Objective  To examine prevalence characteristics of aggression behavior and the association of substance abuse with aggression behavior among schooling adolescents in Macao Special Administrative Region (Macao).

  Methods  We conducted a self-administered anonymous questionnaire survey among 4 306 primary and high school students selected using stratified multistage cluster sampling in Macao, China from September to December 2018. Reactive-Proactive Aggression Questionnaire (RPQ) and a questionnaire on demographics and smoking, alcohol drinking and drug abuse were adopted in the survey.

  Results  For a total of 3 664 valid respondents, the average overall score of aggression behavior was 36.40 ± 19.23 and the average score of reactive aggression was higher than that of proactive aggression (19.94 ± 9.86 vs. 16.46 ± 10.05). Univariate analysis demonstrated that the aggressive behavior scores of the respondents differed significantly by schooling grade and academic performance (both P < 0.001); the scores of junior high school students was higher than that of pupils and senior high school students; the scores of students with better academic performance was lower than that of students with poor academic performance. The respondents′ subjective life satisfaction was significantly correlated with their aggressive behavior scores (P = 0.005), with a lower score among the respondents with higher subjective life satisfaction. Multivariate linear regression indicated that accumulated times of alcohol drinking (P = 0.012), the frequency of alcohol drinking in previous one month (P < 0.001), the frequency of smoking in previous one month (P < 0.001), and the frequency of drug use in previous one month (P = 0.027) were significant influencing factors of aggression behavior among the respondents.

  Conclusion  The prevalence of reactive aggression behavior is higher than that of proactive aggression and substance abuse is a significant risk factor for aggressive behavior among schooling adolescents in Macao. Comprehensive interventions should be promoted to reduce aggressive behavior in the adolescents.