Background: Bullying is a pervasive stressor in U.S. schools, disproportionately affecting sexual and gender minority (SGM) youth. Less is known about how bullying shapes downstream health behaviors and how mental health impacts these pathways. This study examines whether bullying victimization (BV) is associated with control-seeking behaviors—specifically, sexual risk behaviors and attempted weight control—among adolescents, and whether poor mental health mediates these relationships.

Methods: We analyzed 2023 Centers for Disease Control and Prevention Youth Risk Behavior Survey data from 5,420 U.S. high school students who reported ever having sex. BV (binary, past 12 months) was modeled as the primary exposure. Outcomes were a summed sexual risk behavior score (condom non-use, birth control non-use, and substance use at last intercourse) and current attempts to lose weight (binary). Poor mental health was evaluated as a mediator (binary, most/all or none/a few of past 30 days). We used linear regression models to estimate beta coefficients (β) and 95% confidence intervals (CI), adjusted for age and sex and stratified by SGM status. We used causal mediation to calculate the natural indirect effects (NIE) of poor mental health on bullying-sexual risk behavior and bullying-weight control associations.

Results: BV was positively associated with greater sexual risk-taking (β: 0.17, 95% CI: 0.11, 0.22) and attempting weight loss (β: 0.09, 95% CI: 0.06, 0.12). Both associations were stronger among SGM youth. Poor mental health mediated 30.9% of the BV-sexual risk behavior association (NIE odds ratio (OR): 1.09, 95% CI: 1.03, 1.15) and 15.1% of the BV-weight control association (NIE OR: 1.05, 95% CI: 1.00, 1.10).

Discussion: These findings highlight bullying victimization as a structural driver of adolescent health risk behaviors and identify mental health as a key mechanism, particularly for SGM adolescents.