ORIGINAL ARTICLE

Bullying among Jordanian

schoolchildren, its effects on school
performance, and the contribution of
general physical and dentofacial features
Zaid B. Al-Bitar,a Iyad K. Al-Omari,b Hawazen N. Sonbol,b Hazem T. Al-Ahmad,c and Susan J. Cunninghamd
Amman, Jordan, and London, United Kingdom

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 nal sample size was 920 children (470 girls, 450 boys).
Results: The prevalence of bullying was 47% (n 5 433); signicantly more boys reported being bullied than girls
(P \0.001). The percentage of students subjected to name-calling was 40.9%. A signicantly 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. (Am J Orthod Dentofacial Orthop 2013;144:872-8)

T
he problem of bullying in children and adolescents
has become a global concern.1 The prevalence of
bullying in middle-school children in high-
income countries ranges from 5% to 57%.2-4 Data
from the global school-based Student Health Survey
examining 19 middle- and low-income countries
reported bullying prevalences from 21% to 58%.5
Bullying is aggressive behavior or intentional harm
carried out repeatedly over time in a relationship
a
Associate professor and head, Department of Orthodontics and Pediatric
Dentistry, University of Jordan, Amman, Jordan.
b
Associate professor, Department of Orthodontics and Pediatric Dentistry,
University of Jordan, Amman, Jordan.
c
Associate professor, Department of Oral and Maxillofacial Surgery, University of
Jordan, Amman, Jordan.
d
Professor and program director of orthodontics, University College London,
Eastman Dental Institute, London, United Kingdom.
All authors have completed and submitted the ICMJE Form for Disclosure of
Potential Conicts of Interest, and none were reported.
Address correspondence to: Zaid B. Al-Bitar, Department of Orthodontics and
Pediatric Dentistry, University of Jordan, PO Box 13850, Amman 11942, Jordan;
e-mail, z.bitar@ju.edu.jo.
Submitted, July 2013; revised and accepted, August 2013.
0889-5406/$36.00
Copyright 2013 by the American Association of Orthodontists.
http://dx.doi.org/10.1016/j.ajodo.2013.08.016
872
characterized by an imbalance of power.2 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).6
The most common form of direct aggression is verbal
abuse, which usually involves name-calling.7,8 Bullying
among children and adolescents can occur in any
setting, but it typically occurs at school or on the
journey to and from school.2,9
The reported prevalence of bullying in school-aged
children varies from study to study as a result of differ-
ences in the ages of the participants, study designs, cul-
tures, and time frames used to determine the frequency
of bullying.7 Bullying appears to be common among
adolescents, and its incidence seems to reduce with
increasing age.2 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%).10 The implications of bullying are
far-reaching, and studies have found relationships
between bullying and depression, low self-esteem and
Al-Bitar et al
other mental and physical health problems,11,12 poor
academic performance,13 and crime.14
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.15,16 In a sample of
531 schoolchildren (ages, 9-13 years), 7% suffered
bullying related to a dental feature.15 In a group of
adolescents awaiting orthodontic treatment, the preva-
lence of teasing related to dental appearance was
reported to be 15%.17 In addition, comments about
teeth were considered more hurtful than comments
regarding other features such as height and weight.15
Specic dental characteristics that have been described
as potentially associated with an increased risk of
bullying include increased overjet, maxillary crowding,
and deep overbite.15,16,18,19
To date, only 1 study has investigated the prevalence
of bullying in Jordan.20 This earlier work reported that
bullying occurred in 44.2% of 12- to 16-year-old Jorda-
nian 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
Scientic 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 stu-
dents were recruited.
A questionnaire modied from that of Shaw et al15
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 atten-
dance, and perceived effect on academic performance;
American Journal of Orthodontics and Dentofacial Orthopedics
873
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 syn-
drome. 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% condence interval
and 50% response distribution. The calculated sample
size was 380 students; however, because the question-
naire 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 soft-
ware (version 16.0; SPSS, Chicago, Ill). Descriptive statis-
tics 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 signicant
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
December 2013  Vol 144  Issue 6
874 Al-Bitar et al

98%. The nal sample comprised 920 students (470

Table I. Numbers of students who were victims of
girls, 450 boys); they represented 3.2% of all sixth-
bullying or reported bullying other students
grade students in Amman.
Table I shows the experience of bullying: 47% of the Total Boys Girls
students (n 5 433; 247 boys, 186 girls) reported being (n 5 920) (n 5 450) (n 5 470) P
(%) (%) (%) value
bullied in the past month, and boys were signicantly
Victim of bullying 433 (47) 247 (55) 186 (40) \0.001
more likely to report being bullied than were girls Bullied someone else 325 (35) 189 (42) 136 (29) \0.001
(P \0.001). Of those who reported being bullied, 44%
(n 5 191) were bullied by 1 student, 40% (n 5 172)
by 2 to 5 students, and 16% (n 5 70) by a group of Table II. Relationships between feelings toward
6 or more students. Boys reported being bullied by school, playing truant from school, and bullying
6 or more people signicantly more often than did girls
(52 boys compared with 18 girls; P \0.001). Total Bullied Not bullied
(n 5 920) (n 5 433) (n 5 487) P
Thirty-ve percent of the children (n 5 325) reported (%) (%) (%) value
that they had bullied someone else in the past month, Class
and signicantly more boys than girls reported bullying Hate 62 (6.7) 45 (10.4) 17 (3.5) \0.001
others (P \0.001; Table I). Most of these children Ambivalent 97 (10.5) 55 (12.7) 42 (8.6)
reported bullying 1 student (40%), followed by 22% Like 761 (82.7) 333 (76.9) 428 (87.7)
Outside class
bullying 2 children, 13% bullying 3 children, 7% Hate 81 (8.8) 56 (12.7) 25 (5.1) \0.001
bullying 4 children, 5% bullying 5 children, and the Ambivalent 110 (12) 56 (12.7) 54 (11.1)
rest (13%) bullying 6 or more children. Like 729 (79) 321 (74.1) 408 (83.7)
The respondents were asked whether they had a nick- Playing truant 144 (15.7) 117 (27) 27 (5.5) \0.001
name, and 57.6% (n 5 530) answered yes to this ques- 1 day 40 (4.3) 35 (8.1) 5 (1)
2-3 days 56 (6.1) 44 (10.2) 12 (2.5)
tion, with boys having nicknames more frequently than 4 or more days 49 (5.3) 40 (9.2) 9 (1.8)
girls (P \0.004). Of those who had a nickname, 27.7%
(n 5 255) liked it, and 31.4% (n 5 289) did not mind,
but 40.9% (n 5 376) did not like their nickname being Some victims of bullying thought that bullying had
used and found it upsetting. There was no statistically harmed their school grades; 40% (n 5 171) stated
signicant sex difference (chi-square test, P 5 0.138). that they believed their grades had been harmed a great
Of the children who reported having a nickname they deal, and 33% (n 5 141) thought that there had been a
disliked (n 5 376), few of them identied who called small effect. In contrast, 28% (n 5 122) did not think
them by this name, but of those who did (n 5 191), it that bullying had any effect on their academic perfor-
was most frequently peers (n 5 72) and siblings mance. When students were asked whether they were
(n 5 51). bullied for having good grades, 35% (n 5 151)
The questionnaire inquired about feelings toward answered yes.
school, school attendance, and perceived effects on ac- General physical characteristics and dentofacial fea-
ademic performance. The majority of students (82.7%; tures were targeted in the victims of bullying. Of the
n 5 761) reported liking their school classes, and only 433 students who reported being bullied, this was
a small percentage (6.7%; n 5 62) disliked classes; girls directed at various physical features (Table III). Teeth
were more likely to express enjoyment of their classes were the number 1 feature identied by students as a
than were boys (P 5 0.003). The respondents were target for bullying, with 50% of the bullying victims
also asked whether they liked school outside classes, recognizing its importance as a target. This was
and 79% (n 5 729) reported that they did, with only following by strength in 34% and weight in 31% of
8.8% (n 5 81) expressing dislike of this element of the students. There was no signicant difference in
school. Girls liked school outside classes signicantly reporting between the sexes for any physical feature.
more than their male counterparts (P 5 0.022; The dentofacial features that were identied as tar-
Table II). Playing truant from school was also an impor- gets for bullying (n 5 433) are shown in Table IV. Spaced
tant issue; 15.7% (n 5 144) of the participants reported or missing teeth were commented on most frequently by
playing truant from school because of bullying; boys 21.5% of those reported being bullied. This was followed
played truant more frequently than did girls (P 5 by the shape and color of teeth (20.6%) and prominent
0.001). Table II shows the results for the respondents' anterior teeth (19.6%). There was no signicant differ-
feelings toward school, playing truant from school, ence in reporting between the sexes for any of these den-
and being a victim of bullying. tofacial features.

December 2013  Vol 144  Issue 6 American Journal of Orthodontics and Dentofacial Orthopedics
Al-Bitar et al 875

existing dentofacial features rather than to orthodontic

Table III. Physical features reported by victims of
appliances.
bullying (n 5 433)
Children in the sixth grade (ages, 11-12 years) were
n % Boys Girls selected because previous studies have reported that
Teeth 216 50 124 92 most children who were bullied were 12 years or
Strength 149 34 88 61 younger, and this allowed our results to be compared
Weight 133 31 72 61
with previous studies.5,8 Younger children were not
Hair 131 30 74 57
Height 118 27 67 51 included in the study because it would have been
Clothes 112 26 64 48 difcult to ensure adequate understanding of the
Eyes 80 19 45 35 questionnaire and guarantee that the questions were
Nose 74 17 38 36 answered accurately.
Glasses 74 17 42 32
The children in this study were asked to complete a
Ears 73 17 50 23
Lips 62 14 37 25 questionnaire regarding bullying. The original question-
Freckles 50 12 23 27 naire used by Shaw et al15 was used with some additional
Chin 38 9 25 13 questions to assess the impact of bullying on school per-
formance and to look at other dentofacial features that
could contribute to this phenomenon. Questionnaires
Table IV. Dentofacial features identied as targets for have been used to investigate teasing and bullying in
bullying by victims (n 5 433) several cross-sectional studies.5,16 A questionnaire was
used rather than interviews because the participants
Total Boys Girls
might not have disclosed embarrassing or painful
Dentofacial feature n % n n memories and denied bullying during direct
Spacing between teeth or missing teeth 93 21.5 53 40 questioning in interviews.20 The questions regarding
Shape or color of teeth 89 20.6 49 40 bullying were limited to a specic time interval of
Prominent anterior teeth 85 19.6 50 35
1 month before questionnaire distribution to prevent
Anterior open bite 61 14.1 35 26
Crowding of teeth 33 7.6 20 13 any difculty in recalling events related to bullying.
Gummy smile 19 4.4 12 7 However, there might still have been certain limitations
Prominent mandibular anterior teeth 18 4.2 14 4 in using this questionnaire because the participants
Retrognathic mandible 14 3.2 9 5 could have differed in their interpretation of bullying
Incompetent lips 12 2.8 8 4
behavior.
Prognathic mandible 11 2.5 10 1
In a previous study of 2457 Jordanian schoolchil-
dren, the percentage of children who reported being
DISCUSSION bullied was 44.2%.5 This is similar to our results, with
This is the rst study to investigate factors contrib- 47% of the subjects reporting being bullied in the past
uting to bullying among Jordanian school children month. This prevalence was similar to that reported in
and especially dentofacial features. Of course, the socio- other Middle Eastern countries such as Lebanon
cultural context of 1 Middle Eastern country does not (33.6%) and Oman (38.9%) but higher than the reported
necessarily extend to the rest of the world; this limits gure for the United Arab Emirates (20.9%).5 The results
the generalizability of the ndings. However, these nd- of this study were also higher than similarly aged
ings are important, and similar studies could be under- schoolchildren in the United Kingdom (15%),8 Holland
taken in other countries to determine the magnitude (14%),21 and the United States (8.5%).22 These differ-
of the problem and to allow comparison of the results. ences between countries might reect cultural and
The sample size in this study was good, with 920 stu- social differences as well as antibullying programs in
dents included in the analysis; this represented 3.2% of schools and nationwide policies against bullying, both
all sixth-grade students in Amman. The number of stu- found in countries where the prevalence of bullying is
dents was increased above the calculated sample size to relatively low.23 In Jordan, bullying as a topic has
investigate the contribution of a variety of dentofacial been given great attention, yet there are no policies or
features to bullying. Some of these features have rela- support services to help those who are bullied or to pre-
tively low prevalences in the population; hence, a larger vent it.
sample size was thought to be appropriate. Students Signicantly more boys reported being bullied than
with orthodontic appliances were excluded because girls in this study; this agrees with previous research in
this would have been a confounding variable when the Jordan.5 This was also seen in all 40 countries investi-
aim of the study was to investigate bullying related to gated in a study on bullying and victimization in

American Journal of Orthodontics and Dentofacial Orthopedics December 2013  Vol 144  Issue 6
876
adolescents, and this appears to be a reection of
bullying as a dominance strategy in boys.23
The percentage of students who were subjected to
name-calling and did not like their nickname (40.9%)
was similar to the percentage of students who reported
being bullied (47%). This also agrees with previous
research showing that the most common direct aggres-
sion was verbal abuse in the form of name-calling.21
As in most studies, peers were identied as most likely
to be involved in name-calling.8,15,20
Bullying has been found to have negative effects with
respect to feelings toward school and school atten-
dance.24,25 In this study, signicantly more victims of
bullying reported playing truant from school (27%)
compared with those who were not bullied (5.5%).
This is similar to another survey in the United
Kingdom that found that 20% of elementary, middle,
and high school children said they would play truant
from school to avoid being bullied.24 In another study
in Turkey, 25% of the students who reported being
bullied had unexplained absenteeism from school signif-
icantly more often than those who were not in the
bullying cycle (15.9%).26 However, other researchers
found that being a victim of bullying was not associated
with lower attendance by elementary school students.27
We found that signicantly more victims of bullying
disliked both being in class and being outside class
compared with those who were not bullied. This also
agrees with previous research.27,28
There is a belief that bullying impairs concentration
and academic achievement.22,29 In this study, when
students were asked whether they believed that
bullying harmed their grades, 40% of the victims
answered yes. Furthermore, 35% of the victims
believed that they were being bullied for their good
grades. It therefore appears that bullying can be the
result of multiple factors, including physical attributes
and academic abilities.
Teeth were the physical feature that appeared to
be targeted most frequently by bullies, followed
by strength and weight. In the study by Shaw at al,15
teeth were ranked fourth and preceded by height, weight,
and hair. The difference in ndings might be explained
by the fact that dental esthetics have become a key
factor in social attractiveness in our modern society.30,31
The dentofacial features about which victims were
most commonly bullied were spaced or missing teeth,
shape and color of teeth, and prominent maxillary ante-
rior teeth. These ndings were similar to those reported
by Shaw et al,15 although in their study children identi-
ed dental features from pictures of other children with
various dental features and measured their potential as
targets for bulling and teasing. In our study, the children
December 2013  Vol 144  Issue 6 American Journal of Orthodontics and Dentofacial Orthopedics
Al-Bitar et al
were asked which dentofacial features they had been
bullied about. A recent study of orthodontic patients
found that being bullied was signicantly associated
with a Class II Division 1 incisor relationship, increased
overbite, increased overjet, and high need for orthodon-
tic treatment as assessed with the aesthetic component
of the index of orthodontic treatment need.16 Other
dentofacial features not included in the study by Shaw
et al but reported by victims of bullying in this study
were the shape and color of the teeth, anterior open
bite, gummy smile, and incompetent lips.
A main limitation of this study is that our ndings
were based only on self-reported questionnaires without
clinical examinations. However, it would have been
technically difcult to conduct such examinations on a
large sample in schools that lack clinical facilities.
More importantly, it was feared that if students were
examined clinically, it might make the whole procedure
more personal, and they might not disclose any informa-
tion about bullying. Therefore, this study can be
regarded as a baseline that will give insight about
bullying in Jordan. Further studies could be planned in
the future to include clinical examinations and other
age groups not included in this study. Further work
should also be done to clearly determine whether ortho-
dontic treatment reduces bullying.
The results of this study highlight the importance of
addressing the bullying problem in Jordanian schools,
and it provides important data especially for the Ministry
of Education, which is responsible for ensuring that stu-
dents receive education in a safe and healthy environ-
ment, to create nationwide antibullying programs. In
addition, dental and health care professionals should
have a role in implementing preventive measures and
programs to address the sources of this common phe-
nomenon related to dentofacial characteristics.
CONCLUSIONS
Our study demonstrated a high experience of
bullying reported by Jordanian students, with a sig-
nicant number of children being targeted for their
dental and facial appearances. This has important
implications for the dental profession as a whole
and for orthodontists in particular. The possibility
of distress caused by bullying must be considered
when patients come to clinics, with advice provided
as appropriate.
ACKNOWLEDGMENTS
We thank Mahmoud Mohammad, Abdullah Abbushi,
and Abedalrahman Shqaidef for their help in data
collection.
Al-Bitar et al 877

REFERENCES 16. Seehra J, Fleming PS, Newton T, DiBiase AT. Bullying in orthodon-
tic patients and its relationship to malocclusion, self-esteem and
1. Carney AG, Merrell KW. Perspectives on understanding and pre-
oral health-related quality of life. J Orthod 2011;38:247-56.
venting an international problem. Sch Psychol Int 2001;22:364-82.
17. O'Brien C, Benson PE, Marshman Z. Evaluation of a quality of life
2. Olweus D. Bullying at school: basic facts and effects of a school
measure for children with malocclusion. J Orthod 2007;34:
based intervention program. J Child Psychol Psychiatry 1994;35:
185-93.
1171-90.
18. Helm S, Kreiborg S, Solow B. Psychosocial implications of maloc-
3. Unnever JD, Cornell DG. The culture of bullying in middle school. J
clusion: a 15-year follow-up study in 30-year-old Danes. Am
Sch Violence 2003;2:5-27.
J Orthod 1985;87:110-8.
4. Spriggs AL, Iannotti RJ, Nansel TR, Haynie DL. Adolescent bullying
19. Gosney MB. An investigation into some of the factors inuencing
involvement and perceived family peer and school relations: com-
the desire for orthodontic treatment. Br J Orthod 1986;13:
monalities and differences across race/ethnicity. J Adolesc Health
87-94.
2007;41:283-93.
20. Whitney I, Smith PK. A survey of the nature and extent of bullying
5. Fleming LC, Jacobsen KH. Bullying among middle-school students
in junior/middle and secondary schools. Educ Res 1993;35:3-25.
in low and middle income countries. Health Promot Int 2010;25:
21. Fekkes M, Pijpers FI, Verloove-Vanhorick SP. Bullying behaviour
73-84.
and association with psychosomatic complaints and depression
6. Nansel TR, Craig W, Overpeck MD, Saluja G, Ruan WJ. Health
in victims. J Pediatr 2004;144:17-22.
Behaviour in School-aged Children Bullying Analyses Working
22. Nansel TR, Overpeck M, Pilla RS, Ruan WJ, Simons-Morton B,
Group. Cross-national consistency in the relationship between
Scheidt P. Bullying behaviors among US youth: prevalence and as-
bullying behaviors and psychosocial adjustment. Arch Pediatr
sociation with psychosocial adjustment. JAMA 2005;285(16):
Adolesc Med 2004;158:730-6.
2094-100.
7. Solberg ME, Olweus D, Endresen IM. Bullies and victims at
23. Craig W, Harel-Fisch Y, Fogel-Grinvald H, Dostaler S, Hetland J,
school: are they the same pupils? Br J Educ Psychol 2007;77:
Simons-Morton B, et al. A cross-national prole of bullying and
441-64.
victimization among adolescents in 40 countries. HBSC Violence
8. Boulton MJ, Underwood K. Bully/victim problems among middle
& Injuries Prevention Focus Group; HBSC Bullying Writing Group.
school children. Br J Educ Psychol 1992;62:73-87.
Int J Public Health 2009;54(Suppl 2):S216-24.
9. Pellegrini AD. Bullied and victims in school: a review and call for
24. Sharp S. How much does bullying hurt? Educ Child Psychol 1995;
research. J Appl Dev Psychol 1998;19:156-76.
12:81-8.
10. Analitis F, Velderman MK, Ravens-Sieberer U, Detmar S, Erhart M,
25. Byrne B. Bullies and victims in school setting with reference to
Herdman M, et al. European Kidscreen Group. Being bullied: asso-
some Dublin schools. Ir J Psychol Med 1994;15:574-86.
ciated factors in children and adolescents 8 to 18 years old in
26. Arslan S, Savaser S, Yazgan Y. Prevalence of peer bullying in high
11 European countries. Pediatrics 2009;123:569-77. school students in Turkey and the roles of socio-cultural and
11. Kumpulainen K, Rasanen E. Children involved in bullying at demographic factors in the bullying cycle. Indian J Pediatr 2011;
elementary school age: their psychiatric symptoms and deviance 78:987-92.
in adolescence. An epidemiological sample. Child Abuse Negl
27. Glew GM, Fan MY, Katon W, Rivara FP, Kernic MA. Bullying, psy-
2000;24:1567-77. chosocial adjustment, and academic performance in elementary
12. Hawker DS, Boulton MJ. Twenty years' research on peer victimiza- school. Arch Pediatr Adolesc Med 2005;159:1026-31.
tion and psychosocial maladjustment: a meta-analytic review of 28. Haynie D, Nansel T, Eitel P, Crump A, Saylor K, Yu K. Bullies,
cross-sectional studies. J Child Psychol Psychiatry 2000;41:
victims, and bully/victims: distinct groups of at risk youth. J Early
441-55. Adolesc 2001;21:29-49.
13. Pellegrini AD. Bullying during the middle school years. In: 29. Schwartz D, Gorman A. A community violence exposure and chil-
Sanders CE, Phye GD, editors. Bullying: implications for the class-
dren's academic functioning. J Educ Psychol 2003;95:163-73.
room. San Diego, Calif: Elsevier; 2004. 30. Kerosuo H, Hausen H, Laine T, Shaw WC. The inuence of incisal
14. Pepler D, Craig W, Jiang D, Connolly J. The development of malocclusion on the social attractiveness of young adults in
bullying. Int J Adolesc Med Health 2008;20:113-9. Finland. Eur J Orthod 1995;17:505-12.
15. Shaw WC, Meek SC, Jones DS. Nicknames, teasing, harassment and
31. Olsen JA, Inglehart MR. Malocclusions and perceptions of attrac-
the salience of dental features among school children. Br J Orthod tiveness, intelligence, and personality, and behavioral intentions.
1980;7:75-80. Am J Orthod Dentofacial Orthop 2011;140:669-79.

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878 Al-Bitar et al

APPENDIX 9. How much do you think that school bullying harms

Questionnaire (translated from Arabic) your grades?
 Are you: male , female , (a) Not at all
(b) Very little
 What is your date of birth? / /
(c) A lot
1. Have you been bullied by any student(s) from school 10. How much do you get bullied because of good
in the past month? Yes No grades or for showing interest in schoolwork?
- If your answer was YES, by how many students? (a) Not at all
(b) Very little
(a) One person
(c) A lot
(b) A group of 2 to 5 students
(c) A group of 6 or more students 11. Please answer yes or no to the following:
Yes No
2. Have you bullied any student from school in the past
Have you ever been bullied about height?
month? Yes No Have you ever been bullied about weight?
- If your answer was YES, how many students have Have you ever been bullied about strength?
Have you ever been bullied about your eyes?
you bullied? Have you ever been bullied about your nose?
0 1 2 3 4 5 6 or more Have you ever been bullied about your ears?
Have you ever been bullied about your lips?
Have you ever been bullied about your chin?
3. Have you ever skipped school because of Have you ever been bullied about your hair?
bullying? Yes No Have you ever been bullied about freckles?
Have you ever been bullied about your clothes?
4. Do you have a nickname? Yes No Have you ever been bullied about wearing glasses?
Have you ever been bullied about your teeth?
5. Who calls you by this name?
(a) Siblings
(b) Peers 12. If you answered yes to being bullied about your
(c) Others teeth, chin, or lips, please select which items on
6. What do you think about being called by this the following list you have been bullied about
nickname? (you may select more than one answer):
Yes No
(a) I like it Top front teeth sticking out
(b) I do not mind it Bottom front teeth sticking out
(c) I do not like it Chin sticking out
Chin too far back
7. How happy are you in your classes at school? Crooked teeth
Shape or color of teeth
(a) Unhappy Having a gap between the teeth or having
(b) I am neither happy or unhappy missing teeth
(c) Happy Top front teeth not covering your bottom teeth and
having gaps between the front teeth when your
8. How happy are you in school outside of classes? back teeth are biting together
Showing too much gum above your upper front teeth
(a) Unhappy when you smile
(b) I am neither happy or unhappy Being unable to close your lips comfortably or
(c) Happy showing too much of your front teeth

December 2013  Vol 144  Issue 6 American Journal of Orthodontics and Dentofacial Orthopedics