BackgroundSchool bullying among adolescents has been a worldwide public health issue. It has been observed that adolescents who are exposed to violent video games (VVGs) are often more aggressive. However, research on the association between violent video game exposure (VVGE) and different types of school bullying is limited in the Chinese context.ObjectiveThe purpose of this study was to explore whether VVGE is linked to school bullying behaviors among Chinese adolescents and to examine the relationship between different levels of violent game exposure and four sub-types (physical, verbal, relational, and cyber) of school bullying involvement.MethodsThis was a cross-sectional study of 1,992 Chinese students (55.02% boys and 44.98% girls) with the average age of 15.84 ± 1.62 years. Sub-types of school bullying victimization and perpetration, Internet addiction, and VVGE were measured by using a self-administrated questionnaire. The association was examined by multiple logistic regression analysis, adjusting for covariates.ResultsPhysical, verbal, relational, and cyber school bullying victimization were reported by 18.12, 60.34, 11.75, and 12.05% of the adolescents, and physical, verbal, relational, and cyber school bullying perpetration were reported by 16.62, 54.62, 21.49, and 8.23% of them. Of the students, 1,398 (70.18%) were normal Internet users, 514 (25.80%) showed moderate Internet addictive behaviors, and 31 (1.56%) of the students showed severe Internet addictive behaviors. The prevalence of no VVGE, low-level VVGE, medium-level VVGE, and high-level of VVGE were 27.70, 24.10, 24.20, and 24.00%, respectively. The risk of physical victimization and physical perpetration significantly increased with the increasing degree of violent video game exposure (P for trend < 0.001), with the highest adjusted odds ratios (ORs) of 2.251 (95% CI 1.501–3.375) and 2.554 (95% CI 1.685–3.870), when comparing high-level VVGE with no VVGE.ConclusionThese findings highlight the specific association between different sub-types of school bullying involvement and violent video game exposure. Physical school bullying prevention and intervention programs should be conducted after adolescents are exposed to violent video games.