Publications
Publications
The Connection between Sleep Patterns and Mental Health: Insights from Rural Chinese Students
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Background: The association between sleep patterns and young students’ mental health, which is crucial for their development, remains understudied in rural China. Therefore, the relationship between sleep patterns and mental health among primary and junior high school students in rural China was examined. Method: A total of 1592 primary and junior high school students from rural areas of Gansu Province were surveyed, and the Depression Anxiety and Stress Scale (DASS) was utilized to assess mental health, alongside self-reported data on their daily sleep patterns. Results: Significant sleep inadequacies were identified: 28% of students received less than 8 h of sleep on weekdays, and 19% went to bed later than recommended. On weekends, 38% of students had delayed bedtimes, though only 7.2% received less than 8 h of sleep. Notably, a “U-shaped” relationship was uncovered between sleep duration and mental health for students on weekends, with optimal mental health correlated with receiving 10–11 h of sleep, while both shorter and longer sleep durations on weekends worsened outcomes. This pattern is absent on weekdays. Additionally, adequate sleep and an earlier bedtime was linked to a 6–8% decrease in mental health risks. Conclusions: These findings provide valuable insights for policymakers seeking to enhance student mental well-being in rural settings, emphasizing the importance of implementing measures that promote balanced sleep habits among young students.
Can a Teacher Salary Increase Promote Students' Educational Performance?
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Policymakers in China have attempted to improve the quality of rural education by investing in teacher salaries through initiatives like the Rural Teachers Support Plan (RTSP). This study estimates the effects of teacher salary increase on students' educational outcomes in rural China by utilizing the exogenous variations of rural teacher salaries induced by the RTSP. It employs an intensity-based difference-in-differences strategy and panel data from 2010 to 2018 with 3,351 rural children. The findings reveal that an increase in teacher salaries had a significant positive impact on students' examination results. Moreover, the results of mechanism analysis indicate that salary increases could have both quality and quantity effects on students' outcomes by increasing the proportion of highly educated teachers and reducing the student–teacher ratio. Our findings contribute to the discussion on the importance of teacher salary incentives in education production functions and provide insights for other countries undertaking rural education reforms.
Rural China and the Gender Gap in Early Social-emotional Development
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Rural girls in China stay in school longer than boys and outperform them in many subjects. This gender gap suggests analogous disparities in early childhood development, a key factor in later educational outcomes. This study examines gender disparities in social-emotional development among 1,301 children aged 18–30 months in rural China. Results indicate that male children trail their female counterparts by 0.18 SD on average on the scale of standardized ASQ:SE score. A large share of the difference is driven by the bottom 10 % of children, where the magnitude of the gender gap (0.34 SD) is 1.9 times larger than at the median (0.19 SD). Demographic characteristics are uncorrelated with the gender gap in heterogeneity analysis, suggesting that the mechanisms underlying observed gender disparities are similar across rural Chinese households.
Effects of Mindfulness and Life-Skills Training on Emotion Regulation and Anxiety Symptoms in Chinese Migrant Children: A Randomized Controlled Trial
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Purpose
China’s rapid urbanization has been associated with increased mental health challenges, especially in rural-to-urban migrant children. This study evaluates the effects of mindfulness and life-skills (LS) training on emotional regulation and anxiety symptoms from a randomized controlled trial aimed at improving the mental health of Chinese migrant children.
Methods
Two intervention arms—mindfulness training (MT) and MT plus LS mentorship (MT + LS)—were compared to a waitlist control group of 368 migrant children aged 9–17 years. Volunteers were trained to deliver interventions to 285 migrant children in small groups of 15 for eight weeks weekly. Social integration varied: migrant children mixed with local children at public schools were considered highly integrated, those in migrant-only classrooms at public schools had intermediate levels of integration, and children in private migrant schools had low integration. Emotion regulation and anxiety symptoms were assessed preintervention, postintervention, and three months postintervention.
Results
Postintervention and compared to the control group, children with high social integration in the MT arm showed increased cognitive reappraisal ability (p < .05) but higher physical anxiety (p < .01). Children with high social integration in the MT + LS arm had lower anxiety symptoms of harm avoidance (p < .01) and physical anxiety (p < .05). Children with low social integration in the MT + LS arm showed lower cognitive reappraisal (p < .01) and poorer overall emotion regulation abilities (p < .01). Three months later, children with intermediate integration in the MT + LS arm had lower separation anxiety (p < .05) and harm avoidance anxiety (p < .05). No other groups showed significant improvements in emotion regulation or reducing in anxiety symptoms three months postintervention.
Discussion
Mindfulness and LS training may benefit Chinese migrant children who have higher levels of social integration but increase anxiety in those with lower social integration. Future research should consider the sociocultural context in which a treatment is implemented.
Electronic Media Exposure, Parental Language Input, and Child Vocalizations in Rural and Peri-urban China
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To examine the association between electronic media exposure and parental language input, Language Environment Analysis technology was used to collect data on electronic media exposure and parental language input in 158 peri-urban and rural households with children aged 18–24 months in southwestern China. The sounds children made and the sounds they heard were quantified. Multiple linear regression and quantile linear regression were used to determine the relationship between electronic media and the outcomes of interest. The results showed that each hour of electronic media exposure was associated with reduced conversational turn count (p < .05) and child vocalization count (p < .05). A large share of the reduction was driven by the higher quantile of children. Reductions associated with electronic exposure were also observed in number of segments and conversational turns. These results may help explain the association between child electronic media exposure and language delay in an under-studied and at-risk population.
The Shortage of Child Psychiatrists in Mainland China
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Childhood is a crucial period of psychological and social development, rendering individuals susceptible to developing mental health issues. Unfortunately, many countries around the world, including China, are facing a shortage of child psychiatrists, which is a significant concern. This Comment was conducted to clarify the current number of child psychiatrists in mainland China, to analyze the reasons for the shortages and to provide constructive suggestions for solving the current shortage.
Rural-Urban Differences in the Intergenerational Transmission of Cognitive Capabilities in China: Evidence from a Northwestern Province of China
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Purpose
Literature has shown that the intergenerational transmission of cognitive abilities is stronger for children raised in more advantaged environments. However, there has never been an empirical investigation of this pattern in China. This study examines differences in the intergenerational transmission of cognitive capabilities among mothers and young children in urban and rural subpopulations in China and investigates whether these differences are driven by differences in parental investment in the home environment.
Design/methodology/approach
Data collected from randomly selected 6- to 36-month-old babies and their mothers in a Northwestern province in China was used. Child capabilities were assessed by the Bayley Scales of Infant and Toddler Development (3rd edition). Maternal intelligence quotient (IQ) scores were assessed with the Raven’s Progressive Matrices test. The non-parametric regression methods were used to construct the factor scores of child capabilities. The ordinary least squares (OLS) models were employed to investigate the relations between child cognition, maternal IQ and parental investment.
Findings
In urban households, where most children are raised in a positive home environment, child cognitive scores are strongly correlated with maternal IQ. In rural households, where parental investments are lower and more variable, child cognitive scores are not significantly correlated with maternal IQ but are predicted by differences in parental investments in a cognitively stimulating home environment.
Originality/value
This study provides a unique contribution by utilizing rural–urban disparities in China as a unique natural experiment to investigate differences in the transmission of cognitive capabilities across socioeconomic status (SES). It also provides the first empirical evidence of SES differences in the intergenerational transmission of cognitive capabilities in a developing country. This study reveals that intergenerational mother–child cognition associations are disrupted by poor parental investment in rural households but not in urban households.
General Psychopathology Factor in Chinese Adolescents and its Correlation with Trans-diagnostic Protective Psycho-social Factors
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Background
Comorbidity in mental disorders is prevalent among adolescents, with evidence suggesting a general psychopathology factor (“p” factor) that reflects shared mechanisms across different disorders. However, the association between the “p” factor and protective factors remains understudied. The current study aimed to explore the “p” factor, and its associations with psycho-social functioning, in Chinese adolescents.
Methods
2052 students, aged 9–17, were recruited from primary and secondary schools in Shanghai, China. Multiple rating scales were used to assess psychological symptoms and psycho-social functioning. Confirmatory factor analysis was conducted to verify the fit of models involving different psychopathology domains such as externalizing, internalizing, and the “p” factor. Subsequently, structural equation models were used to explore associations between the extracted factors and psycho-social functioning, including emotion regulation, mindful attention awareness, self-esteem, self-efficacy, resilience, and perceived support.
Results
The bi-factor model demonstrated a good fit, with a “p” factor accounting for 46 % of symptom variation, indicating that the psychological symptoms of Chinese adolescents could be explained by internalizing, externalizing, and the “p” factor. Psychologically, a higher “p” was positively correlated with emotion suppression and negatively correlated with mindful attention awareness, emotion reappraisal, self-esteem, and resilience. Socially, a higher “p” was associated with decreased perceived support.
Limitations
Only common symptoms were included as this study was conducted at school. Furthermore, the cross-sectional design limited our ability to investigate causal relationships.
Conclusions
A “p” factor exists among Chinese adolescents. Individuals with higher “p” factor levels were prone to experience lower levels of psycho-social functions.
Association Between Anxiety, Depression Symptoms, and Academic Burnout among Chinese Students: The Mediating Role of Resilience and Self-efficacy
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Background: To explore the associations between anxiety and depression symptoms and academic burnout among children and adolescents in China, and to examine the role of resilience and self-efficacy in addressing academic burnout.
Methods: A total of 2,070 students in grades 4–8 were recruited from two primary and three middle schools in Shanghai, completed the Elementary School Student Burnout Scale (ESSBS), the Multidimensional Anxiety Scale for Children-Chinese (MASC-C), the Center for Epidemiological Studies Depression Scale (CES-D), the Connor-Davidson Resilience Scale (CD-RISC), and the General Self-Efficacy Scale (GSES), with 95.04% effective response rate. Multivariable regression analyses examining the associations between anxiety / depression symptoms and academic burnout (as well as the associations between resilience / self-efficacy and academic burnout) were performed using STATA 16.0 and SmartPLS 3.0.
Results: Anxiety symptoms (β = 0.124, p < 0.01) and depression symptoms (β = 0.477, p < 0.01) were positively correlated with academic burnout. Resilience partially mediated the association between depression symptoms and academic burnout (β = 0.059, p < 0.01), with a mediation rate of 12.37%. Self-efficacy partially mediated the associations between anxiety symptoms and academic burnout (β = 0.022, p < 0.01) and between depression symptoms and academic burnout (β = 0.017, p < 0.01), with mediation rates of 17.74% and 3.56%, respectively. Resilience and self-efficacy together (β = 0.041, p < 0.01) formed a mediating chain between depression symptoms and academic burnout, with a mediation rate of 8.6%.
Conclusions: Anxiety and depression symptoms were positively associated with academic burnout. Resilience and self-efficacy were found to mediate the associations partially.
Isolating the "Tech" from EdTech: Experimental Evidence on Computer Assisted Learning in China
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EdTech, which includes computer assisted learning (CAL), online education, and remote instruction, was expanding rapidly even before the current full-scale substitution for in-person learning at all levels of education around the world because of COVID-19. Studies of CAL interventions often find positive effects, however, these “CAL programs” often include non-technology based inputs such as more time on learning and instructional support by facilitators in addition to technology-based components. In this paper, we discuss the possible channels by which CAL programs affect academic outcomes among schoolchildren. We isolate the technology-based effects of CAL from the total program effects by designing a novel multi-treatment field experiment with more than four thousand schoolchildren in rural China. For the full sample, we find null effects for both the total CAL program and the technology-based effects of CAL (which are measured relative to a traditional pencil-and-paper learning treatment) on math test scores. For boys, however, we find a positive and statistically significant effect of the CAL program, but do not find evidence of a positive effect for the technology-based effect of CAL. When focusing on grades, we find evidence of positive CAL program effects but find null effects when we isolate the technology-based effects of CAL. Our empirical results suggest that the “Tech” in EdTech may have relatively small additional effects on academic outcomes and yet that tech programs can substitute atleast to a certain extent for traditional learning.
Maternal Empowerment, Feeding Knowledge, and Infant Nutrition: Evidence from Rural China
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Background: Maternal empowerment - the capacity to make decisions within households - is linked to better child feeding and nutritional outcomes, but few studies have considered the mediating role of caregiver knowledge. Further, existing literature centres primarily on the husband-wife dyad while overlooking grandmothers as important childcare decision-makers.
Methods: We collected primary data through household surveys in 2019 and 2021 from 1190 households with infants zero to six months living in rural western China. We identified the primary and secondary caregivers for each infant and assessed their feeding knowledge and practices, as well as infant nutritional status. We constructed a maternal empowerment index using a seven-item decision-making questionnaire and examined the relationship between maternal empowerment in childcare and household decisions, caregivers' feeding knowledge, and infant feeding practices and nutritional outcomes.
Results: Mothers had significantly higher levels of feeding knowledge than secondary caregivers (most were grandmothers, 72.7%), with average knowledge scores of 5.4 vs. 4.1, respectively, out of 9. Mothers and secondary caregivers with higher levels of feeding knowledge had significantly higher exclusive breastfeeding rates by 13-15 percentage points (P < 0.01) and 11-13 percentage points (P < 0.01), respectively. The knowledge of secondary caregivers was even more strongly associated with not feeding formula (15 percentage points, P < 0.01). Mothers empowered to make childcare decisions were more likely to exclusively breastfeed (12-13 percentage points, P < 0.01), less likely to formula feed (9-10 percentage points, P < 0.05), and more likely to have children with higher Z-scores for length-for-age (0.32-0.33, P < 0.01) and weight-for-age (0.24-0.25, P < 0.05). Effects remained after controlling for maternal feeding knowledge.
Conclusions: While mothers' and grandmothers' feeding knowledge was both important for optimal infant feeding, grandmothers' knowledge was particularly critical for practicing exclusive breastfeeding. Given the disparity in feeding knowledge between the two caregivers, our study further shows that mothers empowered in childcare decision-making were more likely to exclusively breastfeed their infants. This implies that some mothers with adequate knowledge may not practice optimal feeding because of lower decision-making power. Overall, our study highlights the role of secondary caregivers (grandmothers) in infant care and suggests that future child nutritional interventions may benefit from involving secondary caregivers (grandmothers).
General Psychopathology Factor in Chinese Adolescents and its Correlation with Trans-diagnostic Protective Psycho-social Factors
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Background: Comorbidity in mental disorders is prevalent among adolescents, with evidence suggesting a general psychopathology factor (“p” factor) that reflects shared mechanisms across different disorders. However, the association between the “p” factor and protective factors remains understudied. The current study aimed to explore the “p” factor, and its associations with psycho-social functioning, in Chinese adolescents.
Methods: 2052 students, aged 9–17, were recruited from primary and secondary schools in Shanghai, China. Multiple rating scales were used to assess psychological symptoms and psycho-social functioning. Confirmatory factor analysis was conducted to verify the fit of models involving different psychopathology domains such as externalizing, internalizing, and the “p” factor. Subsequently, structural equation models were used to explore associations between the extracted factors and psycho-social functioning, including emotion regulation, mindful attention awareness, self-esteem, self-efficacy, resilience, and perceived support.
Results: The bi-factor model demonstrated a good fit, with a “p” factor accounting for 46 % of symptom variation, indicating that the psychological symptoms of Chinese adolescents could be explained by internalizing, externalizing, and the “p” factor. Psychologically, a higher “p” was positively correlated with emotion suppression and negatively correlated with mindful attention awareness, emotion reappraisal, self-esteem, and resilience. Socially, a higher “p” was associated with decreased perceived support.
Limitations: Only common symptoms were included as this study was conducted at school. Furthermore, the cross-sectional design limited our ability to investigate causal relationships.
Conclusions: A “p” factor exists among Chinese adolescents. Individuals with higher “p” factor levels were prone to experience lower levels of psycho-social functions.
According to Communist Party discourse, China’s ‘New Era’ began when Xi Jinping was anointed Party boss in 2012. The shape of this New Era became eminently clear in 2023 when Xi commenced his third five-year term as General Secretary of the Party, a fortification of one-man authoritarian rule unprecedented in post-Mao China. Under Xi, the Party has expanded its influence over government, the economy and society. The Party-State is now more Party than State. The year 2023 saw other ‘new eras’ for China as well. Despite initial optimism sparked by the end of COVID-19 restrictions in late 2022, the Chinese economy in 2023 was buffeted by continuing property sector woes, record unemployment, and an unfolding local government debt crisis. Globally, China adopted a series of new and ambitious diplomatic initiatives to woo the Global South and amplify its voice on the world stage. The China Story Yearbook 2023: China’s New Era provides informed perspectives on these and other important stories that will resonate for years to come.
Parenting Style and Child Mental Health at Preschool Age: Evidence from Rural China
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Background
Mental health problems among children at preschool age are a common issue across the world. As shown in literature, a caregiver’s parenting style can play a critical role in child development. This study aims to examine the associations between a caregiver’s parenting style and the mental health problems (or not) of their child when he/she is at preschool age in rural China.
Methods
Participants were children, aged 49 to 65 months, and their primary caregivers. The primary caregivers of the sample children completed the Parenting Styles and Dimensions Questionnaire, Short Version, the Strengths and Difficulties Questionnaire, and a questionnaire that elicited their socio-demographic characteristics. The level of cognitive development of each sample child was assessed using the Wechsler Preschool and Primary Scale of Intelligence, Fourth Edition. Pearson correlation analysis, linear regression analysis, and multivariable regression analysis were used to analyze the data.
Results
The prevalence of mental health problems among sample children at preschool age was high (31.6%). If a caregiver practices an authoritative parenting style, it was found to be negatively associated with the mental health problems of their child. In contrast, a caregiver’s authoritarian parenting style was positively associated with the mental health problems of their child. Compared to those in a subgroup of primary caregivers that used a combination of low authoritative and low authoritarian parenting style, primary caregivers that used a combination of high authoritarian and low authoritative or a combination of high authoritative and high authoritarian were found to have positive association with child health problems. A number of demographic characteristics were found to be associated with the adoption of different parenting styles.
Conclusion
Different parenting styles (including authoritative, authoritarian, and combination of authoritative and authoritarian) of the sample caregivers had different associations with the mental health problems of the sample children. Parenting programs that aim to improve the parenting styles (favoring authoritative parenting styles) should be promoted in an effort to improve the status of child mental health in rural China.
Caregivers’ Parenting Beliefs, Practices, and Child Developmental Outcomes: Evidence from Randomized Controlled Trials in Rural China
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To better understand the impacts of parenting interventions (e.g., parental training of psychosocial stimulating activities) on child developmental outcomes and design effective policies to benefit young children, it is essential to identify the mechanisms through which the interventions work. To this end, this paper presents the results of two randomized controlled trials that offered home visitation, parenting trainings to 435 households (with 527 households as the control group) in 174 villages across three provinces in China. The findings from the randomized controlled trials showed that the interventions significantly improved child cognitive development and had a positive effect on the primary caregivers’ parenting practices and their parenting beliefs. The analysis suggests three possible mechanisms through which the parenting interventions affected child cognitive development: changing the parenting beliefs of the primary caregivers, shifting the parenting practices of the primary caregivers, and improving the primary caregivers’ parenting beliefs, thus fostering better parenting practices.
Willingness-to-pay for Early Childhood Development: A Field Experiment in Western China
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Given the size of the problem and the scientific evidence that timely intervention can improve long-term outcomes, an important question is how to best scale-up early childhood development (ECD) interventions in low- and middle-income countries (LMICs). A key component of the solution is financing. However, there has been little research on the question of whether cost-sharing models can equitably and sustainably finance ECD programs at scale in LMICs. We built parenting centers in two rural communities of Western China to teach caregivers how to stimulate child development through fun and interactive activities. We used the Becker-Degroot-Marschak (BDM) mechanism to elicit the household willingness-to-pay (WTP) for a one-month pass to the parenting centers. The results of the BDM suggest that a cost-sharing model would not be suitable for China's rural population at least in the short-run. Demand was found to be highly elastic. In addition, we found limited evidence of selection effects. We also found no evidence of sunk-cost effects.
English Language Requirement and Educational Inequality: Evidence from 16 Million College Applicants in China
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This paper studies the unintended effect of English language requirement on educational inequality by investigating how the staggered rollout of English listening tests in China’s high-stakes National College Entrance Exam (NCEE) affected the rural-urban gap in college access. Leveraging administrative data covering the universe of NCEE participants between 1999 and 2003, we find that the introduction of English listening tests significantly lowered rural students’ exam score percentile ranks relative to their urban counterparts, resulting in a 30% increase in the rural-urban gap in college access. Our back-of-the-envelope calculations suggest that, as a result of this policy change, more than 54,000 rural students lost college seats to their urban peers between 1999 and 2003, and another 11,000 rural students who elite colleges could have admitted ended up in non-elite colleges, causing them significant future income losses.
Process Quality, Diagnosis Quality, and Patient Satisfaction of Primary Care in Rural Western China: A Study Using Standardized Pateints
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Objectives
Patient satisfaction is an essential indicator of the doctor-patient relationship. This study aimed to investigate the relationship between primary care quality and patient satisfaction for non-communicable diseases (NCDs) in rural western China.
Methods
The study utilized the standardized patients (SPs) approach to present typical symptoms of unstable angina and diabetes to rural healthcare providers. After the consultations, the SPs completed a satisfaction survey. Ordinary least squares and quantile regression were used to examine the association between quality of primary care and patient satisfaction.
Results
We examined 178 anonymous SPs visits. The results showed that higher process quality for angina SPs was correlated with stronger satisfaction for provider ability at a low quantile of ability satisfaction. For diabetes SPs, higher process quality increased overall satisfaction at a low quantile of overall satisfaction, whereas a correct diagnosis significantly contributed to communication satisfaction at a high quantile of communication satisfaction.
Conclusions
The study found positive associations between process and diagnosis quality and SPs satisfaction. Notably, the influence of process quality was most significant among patients with lower satisfaction levels.
Supporting Cognitive Catch-up: The Effects of Cluster-randomized Psychosocial Stimulation Interventions on Preterm Low Birthweight Children in Rural China
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Improved survival of preterm low birthweight (LBW) infants due to advances in neonatal care has brought issues such as postnatal development trajectories to the foreground. This study pools evidence from three cluster-randomized experiments evaluating community-based psychosocial stimulation programs conducted from 2014 to 2017 that included 3571 rural Chinese children aged 6–24 months (51.1% male, 96.2% Han Chinese). The risk of severe cognitive delay was found to be 26.5 percentage points higher for preterm LBW children than for their peers at age 2.5, with a prevalence rate of 48.3%. Results show that psychosocial stimulation interventions can improve child cognitive development at scale, with beneficial impacts on child cognition disproportionately larger for preterm LBW children, helping them to catch up developmentally.
The Medium-term Impact of a Micronutrient Powder Intervention on Anemia among Young Children in Rural China
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Background
Poor development of young children is a common issue in developing countries and it is well established that iron deficiency anemia is one of the risk factors. Research has shown that iron deficiency is a common micronutrient deficiency among children in rural China and can result in anemia. A previous paper using data from the same trial as those used in the current study, but conducted when sample children were younger, found that after 6 months of providing caregivers of children 6–11 months of age free access to iron-rich micronutrient powder (MNP) increased the hemoglobin concentrations (Hb) of their children. However, no effects were found 12 and 18 months after the intervention. The current study followed up the children four years after the start of the original intervention (when the children were 4–5 years old) and aims to assess the medium-term impacts of the MNP program on the nutritional status of the sample pre-school-aged children, including their levels of Hb, the prevalence of anemia, and the dietary diversity of the diets of the children.
Methods
At baseline, this study sampled 1,802 children aged 6–11 months in rural Western China. The intervention lasted 18 months. In this medium-term follow-up study that successfully followed 81% (n = 1,464) of children (aged 49–65 months) from the original study population 4 years after the start of the intervention, we used both intention-to-treat (ITT) effect and average treatment on the treated effect (ATT) analyses to assess the medium-term impacts of the MNP distribution program on the nutritional status of sample children.
Results
The ITT analysis shows that the MNP intervention decreased the prevalence of anemia of young children in the medium run by 8% (4 percentage points, p < 0.1). The ATT analysis shows that consuming 100 (out of 540) MNP sachets during the initial intervention led to a decrease in anemia of 4% (2 percentage points, p < 0.1). Among children with moderate anemia at baseline (Hb < 100 g/L), the intervention reduced the probability of anemia by 45% (9 percentage points, p < 0.1), and, for those families that complied by consuming 100 (out of 540) sachets, a 25% (5 percentage points, p < 0.05) reduction in the anemia rate was found. The MNP intervention also led to a persistent increase in dietary diversity among children that were moderately anemic at baseline. The results from the quantile treatment effect analysis demonstrated that children with lower Hb levels at baseline benefited relatively more from the MNP intervention.
Conclusions
The findings of the current study reveal that the MNP intervention has medium-term effects on the nutritional status of children in rural China. The impacts of the MNP program were relatively higher for children that initially had more severe anemia levels. Hence, the implications of this study are that programs that aim to increase caregiver knowledge of nutrition and improve their feeding practices should be encouraged across rural China. Families, policymakers, and China’s society overall need to continue to pay more attention to problems of childhood anemia in rural areas. This is particularly crucial for families with moderately anemic children at an early age as it can significantly contribute to improving the anemia status of children across rural areas of China.
Depression, Anxiety, Stress Symptoms and their Determinants among Secondary Students with Vision Impairment in Rural Northwestern China during the COVID-19 Pandemic
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Objective: The measures implemented to control the spread of Coronavirus disease 2019 (COVID-19) could affect children’s mental and vision health. Youth particularly from minority and socioeconomically disadvantaged backgrounds were more likely to be impacted by these measures. This study aimed to examine the mental health of children with vision impairment and associated factors in North-western China during the COVID-19 pandemic.
Methods: A cross-sectional study was conducted among 2,036 secondary school children living in Ningxia Hui Autonomous Region. Participants completed a survey on sociodemographic and lifestyle information and answered the Chinese version of the 21-item Depression Anxiety Stress Scales (DASS-21) questionnaire. Presenting visual acuity was measured by a trained enumerator. Multivariate logistic regression analysis was used to identify potential risk factors for mental health problems.
Results: Responses from 1,992 (97.8%) children were included in the analysis after excluding those with incomplete mental health outcome data. The prevalence of depression, anxiety and stress symptoms within the dataset were 28.9, 46.4, and 22.3%, respectively. The distribution of children with different stress levels differed significantly between those with and without vision impairment (p = 0.03). Multivariable logistic regression analyses revealed that depression symptoms decreased with higher parental education (OR, 0.76, 95% confidence intervals (CI):0.63–0.96), longer sleep duration (OR, 0.90, 95% CI: 0.81–0.97) and longer study time (OR, 0.82, 95% CI: 0.74–0.91), whereas they increased with higher recreational screen time (OR, 1.19, 95% CI: 1.08–1.32). Anxiety symptoms decreased with higher parental education (OR, 0.80, 95% CI: 0.66–0.96) and increased with higher recreational screen time (OR, 1.15, 95% CI: 1.04–1.27) and being a left-behind child (OR, 1.26, 95% CI: 1.04–1.54). In addition, stress symptoms decreased with longer sleep duration (OR, 0.92, 95%CI: 0.85–0.99) and increased with higher number of siblings (OR, 1.10, 95% CI: 1.01–1.19), higher recreational screen time (OR, 1.15, 95% CI: 1.04–1.28) and older age (OR,1.12, 95% CI: 1.004–1.24).
Conclusion: A considerable proportion of our sample experienced mental health problems during the pandemic. Healthcare planners in China should consider interventions such as reducing recreational screen time, ensuring sufficient sleep, and timely detection of mental health symptoms among socioeconomically disadvantaged groups.
Measurement of Flourishing: A Scoping Review
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Flourishing is an evolving wellbeing construct and outcome of interest across the social and biological sciences. Despite some conceptual advancements, there remains limited consensus on how to measure flourishing, as well as how to distinguish it from closely related wellbeing constructs, such as thriving and life satisfaction. This paper aims to provide an overview and comparison of the diverse scales that have been developed to measure flourishing among adolescent and adult populations to provide recommendations for future studies seeking to use flourishing as an outcome in social and biological research. We find that most common scales used to measure flourishing are multi-dimensional and assess features over monthly or yearly intervals, and many have been translated and validated across multiple geographical contexts, including higher- and lower-income countries. Complementing self-report measures with other social, economic, regional, and biological indicators of flourishing may provide a holistic and widely applicable measure of wellbeing that could guide strategies to sustain flourishing societies.
Generalizable Evidence that Computer Assisted Learning Improves Student Learning: A Systematic Review of Education Technology in China
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Despite the proliferation of education technologies (EdTech) in education, past reviews that examine their effectiveness in the context of low- and middle-income countries are few and rarely seek to include studies published in languages other than English. This systematic review investigates the effectiveness of educational technology on primary and secondary student learning outcomes in China via a systematic search of both English- and Chinese-language databases. Eighteen (18) unique studies in 21 manuscripts on the effectiveness of EdTech innovations in China met the eligibility criteria. The majority of these evaluate computer aided self-led learning software packages designed to improve student learning (computer assisted learning, CAL), while the rest evaluate the use of education technology to improve classroom instruction (ICI) and remote instruction (RI). The pooled effect size of all included studies indicates a small, positive effect on student learning (0.13 SD, 95% CI [0.10, 0.17]). CAL used a supplement to existing educational inputs – which made up the large majority of positive effect sizes – and RI programs consistently showed positive and significant effects on learning. Our findings indicate no significant differences or impacts on the overall effect based on moderating variables such as the type of implementation approach, contextual setting, or school subject area. Taken together, while there is evidence of the positive impacts of two kinds of EdTech (supplemental computer assisted learning and remote instruction) in China, more evidence is needed to determine the effectiveness of other approaches.
Despite rapid economic growth in China since 1978, rural-urban inequality has widened. High levels of socioeconomic inequality can have profound implications for child development and lifelong educational equity. Using a dataset containing early childhood development (ECD) outcomes of 0- to 3-year-olds (N = 9,053) from study sites in Eastern, Central, and Western China, the study finds that the risks of cognitive, language, and motor delay are, respectively, 43.2, 18.3, and 20.7 percentage points higher in rural study sites than in urban Shanghai (ps < .01). Impact evaluation of cluster-randomized experiments shows that parental training (focusing on child psychosocial stimulation and caregiverchild interaction) can improve parenting beliefs and practices (or investments) and ECD outcomes of disadvantaged rural children (p < .01). Such programs can play an important role in advancing progress toward more social equality and economic equity, the stated goals of China’s “Common Prosperity” policy.
Keywords: early childhood development, Common Prosperity, rural-urban inequality, intergenerational transmission of disadvantage, parental training, parenting beliefs and practices
Market Structure, Resource Allocation, and Industry Productivity Growth: Firm-level Evidence from China's Steel Industry
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Regional monopoly limits market reforms from improving cross-firm resource allocative efficiency, but little empirical evidence is available from developing countries. This paper provides rich evidence that regional monopoly may hinder the expansion of more productive firms, using the Chinese iron and steel sector as a case. Drawing on a comprehensive panel dataset comprising 11,136 iron and steel firms in China from 1998 to 2009, we demonstrate that market reforms in China's steel industry enhance competition at the national level, but do not effectively improve resource reallocation within provinces. Despite a decline in the market share of the top 10 largest steel enterprises from 80% to 50% between 1998 and 2009, resource reallocation only contributes to 14% of industry-level total factor productivity (TFP) growth, amounting to one-sixth of the contribution from within-firm productivity growth. Furthermore, the effects of resource reallocation within provinces are significantly lower compared to those observed between provinces, suggesting that market fragmentation or frictions hinder the expansion of more productive firms within the same province. These findings underscore the importance of eliminating regional monopoly for developing countries undergoing market reforms to enhance resource allocative efficiency.