Health

Objectives
We examined the effectiveness of a school-based intervention focusing on sugar-sweetened beverage (SSB) harms and nutrition-label understanding among children and adolescents.

Study design
We conducted a school-based, two-arm, cluster-randomised controlled trial among upper-primary and lower-secondary students in six Chinese schools. The trial was embedded within the 2022 wave of the Health and Nutrition Panel Survey (HNPS-2022). Classes were the unit of randomisation; within each school and target grade, classes were randomly assigned to a video (<5 min) on SSB harms and nutrition labels or eyesight protection. The trial included a real choice experiment (RCE) and a discrete choice experiment (DCE). Primary outcomes were the probability of selecting a full-sugar fermented milk drink (FMD) at actual beverage selection in the RCE, and the direction and relative importance of preferences for prespecified beverage attributes in the DCE. We used ANCOVA and mixed logit models.

Results
Between September and October 2022, 24 classes were randomly assigned to control (12 classes; 653 students) or intervention (12; 649); 1269 students were analysed (641 control and 628 intervention). At actual beverage selection, 367/641 (57.3%) control participants selected the full-sugar rather than the low-sugar FMD, compared with 228/628 (36.3%) intervention participants (adjusted absolute difference −0.21, 95% CI -0.28 to −0.15; p < 0.0001; adjusted odds ratio 0.39, 95% CI 0.30 to 0.51; p < 0.0001). In the DCE, beverage profile (a combination of beverage type and sugar content) had the highest relative importance (49.6%), followed by price (38.4%). The intervention shifted preferences towards healthier options, especially among primary school students.

Conclusions
A brief health literacy intervention supported healthier immediate beverage choices, but sustained SSB prevention will require clearer, child-friendly sugar information and school policies that make healthier beverage options easier to choose.

Background
The Thinking Healthy Extended Program (THEP) is a nonspecialist-delivered mental health intervention targeting female caregivers (mothers and grandmothers) of children aged 6-36 months in rural China. It consists of 24 fortnightly group sessions, supplemented by individual home visits for caregivers who miss group sessions, and integrates cognitive reframing techniques, behavioral engagement, childrearing skills, and peer support. Embedded within a large-scale randomized controlled trial, this study aims to evaluate implementation fidelity of THEP, examine hypothesized mechanisms of change, and identify contextual factors, including enablers and barriers, that influenced intervention implementation.
 

Methods
In-depth interviews were conducted at 3 months and 10 months into the intervention implementation with 50 caregivers and 10 facilitators. The interview guides were developed based on the UK Medical Research Council’s process evaluation framework, with the facilitator interview guide focused on implementation fidelity, the caregiver interview guide focused on mechanisms of change, and contextual factors explored in both guides. All interviews were audio-recorded, transcribed, and analyzed using thematic analysis.
 

Results
THEP facilitators demonstrated competence in coordinating schedules, delivering sessions, and engaging caregivers. Caregivers reported improvements in peer support and childrearing skills, along with some uptake of behavioral engagement. However, both facilitators and caregivers demonstrated limited understanding of cognitive reframing techniques. Grandmothers (who accounted for 43% of the sample in the current study) experienced greater challenges than mothers with respect to applying the four program mechanisms of change. Several contextual factors, including a child-focused orientation, distractions related to the presence of children at sessions, and intergenerational differences between mother and grandmothers, influenced THEP implementation.
 

Conclusions
THEP was feasible to deliver through nonspecialist facilitators, but implementation quality was constrained by limited understanding of cognitive reframing strategies and variation in caregiver engagement. Future adaptation and scale-up should prioritize facilitator capacity and intervention approaches that are more feasible for nonspecialist providers and more accessible to diverse caregivers.

Background: 
Early motherhood is a critical yet vulnerable life stage shaped by intersecting individual, familial, societal and structural challenges. Existing research often overlooks the multiple everyday stressors mothers experience across ecological domains. This study explores the lived experiences of mothers in urban China, using an ecological framework to examine the multi-level challenges they face during the first three years after childbirth.

Methods: 
In-depth interviews were conducted with 50 mothers of children aged 0–3 years recruited from nine community and township health centers and one childcare program for a migrant community in Shanghai, China, during well-child visits. Interviews were guided by an ecological framework and analyzed using thematic analysis.

Results: 
Challenges clustered across ecological levels, including postpartum physical health problems, caregiving burden, limited family and social support, work–childcare tension and constrained services, and information and financial constraints. These challenges manifested as common themes that negatively affected maternal wellbeing and the child nurturing environment.

Conclusions: 
These findings highlight that the challenges mothers experience extend beyond the individual level to family and institutional contexts, underscoring the need for coordinated interventions from individual support to family- and system-level services.

Maternal mental health issues are pervasive in rural China, yet community-based interventions are scarce. To address this gap, we developed the Thinking Healthy Extended Program, a nonspecialist-led intervention designed to promote mental health among female caregivers of children under the age of three, including mothers and grandmothers, in resource-constrained areas of China. Drawing on an adapted Stages of Implementation Science framework, this study describes the Exploration and Installation phases of a four-phase intervention development process. During the Exploration phase, we assessed caregivers’ mental health needs and preferences for intervention delivery through in-depth interviews. The Installation phase comprised three stages: developing the overall curriculum structure, identifying and validating curriculum topics, and integrating these topics into a comprehensive curriculum based on feedback from interviews, focus group discussions, and cognitive walkthroughs. The development process took place from 2022 to 2024 in a prefecture in southwestern China and involved 73 caregivers of children aged 6-36 months. The resulting 24-session curriculum integrates simplified cognitive reframing techniques, behavioral activation, caregiving skills, and peer support. This study demonstrates the feasibility of a systematic and participatory approach to developing a mental health intervention for low-resource populations.

In rural China, there is an urgent need for investment and innovative approaches for addressing adolescent mental health issues. This embedded mixed-methods study examines the effectiveness of a social-emotional learning (SEL) program in rural primary schools across China and the factors affecting compliance among teachers delivering the program. Pre- and post-intervention surveys assessed its effect on 2027 students in 49 schools, and 38 teachers were interviewed during the intervention. Results show that SEL courses improved student mental health. Some teachers reported increased workload and lack of support, while others noted the importance of mental health education and positive student outcomes. Performance incentives and the positive perceptions of SEL among teachers were crucial for effective delivery, though workload and lack of support often limited commitment. Overall, enhancing rural students' well-being through SEL programs requires raising awareness for SEL among teachers and building institutional support.

Drawing on quantitative and qualitative data collected in 2024 and 2025 in a relatively well-off rural area of China, this study examines the mental health of primary caregivers of young children and its correlates. The quantitative data show high prevalence of cognitive (40%), language (42%), and motor (20%) developmental delays among the children. Caregiver mental health problems may be one possible contributing factor given that approximately 17% of caregivers exhibit at least one mental health issue (i.e. stress, anxiety, or depression). The qualitative analysis identifies several risk factors of caregiver mental health problems: limited awareness of mental health concepts; heavy burden of caregiving; insufficient public services; and a lack of awareness of caregiver mental health’s impact on child development.

This study examines how center-based parenting interventions aimed at improving early child development in rural China affect the mental health of caregivers. Data from an analytic sample of 615 caregiver–child dyads (children aged 6 to 24 months, 48.5% girls; data collection: 2015–2017) in a 2-year cluster randomized controlled trial conducted in 100 villages showed that the intervention had no significant effect on caregiver depressive (β = − .047, SE = .079), anxiety (β = .040, SE = .076), or stress (β = .032, SE = .081) symptoms. Subgroup analyses found no significant difference in effects on mental health by prespecified characteristics after adjustment for multiple comparisons, except that the caregivers of children without social–emotional delay at baseline exhibited lower depression scores after the intervention (β = − .205, SE = .097, p = .043). The findings suggest that the center-based parenting intervention focused solely on strengthening parenting skills may be insufficient to improve caregiver mental health over 2 years.

Objectives
Considering the importance of caregiver mental health for early childhood development, this study investigates risk and protective factors of mental health of mothers and grandmothers caring for infants and toddlers in rural China.

Methods
Using survey data from 777 primary caregivers of children aged 5 to 25 months, we apply regression analysis and structural equation modeling to examine associations between social support, mental health literacy, parenting-related hardships, and mental health among mothers and grandmothers.

Results
The study finds that 33% of the caregivers report symptoms of mental health problems, with grandmothers experiencing more severe symptoms. Poor caregiver mental health is associated with lower child language (p < 0.05) and social-emotional development (p < 0.001). Social support and mental health literacy are associated with better mental health, but this association was not statistically significant among either the mothers or the grandmothers alone.

Conclusions
Enhancing caregiver mental health is crucial for children’s development. Social support and mental health literacy are predictors of mental health. Future research should examine the effect of improving social support and mental health literacy on the mental health of caregivers for young children.

Introduction: Longitudinal trends in breastfeeding (BF) are often overlooked in favor of binary or time-to-cessation measures. Characterizing these trends can inform promotion of sustained BF practices. We identified distinct BF profiles among participants of a maternal and child health program.

Methods: The Healthy Future program consisted of community health workers delivering a BF curriculum to mothers through monthly home visits. The program was evaluated in rural Sichuan, China with a cluster-randomized controlled trial (assigned to program versus not). We clustered 6-month postpartum trends (n = 949) of maternal-reported infant feeding using dynamic time warping. For each month, participants were categorized as either exclusive breastfeeding (EBF), mixed feeding (MF, feeding breastmilk plus other foods or liquids), or not breastfeeding (NBF). After identifying clusters, we regressed BF profiles on intervention assignment using adjusted multinomial logistic regression.

Results: Cluster analysis revealed seven profiles: always EBF, always MF, never breastfed, EBF until the 5th month, MF until the 5th month, mostly EBF, and NBF from the 3rd month. The intervention was associated with improved odds of always EBF (ROR = 2.61, 95% CI 1.25, 5.42), MF until the 5th month (ROR = 2.52, 95% CI 1.18, 5.39), and NBF from the 3rd month (ROR = 2.82, 95% CI 1.16, 6.87) compared to being never breastfed. Mothers in the never breastfed cluster had the lowest age, education, BF knowledge and attitudes, and decision-making power.

Discussion: Cluster analyses found the intervention significantly improved EBF, particularly in mothers characterized by higher baseline educational attainment and BF knowledge. Targeted efforts are needed to help mothers initiate EBF from birth and continue EBF through month 6.

Background
Mental health problems among young children have become a common public health issue worldwide. As the family plays a crucial role in creating a favorable environment for children’s mental health, the parenting style of caregivers is a key factor related to children’s mental health issues. This study aims to examine the associations between parenting styles of primary caregivers and the mental health of their primary school child in rural China and identifies the factors that may influence the adoption of different parenting styles.

Methods
Data were collected from 1,298 primary school children (aged 9–11) and their primary caregivers in northwestern China. The primary caregivers completed the Parenting Styles and Dimensions Questionnaire, the Strengths and Difficulties Questionnaire, and a socio-demographic questionnaire. The cognitive development of children was measured using the Wechsler Preschool and Primary Scale of Intelligence-Fourth Edition, and the non-cognitive development of children was evaluated using the Ages and Stages Questionnaire: Social-Emotional. We performed descriptive statistics, linear regression analysis, and multivariable regression analysis.

Results
Our data showed that 17% of the sampled children exhibited total difficulty problems. The results indicated that authoritative parenting style was negatively associated with child mental health problems. In contrast, authoritarian parenting style was positively associated with child mental health problems. Analysis of combined parenting styles revealed that the combinations that included relatively more intensive authoritative parenting styles was associated with reduced incidence of child mental health problems. In contrast, the combinations that were found to have relatively more authoritarian parenting styles were associated with higher rates of mental health issues among children. Demographic characteristics, such as child gender, child developmental outcomes, child attending preschools, identity of primary caregiver, and family economic status, that were associated with the adoption of different parenting styles.

Conclusions
The study indicates that an authoritative parenting style is positively associated child mental health outcomes. Likewise, when authoritative strategies are more prominent within combined parenting styles, the likelihood that a child will experience mental health problems decreases. In contrast, the more dominant authoritarian behaviors are, the greater the risk of child mental health problems. Therefore, primary caregivers should be encouraged to adopt more positive parenting styles, which can help promote better outcomes of child mental health.

Jing Tian ^1,2, Lei Wang ^1,✉, Steven Sun Zhao ³, Sicong Li ⁴, Zekai Fu ⁵, Scott Rozelle ⁶

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.

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.

This paper exploits the universe of credit- and debit-card transactions in China during 2013–2015 and provides the first nationwide analysis of the health care cost of PM2.5 for a developing country. We leverage spatial spillovers of PM2.5 from long-range transport to generate exogenous variation in local pollution, and we employ a flexible distributed lag model to capture semiparametrically the dynamic response of pollution exposure. We find significant impacts of PM2.5 on health care spending in both the short and medium terms. A 10 g/m decrease in PM2.5 would reduce annual health care spending by over $9.2 billion, about 1.5% of China’s annual health care expenditure.

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.

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.

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.

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.

The effects of psychological factors on complementary feeding behavior have been widely described, yet the mechanisms underlying the complex relationships among personality traits, self-efficacy, and complementary feeding behavior remain unclear. This cross-sectional study was conducted using a multi-stage cluster sampling process to select caregiver-child dyads in Western rural China. Personality traits, self-efficacy, and complementary feeding behavior were evaluated respectively. Both multiple logistic regression and Bayesian network structure (BNs) were used to explore these associations. A total of 787 caregiver-child dyads were enrolled. Results from multiple logistic regression indicated that caregivers with medium (OR = 2.05, p < 0.001) or high (OR = 1.58, p = 0.04) levels of extraversion, as well as those with high self-efficacy recording complementary feeding (OR = 2.08, p < 0.001), significantly increased the likelihood of meeting the criteria for the Infant and Child Feeding Index (ICFI) qualification. Further, BNs were employed to elucidate the pathways of influence, revealing a direct association between the caregiver's level of extraversion, level of self-efficacy and the ICFI. Additionally, the analysis indicated that a caregiver's openness indirectly influenced the ICFI through its influence on self-efficacy regarding complementary feeding. This is one of few studies exploring associations between personality traits, self-efficacy, and complementary feeding behavior. The study highlights the importance of understanding individual differences in caregiving and suggests that interventions should focus on enhancing caregivers' self-efficacy, rather than solely targeting personality traits.

Background: Micronutrient powder (MNP or Yingyangbao, a dietary supplement that contains multiple vitamins and minerals) programs can reduce the risk of anemia among children. One such program in China distributed free MNP to children aged 6–24 months in poor rural areas. However, there are indications that the generation of primary caregiver (i.e., parent or grandparent) may influence MNP feeding behavior. The purpose of this study was to investigate the prevalence and influencing factors of effective MNP feeding behavior among parents and grandparents in a rural developing setting.

Methods: We conducted a cross-sectional study of 884 caregivers and children in formerly impoverished rural areas of Sichuan Province using multi-stage random sampling. Data were collected on caregivers’ MNP feeding behavior, their core perceptions and health beliefs about MNP, children’s responses to MNP, MNP delivery patterns, and demographic characteristics. Influencing factors of parents’ and grandparents’ MNP feeding behavior were analyzed using two-level logistic regression.

Results: Total effective MNP feeding behavior rate among caregivers was 40.95%. Grandparents demonstrated higher MNP adoption than parents (χ2 = 4.445, P = 0.035). After controlling for sociodemographic characteristics, grandparents were more likely than parents to achieve effective MNP adoption (OR = 1.360, P = 0.035); child’s preference for MNPs (ORparental subgroup = 1.736, ORgrandparental subgroup = 1.496; P < 0.050) and caregiver’s self-efficacy (ORparental subgroup = 1.157, ORgrandparental subgroup = 1.393; P < 0.050) were influencing factors of feeding behavior for caregivers of both generations. Parents were also influenced by perceived barriers to feeding MNPs (OR = 0.904, P = 0.040), while grandparents were more strongly influenced by child’s discomfort to MNPs (OR = 0.240, P = 0.023) and caregiver’s knowledge about MNPs (OR = 1.557, P = 0.014).

Conclusion: Future efforts to improve the feeding behavior of caregivers in MNP programs both in China and abroad should improve children’s preference for MNP by changing its composition and taste, and increase caregivers’ feeding self-efficacy through health education. Moreover, parents should be taught to cope with time and ability barriers that may limit MNP adoption, while grandparents should be emphasized the importance and potential side effects of MNP.

The diffusion of high-yielding crop varieties has been a key driver for agricultural productivity. This study examines the relationship between the adoption of high-yielding crop varieties of two staple crops—wheat and maize—and infant mortality in rural China. Using data from 1954 to 1987, we find a significant reduction in infant mortality linked to high-yielding crop varieties diffusion, an association that remains robust even after excluding the Great Famine years. We investigate potential mechanisms driving this relationship, including increased grain production, improved infant nutrition, and changes in maternal characteristics. Additionally, our analysis unveils a spectrum of heterogeneous relationships between high-yielding crop varieties adoption and infant mortality across factors such as infant gender, maternal characteristics, and policy regulation. These findings reaffirm the positive and lasting benefits of dissemination of high-yielding crop varieties for human welfare and provide valuable policy insights for developing nations grappling with food and nutritional insecurity.

This study aims to compare the ratings of primary caregivers and teachers of any mental health problems of preschool children in rural China. The primary caregivers and teachers provided their ratings of mental health of 1,191 sample rural preschool children (mean age = 56.8 months; 587 girls) using the Strengths and Difficulties Questionnaire (SDQ). According to the findings, primary caregivers consistently gave their children higher SDQ scores and identified more symptoms across the different categories of mental health problems (i.e., normal, borderline, and abnormal) than teachers. The correlations between the ratings of caregivers and the ratings of teachers were low. The study also identifies the characteristics of children, caregivers, and teacher that were correlated with the differences in the ratings. Specifically, boys, children that were identified by scales of cognitively development as being delayed, and those that parented with authoritarian style were more likely to be rated differently by primary caregivers and teachers. In addition, primary caregivers from relatively poor families rated their children differently from teachers, compared with primary caregivers from relatively rich families. Regarding teachers, they tended to rate on child mental health differently from primary caregivers when they were male or at older age. These findings suggest considering multi-informant reports when assessing the mental health problems of preschool children in different settings. In addition, understanding factors linked to informant discrepancies can potentially improve the accuracy of the assessments.