Using the Global School Health Survey, we found a prevalence of having engaged in a physical fight in the past 12 months at 31.5% among adolescents in grades 7th to 9th in Barinas, Venezuela. Boys were more than twice as likely to report history of been engaged in a physical fight than girls. This male predominance in physical fighting has also been reported in other settings [11, 12]. It is generally believed that societal tolerance toward male fighting may be responsible for the observed differences between the sexes [11, 12].
Brown and Tappan , exploring ideas by Connell  have reported how adolescent girls' violence can be perceived as "hegemonic masculinity" . In general, many studies have reported males exhibiting unhealthy behaviors than females. Granero et al  have reported on adolescents in Lara, Venezuela in which males were more likely to have engaged in sexual intercourse.
In bivariate logistic regression analysis, we found that physical fighting was positively associated with history of bullying victimization (being a victim of bullying), substance use, male sex, and being 15 years of age or older. These findings are similar to previous reports on adolescents physical fighting [5–7].
Finally we run multivariate (logistic) models to assess the independent effect of bullying victimization on physical fighting. We found that history of bullying victimization was positively associated with having engaged in a fight. Furthermore the effect was dose-dependent i.e. increased exposure to victimization was associated with high odds of having engaged in a fight.
Despite the fact that this study enrolled a large sample size and that the findings may be considered representative of the school-going age group in Barinas, Venezuela, there are a number of limitations that we must also highlight.
Furthermore, as we have reported results from data among adolescents in Barinas, the findings may only be representative of the adolescents in this area, and may not be representative of the rest of the country. In addition, data were collected via self reports. To the extent that the adolescents may have mis-reported, either intentionally or unintentionally, bias may have been introduced. Furthermore, data were collected in a cross sectional survey. One important limitation of a cross sectional study is the inability to determine causation. We cannot therefore confirm whether bullying victimization caused fighting or the variables are merely associated. However it is plausible to consider that some adolescents who may have been bullied may have engaged in fighting as a means of self-defense. Adolescents may have resorted to fighting to protect themselves from further inconsiderate behaviors from their peers. Nansell et al  have reported that adolescents who were bullied were more likely to bear weapons at school compared to those who had not so exposed. If there was a cause-effect relationship, this would possibly occur if the adolescents thought they needed to defend themselves. As is the case with all cross sectional data collection methods, we cannot ascertain whether any of the variables found associated with the outcome (physical fighting) are causal [16, 17].
It can also be observed that the variables were assessed without consideration of their temporal sequence i.e. data of physical fighting related to 12 months prior to the study while most of the other variables were assessed for a much shorter period. The lesson however remains that having been involved in a physical fight within the past 12 months was associated bullying victimization, substance use, and limited or no parental supervision.
In a survey where adolescents are being asked potentially sensitive information such as substance use, physical violence and parental behaviors, there is always a concern as to whether their reports and the subsequent findings are reliable. We have no further information as to how reliable these findings are. However, previous studies from the United States using similar questions found that data had high reliability scores [18, 19]. We are not aware of the reliability of the Global School Health Survey questionnaire among Venezuelan adolescent population. We suggest that future studies should be conducted to assess the reliability of, not only the GSHS questionnaire, but also other questionnaire data collection methods whose reliability outside of the United States, is not known. The Global Youth Tobacco Survey (GYTS) is one such questionnaire survey tool that may benefit from such reliability testing in a diversity of settings in low-, middle and high-income nations. Although the GSHS has some data that we used to estimate the prevalence and correlates of physical violence, the data set does not collect data on weapons bearing, neighborhood factors and household socio-economic position, experience of violence in the home; all factors having been previously found to be associated with adolescent violent behaviors [20–23].