our updated meta‐analysis found that school‐based antibullying programs are effective in reducing both school‐bullying perpetration and victimization. For school‐bullying perpetration the weighted mean OR = 1.324 under the MVA model, or OR = 1.309 under a random‐effects model (RE) were associated with reductions of approximately 19–20%.The results of this meta‐analysis are consistent with findings from most of previous reviews that indicate that antibullying programs have a small but significant effect, with some variations in overall results being attributable to methodological differences in inclusion and exclusion criteria  showed that school‐bullying is perceived differently across different countries and cultures and this may explain variability in bullying reporting. Definitions of school bullying, and behaviors that constitute bullying, differ between countries. For example, Smith et al.  showed tOur meta‐analysis included several examples of cases where the same intervention program was evaluated in different countries , but varied greatly in the sample size. Thus, further research is needed to explain why some interventions  appear to be more effective in some samples compared to others. The programs are still effective, but the variation in effect size could be attributable to a number of different methodological and implementation factors that warrant further exploration.10.2.4Following this logic, we also explored the effectiveness of the specific antibullying programs. Out of the four most widely disseminated antibullying programs included in our review , the OBPP was collectively the most effective in reducing school bullying perpetration of these. Across 11 evaluations, the OBPP reduced bullying perpetration by approximately 26%, which was larger than any other widely disseminated program.In relation to school‐bullying victimization outcomes, the NoTrap! program was the most effective, reducing victimization by around 37%. NoTrap! also reduced bullying perpetration by a considerable amount, approximately 22%, but this effect was not statistically significant. The KiVA program, significantly reduced school bullying perpetration by approximately 9% and school bullying victimization by approximately 11%. The ViSC program was the only program to increase bullying perpetration (by roughly 4%) and bullying victimization (by roughly 4%) although these effects were not statistically significant.Another moderator we used to code differences between included evaluations was the specificity of the intervention program. In other words, we evaluated each intervention program on how specific it related to bullying behaviors. Unsurprisingly, our findings suggest that antibullying programs gave the largest overall effect sizes. While the significance of the differences between subgroups was not computed due to the large discrepancies between the numbers of evaluations included in each subgroup.However, our inclusion criteria for the current report was strictly concerned with school‐bullying intervention programs and behavioral outcomes of bullying. As such, we may have overlooked effective programs that only included nonbehavioral outcomes of bullying  or other problem behaviors  that occur among young people in schools. Changes in these behaviors may also impact bullying, either directly or indirectly, yet, more research is needed to understand this potential effect. Most obvious in the present report is how programs that target specifically school‐bullying may impact cyber‐bullying, and vice versa, given the significant overlap in the prevalence of these behaviors  are more effective than studies in subgroup B . Due to the correlational nature of our moderator analyses we cannot make causal inferences. In addition to this limitation, and those previously discussed  reported bullying victimization, while 23% of participants in the control group (N = 800) also reported bullying victimization at baseline. Hence, the baseline OR was calculated as follows . Moreover, the percentage decrease would be approximately 16.67%  × 100).n values that give the closest possible mean effect size we can thus estimate the corresponding percentage reduction in either bullying perpetration or victimization outcomes.Using this basic formula, we can manipulate the % and number of victims in each experimental condition in order to achieve a odds ratio that corresponds to our weighted mean effect size . Using the


There is a dearth of indicators and management information systems to assess early childhood nurturing care environments.The Brazilian Early Childhood Care Friendly Municipal Index (IMAPI) is a robust tool to assess nurturing care environments at the local level.IMAPI was able to detect nurturing care inequities within and across regions.Further validation work is needed to confirm the utility of IMAPI for policymaking. The Global Nurturing Care Framework developed from the 2016 Lancet Early Childhood Development Series , Adequate nutrition (n = 4), Opportunities for early learning (n = 7), Security and safety (n = 5), and Responsive caregiving (n = 1).The IMAPI was developed following an 8‐step methodology. The first article of this supplement , “Coverage of daycare and preschool” , “Number of students per preschool professional” , and “Visits by national home‐visiting parenting skills programme” . The goal of mapping the three dimensions of nurturing care indicators  aimed to facilitate the interpretation of IMAPI findings and increase the understanding of decision‐makers about the causal pathways and interconnectedness within and across the Nurturing Care Framework domains. This study does indicate the IMAPI has a strong potential to inform ECD decision‐making in metropolitan areas that have some level of autonomy.Lastly, the fourth article of the supplement . PIPAS is a validated instrument that can be used to quickly and inexpensively evaluate developmental outcomes of infant and young children under five years of age during multi‐vaccination campaigns at the municipal level in Brazil (Venancio et al., First, quantitative studies are needed to examine the correlation between municipal IMAPI scores and ECD outcomes to fully confirm the predictivity validity of IMAPI. However, currently, ECD outcomes are not available at the populational level in Brazil, however this is likely to change soon with the ongoing application of PIPAS (Second, qualitative research is needed to understand if an IMAPI driven qulaity assurance process could help improve nurturing care program coverage and quality at the municipal level. This approach has been followed with a breastfeeding decision making toolbox analogous to IMAPI but only at the national level (Buccini et al., The authors declare no conflict of interests.RPE wrote the first draft that was critically reviewed by SV and GB. All authors read and approved the submitted version of the manuscript.Supporting information.Click here for additional data file.


Artemisia annua against malarial parasite strains resistant to artemisinin combination therapy, the ability to produce clinical‐grade protein drugs in leaves to treat infectious diseases and the long‐term storage of protein drugs in dried leaves at ambient temperatures. Recent FDA approval of the first orally delivered protein drug encapsulated in plant cells to treat peanut allergy has opened the door for the development of affordable oral drugs that can be manufactured and distributed in remote areas without cold storage infrastructure and that eliminate the need for expensive purification steps and sterile delivery by injection.The fight against infectious diseases often focuses on epidemics and pandemics, which demand urgent resources and command attention from the health authorities and media. However, the vast majority of deaths caused by infectious diseases occur in endemic zones, particularly in developing countries, placing a disproportionate burden on underfunded health systems and often requiring international interventions. The provision of vaccines and other biologics is hampered not only by the high cost and limited scalability of traditional manufacturing platforms based on microbial and animal cells, but also by challenges caused by distribution and storage, particularly in regions without a complete cold chain. In this review article, we consider the potential of molecular farming to address the challenges of endemic and re‐emerging diseases, focusing on edible plants for the development of oral drugs. Key recent developments in this field include successful clinical trials based on orally delivered dried leaves of  Infectious diseases can also be divided into categories based on their epidemiology and are often described as epidemic or pandemic  or technologies (e.g. helminth infections are restricted to areas that lack water purification). A hyperendemic disease has a high level of incidence in an endemic area and can even trigger local epidemics, in which a more serious outbreak is sudden and unexpected  and β linkages that resist hydrolysis by enzymes in the mammalian upper digestive tract, thus protecting protein drugs and vaccine antigens from the acids and enzymes in the stomach. The survival of recombinant proteins encapsulated in plant cells after passing through the stomach has been demonstrated for reporter proteins  infection  or by injection. The failure of previous vaccine trials may in some cases therefore reflect the lack of oral adjuvants to prime the gut immune system  carried mainly by the mosquitoes N. benthamiana  and non‐structural protein 1 (NS1) have been produced by transient expression in et al., et al., et al., N. benthamiana by transient co‐expression of structural and non‐structural proteins were immunogenic in mice  but occasionally via infected blood or from mother to infant  of the envelope (E) protein have been expressed in plants, either by transient expression in tobacco , and the rabies virus surface glycoprotein and nucleoprotein, either as complete proteins or as epitopes. These have been expressed transiently in spinach and tobacco, as well as in transgenic maize, tobacco and tomato plants or cell lines  has been approved (efficacy = 30–40%) and is undergoing extended testing in Ghana, Kenya and Malawi as part of the WHO’s Malaria Vaccine Implementation Programme  have been expressed in tobacco, Arabidopsis, lettuce and rice . A commercial vaccine  based on the mme WHO, . As for P. vivax chimaeric recombinant MSP1/CSP induced antigen‐specific IgG1 production. The rabbit immune sera reacted well with the P. falciparum native protein and strongly inhibited the growth of blood‐stage parasites in vitro  to develop dual cholera–malaria vaccines ) was expressed at high levels in N. benthamiana (up to 300 mg/kg fresh leaf biomass), exceeding the yields achieved in the yeast Pichia pastoris  which elicited an immune response similar to that of the original formulation in mice and macaques  is the most important tick‐borne viral disease in humans, causing sporadic cases or outbreaks of severe illness across a huge geographic area, from western China to the Middle East and south‐eastern Europe and throughout most of Africa, with fatality rates of 5–80%  produced by the proteolytic cleavage of a precursor, a nucleocapsid protein (N) and a large transcriptase (L). Both the glycoprotein and nucleocapsid protein have been expressed in plants and evaluated as vaccine candidates. The glycoprotein was expressed in tobacco leaves and hairy roots, with yields of 1.4 and 1.8 g/kg fresh biomass, respectively  and cross‐reacted with anti‐CCHFV IgG in sera from convalescent patients, but its immunogenicity has not been evaluated directly  is an infectious disease caused by poliovirus, which is spread via the oral‐faecal route. Most cases occur without symptoms, but in a minority (˜0.5%), there is a period of muscle weakness often but not exclusively affecting the legs. Most people recover, but up to 5% of children and 30% of adults within this group can progress to a more serious and often fatal disease stage. The disease is preventable by vaccination with multiple doses of inactivated or live‐attenuated virus. Coordinated global vaccination programmes have led to the near eradication of poliovirus types 2 and 3 and wild‐type polio infections were reduced to just 46 cases in 2016, rising to 176 in 2019 (mainly in Pakistan and Afghanistan). However, both vaccines have drawbacks such as the need to cultivate live virus, the risk of vaccine‐derived poliomyelitis (365 cases in 2019) and production bottlenecks. Because these drawbacks prevent the total global eradication of polio, a virus‐free vaccine is of interest for the WHO polio eradication programme. Since 2013, the WHO has funded an ongoing project for the development of a VLP polio vaccine. The consortium that works on this project includes eight members using different expression platforms and analysis methods to achieve the main goal of the project, the production of antigenic VLPs of all three polio serotypes. However, the development of polio VLPs has been hampered because, in the absence of the genomic RNA, the virus capsid is antigenically unstable, rapidly converting to the C form which does not stimulate protective immunity. To develop antigenically stable VLPs, predominantly in the D form, the National Institute for Biological Standards and Control (NIBSC) selected thermostable empty capsids representing all three serotypes . The Daniell laboratory has developed a virus‐free oral booster vaccine that does not require a cold chain by expressing the vaccine antigen VP1 common to all poliovirus serotypes in chloroplasts. The oral delivery of lyophilized plant cells expressing CTB‐VP1 induced strong mucosal and systemic immunity, with high antigen‐specific titres of both IgG1 and IgA. Poliovirus neutralization studies using sera from immunized animals confirmed protection against all three poliovirus serotypes, with high‐level neutralization titres and seropositivity  was withdrawn by the WHO due to circulating vaccine‐derived polioviruses and polio virus transmission  and systemic immunity through the delivery of recombinant proteins presented in plant tissues. Another important issue that is particularly relevant for the treatment and prevention of endemic diseases in developing regions is to ensure that the technology and product can be made available to local stakeholders without the encumbrance of IP restrictions and onerous licensing requirements, therefore allowing these valuable medicines to be delivered to those most in need (Drake and Thangaraj, The authors declare no conflicts of interest.PC and TC conceived the topic. All authors contributed sections to this article based on their expertise and experience, provided comments and recommendations on the combined draft and approved the final version.Table S1 Classification of endemic and re‐emerging diseases based on their epidemiology.Click here for additional data file.


A lung cancer patient suspected to have leptomeningeal carcinomatosis was referred for radiation. A careful evaluation of the MRI by a neuroradiologist revealed multiple brain infarcts. Multidisciplinary meetings are important for patient's case. A lung cancer patient suspected to have leptomeningeal carcinomatosis was referred for radiation. A careful evaluation of the MRI by a neuroradiologist revealed multiple brain infarcts. Multidisciplinary meetings are important for patient's. After careful evaluation of the MRI by a neuroradiology specialist at a multidisciplinary meeting, the diagnosis of multiple brain infarcts was made. Treatment with whole‐brain‐irradiation in this case would have been harmful to the patient and inappropriate.leptomeningeal carcinomatosis to consider whole‐brain irradiation. A careful evaluation of the MRI by a neuroradiology specialist at a multidisciplinary meeting revealed that not all T2 hyperintense cortical lesions were enhancing, some lesions showed diffusion restriction and lesions location matched watershed distribution. Therefore, the diagnosis of multiple brain watershed infarcts was made. The patient was referred for further evaluation for ischemic cerebrovascular disease and a follow‐up brain imaging showed improvement in the MRI abnormalities, with a resolution of enhancement, confirming the diagnosis of multiple brain infarcts. This case emphasizes the importance of multidisciplinary discussions and involving imaging experts in these meetings. Treatment with whole‐brain‐irradiation in this case would have been harmful to the patient and inappropriate.A 82‐years‐old female, shortly after a locally advanced lung cancer diagnosis, prior to starting systemic therapy, developed right hemiparesis. Her past medical history includes a right bundle branch block and recent deep vein thrombosis. A Brain MRI with gadolinium showed scattered gyriform enhancement in supratentorial and infratentorial compartments. The lesions show increased T2 signal Figure  and someNo conflict of interests or disclosures.Both authors contributed equally to this work and have approved the submitted version, no ethics approval was needed in this case. Their work is original and is not under consideration by any other journal.


An endoscope system using 5‐color light‐emitting diodes (LEDs)  was released worldwide in July 2020. In addition to the improvement of narrow band imaging (NBI), this system enables texture and color enhancement imaging (TXI). TXI makes the lesion reddish and supports better visibility of colorectal lesions in comparison to white light imaging for improving lesion detection. On the other hand, another 4‐color LED endoscope system  has been on the market in the West since 2017. This system enables blue light imaging (BLI) and linked color imaging (LCI). Generally, the accurate comparison between two images obtained by two different endoscope systems is difficult. To resolve this problem, we developed a method named the tablet‐image comparison (TIC) method. TIC is a simple, easy, and paperless method to get images under similar conditions of two endoscope systems for an accurate comparison. We herein report two colorectal lesions in which accurate comparisons of images between TXI and LCI and between improved NBI and BLI obtained in the EVIS X1 and ELUXEO systems were performed using the TIC method. One was IIa 30 mm (high‐grade dysplasia) and the other was IIa 25 mm (low‐grade adenoma). A detailed comparison between TXI and LCI could be performed by TIC. In these two cases, with a distant view, TXI showed greater redness than LCI. LCI showed slightly higher brightness than TXI. In magnified TXI and LCI, the irregularities observed were similar to NBI and BLI, respectively. A novel endoscope system that uses light‐emitting diodes (LEDs) of five colors as a light source  and adopts both the simultaneous method and the frame sequential method was released worldwide in July 2020. A dedicated colonoscope with a dual focus function (CF‐EZ1500DL/I) under the simultaneous method was also released  and a dedicated colonoscope (EC‐760ZP‐V/M) was released in Europe and the United States in 2017  method. TIC is a simple method to get images under similar conditions for comparing images from two endoscope systems accurately. We herein report two cases of high‐grade colonic dysplasia in which accurate comparisons of images between TXI and LCI and between improved NBI and BLI obtained in the EVIS X1 and ELUXEO systems were performed using TIC.With advances in endoscope systems, the comparison of images obtained with different modalities is becoming increasingly important. We developed the TIC method, which gets images under the same conditions of two different endoscope systems in the same case for an accurate comparison. In detail, images obtained with the first system are saved in the filing system, and then, we take a picture of these images with a tablet device. Subsequently, these images are displayed on the tablet held next to the monitor of a second system by an assistant. Then, images are obtained with a second system according to the images obtained with the first modality, endoscopists can then adjust the amount of air and the angle and distance of a lesion to make the images obtained with the two modalities accurately same Figure . FinallyThe first case was a woman in her 70s. A neoplastic lesion on the ascending colon was observed with EVIS X1 for the preoperative diagnosis and then with ELUXEO by TIC on the day of endoscopic submucosal dissection (ESD). A distant‐view observation with WLI using CF‐EZ1500DI (EVIS X1: structure enhancement setting: A5) revealed a superficial elevated lesion of 30 mm with granules on the surface Figure . In WLI The second case was a man in his 50s. Distant‐view observation with WLI using the CF‐XZ1200I (EVIS X1: structure enhancement setting: A5) revealed a superficial elevated lesion of 25 mm with a nodule on the surface Figure . In WLI We calculated the color difference value and the brightness value of the tumors as an objective evaluation of TXI and LCI with software  using the CIEL*a*b* color space and delta ELab formulas according to our previous report.Regarding the comparison of images obtained by two systems, we previously used an electronic medical report. Thus, we saw a report and remembered a situation and obtained images according to our memory. However, in most cases, we failed to obtain appropriate images for comparison. Then, we changed this method to use a printed image. However, this was cumbersome, especially in cases with large amounts of images. Finally, we developed our original method, TIC, which enabled the accurate comparison of images obtained by two modalities, as was demonstrated in this report.Some papers already showed the efficacy of LCI for improving polyp detection.In conclusion, we herein report our experience with two colonic neoplastic lesions in which we were able to precisely compare the endoscopic views of two LED colonoscopes, especially TXI and LCI, by TIC.Naohisa Yoshida and Osamu Dohi received a research grant from Fujifilm. All other authors declare no conflict of interest.The author Naohisa Yoshida and Osamu Dohi were supported by a research grant from Fujifilm (J162001222).This case report was performed with the approval of the Ethics Committee of Kyoto Prefectural University of Medicine (ERB‐C‐1600) and was in accordance with the World Medical Association Declaration of Helsinki. We obtained a written informed consent from each case.