Objective  To explore the association between hygiene habits and school bullying behaviors among middle school students.

  Methods  Using stratified multistage cluster sampling, we conducted a on-site self-administered survey among 8 224 students recruited at 32 middle schools in urban and rural regions across Hunan province during April – July 2018. Olweus Bully/Victim Questionnaire (OBVQ) and a self-designed questionnaire were used to collect relevant data for analyses on the association of hygiene habits and bullying incidence in the students.

  Results  Of the 8 224 respondents with valid information, 54.3% and 57.1% reported good oral and hand hygiene behavior. The reported frequencies of physical bullying victimization and physical/relational/cyber bullying perpetration differed significantly by oral hygiene (P < 0.05 for all); while, the frequencies of verbal/physical/cyber bullying victimization and verbal/physical/relational/cyber bullying perpetration differed significantly by hand hygiene among the students (all P < 0.05). Multivariate logistic regression analysis indicated that the students reporting poor hand hygiene were more likely to be exposed to school bullying victimization (odds ratio OR = 1.476, 95% confidence interval 95% CI: 1.303 – 1.672) and the students with poor hand hygiene were more likely to conduct school bullying perpetration (OR = 1.575, 95% CI: 1.280 – 1.936).

  Conclusion  Hand hygiene is associated with bullying behaviors among middle school students and promoting hand hygiene may be helpful for the prevention of bullying among middle school students.