Publications

Alexis Medina

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Journal Articles

The Salience of Information: Evidence from a Health Information Campaign in Rural China

Economic Development and Cultural Change, 2023

The Home Language Environment in Rural China: Variations Across Family Characteristics

BMC Public Health, 2023

Background
A rich language environment is an important element of a nurturing home environment. Despite their proven importance, vocabulary and conversation have been shown to vary widely across households—even within the same socio-economic class. One significant gap in the existing literature is its nearly exclusive geographic focus on Western and developed settings, with little attention given to poorer communities in lower/middle income countries. The purpose of this study was to empirically illustrate the characteristics of the home language environment in the low SES, non-Western cultural setting of rural China.

Methods
Using Language Environment Analysis (LENA) automated language-analysis system, this study measured the home language environment of 38 children aged 20-27 months in Northwest rural China. Our primary measures of the home language environment were Adult Word Count (AWC), Conversational Turn Count (CTC) and Child Vocalization Count (CVC). Multivariate linear regression models were used to examine the association between home language environment and family/child characteristics, and language skills (Measured by MacArthur-Bates Communicative Developmental Inventory score).

Results
In this paper, by comparison, we found that the home language environment of our rural sample fell far behind that of urban households. We also identify significant, positive correlations between language skills and both AWC and CTC. Our analysis finds no significant correlations between home language environment and family/child characteristics.

Conclusion
In this paper, we present the first ever findings using the LENA system to measure the home language environment of young children from poor rural communities in China. We found that the home language environment of lower-SES household was significantly worse than high-SES households, and demonstrated the importance of the home language environment to language skills, pointing to a need for more high-quality studies of the home language environment in rural China to better understand possible mechanisms behind low levels of parent-child language engagement and ways to improve the home language environment.

Journal Articles

Effect of the mHealth-Supported Healthy Future Programme Delivered by Community Health Workers on Maternal and Child Health in Rural China: Study Protocol for a Cluster Randomised Controlled Trial

BMJ Open, 2023

Introduction Millions of young rural children in China still suffer from poor health and malnutrition, partly due to a lack of knowledge about optimal perinatal and child care among rural mothers and caregivers. Meanwhile, there is an urgent need to improve maternal mental health in rural communities. Comprehensive home visiting programmes delivered by community health workers (CHWs) can bridge the caregiver knowledge gap and improve child health and maternal well-being in low-resource settings, but the effectiveness of this approach is unknown in rural China. Additionally, grandmothers play important roles in child care and family decision-making in rural China, suggesting the importance of engaging multiple caregivers in interventions. The Healthy Future programme seeks to improve child health and maternal well-being by developing a staged-based curriculum that CHWs deliver to mothers and caregivers of young children through home visits with the assistance of a tablet-based mHealth system. This protocol describes the design and evaluation plan for this programme.

Methods and analysis We designed a cluster-randomised controlled trial among 119 rural townships in four nationally designated poverty counties in Southwestern China. We will compare the outcomes between three arms: one standard arm with only primary caregivers participating in the intervention, one encouragement arm engaging primary and secondary caregivers and one control arm with no intervention. Families with pregnant women or infants under 6 months of age are invited to enrol in the 12-month study. Primary outcomes include children’s haemoglobin levels, exclusive breastfeeding rates and dietary diversity in complementary feeding. Secondary outcomes include a combination of health, behavioural and intermediate outcomes.

Journal Articles

Parenting Centers and Caregiver Mental Health: Evidence from a Large-Scale Randomized Controlled Trial in China

Child Development, 2022

Journal Articles

Passive Versus Active Service Delivery: Comparing the Effects of Two Parenting Interventions on Early Cognitive Development in Rural China

World Development, 2021

Journal Articles

Early Childhood Development and Parental Training Interventions in Rural China: A Systematic Review and Meta-Analysis

BMJ Global Health, 2021

Introduction: Inadequate care during early childhood can lead to long-term deficits in skills. Parenting programmes that encourage investment in young children are a promising tool for improving early development outcomes and long-term opportunities in low-income and middle-income regions, such as rural China. Methods: We conducted a systematic review and a meta-analysis to investigate the prevalence of early developmental delays and stimulating parenting practices as well as the effect of parental training programmes on child development outcomes in rural China. We obtained data in English from EconPapers, PubMed, PsycARTICLES, Cochrane Library, Web of Science and Scopus (Elsevier) and in Chinese from China National Knowledge Infrastructure, Wanfang Data and VIP Information. We conducted frequentist meta-analyses of aggregate data and estimated random-effects meta-regressions. Certainty of evidence was rated according to the Grading of Recommendations Assessment, Development and Evaluation approach. Results: We identified 19 observational studies on the prevalence of developmental delays and stimulating parenting practices for children under 5 years of age (n=19 762) and ten studies on the impact of parental training programmes on early child development (n=13 766). Children’s risk of cognitive, language and social-emotional delays in the rural study sites (covering 14 provinces mostly in Central and Western China) was 45%, 46%, and 36%, respectively. Parental training programmes had a positive impact on child cognition, language and social-emotional development. Conclusion: There is evidence to suggest that early developmental delay and the absence of stimulating parenting practices (ie, reading, storytelling and singing with children) may be prevalent across rural, low-income and middle-income regions in Central and Western China. Results support the effectiveness of parental training programmes to improve early development by encouraging parental engagement.

Journal Articles

Passive versus Active Service Delivery: Comparing the Effects of Two Parenting Interventions on Early Cognitive Development in Rural China

2020

Journal Articles

Structural Equation Modeling (SEM) of Cysticercosis in School-Aged Children in Tibetan Rural Farming Areas of Western China: Implications for Intervention Planning

Environmental Research and Public Health, 2019

Journal Articles

Effect of a Local Vision Care Center on Eyeglasses Use and School Performance in Rural China A Cluster Randomized Clinical Trial

JAMA Ophthalmology, 2018

Journal Articles

Prevalence and risk factors for Taenia solium cysticercosis in school-aged children: A school based study in western Sichuan, People’s Republic of China

PLOS Neglected Tropical Diseases, 2018

Journal Articles

Rural education across China's 40 years of Reform: past successes and future challenges

China Agricultural Economic Review, 2018

Publications

The Salience of Information: Evidence from a Health Information Campaign in Rural China

The Home Language Environment in Rural China: Variations Across Family Characteristics

Effect of the mHealth-Supported Healthy Future Programme Delivered by Community Health Workers on Maternal and Child Health in Rural China: Study Protocol for a Cluster Randomised Controlled Trial

Parenting Centers and Caregiver Mental Health: Evidence from a Large-Scale Randomized Controlled Trial in China

Passive Versus Active Service Delivery: Comparing the Effects of Two Parenting Interventions on Early Cognitive Development in Rural China

Early Childhood Development and Parental Training Interventions in Rural China: A Systematic Review and Meta-Analysis

Health, Economic, and Social Implications of COVID-19 for China's Rural Population

Early Childhood Reading in Rural China and Obstacles to Caregiver Investment in Young Children: A Mixed-Methods Analysis

Maternal Health Behaviors During Pregnancy in Rural Northwestern China

Visual Impairment in Rural and Migrant Chinese School-Going Children: Prevalence, Severity, Correction and Association

Conditional Cash Transfers, Uptake of Maternal and Child Health Services, and Health Outcomes in Western Rural China

Passive versus Active Service Delivery: Comparing the Effects of Two Parenting Interventions on Early Cognitive Development in Rural China

Parental Migration and Early Childhood Development in Rural China

Using Standardised Patients to Assess the Quality of Medical Records: An Application and Evidence from Rural China

Concurrent Validity of the Ages and Stages Questionnaire and the Bayley Scales of Infant Development III in China

Stimulation and Early Child Development in China: Caregiving at Arm's Length

Use of maternal health services among women in the ethnic rural areas of western China

Structural Equation Modeling (SEM) of Cysticercosis in School-Aged Children in Tibetan Rural Farming Areas of Western China: Implications for Intervention Planning

Breastfeeding and the Risk of Illness among Young Children in Rural China

Caregiver Depression and Early Child Development: A Mixed-Methods Study From Rural China

Do Infant Feeding Practices Differ Between Grandmothers and Mothers in Rural China? Evidence From Rural Shaanxi Province

China's Invisible Crisis: Cognitive Delays among Rural Toddlers and the Absence of Modern Parenting

Effect of a Local Vision Care Center on Eyeglasses Use and School Performance in Rural China A Cluster Randomized Clinical Trial

Prevalence and risk factors for Taenia solium cysticercosis in school-aged children: A school based study in western Sichuan, People’s Republic of China

Rural education across China's 40 years of Reform: past successes and future challenges