Publications

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.

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.

This paper examines how power lawyers shape judicial and economic outcomes by studying the “revolving door” between judges and lawyers in China’s judicial system—namely, former judges who quit the bench to practice law. In otherwise identical lawsuits, revolving-door lawyers deliver 8−23% higher win rate for their clients. Their performance in home versus away courts suggests these gains stem from both “know how” and “know who.” We extend the theoretical framework of Dewatripont and Tirole (1999) to show that revolving-door lawyers create countervailing forces in society: they enhance judicial decision-making through evidence and reasoning, but also exploit strategic arguments and connections to bias outcomes in favor of their clients. We estimate a structural model of the judicial process to quantify these trade-offs and find that increasing the supply of power lawyers can have a non-monotonic effect on equilibrium judicial quality.

Policy experiments are crucial for fostering innovation and mitigating risks and can serve as catalysts for transformative changes. This study investigates the governance of policy experiments in China, focusing on how political factors shape their outcomes. It emphasizes the need to consider concurrent trials—related policy trials implemented simultaneously in a locality that can influence outcomes—when selecting comparable cases for analysis. Such consideration is critical, especially when the policy issue spans multiple sectors and the level of difficulty differs across sectors. By comparing five cities engaged in the same three decarbonization pilots between 2010 and 2015, Hangzhou and Xiamen are identified to have had similar initial conditions and goals but achieved divergent outcomes. This research uncovers the critical role of political leadership in achieving varying levels of decarbonization progress and identifies policy coherence with broader local priorities to be the key explanation for continued leadership attention and efforts devoted to decarbonization despite turnover. The study contributes to the literature by addressing the under-studied impact of political factors and concurrent trials, offering a replicable procedure for future research and practical policy applications.

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.

This paper examines whether education can play a role in mitigating gender inequality in the process of sectoral reallocation of labour. We exploit the exogenous variations in educational attainment induced by the implementation of the 1986 Compulsory Education Law (CEL) in China. Using data from the 2018 wave of the China Family Panel Studies (CFPS) and a cohort difference-in-differences (DID) approach, we find that the CEL narrowed the gender gap in education for rural residents, but it did not reduce gender inequality in labour market outcomes, such as wage labour participation and wage rate. Our analysis reveals that this persistent inequality in labour market outcomes can be attributed to gender differences in migration and occupational choices. Specifically, rural males exposed to the CEL were more likely to migrate outside local provinces and work in low-skilled manufacturing sectors, while rural females tended to stay within local counties and work in low-skilled service sectors. Furthermore, we provide evidence that their differential migration responses are driven by household labour divisions and social gender norms, rather than disparities in cognitive skills.

This paper examines whether education can play a role in mitigating gender inequality in the process of sectoral reallocation of labour. We exploit the exogenous variations in educational attainment induced by the implementation of the 1986 Compulsory Education Law (CEL) in China. Using data from the 2018 wave of the China Family Panel Studies (CFPS) and a cohort difference-in-differences (DID) approach, we find that the CEL narrowed the gender gap in education for rural residents, but it did not reduce gender inequality in labour market outcomes, such as wage labour participation and wage rate. Our analysis reveals that this persistent inequality in labour market outcomes can be attributed to gender differences in migration and occupational choices. Specifically, rural males exposed to the CEL were more likely to migrate outside local provinces and work in low-skilled manufacturing sectors, while rural females tended to stay within local counties and work in low-skilled service sectors. Furthermore, we provide evidence that their differential migration responses are driven by household labour divisions and social gender norms, rather than disparities in cognitive skills.

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.

Despite investments in teacher education programs, teacher shortages persist in rural areas of many low- and middle-income countries. Using data from 1860 tuition-free students, we examine factors influencing enrollment in China's Tuition-Free Normal Education (TNE) program and their implications for teacher recruitment and retention in rural schools. Descriptive analysis and OLS regression reveal that TNE students mostly come from larger, poorer families, and enroll for job security and financial benefits. Many aspire to teach but resist rural placements, risking non-compliance. These findings can guide the design and reform of programs to attract qualified teachers to rural areas in China and abroad.

In an era of disruptive global challenges, from climate crises to pandemics, understanding the drivers of drastic policy innovation is paramount. This study defines drastic policy innovation as a significant shift in governmental priorities through policies untried by most jurisdictions in a country. While policy entrepreneurs are often credited with initiating change, this study argues that political will is essential for enacting and implementing such innovative policies. Political will is defined as the degree of commitment among key decision makers to enact and implement specific policies. It is characterized by three key components: authority (the power to enact and enforce policy), capacity (the resources to implement it effectively), and legitimacy (the perceived rightfulness of actions by stakeholders). Through the case of low-carbon city experimentation in China, this study examines how political will drives the adoption and implementation of these policies. The findings reveal that a high level of political will is significantly linked to more drastically innovative policies being enacted and implemented and that when political will is institutionalized, implementation continues despite leadership turnover. These insights likely apply to other policy contexts and countries, regardless of regime type, albeit with some caveats.

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.

Against the backdrop of China’s post-1978 economic transformation, recent challenges such as COVID-19 have prompted speculations about rising popular pessimism regarding current inequalities and opportunities to get ahead. This study compares findings from three new nationally representative surveys conducted in 2023 with three earlier surveys from 2004, 2009, and 2014. Results reveal a significant attitudinal shift, with 2023 respondents expressing markedly more critical views about the fairness of current inequality patterns. Respondents in the 2023 surveys increasingly attribute poverty versus wealth to structural factors like unequal opportunities rather than to variations in individual merit. Respondents also reported lower expectations for future income growth compared with the earlier surveys. While not indicating imminent threats to political stability, such trends suggest that China’s leaders will likely face increasing skepticism and even critical popular responses as they try to mobilize their citizens to confront the serious challenges that China faces in coming years.

There is a widespread perception that China’s digital censorship distances its people from the global internet, and the Chinese Communist Party, through state-controlled media, is the main gatekeeper of information about foreign affairs. Our analysis of narratives about the Russo-Ukrainian War circulating on the Chinese social media platform Weibo challenges this view. Comparing narratives on Weibo with 8.26 million unique news articles from 2,500 of some of the most trafficked websites in China, Russia, Ukraine, and the United States (totaling 10,000 sites), we find that Russian news websites published more articles matching narratives found on Weibo than news websites from China, Ukraine, or the United States. Similarly, a plurality of Weibo narratives were most associated with narratives found on Russian news websites while less than ten percent were most associated with narratives from Chinese news sites. Narratives later appearing on Weibo were more likely to first appear on Russian rather than Chinese, Ukrainian, or US news websites, and Russian websites were highly influential for narratives appearing on Weibo. Altogether, these results show that Chinese state media was not the main gatekeeper of information about Russia’s invasion of Ukraine for Weibo users.

Purpose: This mixed-methods study examined how differences in parental time, knowledge, and economic constraints, as well as community socioeconomic contexts, may contribute to differences in home language environment and child language ability outcomes between peri-urban and rural households in China.

Method: We conducted an explanatory sequential mixed-methods analysis using data from 158 children aged 18–24 months among peri-urban and rural households with low socioeconomic status (SES) in southwestern China. Audio recordings were collected from each household and analyzed using the Language ENvironment Analysis system. The Mandarin version of the MacArthur–Bates Communicative Development Inventories was administered to each child's primary caregiver. We also conducted qualitative interviews with primary caregivers in 31 peri-urban and 32 rural households. Interviews were recorded, transcribed, and coded.

Results: The quantitative results reveal that children in peri-urban households heard less adult speech and had lower language ability than children in rural households. Directed content analysis of interviews found that peri-urban caregivers faced more severe time constraints and less favorable community socioeconomic contexts than rural primary caregivers. Taken together, these findings suggest that differences in time constraints and community socioeconomic contexts between the two populations are the most likely factors contributing to the inferior language environment and language ability among children in peri-urban households.

Conclusion: The mixed-methods study indicated that parental time constraints and community socioeconomic contexts should be considered alongside SES for a comprehensive understanding of factors influencing parental investment in the home language environment in China.

The literature has shown that cognitive and non-cognitive development before the age of three is associated with children’s levels of development at later ages. However, the extent to which the different pathways of cognitive and non-cognitive development before age three (between 6–12 months and 22–30 months of age) are associated with developmental outcomes at primary school age remains unknown. This study aims to examine this research question using three waves of longitudinal data collected from 1087 children aged 9 to 10 years and their primary caregivers in rural China. Results demonstrated four pathways of cognitive and non-cognitive development between 6–12 months and 22–30 months of age. The four pathways include: “never delayed”, “persistently delayed”, “improving”, or “deteriorating.” Children that experienced either persistently delayed or deteriorating development had lower levels of cognitive and non-cognitive development and performed worse academically than children that were never delayed when they were 9–10 years old. Maternal education attainment, family assets, and whether the child was born prematurely all predicted the child’s entry into different developmental pathways. Findings suggest that early childhood development screening and interventions that aim to facilitate healthy early development among children under three years old are needed for rural China’s young children.

Background
Despite the benefits of exclusive breastfeeding, the proportion of exclusively breastfed children remains low in rural China. Self-efficacy is one of the most crucial modifiable factors predicting breastfeeding behavior. However, existing instruments in China do not specifically measure self-efficacy for exclusive breastfeeding but rather measure self-efficacy for any breastfeeding. Furthermore, they have been validated only in high-income Chinese settings. We sought to adapt and validate an instrument to measure exclusive breastfeeding self-efficacy within rural Chinese contexts.

Methods
We introduced relevant items to Dennis’ Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF), which can assess maternal self-efficacy for exclusive breastfeeding. It was then implemented in a multistage random cluster sampling design and cross-sectional survey with home-visit interviews among women 0–6 months postpartum (n = 654) in the rural areas of four counties in Sichuan, China. We performed item-total and adjusted item-total correlations, as well as exploratory factor analysis to remove redundant items and determine the latent factor structure. We further applied confirmatory factor analysis to test the dimensionality of the scale. We then assessed the reliability of the scale and conducted tests of predictive and divergent validity. Known group comparisons were made by primiparous status and breastfeeding support level. We compared the validated Exclusive Breastfeeding Self-Efficacy Scale with the BSES-SF in terms of reliability and validity to explore the added value of scale modification.

Results
Our modification of the BSES-SF to target exclusive breastfeeding produced 19 items. This was further reduced to 15 items based on adjusted item-total correlations and exploratory factor analysis, forming the Exclusive Breastfeeding Self-Efficacy Scale. This scale had three dimensions: “Breast milk supply and quality,” “Breastfeeding skills,” and “Exclusive breastfeeding” subscales. The Exclusive Breastfeeding Self-Efficacy Scale demonstrated strong internal consistency and overall reliability with a Cronbach’s alpha coefficient of 0.91. Predictive and divergent validity and known group comparison assessments supported its validity. Robust psychometric evaluations demonstrated enhanced validity and reliability compared to the original BSES-SF.

Conclusions
Our Exclusive Breastfeeding Self-Efficacy Scale is valid and reliable for measuring exclusive breastfeeding self-efficacy within rural Chinese contexts and is ready for adaptation and validation for clinical and programmatic use elsewhere, particularly within LMICs.

A country’s national income broadly depends on the quantity and quality of workers and capital. But how well these factors are managed within and between firms may be a key determinant of a country’s productivity and its GDP. Although social scientists have long studied the role of management practices in shaping business performance, their primary tool has been individual case studies. While useful for theory-building, such qualitative work is hard to scale and quantify. We present a large, scalable dataset measuring structured management practices at the business level across multiple countries. We measure practices related to performance monitoring, target-setting, and human resources. We document a set of key stylized facts, which we label “the international empirics of management”. In all countries, firms with more structured practices tend to also have superior economic performance: they are larger in scale, are more profitable, have higher labor productivity and are more likely to export. This consistency was not obvious ex-ante, and being able to quantify these relationships is valuable. We also document significant variation in practices across and within countries, which is important in explaining differences in the wealth of nations. The positive relationship between firm size and structured management practices is stronger in countries with more open and free markets, suggesting that stronger competition may allow firms with more structured management practices to grow larger, thereby potentially raising aggregate national income.

This paper examines the correlation between cognitive ability and firm creation. Drawing on administrative college admissions data and firm registration records in China, we investigate who had created firms by their mid-30s. We find a clear pattern of entrepreneurial reluctance: Given the same backgrounds, individuals with higher college entrance exam scores are less likely to create firms. Through an exploration of firm performance, alternative career trajectories, and variations across regions, we propose an explanation: The ability represented by exam scores is useful across occupations, yet higher-scoring individuals are attracted to waged jobs, particularly those of the state sector.

In rural China, there exists a gender gap in academic achievement where girls outperform boys, suggesting similar differences in early language development. Moreover, recent research has revealed that children in peri-urban communities have worse language outcomes than children in rural communities. This study examines the impact of gender on early language development in low-SES, peri-urban Chinese communities. Data from 81 children (56.79% boys) aged 18-24 months (Mage = 21.16) living in peri-urban China were collected using two caregiver-reported tests for child language development and ability, and language environment analysis technology for measuring the home language environment. Results show that in peri-urban communities, girls were generally exposed to more adult-child conversations and showed higher counts of vocalizations than did boys; girls scored higher on language development measures than did boys. The implications of these findings on the gender gap and child development are discussed.

Using a longitudinal data set developed from surveys of 1,285 children (and their families), as well as 683 preschools teachers in 382 preschools in rural western China, we examined the association between preschool quality and the development (cognitive and social-emotional skills) of preschool children. The findings showed that 55 % of the sample children were cognitively delayed, and 49 % of the children were social-emotionally delayed at age 3. The rates of delay decreased to less than 40 % when the children were at preschool age. Although other factors were associated with the decline in development delays, according to the findings, preschool attendance respectively led to an improvement of 0.47 SD (p = 0.001) in child cognitive development (i.e., the fall in delays). More specifically, the global quality and the structural quality of preschools improved child cognitive development by 0.11 SD (p = 0.001) and 0.09 SD (p = 0.004), respectively. The findings of the subgroup analyses suggested that children from disadvantaged backgrounds benefited more from being able to attend quality preschools. Preschool quality also helped to improve developmental outcomes (cognitive abilities and social-emotional skills): for children that were developmentally delayed before age 3, but not for those children that were not delayed when they were 3 years old; for children with lower educated parents, but not for those with more highly educated parents; for children that were from relatively poor families, but not for those that were from relatively rich families; and for children that were attending preschools in rural areas, but not for those who were attending a preschool in an urban area.

Purpose: Depression is a growing public health concern around the world. For adolescents, depression not only impedes healthy development, but is negatively associated with academic performance. The purpose of this paper is to examine the prevalence of adolescent depressive symptoms in a sample of rural primary and junior high school students. Additionally, we examine various factors to identify subgroups within the sample that may be more vulnerable to depression. Finally, we explore the extent to which depression correlates with academic performance and conduct a series of heterogeneity analyses.

Patients and Methods: We utilize cross-sectional data derived from 30 schools in underdeveloped regions of rural China encompassing primary and junior high school students (n = 1,609).

Results: We find a high prevalence of depression, with 23% and 9% of students experiencing general depression (depression score ≥ 14) and severe depression (depression score ≥ 21), respectively. Female gender, elevated stress and anxiety levels, boarding at school, exposure to bullying, and having depressed caregiver(s) are positively correlated with depressive symptoms, while high social support exhibits a negative association. Importantly, our analyses consistently show a significantly negative link between depression and academic performance, which is measured using standardized math tests. For instance, transitioning from a non-depressed state to a state of general depression (depression score ≥ 14) is linked to a decline of 0.348– 0.406 standard deviations in math scores (p < 0.01). Heterogeneity analyses reveal that this adverse relationship is more pronounced for male students, boarding students, those with lower social support, individuals with more educated mothers, and those with lower family assets.

Conclusion: Our findings underscore the high prevalence of depression in rural schools and the detrimental impact on academic performance. We advocate for the implementation of policies aimed at reducing student depression, particularly within vulnerable populations and subgroups.