Global Affiliates Publications

Objective
Psychological factors shaping maternal diet remain underexplored, particularly in rural contexts. This study examined the associations of psychological symptoms with maternal dietary diversity in rural Western China.

Methods
This cross-sectional study included 2430 women (847 pregnant, 1583 postpartum) selected through multi-stage random cluster sampling. Dietary diversity was assessed using the Woman's Dietary Diversity Score, which was categorized into tertiles. Depression, anxiety, and stress symptoms were measured and integrated into a standardized composite psychological index. Multinomial logistic regression examined associations between psychological symptoms and dietary diversity adjusting for relevant covariates.

Results
In the full sample, using the lowest dietary diversity score tertile as the reference group, depression symptom was associated with lower odds of being in the high dietary diversity group (relative risk ratio [RRR] = 0.71, 95% confidence interval [CI] 0.53–0.95). Anxiety and stress symptoms were associated with lower odds of being in both medium (anxiety: RRR = 0.74, 95% CI 0.58–0.95; stress: RRR = 0.64, 95% CI 0.46–0.89) and high (anxiety: RRR = 0.78, 95% CI 0.61–0.99; stress: RRR = 0.56, 95% CI 0.39–0.79) dietary diversity group. Higher composite index scores were consistently associated with lower odds of being in the medium (RRR = 0.86, 95% CI 0.78–0.95) and high (RRR = 0.83, 95% CI 0.75–0.93) dietary diversity group. Interaction analyses showed significant effects for depression, stress, and the composite psychological index (P for interaction <0.01), but not for anxiety (P for interaction = 0.954).

Conclusion
Psychological symptoms were inversely associated with maternal dietary diversity. Moreover, these associations varied by pregnancy status for depression, stress, and overall psychological distress. Findings support integrating psychological care into maternal nutrition programs in rural settings.

Mental health symptoms are common among caregivers of young children in low-resource settings, yet access to psychological care remains limited due to shortages of specialists, low awareness, and stigma. This qualitative study explored the acceptability and appropriateness of delivering a postnatal mental health intervention for mothers through community and township health centers (CTHCs) in Shanghai, China. We conducted in-depth interviews with 50 mothers of children under 3 years of age, recruited from nine CTHCs and one parenting center, including both those with and without depressive symptoms. Data were analyzed using a rapid analysis approach to identify themes related to perceived values, burdens, motivations, and barriers to participation. Mothers valued interventions that aligned with their personal needs, addressed both parenting knowledge and mental health, offered emotional and social support, and involved family members. Key barriers included time constraints, childcare responsibilities, stigma toward mental health, and accessibility of the location of the intervention. Flexible delivery formats and modes, integration with routine child health services, and nonstigmatizing framing were identified as potential strategies to enhance engagement.

A growing body of research on large language models (LLMs) has identified various biases, primarily in contexts where biases reflect societal patterns. This article focuses on a different source of bias in LLMs—government censorship. By comparing foundation models developed in China and those from outside China, we find substantially higher rates of refusal to respond, shorter responses, and inaccurate responses to a battery of 145 political questions in China-originating models. These disparities diminish for less-sensitive prompts, showing that technological and market differences cannot fully explain this divergence. While all models exhibit higher refusal to respond rates with Chinese-language prompts than English ones, language differences are less pronounced than disparities between China-originating and non-China-originating models. We caution that our study is observational and cross-sectional and does not establish a causal linkage between regulatory pressures and censorship behaviors of China-originating LLMs, but these results suggest that censorship through government regulation requiring companies to restrict political content may be an important factor contributing to political bias in LLMs.

Language development and the home language environment during early childhood are critical for long-term child outcomes. Caregiver mental health may influence early language outcomes directly, but it can also introduce perception bias, which refers to the discrepancies between caregiver self-assessments and the actual status of child language outcomes. This study examines the associations between caregiver mental health symptoms and (1) child language development and home language environment, and (2) caregiver perception bias in self-report assessments of child language development and home language environment. The study recruited 137 rural Chinese households with children aged 16–24 months. Objective measures of child language development and the home language environment were collected using Language Environment Analysis (LENA) technology. Caregiver perception biases were measured by the discrepancies between the objective and caregiver self-report measurements. Results show that caregiver anxiety and stress symptoms were linked to poor child language development, while symptoms of depression and anxiety were associated with less stimulating home language environment. Caregivers with depressive and anxiety symptoms tended to overestimate their children’s language development, and those with depressive symptoms also overestimated their own verbal inputs. These findings call for caution when implementing self-report assessments of early childhood development.

Background: High rates of iron-deficiency anemia among school-age children have been a common issue in developing countries. In 2012, China rolled out a school feeding program (SFP) to address this issue. This study assesses changes in anemia rates, as well as potential factors driving these changes, both 3 and 10 years after the SFP was implemented.

Methods: Data were from two cross-sectional surveys (n = 1510) in northwestern China. T-tests were used to compare the differences in health outcomes of students and their dietary diversity across the different sample years. Regressions were used to examine the associations between health outcomes and dietary diversity.

Results: After the SFP was launched, hemoglobin levels of students improved from 126 to 131 g/L between 2015 and 2022/2023; the rates of anemia and stunting decreased from 17% to 6% and 9% to 1%, respectively. A rise in student dietary diversity and an increase in the share of students that consumed iron-rich foods are two main contributing factors.

Implications for School Health Policy, Practice, and Equity: Increase in funding allotted to the SFP over time appears to be a key element in improving the health and nutrition of rural students.

Conclusions: SFP in rural China exemplifies the concrete advantages in improving the health and potential educational outcomes of students.

Why do authoritarian regimes charge political opponents with nonpolitical crimes when they can levy charges directly related to opponents’ political activism? We argue that doing so disguises political repression and undermines the moral authority of opponents, minimizing backlash and mobilization. To test this argument, we conduct a survey experiment, which shows that disguised repression decreases perceptions of dissidents’ morality, decreases people’s willingness to engage in dissent on behalf of the dissident, and increases support for repression of the dissident. We then assess the external validity of the argument by analyzing millions of Chinese social media posts made before and after a large crackdown of vocal government critics in China in 2013. We find that individuals with larger online followings are more likely to be charged with nonpolitical crimes, and those charged with nonpolitical crimes are less likely to receive public sympathy and support.

Background: Poor mental health affects caregivers' parenting practices and threatens the early development of children under 2 years old. This study examined the correlations between caregivers' mental health and parenting practices among 5- to 24-month-old children in rural China.

Methods: Data were collected in two cohorts (October 2022 and March 2023) from 948 households randomly sampled from 120 villages. Dependent variable: parenting practices measured by the Family Care Indicators (FCI). Independent variables: caregiver mental health (DASS-21), perceived social support (MSPSS) and socioeconomic status (SES; household asset index, caregiver education). Models adjusted for child age, child sex, caregiver age and household size, with standard errors clustered at the village level.

Results: Although caregivers provided more play materials for their children compared to previous research, the variety of play materials did not improve. Depressive symptoms among caregivers were associated with inadequate parenting practices, particularly with providing a lower variety of play materials. Both lower SES and more severe caregiver depressive symptoms were linked to less stimulating parenting, whereas higher perceived social support was associated with more stimulating practices and partially attenuated these SES- and mental health–related disparities.

Conclusion: Although rural Chinese caregivers now supply more play materials, limited diversity and widespread caregiver mental health risks persist. Strengthening caregiver mental health and social support could enrich home stimulation and improve early childhood development.

Purpose: Previous research has found an association between with early childhood development (ECD) and paternal beliefs and evidence suggests that paternal beliefs about their own role in child rearing might affect parental involvement. However, there has been no such empirical study in rural China. This study examines the interrelationships among paternal beliefs, parental involvement and ECD among rural Chinese children.

Design/methodology/approach: Data used for this study were collected from 6-to-42-month-old children and their primary caregivers in southwestern China in 2020. ECD was assessed by the Bayley Scales of Infant and Toddler Development-III. Paternal beliefs were assessed with the Role of the Father Questionnaire. The non-parametric regression methods were used to construct the factor scores of ECD. The ordinary least squares models, the mediation models and the bootstrapping approach were employed to investigate the interrelationships of paternal beliefs, parental involvement and ECD.

Findings: A large share of the sample children displayed delays in cognitive, language and social-emotional development. Paternal involvement significantly mediated the link between paternal beliefs and child cognitive and social-emotional development, while maternal involvement mediated the associations between paternal beliefs and child language and social-emotional development.

Originality/value: This study provides a unique contribution by utilizing unique data fathers' beliefs and their involvement in parenting to investigate the underlying mechanisms of how the role of fathers in parenting can lead to the improvement of early child developmental outcomes. This study also provides the first empirical evidence on the role of paternal beliefs in fostering human capital formation during the early stages of life in rural China. This study suggests that shifting paternal beliefs and improving parental involvement are effective pathways to benefit rural children in their early development.

The massive flow of migrants from rural to urban areas in China over the past decades has sparked concerns about the development of left-behind children. Drawing on a six-round, longitudinal cohort survey in rural China from 2013 to 2023 that follows children from 6 months to 11 years of age, we analyse the effects of two maternal migration patterns – persistent migration (migration without return) and return migration (migration followed by return) – on the cognitive development and nutrition of left-behind children from infancy to early adolescence. The results show that persistent maternal migration has adverse effects on the cognitive development and increased the BMI of left-behind children. In contrast, maternal migration had no significant effect on either cognitive development or any indicator of nutrition when the mother later returned. Persistent maternal migration had a strong, long-term negative effect on the cognitive development of left-behind children especially when mothers migrate within one or one and a half years after childbirth; maternal migration also had a short-term, negative effect on cognitive development when mothers migrate when the child is between 2 and 3 years old. These effects are likely driven by the lower levels of stimulating parenting practices and dietary diversity provided by the stand-in primary caregivers of left-behind children.

The connections between bullying and student well-being in rural areas are not well understood, particularly among younger, more vulnerable students. This study aims to explore the relationship between bullying experiences and the academic performance and mental health of primary and junior high school students in rural China. The sample comprised 1609 students from 30 schools (20 primary schools and 10 junior high schools) in Gansu province. A self-report questionnaire was used to collect data on students’ demographics, bullying experiences, mental health, and social support. Additionally, a 30-minute standardized math test was administered to assess academic performance. Results indicated that bullying was prevalent in rural settings, with 42.64% of students reporting being bullied and 12.74% experiencing it weekly. A significant correlation was found between bullying experiences and both lower academic performance and higher risk of mental health problems, such as depression and anxiety. These correlations became more pronounced with increased frequency of bullying incidents. We also found that female students and younger students who were bullied were more likely to report mental health issues. Furthermore, social support could diminish, but not entirely counteract, the adverse associations between bullying and mental health. These findings highlight the prevalence of bullying among rural students in this age group and demonstrate the associated negative outcomes for their mental health and academic performance. They also emphasize the need for targeted attention and the development of intervention programs, including enhanced school-based anti-bullying initiatives and improved social support systems.

China’s urbanization has created growing peri-urban communities, where children face challenges to early childhood development (ECD) despite proximity to developed urban areas. Little is known about how the environmental factors of ECD differ between rural migrants and new urban residents. To address this, we sampled 77 peri-urban households with 18–24-month-old Han Chinese children to examine the associations between early cognitive and language development, parental self-efficacy, stimulating parenting practices, and the home language environment measured with Language Environment Analysis (LENA). We find that rural migrants and new urban residents exhibited no significant difference in any child or household characteristic except parental residency. There was no significant difference in the family environment factors or early cognitive or language development, either. However, parental self-efficacy and stimulating parenting practices both predicted better cognitive and language development in rural migrant households, whereas only conversation turn counts predicted better language development in new urban resident households.

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Background
The quality of parenting can affect the developmental outcomes of young children. This study aims to investigate the associations between parenting quality and the early childhood development of children under age 3 across four major rural subpopulations in China.

Methods
Using a stratified cluster sampling method, 760 children aged 6–36 months and their primary caregivers in four rural subpopulations from four provinces and a metropolis in China were surveyed. Child development was assessed by the Third Edition of the Bayley Scales of Infant and Toddler Development. Parenting quality was measured using the Family Care Indicators. Data were analyzed using descriptive statistics, t-tests, multivariable regression analysis, and linear regression analysis.

Results
Across the four subpopulations, prevalences of delays of the sample children in four domains — cognition, language, social-emotional, and motor development are 52%, 45%, 52%, and 19%, respectively. The proportion of children with any type of delay is 82%, while over half (53%) have delays in at least two areas, and 27% have delays in three or more areas. Child’s mother as the primary caregiver, maternal education levels, and family asset values are all positively associated with the quality of parenting. Notably, low levels of parenting quality in rural China are linked to high rates of developmental delays.

Conclusions
This study demonstrates that the level of parenting quality is significantly associated with early childhood developmental outcomes. Results highlight the need for raising investments in family care to improve early childhood development in different rural subpopulations in China.

Background
Mindfulness-based interventions (MI) have shown efficacy in improving mental health among adults; however, the results for younger populations remain inconsistent Research on this topic in low- and middle-income countries is still limited. This study seeks to address this gap by examining the impact of a mindfulness-based intervention on Chinese migrant youth.

Methods
A randomized controlled trial delivering mindfulness and life skills mentorship to 653 migrant students aged 9 to 17 in China. Quantitative results in depression and anxiety were examined between Mindfulness Training group (MT group, n = 167), the Mindfulness Training plus Life Skill Training group (MT + LS group, n = 118), and Control group (n = 368) using student t-tests and Differences-in-Differences. Qualitative study from 20 interviews was conducted using a semi-structured interview and deductive approach.

Results
Quantitatively, participants in intervention group did not show significantly different anxiety and depression symptoms compared to control groups post intervention. Nevertheless, qualitative data highlighted several key benefits of the mindfulness intervention, including improved emotional regulation and increased social support among participants.

Conclusions
A volunteer-led, two-month mindfulness and life skills intervention with Chinese migrant youth did not yield statistically significant reduction in depression or anxiety symptoms. While no notable quantitative benefits were observed, qualitative findings suggested enhanced application of mindfulness and emotional regulation skills among participants that the quantitative measures failed to capture.

Background
Under-resourced communities in rural China have long faced limitations in accessing and utilising caregiver and child healthcare (CCH). The COVID-19 pandemic exacerbated health inequities globally, while its precise impacts on CCH remain understudied. We report differences in parental migration, maternal mental health, household and nutrition expenditures, child feeding practices, and prenatal, postnatal, and childbirth care following pandemic lockdowns in rural China.

Methods
We compared two groups of families with children who grew to the age of six months either before or during lockdowns. We enrolled eligible households from 80 rural townships, randomly selected from four poverty-designated counties in Sichuan Province, China. We interviewed the control group of primary caregivers in November and December of 2019 (pre-COVID-19), and the case group in May of 2020 (approximately five months into the pandemic). Statistical analyses included t tests and linear regressions with adjustments. P-values <0.05 were considered statistically significant.

Results
Compared to the control group, the case group presented significantly lower paternal migration and more favourable maternal mental health. Caregiving behaviours (including household and nutrition expenditures) and child feeding practices did not differ, except for higher spending on infant micronutrient supplements. Prenatal health services utilisation, including home visits, was slightly higher, while postnatal services utilisation was lower.

Conclusions
Our findings suggest that many aspects of CCH in rural China were similar or improved during the early pandemic lockdowns. These data highlight the importance of promoting targeted public health interventions, such as mental health support initiatives, accessible perinatal care options, and family-centred education campaigns, in under-resourced communities and during future healthcare crises.

We examine whether the U.S. Securities Exchange Act of 1934 significantly stabilized the market by introducing mandatory disclosure of information. We argue that mandatory information disclosure can curb stock manipulation by enhancing transparency, thereby reducing excess stock volatility. After a comprehensive assessment of the voluntary disclosure practices of NYSE-listed companies before 1934, we group the companies and find that those with poor disclosure practices experienced a significantly greater reduction in volatility after the implementation of the 1934 Act compared to those with good disclosure practices. Further analysis reveals that the liquidity of these poorly disclosing companies also improved significantly more than that of the better disclosing companies, and the improvement in liquidity was linked to the decrease in their volatility. Given that one of the key intentions of the legislators was to reduce excess market volatility through the Act, our findings provide empirical support for this legislative intent.

The number of acutely food insecure people worldwide has doubled since 2017, increasing demand for early warning systems (EWS) that can predict food emergencies. Advances in computational methods, and the growing availability of near-real time remote sensing data, suggest that big data approaches might help meet this need. But such models have thus far exhibited low predictive skill with respect to subpopulation-level acute malnutrition indicators. We explore whether updating training data with high frequency monitoring of the predictand can help improve machine learning models’ predictive performance with respect to child acute malnutrition by directly learning the dynamic determinants of rapidly evolving acute malnutrition crises. We combine supervised machine learning methods and remotely sensed feature sets with time series child anthropometric data from EWS’ sentinel sites to generate accurate forecasts of acute malnutrition at operationally meaningful time horizons. These advances can enhance intertemporal and geographic targeting of humanitarian response to impending food emergencies that otherwise have unacceptably high case fatality rates.

This article studies whether pure legality, stripped of normative components that are central to the rule of law, can convey perceived legitimacy to governmental institutions and activity. Through a survey experiment conducted among urban Chinese residents, it examines whether such conveyance is possible under current sociopolitical conditions in which the party-state continues to invest in pure legality without imposing legal checks on the party leadership’s political power and without corresponding investment in substantive rights or freedoms. Among survey respondents, government investment in professional and consistent law enforcement conveys meaningful amounts of political legitimacy. In fact, it does so even when it supports government activity, such as censorship of online speech, that is freedom depriving and socially controversial and even when such investment does not necessarily enhance the external predictability of state behavior. However, the legitimacy-enhancing effects of pure legality are likely weaker than those of state investment in procedural justice.

The rise of social media in the digital era poses unprecedented challenges to authoritarian regimes that aim to influence public attitudes and behaviors. To address these challenges, we argue that authoritarian regimes have adopted a decentralized approach to produce and disseminate propaganda on social media. In this model, tens of thousands of government workers and insiders are mobilized to produce and disseminate propaganda, and content flows in a multidirectional, rather than a top-down manner. We empirically demonstrate the existence of this new model in China by creating a novel data set of over five million videos from over 18,000 regime-affiliated accounts on Douyin, a popular social media platform in China. This paper supplements prevailing understandings of propaganda by showing theoretically and empirically how digital technologies are transforming not only the content of propaganda, but also how propaganda materials are produced and disseminated.

Achieving minimum dietary diversity (MDD), a crucial indicator of infant and young child diet quality, remains a challenge in rural China, especially for infants aged 6–11 months. This study examined the rate of MDD attainment in rural China, identified its determinants using the Capability, Opportunity, Motivation, and Behavior (COM-B) model and Bayesian network analysis, and estimated the potential impact of improving each modifiable determinant. A multi-stage sampling design selected 1328 caregivers of infants aged 6–11 months across 77 rural townships in China. Data were collected through a cross-sectional survey via in-person household interviews. Bayesian network analysis identified key factors influencing MDD attainment and their interrelationships, while Bayesian inference estimated MDD attainment probabilities. Results showed that only 22.2 % of the sample infants attained MDD. Bayesian network analysis revealed that caregiver knowledge (a proxy of capability), self-efficacy and habits (proxies of motivation), and infant age directly influenced MDD attainment. Social support (a proxy of opportunity) indirectly promoted MDD attainment by boosting self-efficacy and habit. Notably, simultaneous improvements in knowledge, self-efficacy, and habit could increase MDD attainment by 17.6 %, underscoring the potential effectiveness of interventions focused on enhancing caregiver capability and motivation. The critically low MDD attainment rate among rural Chinese infants highlights the urgent need for targeted interventions. Strategies should prioritize enhancing caregiver feeding knowledge, self-efficacy, and habit formation to improve infant dietary diversity. Addressing these key factors could substantially boost MDD attainment in rural China.

Background: The content of children’s screen exposure and interactive coviewing with caregivers are important determinants of early childhood development (ECD) that have been overlooked in past research in resource-limited rural regions. Given the prevalence of digital devices and diverse digital content today, determining screen use practices that minimize the negative impacts on children’s development is crucial for promoting healthy screen use among children.

Objective: This study aims to examine screen exposure among children aged <3 years in rural China and investigate its relationship with ECD outcomes, focusing on duration, content, coviewing, and interaction.

Methods: The sample includes all children aged between 6 and 26 months and their primary caregivers residing in the study area. A survey of screen exposure and household characteristics was conducted for 1052 eligible households. Caregivers reported the duration of screen exposure, defined as the average daily screen time over the past month; the content of exposure, defined by the time spent on educational and child-friendly content; and the caregiver’s presence and interaction with the child during exposure. ECD outcomes were evaluated using the third edition of the Bayley Scales of Infant and Toddler Development assessment scale and the Brief Infant Toddler Social Emotional Assessment. Ordinary least squares regression, logistic regression, and chi-square tests were conducted.

Results: In total, 28.23% (297/1052) of the children in our sample were first exposed to screens before the age of 12 months. Children exposed to screens had an average daily screen time of 27.57 (SD 38.90) minutes. Children who were exposed to screens before the age of 12 months and those who had longer screen time between the ages of 12 and 18 months were more likely to be at risk of motor developmental delays. Children exposed to educational content for >15 minutes on a daily basis had fewer social-emotional or behavioral problems than those with no screen exposure and a lower risk of delay in motor skills development than those exposed to educational content for <15 minutes on a daily basis. Caregiver interaction during screen exposure was associated with a lower risk of cognitive and language delays and better socioemotional skills.

Conclusions: The type of content viewed and how caregivers engaged in children’s screen time were strongly associated with ECD outcomes. Guiding parents to select educational content for their children and engaging in interactive coviewing may better protect children from the negative effects of screen exposure. The findings complement conclusions regarding the impact of screen exposure on ECD in resource-limited rural areas.

Using reading performance data from a randomized controlled trial of 5224 fifth-grade students in East China, this paper provides a novel test of the hypothesis that evoking a gender stereotype creates gender gaps in education through self-fulfilling prophecies. We found that without intervention, boys performed worse than girls did in reading tests. Evoking a gender stereotype by indicating the expected outperformance of girls over boys in reading had a significantly negative effect on boys and an insignificant effect on girls. As a result, the net effect on the gender gap in reading performance was economically important but statistically insignificant. We also found evidence that increased anxiety was likely the underlying mechanism. Finally, a heterogeneous analysis showed that boys from environments with biased gender role beliefs were more susceptible to the intervention.

China’s total fertility rate declined very little following implementation of the One Child Policy (OCP) in 1979/1980, but then fell sharply, by more than one-third, during the early 1990s. In this paper, we propose that strengthening bureaucratic incentives under the “One Vote Veto” (OVV) policy, which strictly prohibited career promotion for adherence failure, was necessary for more “effective” implementation of the OCP—and for its delayed impact on fertility. We use provincial variation in OVV implementation to estimate event study regression inputs needed to build actual and counterfactual sequential multi-decrement fertility life tables, finding that the policy explains 46% of China’s total fertility rate decline during the 1990s, driving it below replacement level. Use of intrauterine devices (IUDs, the most prevalent form of modern contraception in China) that was “recommended” by party officials increased by 133% under the policy, a relative increase more than four times as large as the increase in “voluntary” use. Overall, our paper suggests that population policy made a larger contribution to low fertility in China than suggested by past research. More generally, our paper highlights the central role of aligning bureaucratic incentives with public policy objectives, even in a centrally-planned economy like China’s.