Introduction
The aims of this study were to investigate the experience of bullying in a representative sample of Jordanian schoolchildren in Amman, to look at its effect on school attendance and perception of academic performance, and to look at the contribution of general physical and dentofacial features to this phenomenon.
Methods
This was a cross-sectional study in which a representative sample of sixth-grade students (11-12 years of age) from randomly selected schools was asked to complete questionnaires distributed in the classroom in the presence of the researchers. The final sample size was 920 children (470 girls, 450 boys).
Results
The prevalence of bullying was 47% (n = 433); significantly more boys reported being bullied than girls ( P <0.001). The percentage of students subjected to name-calling was 40.9%. A significantly greater proportion of victims of bullying reported playing truant from school and disliking school than those who were not bullied. Teeth were the number 1 feature targeted for bullying, followed by strength and weight. The 3 most commonly reported dentofacial features targeted by bullies were spacing between the teeth or missing teeth, shape or color of the teeth, and prominent maxillary anterior teeth.
Conclusions
This study demonstrated a high prevalence of bullying in Jordanian schools, with many children experiencing bullying because of their dental or facial appearance.
The problem of bullying in children and adolescents has become a global concern. The prevalence of bullying in middle-school children in high-income countries ranges from 5% to 57%. Data from the global school-based Student Health Survey examining 19 middle- and low-income countries reported bullying prevalences from 21% to 58%.
Bullying is aggressive behavior or intentional harm carried out repeatedly over time in a relationship characterized by an imbalance of power. This can be direct bullying, which includes physical aggression (hitting, kicking) and verbal aggression (insults, threats); and indirect bullying, which involves manipulation of social relationships (gossip, rumors, social exclusion). The most common form of direct aggression is verbal abuse, which usually involves name-calling. Bullying among children and adolescents can occur in any setting, but it typically occurs at school or on the journey to and from school.
The reported prevalence of bullying in school-aged children varies from study to study as a result of differences in the ages of the participants, study designs, cultures, and time frames used to determine the frequency of bullying. Bullying appears to be common among adolescents, and its incidence seems to reduce with increasing age. A recent study looking at bullying in 8- to 18-year-old students in 11 European countries found that 20.6% of the entire group reported being bullied, with the United Kingdom having the highest prevalence (29.5%). The implications of bullying are far-reaching, and studies have found relationships between bullying and depression, low self-esteem and other mental and physical health problems, poor academic performance, and crime.
Few studies have looked at the impact of dentofacial features on bullying in schools. Dental features have been found to be targets for nicknames, harassment, and teasing among schoolchildren. In a sample of 531 schoolchildren (ages, 9-13 years), 7% suffered bullying related to a dental feature. In a group of adolescents awaiting orthodontic treatment, the prevalence of teasing related to dental appearance was reported to be 15%. In addition, comments about teeth were considered more hurtful than comments regarding other features such as height and weight. Specific dental characteristics that have been described as potentially associated with an increased risk of bullying include increased overjet, maxillary crowding, and deep overbite.
To date, only 1 study has investigated the prevalence of bullying in Jordan. This earlier work reported that bullying occurred in 44.2% of 12- to 16-year-old Jordanian schoolchildren, but the authors looked only at the prevalence of bullying without further analysis of this phenomenon. There are limited data regarding the factors contributing to bullying in the Middle East; no studies have addressed this issue in Jordan.
Therefore, the aims of this study were to investigate the experience of bullying in a representative sample of Jordanian schoolchildren in Amman, the effect of bullying on school attendance and perceived effects on academic performance, and the contribution of general physical and dentofacial features to bullying.
Material and methods
Ethical approval for the study was obtained from the Jordanian Ministry of Education and the Deanship of Scientific Research of the University of Jordan.
This was a cross-sectional study. We recruited a representative sample of sixth-grade students (ages, 11-12 years) in Amman, the largest city and capital of Jordan with a population of over 2 million. Twelve schools were randomly selected from a list of all schools in the 6 educational directories in Amman obtained from the Jordanian Ministry of Education. A representative sample of sixth-grade students was drawn from each of the 6 directories; in total, 3.2% of the sixth-grade students were recruited.
A questionnaire modified from that of Shaw et al was distributed to all subjects ( Appendix ). This was a structured, anonymous, self-reported questionnaire divided into 3 main sections: (1) personal experience of bullying; (2) feelings toward school and school attendance, and perceived effect on academic performance; and (3) general physical characteristics and dentofacial features targeted in the victims of bullying.
Before commencing the research, a pilot study was undertaken with 20 students from the sixth grade to test the clarity of the questionnaire and the language used. In a few instances, the words were beyond the sixth-grade reading level; this problem was overcome by adding 1 or 2 simple descriptions so that each child was more likely to understand.
Before distributing the questionnaires, information packs were sent to all school principals, who in turn sent them to the parents. The packs contained a letter to the parents informing them of the study goals and a passive consent form. It was made clear to all parents that they could ask that their child not be included in the study if they wished. Then the questionnaires were distributed in the classroom in the presence of the teacher, and a researcher was present to clarify any items in the questionnaire that were not clear to any student.
The sample consisted of sixth-grade Jordanian schoolchildren in Amman (ages, 11-12 years) with no orthodontic appliance in situ. Children were excluded if they had a diagnosed congenital anomaly or syndrome. Any questionnaire that was not completed correctly was excluded.
The total number of sixth-grade students in Amman during the academic year 2011 to 2012 was 29,157 (15,072 girls, 14,085 boys). A sample size calculation was undertaken using the Web site http://www.raosoft.com/samplesize.html . A 5% margin of error was selected, along with a 95% confidence interval and 50% response distribution. The calculated sample size was 380 students; however, because the questionnaire did not require simple yes or no answers but asked some more complex questions, it was aimed to recruit at least double the number to achieve a representative sample.
Statistical analysis
Analysis of the data was conducted using SPSS software (version 16.0; SPSS, Chicago, Ill). Descriptive statistics were calculated for all measures including sex and the study variables. Chi-square tests were performed to compare responses between the sexes and also between the victims of bullying and those who were not bullied. A P value of <0.05 was accepted as statistically significant throughout.
Results
A total of 960 questionnaires were distributed equally between boys and girls. Forty questionnaires were not completed correctly, giving a response rate of 98%. The final sample comprised 920 students (470 girls, 450 boys); they represented 3.2% of all sixth-grade students in Amman.
Table I shows the experience of bullying: 47% of the students (n = 433; 247 boys, 186 girls) reported being bullied in the past month, and boys were significantly more likely to report being bullied than were girls ( P <0.001). Of those who reported being bullied, 44% (n = 191) were bullied by 1 student, 40% (n = 172) by 2 to 5 students, and 16% (n = 70) by a group of 6 or more students. Boys reported being bullied by 6 or more people significantly more often than did girls (52 boys compared with 18 girls; P <0.001).
| Total (n = 920) (%) | Boys (n = 450) (%) | Girls (n = 470) (%) | P value | |
|---|---|---|---|---|
| Victim of bullying | 433 (47) | 247 (55) | 186 (40) | <0.001 |
| Bullied someone else | 325 (35) | 189 (42) | 136 (29) | <0.001 |
Thirty-five percent of the children (n = 325) reported that they had bullied someone else in the past month, and significantly more boys than girls reported bullying others ( P <0.001; Table I ). Most of these children reported bullying 1 student (40%), followed by 22% bullying 2 children, 13% bullying 3 children, 7% bullying 4 children, 5% bullying 5 children, and the rest (13%) bullying 6 or more children.
The respondents were asked whether they had a nickname, and 57.6% (n = 530) answered yes to this question, with boys having nicknames more frequently than girls ( P <0.004). Of those who had a nickname, 27.7% (n = 255) liked it, and 31.4% (n = 289) did not mind, but 40.9% (n = 376) did not like their nickname being used and found it upsetting. There was no statistically significant sex difference (chi-square test, P = 0.138). Of the children who reported having a nickname they disliked (n = 376), few of them identified who called them by this name, but of those who did (n = 191), it was most frequently peers (n = 72) and siblings (n = 51).
The questionnaire inquired about feelings toward school, school attendance, and perceived effects on academic performance. The majority of students (82.7%; n = 761) reported liking their school classes, and only a small percentage (6.7%; n = 62) disliked classes; girls were more likely to express enjoyment of their classes than were boys ( P = 0.003). The respondents were also asked whether they liked school outside classes, and 79% (n = 729) reported that they did, with only 8.8% (n = 81) expressing dislike of this element of school. Girls liked school outside classes significantly more than their male counterparts ( P = 0.022; Table II ). Playing truant from school was also an important issue; 15.7% (n = 144) of the participants reported playing truant from school because of bullying; boys played truant more frequently than did girls ( P = 0.001). Table II shows the results for the respondents’ feelings toward school, playing truant from school, and being a victim of bullying.
| Total (n = 920) (%) | Bullied (n = 433) (%) | Not bullied (n = 487) (%) | P value | |
|---|---|---|---|---|
| Class | ||||
| Hate | 62 (6.7) | 45 (10.4) | 17 (3.5) | <0.001 |
| Ambivalent | 97 (10.5) | 55 (12.7) | 42 (8.6) | |
| Like | 761 (82.7) | 333 (76.9) | 428 (87.7) | |
| Outside class | ||||
| Hate | 81 (8.8) | 56 (12.7) | 25 (5.1) | <0.001 |
| Ambivalent | 110 (12) | 56 (12.7) | 54 (11.1) | |
| Like | 729 (79) | 321 (74.1) | 408 (83.7) | |
| Playing truant | 144 (15.7) | 117 (27) | 27 (5.5) | <0.001 |
| 1 day | 40 (4.3) | 35 (8.1) | 5 (1) | |
| 2-3 days | 56 (6.1) | 44 (10.2) | 12 (2.5) | |
| 4 or more days | 49 (5.3) | 40 (9.2) | 9 (1.8) |
Some victims of bullying thought that bullying had harmed their school grades; 40% (n = 171) stated that they believed their grades had been harmed a great deal, and 33% (n = 141) thought that there had been a small effect. In contrast, 28% (n = 122) did not think that bullying had any effect on their academic performance. When students were asked whether they were bullied for having good grades, 35% (n = 151) answered yes.
General physical characteristics and dentofacial features were targeted in the victims of bullying. Of the 433 students who reported being bullied, this was directed at various physical features ( Table III ). Teeth were the number 1 feature identified by students as a target for bullying, with 50% of the bullying victims recognizing its importance as a target. This was following by strength in 34% and weight in 31% of the students. There was no significant difference in reporting between the sexes for any physical feature.
| n | % | Boys | Girls | |
|---|---|---|---|---|
| Teeth | 216 | 50 | 124 | 92 |
| Strength | 149 | 34 | 88 | 61 |
| Weight | 133 | 31 | 72 | 61 |
| Hair | 131 | 30 | 74 | 57 |
| Height | 118 | 27 | 67 | 51 |
| Clothes | 112 | 26 | 64 | 48 |
| Eyes | 80 | 19 | 45 | 35 |
| Nose | 74 | 17 | 38 | 36 |
| Glasses | 74 | 17 | 42 | 32 |
| Ears | 73 | 17 | 50 | 23 |
| Lips | 62 | 14 | 37 | 25 |
| Freckles | 50 | 12 | 23 | 27 |
| Chin | 38 | 9 | 25 | 13 |
The dentofacial features that were identified as targets for bullying (n = 433) are shown in Table IV . Spaced or missing teeth were commented on most frequently by 21.5% of those reported being bullied. This was followed by the shape and color of teeth (20.6%) and prominent anterior teeth (19.6%). There was no significant difference in reporting between the sexes for any of these dentofacial features.
| Dentofacial feature | Total | Boys | Girls | |
|---|---|---|---|---|
| n | % | n | n | |
| Spacing between teeth or missing teeth | 93 | 21.5 | 53 | 40 |
| Shape or color of teeth | 89 | 20.6 | 49 | 40 |
| Prominent anterior teeth | 85 | 19.6 | 50 | 35 |
| Anterior open bite | 61 | 14.1 | 35 | 26 |
| Crowding of teeth | 33 | 7.6 | 20 | 13 |
| Gummy smile | 19 | 4.4 | 12 | 7 |
| Prominent mandibular anterior teeth | 18 | 4.2 | 14 | 4 |
| Retrognathic mandible | 14 | 3.2 | 9 | 5 |
| Incompetent lips | 12 | 2.8 | 8 | 4 |
| Prognathic mandible | 11 | 2.5 | 10 | 1 |
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