School bullying and victimization have been recognized as major social and health problems worldwide, requiring the integrated efforts of the public, clinical practitioners, public health professionals, and educators . Although it could be assumed that small communities and rural areas are protected from violence, there has been a dramatic rise in reported rural crime during the last few decades. The emergence of violence in rural schools is of particular concern in recent years . Our findings revealed a markedly high prevalence of bullying behavior (77.8%) among adolescent rural school students. Among these, the highest prevalence was for bully-victims (57.8%) which could be explained by the greater likelihood of victims to turn into bullies in a way of expressing their anger. High rates of violence were also detected by another study conducted among elementary school children in Egypt, where the prevalence of physical violence was 69%, 82.8%, and 29% for victimization, witness of violence, and initiation of violent act, respectively . However, a national survey conducted in 40 western countries (2009)  reported much lower rates of involvement in all the three groups of bullying combined (ranging from 4.8 to 45.2%). These variations in prevalence across countries could be attributed to methodological and cultural differences in defining the problem and to variations in target populations and instrumentation used.
Regarding sociodemographic factors associated with bullying behavior in the current study, the prevalence of being bully-victims was significantly associated with younger age and preparatory grade, which could reflect that older age was a protective factor for involvement in bullying. Similarly, other studies pointed out that bullying is more prevalent among students ranging from 11 to 13 years old, while prevalence from later childhood is reported comparatively rarely [26, 27]. Variation of prevalence according to age could be related to different physiological, biological, and psychological changes that accompany each stage of life. Male students in this study were more prone to be bullies and bully-victims, which could be attributed to cultural factors where boys in our community especially the rural are less often punished for misbehavior compared to girls. Similarly, the findings of Cook et al.  and Yang et al.  reported that bullying is more frequent in boys than girls. The fact that boys are more commonly involved in bullying does not necessarily mean they are more aggressive, but probably, they are more likely to adopt this behavior in an overt way (i.e.physical bullying), while girls are frequently involved in forms of bullying which may be difficult to identify like gossiping, teasing, rejecting, verbal threatening, and humiliating .
The finding that mothers’ education in the current study was inversely associated with bullying could be explained by the fact that the level of education plays an important role through its impact on the socioeconomic status on one hand and the behavior and lifestyle of children on the other. In agreement with our finding, Jansen et al.  reported that low educational level of parents was independently associated with the risk of children being bullies or bully-victims.
In this study, students watching violent movies and those having violent friends reported more involvement in bullying behavior as bullies and bully-victims, respectively. Similarly, Gentile et al.  reported that exposure to media violence is a risk factor for aggression and antisocial behavior. Moreover, Salmivalli et al. found that students who are engaged in a peer group involved in bullying show higher rates of bully perpetration . In contrast, Larsen et al. stated that an aggressive youth is less likely to be susceptible to friends’ influence because he/she has already established a habit of aggression .
The relationship between drug abuse and bullying is well-documented in several studies [34, 35]. In the present study, students who reported being drug abusers were more prone to be bully-victims. A possible explanation is that substance abuse increases the risk of weapon carrying and being a victim or perpetrator of violence. Furthermore, having a drug addict friend was significantly associated with all groups of bullying. This is in consistence with the findings of a study conducted in Spain  which revealed that adolescent students who perceive that their friends have an easy access to drugs are more likely to be victims. Unexpectedly, exposure to sexual abuse in the current study was not significantly associated with bullying behavior. This could be explained by the conservative nature of the rural community where students are too shy or afraid to mention anything related to sexual abuse. In contrast, Duke et al. reported the association between childhood physical and sexual abuse and physical fighting together with other delinquencies .
Unfavorable familial conditions including living with a single parent, violence, and physical punishment among family members are significantly related to school bullying and victimization [26, 28]. The current study revealed that being a bully-victim was significantly more associated with experiencing fights and exposure to physical and verbal abuse at home, which may be explained by the stressful environment in which these children endure and also the possibility of imitating such aggressive behavior at school. This goes in line with another study conducted in Egypt , where a significant positive correlation was detected between verbal aggression among students and personal history of physical abuse.
Corporal punishment at schools markedly affects the school climate as victims may have the desire to displace their anger on teachers or other students and thus promoting aggressive behaviors . In accordance, students who were exposed to punishment at school in the current study showed higher rates of being bully-victims. Similarly, Ez-Elarab et al.  found that corporal punishment was a risk factor of violence among public school students.
In the current study, the significant association between failure in previous scholastic years and bullying (P = 0.009) could be related to the fact that school failure causes suppression to students which reflects negatively on their behavior. Similarly, Nansel et al.  found that students involved in bullying and victimization are less academically engaged.
In this study, the significant association between being bully-victims and students’ exposure to physical violence in the street could be explained by the idea that exposure to hostile interactions in the neighborhood encourages students to imitate such behaviors especially among their peers . In the same context, Cook et al. reported that characteristics of neighborhoods have a detrimental effect on bullying behavior, where living in a safe neighborhood predicted less bullying and victimization .
After conducting a multivariate logistic regression model in the current study, the most predicting factor for being a bully was failure in previous scholastic years (OR = 11.1, 95% CI 1.1–101.4, P = 0.033), followed by witnessing family members using weapons. Male students were 2.3 times at a higher risk of being a bully. However, mothers’ education (university or higher) was the least predicting variable for bullying. Students having a drug addict friend were 2.5 times more prone to be victims (OR = 2.5, 95% CI 1.1–5.4, P = 0.025). Furthermore, the most significant predictors in order of importance for being bully-victims were exposure to physical violence in the street (OR = 5.1, 95% CI 1.2–22.7, P = 0.031), male gender, and witnessing fights among family members; however, younger age was the least predicting variable (OR = 0.7, 95% CI 0.6–0.8, P < 0.001). These results revealed that in comparison with past studies of urban youth, nearly similar factors predict bullying behavior among urban and rural youth. In another study conducted in Egypt, risk factors of violence in schools detected by multivariate analysis were absence of attachment figure as a father, mother, and teacher; mode of delivery; living with a single parent; low school marks; and corporal punishment . In a study conducted in Spain, risk factors of peer school victimization detected on multiple logistic regression analysis were being male, school adaptation (students rejected by their peers), social maladjustment, and perception of the friends’ attitude toward access to drugs (students who perceive that their friends would have a moderate or easy access to drugs) .
Bullying and victimization do not only affect the physical status of students but their emotional, psychological, and social well-being as well which consequently affect different aspects of their behavior . The SDQ tool which was used in this study for probing the relation between bullying/victimization and behavioral problems among students revealed that only bully-victims scored significantly higher in the conduct problems scale. This could be explained by the idea that the tool used for detecting bullying behavior depended on measuring the frequency of initiation or exposure to violence in the past 7 days only which may not permit precise estimation of the problem. In the study conducted in Egypt by Ez-Elarab et al., SDQ revealed highest abnormal score in the total score and in the emotional, conduct, and hyperactivity problems as well in victimized students .
Limitations of the study
First, the tool used for detecting bullying and victimization depends on the frequency of being a bully, a victim, or a bully-victim in the past 7 days only which may not be an accurate estimation of the problem; second, this study is cross-sectional which eliminates the causal relationship of the data; and third, behavioral problems were identified using the self-reported version of the SDQ which was a single informant assessment from the students and not from the teachers or the parents, which may not have provided a complete picture of the problem. Finally, no direct comparison with non-rural students was done; we relied only on findings from previous studies of urban youth to compare predictors across communities.