Research: Community support can ease rural bullying effects

Findings published in SD Medicine, plus other Sanford Health research notes.

Emily Griese

Rural communities might not be able to stop childhood bullying. But a Sanford Health researcher found that people in small towns can minimize some of the impact, so it’s not just an issue for schools.

Emily Griese published preliminary findings of her study on peer victimization and protective factors in South Dakota Medicine. It focused on rural children and showed the need for a community-wide approach to prevent bullying and intervene when it happens, including health care providers.

Griese grew up in the rural South Dakota town of Platte near the Missouri River. She received her bachelor’s degree in psychology from Northwestern College, and her master’s in educational psychology and doctorate in psychological research from the University of Nebraska-Lincoln. She and husband Russ have twin 4-year-olds, a boy and girl.

Griese came to Sanford Health six years ago for her post-doctorate work in population health and then moved into a faculty position. She’s an assistant scientist in the behavioral sciences research group and the director of population health for the entire company. In this Q&A, Griese discusses her research and how population health will play a large role in the future of care:

How did growing up in a small town prepare you for your work?

When you’re in it, you don’t recognize the craziness of driving two hours for an appointment or to go shopping for school clothes. But now that I’m in Sioux Falls, you realize that was a lot. But growing up, it wasn’t a thing. You just did what you had to do, and then you got to go back to small-town living and knowing everyone in your community.

What is population health?

A lot of my work in helping the organization from a research and enterprise perspective is helping to define what population health is. Everyone knows we should be doing it, but it’s a hard concept to wrap your head around. So from a research perspective, we’ve looked at it as studying the health outcomes of different populations, barriers to access and how social factors determine health outcomes.

From an organizational perspective, we’ve really looked at population health as our transition to value. How do we move from our structure of living in a fee-for-service world to living in a health care environment that incentivizes us for the quality and outcome of our care? Ultimately, to keep people out of our system because of the up-front work we’ve done to keep them healthy.

What does your research entail?

My research background has always focused on rural health, given where I grew up, and my interest in getting the best outcomes for rural patients. The grant I’m working on now looks at bullying and associated protected factors: What are those things that can begin to offset the negative effects — especially for rural kids? Kids who are bullied chronically over time as they move into adulthood see psychological health issues and often mental health issues, both at the time they are bullied, but these effects can also be lifelong.

We’re looking at kids in elementary and middle school, asking about their experiences but also things that offset that. How connected they feel to their community, parents, peers, teachers. If we have enough of those in place, can we start to offset the negative aspects of bullying? A lot of research has focused on trying to prevent bullying in the first place. Not that we don’t want that to happen. But how can we also help kids deal with it? We asked about depression, loneliness and suicidal ideation. If they’re bullied, those are higher, but the positive is a lot of kids showed positive connections to community and teachers. Influences that can really start to offset the impact of bullying.

What schools were included in your research?

Four rural schools in South Dakota. We picked three remote schools, so they don’t have an urban influence. And we had one fringe school that’s considered rural but is close to an urban center. Those kids might experience bullying differently.

What does victimization include?

There are lots of forms. One is direct: getting hit, kicked, pushed. There’s relational victimization: gossip, rumors. And now more than ever is cyber victimization through social media or through technology in some form: phone, text, anything that’s not direct face-to-face. Those rates are continuing to increase in all populations. And rural kids are not immune to that. We are seeing some of the same rates in rural kids compared to those in urban.

Anything particular about the rural setting?

One thing is we see a lack of mental health access for kids. If they’re experiencing bullying, they don’t have a resource. We also know that in rural settings, kids will typically stay in the same cohort of kids from preschool or kindergarten through high school. Peer groups get redistributed every year in an urban setting. In a small town, being with the same peers every year, you are much more likely to have the same bully from kindergarten through high school.

On a positive note, rural communities are strong. The kids recognize people outside of their teachers and parents and peers, and feel like, “I have a community around me that supports me.” “I know there’s a community member who cares enough to show up at a basketball game, if a parent doesn’t.” Everybody knows everybody, which some see as a negative. But for kids at that age, if they don’t have that parent or peer, that community might be a really strong protective factor.

So adults in the community can have a huge impact.

Absolutely. And we’re empowering the schools to call on their community. We have bullying happening on the school grounds. But it’s also happening outside of the schools. We need to all come together. It’s not just a school issue. Schools can do all the prevention and intervention, but there is this factor of how does the community support these kids.

Why is this research important?

I think there’s a lack of resources. They have tragedies that happen, and people remember the suicide. They know it’s an issue, but they’ve never been empowered with data to understand what’s happening. The study goal was to get the data into the hands of the school administrator. But the other part is for the kids being victimized. We don’t do a good enough job helping them learn coping mechanisms. We need to help them, to offset the negative.

What do you hope comes from your research?

We’re just now starting to communicate this data to the schools and empowering them to think about next steps. We could write another grant and continue to study these kids. But we’re asking the schools for the next steps, to figure out what’s best for each community. Scientifically, we’re trying to push the field forward in identifying those protective factors for kids who are being bullied, especially in these rural communities.

How does your research relate to patient care?

Right now our financial structure pays us for sick care. We’re incentivized to patch somebody together when something bad has happened to them. Shifting health care reimbursement tells us we can’t keep functioning that way. We have to start getting better at the prevention work and get people in before there’s a catastrophe.

Over time, these kids will become the adults who come into the emergency room every day because they’re lonely and have suicidal ideation that started in childhood. Maybe one of the bullied kids in our study copes by overeating. That coping mechanism they learned in fourth grade becomes the patient we can’t move the dial on for obesity. Eventually, we’re going to be responsible for their health outcomes.

In the more immediate world, we see kids who have physical reactions to being bullied: anxiety, stomachaches and physical changes that happen. Health care providers can be the front lines in seeing these signs.

Research notes

Griese’s publication was one of numerous recent developments involving Sanford Research, one of the key areas of innovation at Sanford Health. Some other highlights:

Behavioral sciences

The abuse of multiple illicit or prescribed drugs is well described, but little is known about patterns of polysubstance use across different racial groups. Using data from the 2013 Youth Risk Behavior Survey, Arielle Selya analyzed substance use patterns in adolescent racial groups to improve efficacy of targeted intervention programs. These data were published in Preventing Chronic Disease.

Some research suggests that eating disorders are related to poor sleep health. Leah Irish examined the associations between sleep, chronotype and eating disorder psychopathology, finding that patients with bulimia nervosa and binge eating disorder reported poorer sleep quality. These data were published in Eating and Weight Disorders.

People with impaired immune systems are more likely to have severe infection and higher mortality rates after contracting coccidioidomycosis, which is responsible for Valley Fever. In a review published in Medical Mycology, Susan Hoover summarized the clinical manifestations, diagnosis, treatment and prevention of coccidioidomycosis in persons with compromised immune systems such as those with HIV infection or recipients of organ transplants.

Cancer biology and immunotherapies

Ninety percent of cancer deaths are attributed to metastasis, but treatment options are frequently limited. Keith Miskimins recently discovered that treatment with polynitroxyl albumin (PNA), a drug with antioxidant function, converts triple negative breast cancer cells from a metastatic state to a cytostatic state. These data were published in the Journal of Oncology.

Michael Kareta and members of his laboratory recently attended the annual meeting for the American Association for Cancer Research in Atlanta. The meeting was attended by scientists and physicians in the cancer research community working toward a common goal of accelerating dissemination of new research findings and advancing the understanding of cancer etiology, prevention, diagnosis and treatment. While there, Ellen Voigt and Hannah Wollenzien both presented research projects and networked with leaders in the cancer field, while being informed of the latest advancements in cancer research.

Enabling technologies

Indra Chandrasekar’s laboratory presented research updates at the American Physiological Society (APS) annual meeting in Orlando, Florida. The APS sponsors this interdisciplinary biomedical and scientific meeting to advance and disseminate information on the physiological sciences. Karla Otterpohl received a T. Denny Sanford Pediatric Fellowship travel award and presented a poster.

Cellular therapies and stem cell biology

Bethany Freel, a University of South Dakota Ph.D. candidate in the laboratory of Kevin Francis, was recently awarded a fellowship from the USD’s Neuroscience, Nanotechnology and Networks (USD-N3) program. The USD-N3 program is funded by the National Science Foundation to support integrative research projects and professional skill development in STEM graduate students. The fellowship will provide stipend and travel support for Bethany for two years of her dissertation research.


Kurt Griffin and the Sanford Project clinical research team had a booth at the Sioux Falls JDRF walk to provide information about type 1 diabetes clinical trials and to screen family members for early signs of autoimmunity.

Pediatrics and rare diseases

Collapsin response mediator protein 2 (CRMP2) supports migration, division, polarity and synaptic connections in neurons and is therefore critical for neurodevelopment and neurological diseases. Jill Weimer and Peter Vitiello co-authored a comprehensive review in Molecular Neurobiology on CRMP2 modifications and signaling in respect to neurological functions and a variety of diseases.

Clinical research

With rapidly evolving medical technology and advancing skills of neonatologists, there are increasing reports of extremely premature babies surviving despite the odds. However, there is little published evidence to help guide physicians and parents who are faced with a decision about whether or not to resuscitate babies who born at the extreme limits of “viability.” Physician-scientist and neonatologist Michelle Baack recently co-authored an article from the NICHD Neonatology Research Network in JAMA Pediatrics reporting health outcomes of extremely preterm and low birthweight babies, previously thought to be too small to survive.

Women with refractory overactive bladder underwent selective bladder denervation as part of a safety and efficacy study. Six months following treatment, clinical investigator and obstetrician-gynecologist Kevin Benson reported bladder health improvements, demonstrating that bladder denervation is a promising and minimally invasive treatment option in women with refractory overactive bladder. These data were published in The Journal of Urology.

Clinical investigator and pediatric infectious disease specialist Archana Chatterjee co-authored an invited commentary in Academic Medicine on parental leave for medical student and residents. The authors identify cultural and practical challenges to standardizing parental leave options and issue a call to action for implementing potential solutions.

Education outreach

Donna Hardie co-authored a publication in the American Journal of Health Education describing the theoretical foundation, model and programs created by Sanford fit, to promote children’s health and wellness.

More research stories

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