Publications

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.

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.

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 at least to a certain extent for traditional learning.

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).

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.

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.

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.

A growing body of literature explores the effect of higher education on the urban–rural divide in China. Despite an increasing number of rural students gaining access to college, little is known about their performance in college or their job prospects after graduation. Using nationally representative data from over 40,000 urban and rural college students, we examine rural students’ college performance and estimate the impact of rural status on students’ first job wages in comparison to their urban peers. Our results indicate that once accepted into college, rural students perform equally as well, if not better, than their urban counterparts. Additionally, we discovered that rural students earn a 6.2 per cent wage premium compared to their urban counterparts in their first job after graduation. Our findings suggest the importance of expanding access to higher education for rural students, as it appears to serve as an equalizer between urban and rural students despite their significantly different backgrounds.

We study how an elite college education affects social mobility in China. China provides an interesting context because its college admissions rely mainly on the scores of a centralized exam, a system that has been the subject of intense debate. Combining the data from a large-scale college graduate survey and a nationally representative household survey, we document three main findings.First, attending an elite college can change one’s fate to some extent. It raises the child’s rank in the income distribution by almost 20 percentiles. Nevertheless, it does not change the intergenerational relationship in income ranks or guarantee   one’s entry into an elite occupation or industry. Second, while elite college access rises with parental income, the disparity is less pronounced in China than in the United States. In China, top-quintile children are 2.3 times more likely to attend an elite college compared to bottom-quintile children, versus an 11.2-fold difference in the U.S. Third, the score-based cutoff rule in elite college admission is income neutral. Overall, these findings reveal both the efficacy and limitations of China’s elite colleges in shaping social mobility.

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.

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.

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.

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.

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.

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.

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.

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 caregiver-child 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

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.

Breastfeeding self-efficacy (BSE), defined as a mother’s confidence in her ability to breastfeed, has been confirmed to predict the uptake of exclusive breastfeeding (EBF). Early experiences during the birth hospital stay, especially in-hospital formula feeding (IHFF), can impact both EBF and maternal breastfeeding confidence. Therefore, our objective was to examine the association between IHFF and EBF outcomes and investigate whether this association is influenced by BSE. The study included 778 infants from a larger cohort study conducted in 2021, with a one-year follow-up in rural areas of Sichuan Province, China. We used a causal mediation analysis to estimate the total effect (TE), natural direct (NDE), and nature indirect effects (NIE) using the paramed command in Stata. Causal mediation analyses revealed that IHFF was negatively associated with EBF (TE odds ratio = 0.47; 95% CI, 0.29 to 0.76); 28% of this association was mediated by BSE. In the subgroup analysis, there were no significant differences in the effects between parity subgroups, as well as between infant delivery subgroups. Our study found that IHFF hindered later EBF and that BSE mediated this association. Limiting the occurrence of in-hospital formula feeding or improving maternal breastfeeding self-efficacy is likely to improve exclusive breastfeeding outcomes.

The objective of the current study is to examine the impact of an in-school computer-assisted learning (CAL) intervention on the math achievement of rural students in Taiwan, including a marginalized subgroup of rural students called Xinzhumin, and the factors associated with this impact. In order to achieve this, we conducted a cluster randomized controlled trial involving 1,840 fourth- and fifth-grade students at 95 schools in four relatively poor counties and municipalities of Taiwan during the spring semester of 2019. While the Intention-To-Treat (ITT) analysis found that the CAL intervention had no significant impacts on student math achievement, the Local Average Treatment Effect (LATE) analysis revealed significant associations with the math performance of the most active 20% of students in the treatment group. LATE estimates suggest that using CAL for more than 20 minutes per week for ten weeks corresponds to higher math test scores, both in general (0.16 SD–0.22 SD), and for Xinzhumin students specifically (0.3 SD–0.34 SD). Teacher-level characteristics were associated with compliance rates.

Objective To investigate factors that differentiate elderly adults in rural China who accept free vision screening and cataract surgery from those who could benefit from vision care but refuse it when offered.

Design We conducted a population-based, cross-sectional study between October and December 2016. Logistic regression models were used to examine the predictors of accepting free vision screening and cataract surgery.

Setting Rural communities in Handan, China.

Participants Adults aged 50 years or older, with presenting visual acuity ≤6/18 in the better seeing eye, suspected by examining ophthalmologist to be due to cataract.

Results Among 613 persons with cataract identified on a population basis, 596 (97.2%) completed the household survey (mean (SD) age, 71.5 (10.0) years; 79.8% female). A total of 214 persons (35.9%) refused participation, while 382 (64.1%) took part in the vision screening. A total of 193 (50.5%) participants were found eligible for surgery, while 189 (49.5%) were not. Among 99 randomly selected participants who were offered immediate free surgery, surgery was accepted by 77 participants (77.8%) and refused by 22 (22.2%). In the multivariate model, being engaged in income-generating activities (p<0.01), self-reported better physical capacity (p<0.001) and having had a recent physical examination (p=0.01) were significantly associated with acceptance of vision screening. The only variable significantly associated with acceptance of surgery was presenting visual acuity, with better vision inversely associated with acceptance of surgery (p<0.05) models.

Conclusion Our results suggest that refusal of basic eye examinations may be at least as important a determinant of low surgical rates in rural China as lack of acceptance of surgery itself.

At SCCEI, we aim to shed some light on what actually is happening in China, and exactly how these happenings might affect the rest of the world. This year has been one of unprecedented growth for SCCEI, take a look at our 2022-23 Annual Report to see all of the incredible work and accomplishments we have achieved together. Download your copy or read it online.

In low- and middle-income countries, urbanization has spurred the expansion of peri-urban communities, or urban communities of formerly rural residents with low socioeconomic status. The growth of these communities offers researchers an opportunity to measure the associations between the level of urbanization and the home language environment (HLE) among otherwise similar populations. Data were collected in 2019 using Language Environment Analysis observational assessment technology from 158 peri-urban and rural households with Han Chinese children (92 males, 66 females) aged 18–24 months in China. Peri-urban children scored lower than rural children in measures of the HLE and language development. In both samples, child age, gender, maternal employment, and sibling number were positively correlated with the HLE, which was in turn correlated with language development.