Purspose: The prevention of youth violence is a public health priority in many countries. We
examined the prevalence of bullying victimization and physical fighting in youths in 79 high- and
low-income countries and the relations between structural determinants of adolescent health
(country wealth, income inequality, and government spending on education) and international
differences in youth violence.
Methods: Cross-sectional surveys were administered in schools between 2003 and 2011. These surveys
provided national prevalence rates of bullying victimization (n ¼ 334,736) and four or more episodes of
physical fighting in the past year (n ¼ 342,312) in eligible and consenting 11e16 year olds. Contextual
measures included per capita income, income inequality, and government expenditures on education.
We used meta-regression to examine relations between country characteristics and youth violence.
Results: Approximately 30% of adolescents reported bullying victimization and 10.7% ofmales and 2.7%
of females were involved in frequent physical fighting. More youth were exposed to violence in African
and Eastern Mediterranean countries than in Europe and Asia. Violence directly related to country
wealth; a 1 standard deviation increase in per capita income corresponded to less bullying ("3.9% in
males and"4.2% in females) and lessfighting ("2.9% inmales and"1.0% in females). Income inequality
and education spending modified the relation between country wealth and fighting; where inequality
was high, country wealth related more closely to fighting if education spending was also high.
Conclusions: Country wealth is a robust determinant of youth violence. Fighting in affluent but
economically unequal countries might be reduced through increased government spending on
education.