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Matthew Boswell
Journal Articles

Depressive and Anxiety Symptoms among Children and Adolescents in Rural China: A Large-Scale Epidemiological Study

Qi Jiang, Xinshu She, Sarah-Eve Dill, Sean Sylvia, Manpreet Kaur Singh, Huan Wang, Matthew Boswell, Scott Rozelle
International Journal of Environmental Research and Public Health, 2022 April 20, 2022

Although children living in low- and middle-income countries (LMICs) account for 90% of the global population of children, depression, and anxiety among children in LMICs have been understudied. This study examines the prevalence of depression and anxiety and their associations with biological and psychosocial factors among children across China, with a focus on rural areas. We conducted a large-scale epidemiological study of depression and anxiety among 53,421 elementary and junior high school-aged children across China. The results show that 20% are at risk for depression, 6% are at risk for generalized anxiety, and 68% are at risk for at least one type of anxiety. Girls and junior high school students show a higher risk for both depression and anxiety symptoms, while socioeconomic status has varying associations to depression and anxiety symptoms. Our results also show consistent correlations between depression and anxiety symptoms and standard math test scores. These findings underscore the importance of identification, prevention, and treatment of youth depression and anxiety in underdeveloped areas. As China constitutes 15% of the global population of children under age 18, this study offers valuable information to the field of global mental health.

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Journal Articles

Exploring Teacher Job Satisfaction in Rural China: Prevalence and Correlates

Huan Wang, Claire Cousineau, Bill Wang, Lucy Zeng, Andrew Sun, Ezra Kohrman, Nick Li, Esther Tok, Matthew Boswell, Scott Rozelle
International Journal of Environmental Research and Public Health, 2022 March 16, 2022

Extant research continues to establish the importance of teacher job satisfaction to student performance, yet teacher job satisfaction remains under-investigated in rural China. In this paper, we examine the prevalence and correlates of teacher job satisfaction. Using data from 634 teachers across 120 schools in rural China, we find an alarmingly high prevalence of teacher job dissatisfaction: roughly 21% of rural teachers were less than satisfied with their jobs. In addition, we find that several individual- and school-level characteristics, including being a male teacher, being a homeroom teacher, not having a management role in school, being a middle-aged teacher, and a school’s boarding status, are correlated with teacher job dissatisfaction. In sum, the results demonstrate a need for further research and policy interventions to improve teacher job satisfaction in rural schools.

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Journal Articles

Off the COVID-19 Epicentre: The Impact of Quarantine Controls on Employment, Education and Health in China's Rural Communitites

Huan Wang, Sarah-Eve Dill, Huan Zhou, Yue Ma, Hao Xue, Prashant Loyalka, Sean Sylvia, Matthew Boswell, Jason Lin, Scott Rozelle
The China Quarterly, 2022 March 9, 2022

This study documents the COVID-19 disease-control measures enacted in rural China and examines the economic and social impacts of these measures. We conducted two rounds of surveys with 726 randomly selected village informants across seven provinces. Strict disease-control measures have been universally enforced and appear to have been successful in limiting disease transmission in rural communities. The infection rate in our sample was 0.001 per cent, a rate that is near the national average outside of Hubei province. None of the villages reported any COVID-19-related deaths. For a full month during the quarantine, the rate of employment of rural workers was essentially zero. Even after the quarantine measures were lifted, nearly 70 per cent of the villagers still were unable to work owing to workplace closures. Although action has been taken to mitigate the potential negative effects, these disease-control measures might have accelerated the inequality between rural and urban households in China.

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Journal Articles

Gender Equity in Vision Care Seeking Behavior Among Caregivers: Evidence from a Randomized Controlled Trial in Rural China

Huan Wang, Claire Cousineau , Yingjie Fan, Sarah-Eve Dill, Matthew Boswell, Scott Rozelle, Xiaochen Ma
International Journal for Equity in Health, 2022 February 19, 2022

Background

Despite rising incomes and rapid economic growth, there remains a significant gender gap in health outcomes among rural children in China. This study examines whether the gender gap in child health is related to the behavior of caregivers when seeking healthcare, and whether healthcare subsidies help to bridge the gender gap in rural health outcomes.

Methods

Focusing on vision care specifically, we draw on data from a randomized controlled trial of 13,100 children in Gansu and Shaanxi provinces in China that provided subsidized eyeglasses to myopic children in one set of schools (henceforth, referred to as the treatment schools) and provided prescription information but not subsidized eyeglasses to myopic children in another set of schools (control schools).

Results

The baseline results reveal that while female students generally have worse vision than male students, they are significantly less likely than male students to be taken by their caregivers to a vision exam. The experimental results indicate, however, that caregivers respond positively to both health information and subsidized healthcare, regardless of the gender of their children. When prescription information is paired with a subsidy voucher for healthcare (a free pair of eyeglasses), the uptake rate rises dramatically.

Conclusions

The gender gap in healthcare can be minimized by implementing subsidized healthcare policies.

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Journal Articles

Bullying Victims in Rural Primary Schools: Prevalence, Correlates, and Consequences

Huan Wang, Jingjing Tang, Sarah-Eve Dill, Jiusi Xiao, Matthew Boswell, Claire Cousineau, Scott Rozelle
International Journal of Environmental Research and Public Health, 2022 January 11, 2022

School bullying is a widely recognized problem in developed countries, but remains under-investigated in developing countries, especially in remote rural areas. In this paper, we examine the prevalence, correlates, and consequences of bullying victimization and its relation to educational performance and creative attitudes. Using data from 10,528 students across 120 primary schools in rural China, we find an alarmingly high prevalence of bullying victimization and that several individual, family, and school characteristics are correlated with bullying victimization. Analyses indicate students who are bullied frequently score lower in Chinese, reading, and math tests and creative attitudes. Taken together, the results demonstrate a need for further research and policy interventions to reduce bullying in schools.

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Journal Articles

Attention Deficit Hyperactivity Disorder (ADHD) among Elementary Students in Rural China: Prevalence, Correlates, and Consequence

Xiaodong Pang, Huan Wang, Sarah-Eve Dill, Matthew Boswell, Xiaopeng Pang, Manpreet Singh, Scott Rozelle
Journal of Affective Disorders, 2021 June 18, 2021

Background: Attention deficit hyperactivity disorder (ADHD) is a widely recognized mental health problem in developed countries but remains under-investigated in developing settings. This study examines the prevalence, correlates, and consequences of ADHD symptoms among elementary school students in rural China.

Methods: Cross-sectional data were collected from 6,719 students across 120 rural primary schools in China on ADHD symptoms, demographic characteristics, and academic performance in reading and math. ADHD symptoms were evaluated using the caregiver-reported ADHD Rating Scale-IV.

Results: The prevalence of ADHD symptoms was 7.5% in our sample. Male students, students in lower grade levels, and students with lower cognitive ability showed a significantly higher prevalence of ADHD symptoms (ORs = 2.56, 2.06, and 1.84, respectively; p<0.05). Left-behind children showed a significantly lower prevalence of ADHD symptoms than did children who were living with their parents (OR = 0.74, p < 0.05). Adjusted regressions show that students with ADHD symptoms scored 0.12 standardized deviations lower in reading (p < 0.05) and 0.19 standardized deviations lower in math (p < 0.01).

Limitations: The ADHD Rating Scale-IV is a screening scale rather than a diagnostic test. Caregiver self-report measures also may underestimate ADHD symptoms for our sample.

Conclusions: ADHD is a common disorder among rural students in China and appears to be contributing to poor academic outcomes. The higher prevalence of ADHD among students with low cognitive ability also suggests that many rural children in China face multifactorial learning challenges. Taken together, the findings indicate a need for educators and policymakers in rural China to develop programs to reduce risk and support students with ADHD symptoms.

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Journal Articles

Complicating China’s Rise: Rural Underemployment

Scott Rozelle, Matthew Boswell
The Washington Quarterly, 2021 June 17, 2021

China’s economy has doubled in size every eight years since 1979, making it over 32 times bigger now then it was then and the second largest in the world today.1 Four decades of growth have ushered more than 400 million people in China into the global middle class.2 According to the World Bank, China is currently an upper middle-income country. The country is the only major economy on earth to report growth in 2020 in the wake of the coronavirus pandemic.3 What are the prospects for China to continue its spectacular economic rise and become a high-income country? In this article, we aim to draw attention to an underappreciated factor that we believe may complicate China’s continued economic ascent: hundreds of millions of poorly educated, increasingly underemployed workers hailing from China’s rural hinterland.

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Journal Articles

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

Huan Wang, Sarah-Eve Dill, Huan Zhou, Yue Ma, Hao Xue, Sean Sylvia, Kumi Smith, Matthew Boswell, Alexis Medina, Prashant Loyalka, Cody Abbey, Dimitris Friesen, Nathan Rose, Yian Guo, Scott Rozelle
Agricultural Economics, 2021 May 11, 2021

This study examines the effects of local and nationwide COVID‐19 disease control measures on the health and economy of China's rural population. We conducted phone surveys with 726 randomly selected village informants across seven rural Chinese provinces in February 2020. Four villages (0.55%) reported infections, and none reported deaths. Disease control measures had been universally implemented in all sample villages. About 74% of informants reported that villagers with wage‐earning jobs outside the village had stopped working due to workplace closures. A higher percentage of rural individuals could not work due to transportation, housing, and other constraints. Local governments had taken measures to reduce the impact of COVID‐19. Although schools in all surveyed villages were closed, 71% of village informants reported that students were attending classes online. Overall, measures to control COVID‐19 appear to have been successful in limiting disease transmission in rural communities outside the main epidemic area. Rural Chinese citizens, however, have experienced significant economic consequences from the disease control measures.

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Journal Articles

Tracking the Effects of COVID-19 in Rural China Over Time

Huan Wang, Markus Zhang, Robin Li, Oliver Zhong, Hannah Johnstone, Huan Zhou, Hao Xue, Sean Sylvia, Matthew Boswell, Prashant Loyalka, Scott Rozelle
International Journal for Equity in Health, 2021 January 14, 2021
Background: China issued strict nationwide guidelines to combat the COVID-19 outbreak in January 2020 and gradually loosened the restrictions on movement in early March. Little is known about how these disease control measures affected the 600 million people who live in rural China. The goal of this paper is to document the quarantine measures implemented in rural China outside the epicenter of Hubei Province and to assess the socioeconomic effect of the measures on rural communities over time. Methods: We conducted three rounds of interviews with informants from 726 villages in seven provinces, accounting for over 25% of China’s overall rural population. The survey collected data on rural quarantine implementation; COVID-19 infections and deaths in the survey villages; and effects of the quarantine on employment, income, education, health care, and government policies to address any negative impacts. The empirical findings of the work established that strict quarantine measures were implemented in rural villages throughout China in February. Results: There was little spread of COVID-19 in rural communities: an infection rate of 0.001% and zero deaths reported in our sample. However, there were negative social and economic outcomes, including high rates of unemployment, falling household income, rising prices, and disrupted student learning. Health care was generally accessible, but many delayed their non-COVID-19 health care due to the quarantine measures. Only 20% of villagers received any form of local government aid, and only 11% of villages received financial subsidies. There were no reports of national government aid programs that targeted rural villagers in the sample areas. Conclusions: By examining the economic and social effects of the COVID-19 restrictions in rural communities, this study will help to guide other middle- and low-income countries in their containment and restorative processes. Without consideration for economically vulnerable populations, economic hardships and poverty will likely continue to have a negative impact on the most susceptible communities.
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Working Papers

Off the Epicenter: COVID-19 Quarantine Controls and Employment, Education, and Health Impacts in Rural Communities

Huan Wang, Sarah-Eve Dill, Huan Zhou, Yue Ma, Hao Xue, Prashant Loyalka, Sean Sylvia, Matthew Boswell, Jason Lin, Scott Rozelle
2020 October 19, 2020

In late January 2020, China’s government initiated its first aggressive measures to combat COVID-19 by forbidding individuals from leaving their homes, radically limiting public transportation, cancelling or postponing large public events, and closing schools across the country. The rollout of these measures coincided with China’s Lunar New Year holiday, during which more than 280 million people had returned from their places of work to their home villages in rural areas. The disease control policies remained in place until late February and early March, when they were gradually loosened to

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Journal Articles

Independent Reading in Rural China's Elementary Schools: A Mixed-Methods Analysis

Huan Wang, Hongyu Guan, Hongmei Yi, Emma Seevak, Reid Manheim, Matthew Boswell, Scott Rozelle, Sarah Kotb
International Journal of Educational Development, 2020 June 21, 2020
Abstract: Independent reading—unassigned reading for personal pleasure—has been shown to be an important driver of reading skills and academic success. Children that commonly read for pleasure exhibit higher academic performance. However, little research has been done on independent reading in rural China, where the education system is charged with schooling tens of millions of students. Many rural students fall behind their urban counterparts in school, with potentially troubling implications for China’s ongoing development. This article explores the prevalence of independent reading and its associations with reading ability and academic performance among rural students. Using a mixed methods approach, we analyze quantitative data from a survey of 13,232 students from 134 rural schools and interviews with students, teachers, principals, and caregivers. We find that independent reading is positively and significantly correlated with reading ability as well as standardized math and Chinese tests scores. Despite such correlations, only 17 percent of students report reading for pleasure for an hour a day. Interview findings suggest that inaccessible bookstores, curriculum constraints, unsupportive home environments, low availability of appealing and level-appropriate books, and insufficient school investment in reading resources may explain the low prevalence of independent reading.
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Journal Articles

Effect of Chinese Eye Exercises on Change in Visual Acuity and Eyeglasses Wear among School-Aged Children in Rural China: A Propensity-Score-Matched Cohort Study

Huan Wang, Yiwei Qian, Nathan Congdon, Matthew Boswell, Scott Rozelle, Xiaochen Ma
BMC Complementary Medicine and Therapies, 2020 March 13, 2020
Background Daily “eye exercises,” massaging of periocular acupuncture pressure points, have been part of China’s national vision care policy in schools for some 50 years. However, the effect of eye exercises on myopia progression and eyeglasses wear has not been definitively investigated. This study evaluates the effectiveness of eye exercises on visual acuity and the propensity of rural children to wear eyeglasses. Methods Cohort study in 252 randomly-selected rural schools with baseline in September 2012 and follow up surveys 9 and 21 months later. Outcomes were assessed using propensity-score matching (PSM), multivariate linear regression and logistic regression to adjust for differences between children performing and not performing eye exercises. Results Among 19,934 children randomly selected for screening, 2374 myopic (spherical equivalent refractive error ≤ − 0.5 diopters in either eye) children (11.9%, mean age 10.5 [Standard Error 1.08] years, 48.5% boys) had VA in either eye ≤6/12 without eyeglasses correctable to > 6/12 with eyeglasses. Among these who completed the 21-month follow up, 1217 (58.2%) children reported practicing eye exercises on school days and 874 (41.8%) did not. After propensity-score matching, 1652 (79%) children were matched: 826 (50%) in the Eye Exercises group and 826 (50%) in the No Exercise group. Performing eye exercises was not associated with change in LogMAR uncorrected visual acuity and wear of eyeglasses, using either logistic regression or PSM at 9 or 21 months. Conclusions We found no evidence for an effect of eye exercises on change in vision or eyeglasses wear.
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Journal Articles

Visual Impairment and Spectacles Ownership among Upper Secondary School Students in Northwestern China

J Zhao, H Guan, K Du, Huan Wang, Matthew Boswell, Yaojiang Shi, Scott Rozelle, Nathan Congdon, Annie Osborn
Hong Kong Medical Journal, 2020 February 6, 2020
PURPOSE: To assess the prevalence of visual impairment and spectacles ownership among academic and vocational upper secondary school students in rural China. METHODS: This cross-sectional study included 5583 students from four academic upper secondary schools (AUSSs) and two vocational upper secondary schools (VUSSs) in Mei and Qianyang counties, Baoji Prefecture, Shaanxi Province. In March and April 2016, students underwent assessment of visual acuity (VA) and completed a questionnaire regarding spectacles use and family characteristics. Students with visual impairment (presenting VA ≤6/12 in the better eye) and students needing spectacles (uncorrected VA ≤6/12 in the better eye, which could be improved to >6/12 with refraction) were identified. RESULTS: Among 5583 students (54% boys, mean age 16.4±1.0 years) in grades 10 and grade 11 attending AUSSs (n=4549) and VUSSs (n=1034), visual impairment was detected in 4026 students. Among the AUSS students, 3425 (75%) needed spectacles; 2551 (75%) had them. Among the VUSS students, 601 (58%) needed spectacles; this proportion was significantly smaller (P=0.004), as was the proportion who had spectacles (n=212, 35%, P
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Journal Articles

Can School Feeding Programs Reduce Malnutrition in Rural China?

Huan Wang, Qiran Zhao, Matthew Boswell, Scott Rozelle
Journal of School Health, 2019 November 8, 2019
BACKGROUND
Childhood malnutrition is commonplace among poor rural communities in China. In 2012, China launched its first nationwide school‐feeding program (SFP) to address this problem. This study examines the prevalence of malnutrition before and after the SFP and identifies possible reasons for the trends observed.
 
METHODS
Ordinary least squares regression and propensity score matching were used to analyze data from 2 cross‐sectional surveys of 100 rural primary schools in northwestern China. Participants were fourth‐and fifth‐grade students. Outcome measures include anemia rates, hemoglobin levels, body mass index, and height for age Z scores.
 
RESULTS
Three years after implementation of the SFP, malnutrition rates among sample students had not fallen. The SFP had no statistically significant effect on either anemia rates or BMI, but was linked to an increase in the proportion of students with below normal height for age Z scores. Meals provided to students fell far short of national recommendations that the SPF should provide 40% of the recommended daily allowance of micronutrients.
 
CONCLUSIONS
Despite significant budgetary outlays between 2012 and 2015, China's SFP has not reduced the prevalence of malnutrition among sample students. To make the SFP more effective, funding and human resources both need to be increased.
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Working Papers

EdTech for Equity in China: Can Technology Improve Teaching for Millions of Rural Students?

Cody Abbey, Yue Ma, Guirong Li, Matthew Boswell, Claire Cheng, Robert Fairlie, Oliver Lee, Prashant Loyalka, Andrew Mi, Evan Peng, Scott Rozelle, Adrian Sun, Andy Zeng, Jenny Zhao
2019 October 21, 2019

Previous literature suggests subpar teaching is a primary reason why rural Chinese students lag behind academically. We initiate an investigation into the potential of educational technology (EdTech) to increase teaching quality in rural China. First, we discuss why conventional approaches of improving teaching in remote schools are infeasible in China’s context, referring to past research. We then explore the capacity of technology-assisted instruction to improve academic performance by examining previous empirical analyses. Third, we show that China is not limited by the resource constraints of other developing countries due to substantial policy support and a thriving EdTech industry. Finally, we identify potential implementation-related challenges based on the results of a preliminary qualitative survey of pilots of EdTech interventions. With this paper, we lay the foundation for a long-term research investigation into whether EdTech can narrow China’s education gap.

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Journal Articles

Impact of Various Types of Near Work and Time Spent Outdoors at Different Times of Day on Visual Acuity and Refractive Error Among Chinese School-Going Children

Hongyu Guan, Ning Neil Yu, Huan Wang, Matthew Boswell, Yaojiang Shi, Scott Rozelle, Nathan Congdon
PLoS ONe, 2019 April 26, 2019
Background: Various types of near work have been suggested to promote the incidence and progression of myopia, while outdoor activity appears to prevent or retard myopia. However, there is a lack of consensus on how to interpret these results and translate them into effective intervention strategies. This study examined the association between visual acuity and time allocated to various activities among school-going children.
Methods: Population-based survey of 19,934 students in grade 4 and 5 from 252 randomly selected rural primary schools in Northwest China in September 2012. This survey measured visual acuity and collected self-reported data on time spent outdoors and time spent doing various types of near activities.
Results:  Prolonged (>60 minutes/day) computer usage (-0.025 LogMAR units, P = .011) and smartphone usage (-0.041 LogMAR units, P = .001) were significantly associated with greater refractive error, while television viewing and after-school study were not. For time spent outdoors, only time around midday was significantly associated with better uncorrected visual acuity. Compared to children who reported no midday time outdoors, those who spent time outdoors at midday for 31–60 minutes or more than 60 minutes had better uncorrected visual acuity by 0.016 LogMAR units (P = .014) and 0.016 units (P = .042), respectively.
Conclusions: Use of smart phones and computers were associated with declines in children’s vision, while television viewing was not. Statistically significant associations between outdoor time at midday and reduced myopia may support the hypothesis that light intensity plays a role in the protective effects of outdoor time.
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Journal Articles

The Effect of Providing Free Eyeglasses on Children's Mental Health Outcomes in China: A Cluster-Randomized Controlled Trial

Hongyu Guan, Huan Wang, Kang Du, Jin Zhao, Matthew Boswell, Yaojiang Shi, Yiwei Qian
International Journal of Environmental Research and Public Health, 2018 December 5, 2018
Abstract: If children with common vision problems receive and use eyeglasses, their educational performance rises. Without proper treatment, visually impaired children may not achieve educational gains and could suffer from poor mental health. We use a randomized controlled trial to study the impact of an eyeglasses promotion program in rural China on the mental health of myopic primary school students. Three measures of mental health are used: learning anxiety, physical anxiety, and scores on the Mental Health Test (MHT). Our empirical analysis showed that on average, the treatment has small and insignificant for learning anxiety and MHT, and a small but significant reduction in physical anxiety. However, subgroup analysis reveals that myopic students who study more intensively see their learning anxiety and physical anxiety reduced after being provided with eyeglasses. In contrast, students with the lower study intensity suffer a rise in learning anxiety after receiving eyeglasses. A potential mechanism for the differing impacts is the increase in teasing reported among low study-intensity students that does not occur for high study-intensity students. Care should be taken to maximize the benefits and minimize the costs of in-school vision programs.
 
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Journal Articles

The Cost-Effectiveness of Alternative Vision Screening Models among Preschool Children in Rural China

Lei Wang, Nathan Congdon, Ruth E. Hogg, Siqi Zhang, Mengjie Li, Yaojiang Shi, Ling Jin, Fei He, Huan Wang, Matthew Boswell, Mony Iyer
Acta Ophthalmologica, 2018 October 21, 2018
PURPOSE: To explore the accuracy and cost-effectiveness of three vision screening models among preschool children in rural China. METHODS: Vision screening was carried out among children aged 4-5 years in 65 preschools in two counties in Northwest China, using Crowded Single Lea Symbols to test visual acuity. Children were assigned randomly by school to one of three screening models: screening by teachers (15 schools, 1835 children), local optometrists (30 schools, 1718 children) or volunteers (20 schools, 2183 children). Children identifying ≥2 symbols incorrectly in either eye failed screening. Accuracy of screening was compared with screenings executed by experienced optometrists among 141 children selected randomly from the three screening models. Direct and indirect costs for each model were assessed. Costs to detect a true case failed screening were estimated. RESULTS: The sensitivity for three models ranged from 76.9% to 87.5%, specificity from 84.9% to 86.7% and standardized positive predictive value from 83.7% to 85.7%. None differed significantly between models. The costs per case detected were $37.53, $59.14 and $52.19 for the teachers, local optometrists and volunteers. In producing the cost estimates for teacher screening and local optometrist screening models, we used a salary payment that was identical for both models (with the salary being equal to that of the optometrist). The teacher screening model was the most cost-effective. CONCLUSION: Accuracy of screening by teachers, local optometrists and volunteers was the same in this setting, but the use of teachers was most cost-effective, reducing the cost per case detected by almost 40%.
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Journal Articles

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

Yue Ma, Nathan Congdon, Yaojiang Shi, Ruth Hogg, Alexis Medina, Matthew Boswell, Scott Rozelle, Mony Iver
JAMA Ophthalmology, 2018 May 10, 2018

Can a county-based vision center increase eyeglasses use and improve school performance among primary schoolchildren in rural China? This cluster randomized clinical trial of 31 schools and 2613 participants showed that children who received eyeglasses earlier in the school year performed significantly better on an end-of-year mathematics test than children who received eyeglasses later in the year, equivalent to half a semester. Provision of free eyeglasses also improved children's use of spectacles.

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Journal Articles

Inequities in the Allocation of Medical Resources in China's Township Health Centers

Yue Ma, Linxiu Zhang, Matthew Boswell
China Agricultural Economic Review , 2016 August 25, 2016

Purpose – The purpose of this paper is to produce a high-quality measure of the nature of healthcare resources available in China’s Township Health Centers (THCs), paying particular attention to equity between high- and low-income areas.

Design/methodology/approach – This study makes use of data from a nearly nationally representative survey in rural China conducted by the Center for Chinese Agricultural Policy at the Chinese Academy of Sciences in 2011. The samples of towns were selected randomly from 25 counties located in five provinces from different regions of China. Data were collected through questionnaires and direct observation.

Findings – The THCs located in rich areas have higher levels of human resources than poor areas. THCs in rich areas also have more fixed assets than those in poor areas. In fact, even though the Chinese Ministry of Health mandates that all THCs have certain basic levels of medical equipment and facilities, many THCs in poor areas do not have them. The allocation of mandated equipment is unequal. 

Practical implications – These findings suggest that Chinas government should pay more attention to THCs located in poor areas, especially in light of new initiatives to improve health care in poor rural areas.

Originality/value – This is the first nationally representative study to employ rigorous empirics to investigate the extent of inequality in allocation of resources within THCs across China.

Keywords China, Health, Inequality, Rural development, Medical resources, Township health centers 

Paper type Research paper 

 

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Journal Articles

The Impact of Integrating ICT with Teaching: Evidence From a Randomized Controlled Trial in Rural Schools in China

Yu Bai, Di Mo, Linxiu Zhang, Matthew Boswell, Scott Rozelle
Elsevier, 2016 February 13, 2016

Recent attention has been placed on whether integrating Information Communication Technology (hereafter, ICT) into education can effectively improve learning outcomes. However, the empirical evidence of the impact of programmes that adopt ICT in schooling is mixed. Theory suggests it may be due to differences in whether or not the ICT pro-grammes are integrated into a teaching programme of a class. Unfortunately, few empirical studies compare the relative effectiveness of programmes that integrate ICT into teaching with the ones that do not. In order to understand the most effective way to design new programmes that attempt to utilize ICT to improve English learning, we conducted a clustered randomized controlled trial (RCT) with some schools receiving ICT that was in-tegrated into the teaching programme of the class; with some schools that received ICT without having it integrated into the teaching programme; and with other schools being used as controls. The RCT involved 6304 fifth grade students studying English in 127 rural schools in rural China. Our results indicate that when the programme is integrated into the teaching programme of a class it is effective in improving student test scores relative to the control schools. No programme impact, however, is found when the ICT programme is not integrated into the teaching program. We also find that when ICT programmes are inte-grated into teaching, the programmes work similarly for students that have either high or low initial (or baseline) levels of English competency. When ICT programmes are not in-tegrated with teaching, they only raise the educational performance of English students who were performing better during the baseline.

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Journal Articles

Computer Technology in Education: Evidence from a Pooled Study of Computer Assisted Learning Programs among Rural Students in China

Weiming Huang, Di Mo, Yaojiang Shi, LInxiu Zhang, Matthew Boswell, Scott Rozelle
China Economic Review, 2015 December 1, 2015
There is a great degree of heterogeneity among the studies that investigate whether computer technologies improve education and how students benefit from them – if at all. The overall goal of this study is to assess the effectiveness of computing technologies to raise educational performance and non-cognitive outcomes and identify what program components are most effective in doing so. To achieve this aim we pool the data sets of five separate studies about computer technology programs that include observations of 16,856 students from 171 primary schools across three provinces in China. We find that overall computing technologies have positive and significant impacts on student academic achievement in both math and in Chinese. The programs are found to be more effective if they are implemented out-of-school, avoiding what appear to be substitution effects when programs are run during school. The programs also have heterogeneous effects by gender. Specifically, boys gain more than girls in Chinese. We did not find heterogeneous effects by student initial achievement levels. We also found that the programs that help students learn math—but not Chinese—have positive impacts on student self-efficacy.
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Journal Articles

Teaching the Language of Wider Communication, Minority Students, and Overall Educational Performance: Evidence from a Randomized Experiment in Qinghai Province, China

Fang Lai, Linxiu Zhang, Qinghe Qu, Xiao Hu, Matthew Boswell, Scott Rozelle
Economic Development and Cultural Change, 2015 May 4, 2015

The education of poor and disadvantaged populations, particularly those from minority subgroups, has been a long-standing challenge to education systems in both developed and developing countries (e.g., World Bank 2001, 2004; Glewwe and Kremer 2006; Planty et al. 2008). For example, over the past decade in the United States the high school dropout rate of Hispanic students has remained at least twice as high as that of white students (Aud et al.

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Journal Articles

The Persistence of Learning Gains from Computer Assisted Learning: Experimental Evidence from China

Di Mo, Linxiu Zhang, Jiafu Wang, Weiming Huang, Yaojiang Shi, Matthew Boswell, Scott Rozelle
Journal of Computer Assisted Learning, 2015 January 11, 2015

Computer assisted learning (CAL) programs have been shown to be effective in improving educational outcomes. However, the existing studies on CAL have almost all been conducted over a short period of time. There is very little evidence on how the impact evolves over time. In response, we conducted a clustered randomized experiment involving 2741 boarding students in 72 rural schools in China to evaluate impacts of CAL programs over the long term. Our results indicate that a CAL program that was implemented for one year and a half increased math scores by 0.25 standard deviations for third graders and 0.26 standard deviations for fifth graders. In addition, we have shown that students gained in math learning in both CAL Phase I (which ran for one semester in spring 2011) and CAL Phase II (which ran for both semesters of the 2011–2012 academic year) programs. By testing for heterogeneous effects, we find that the CAL intervention worked well for both the poorer performing and better performing students in the third and fifth grades.We also find that the third grade girls seem to have improved more than the boys in math in the short term (CAL Phase I).

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Journal Articles

Poor Vision Among China’s Rural Primary School Students: Prevalence, Correlates and Consequences

Hongmei Yi, Linxiu Zhang, Xiaochen Ma, Nathan Congdon, Yaojiang Shi, Xiaopeng Pang, Junxia Zeng, Lei Wang, Matthew Boswell, Scott Rozelle
2015 January 1, 2015

Using a survey of 19,977 children in two provinces, this paper explores the prevalence, correlates and potential consequences of poor vision among children in China's vast but understudied rural areas. We find that 24% of sample students suffer from reduced uncorrected visual acuity in either eye and 16% in both eyes. Poor vision is significantly correlated with individual, parental and family characteristics, with modest magnitudes for all correlates but home province and grade level. The results also suggest a possible adverse impact of poor vision on academic performance and mental health, particularly among students with severe poor vision.

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