Objective   To compare differences in aggression behaviors among rural left-behind children (LBC) and non-left-behind children (NLBC) and to explore factors influencing the differences for providing evidences to interventions on the children's aggression behaviors.

  Methods   Using stratified multistage cluster sampling, we conducted a survey among primary and high school students recruited in 5 provinces across China from November 2014 to May 2015. A questionnaire on general information, the Buss-Warren Aggression Questionnaire Revised in China (BWAQ-RC) , Parent-Child Conflict Tactics Scales, and the Resilience Scale for Chinese Adolescents were adopoted to assess the students′ aggression behaviors, neglect, physical abuse, and resilience.

  Results   Of the 16 977 students surveyed, 5 477 (32.26%) and 11 500 (67.74%) were LBC and NLBC. Compared to the NLBC, the LBC showed significantly higher overall BWAQ-RC score (70.96 ± 16.53 vs. 69.03 ± 16.50) and domain scores of physical aggression (13.51 ± 4.50 vs. 13.00 ± 4.83), verbal aggression (12.16 ± 3.27 vs. 11.92 ± 3.34), indirect aggression (12.07 ± 3.86 vs. 11.79 ± 3.82), anger (15.54 ± 4.58 vs. 15.35 ± 4.55), and hostility (17.68 ± 5.34 vs. 16.96 ± 5.29) (P < 0.01 for all). Significantly higher rate of aggressive behaviors was reported by the LBC than the NLBC in the following same subgroups of the students: the males (33.19% vs. 29.60%), the females (28.91% vs.25.63%), primary school students of grade 4 – 6 (31.26% vs. 25.16%), junior high school students (30.18% vs. 26.79%), with mother as the main caregiver (29.89% vs. 26.62%), under democratic style parenting of main caregivers (26.99% vs. 25.12%), and under strict style parenting of main caregivers (31.94% vs. 25.79%) (all P < 0.01). The results of logistic regression analysis indicated that the LBC were more likely to have aggressive behaviors than the NLBC (odds ratio = 1.105, 95% confidence interval: 1.016 – 1.200) and major influencing factors for aggressive behaviors were gender, parenting style, physical abuse, and resilience in both LBC and NLBC.

  Conclusion   Left behind may be a risk factor for aggressive behaviors and the prevalence of aggressive behavior is positively influenced by male gender, undesirable parenting style, and physical abuse but reversely by resilience among rural primary and high school children.