REAP Publications

We present evidence from a randomized experiment testing the impacts of a six-month early childhood home-visiting program on child outcomes at school entry. Two and a half years after completion of the program, we find persistent effects on child working memory - a key skill of executive functioning that plays a central role in children's development of cognitive and socio-emotional skills. We also find that the program had persistent effects on parental time investments and preschool enrollment decisions. Children were enrolled earlier and in higher quality preschools, the latter reflecting a shift in preferences over preschool attributes toward quality. Our findings imply an important role for the availability of high-quality subsequent schooling in sustaining the impacts of early intervention programs.

Research in developed countries has found that paternal involvement has positive and significant effects on early childhood development (ECD). Less is known, however, about the state of paternal involvement and its influence on ECD in rural China. Using data collected in Southern China that included 1,460 children aged 6–42 months and their fathers (as well as their primary caregivers), this study examines the association between paternal involvement and ECD. Although the results demonstrate that the average level of paternal involvement is low in rural China, paternal involvement is related to a significant increase in three domains of ECD (cognition, language, and social-emotional skills). Older children benefit significantly more than do younger children from paternal involvement in all domains of ECD. The results also show that, if the mother is the primary caregiver, the mother’s higher educational level and the family’s higher socioeconomic status are positively associated with paternal involvement.

We present the results of a cluster-randomized controlled trial that evaluates the effects of a free, center-based parenting intervention on early cognitive development and parenting practices in 100 rural villages in China. We then compare these effects to a previous trial of a home-based intervention conducted in the same region, using the same parenting curriculum and public service system, accounting for potential differences between the studies. We find that the center-based intervention did not have a significant impact on child development outcomes, but did lead to increases in the material investments, time investments, and parenting skills of caregivers. The average impact of the center-based intervention on child skills and investments in children was significantly smaller than the home-visiting intervention. Analysis of the possible mechanisms suggests that the difference in effects was driven primarily by different patterns of selection into program participation.

Purpose: To determine the prevalence of visual impairment and glasses ownership among Han Chinese and Hui minority junior high school children in Ningxia Hui Autonomous Region, China. 

Design: Population-based cross-sectional study. 

Methods: Vision screening was conducted on 20,376 children (age 12–15 years) in all 124 rural junior high schools in Ningxia. Personal and family characteristics, glasses ownership, and academic performance were assessed through a survey questionnaire and standardized mathematics test, respectively. 

Results: The prevalence of visual acuity (VA) ≤6/12 in either eye was significantly higher among Han (54.5%) than Hui (45.2%) children (P<0.001), and was significantly positively associated with age, female sex, Han ethnicity, parental outmigration for work, shorter time spent outside during recess, shorter time spent watching television and higher time spent studying. Among children with VA≤6/12 in both eyes, only 56.8% of Han and 41.5% of Hui children had glasses (P<0.001). Glasses ownership was significantly associated with worse vision, greater family wealth, female sex, higher test scores, age, parental outmigration for work, understanding of myopia and glasses, higher time spent studying and Han ethnicity. 

Conclusion: One of the first of its kind, this report on Han and Hui ethnic schoolchildren confirms a high prevalence of visual impairment among both populations, but slightly higher among the Han. Both groups, especially the Hui, have low rates of glasses ownership. Future interventions and policies designed to improve glasses usage should focus on populations with lower incomes and seek to correct erroneous beliefs about the safety of glasses and efficacy of traditional eye exercises.

Introduction: Inadequate care during early childhood can lead to long-term deficits in skills. Parenting programmes that encourage investment in young children are a promising tool for improving early development outcomes and long-term opportunities in low-income and middle-income regions, such as rural China.

Methods: We conducted a systematic review and a meta-analysis to investigate the prevalence of early developmental delays and stimulating parenting practices as well as the effect of parental training programmes on child development outcomes in rural China. We obtained data in English from EconPapers, PubMed, PsycARTICLES, Cochrane Library, Web of Science and Scopus (Elsevier) and in Chinese from China National Knowledge Infrastructure, Wanfang Data and VIP Information. We conducted frequentist meta-analyses of aggregate data and estimated random-effects meta-regressions. Certainty of evidence was rated according to the Grading of Recommendations Assessment, Development and Evaluation approach.

Results: We identified 19 observational studies on the prevalence of developmental delays and stimulating parenting practices for children under 5 years of age (n=19 762) and ten studies on the impact of parental training programmes on early child development (n=13 766). Children’s risk of cognitive, language and social-emotional delays in the rural study sites (covering 14 provinces mostly in Central and Western China) was 45%, 46%, and 36%, respectively. Parental training programmes had a positive impact on child cognition, language and social-emotional development.

Conclusion: There is evidence to suggest that early developmental delay and the absence of stimulating parenting practices (ie, reading, storytelling and singing with children) may be prevalent across rural, low-income and middle-income regions in Central and Western China. Results support the effectiveness of parental training programmes to improve early development by encouraging parental engagement.

Objective: Consultation length, the time spent between patient and health care provider during a visit, is an essential element in measuring quality of health care patients receive from a primary care facility. However, the linkage between consultation length and process quality and diagnosis quality of primary care is still uncertain. This study aims to examine the role consultation length plays in delivering process quality and diagnosis quality, two central components of overall primary care quality, in rural China.

Methods: We recruited unannounced standardized patients (SPs) to present classic symptoms of angina and tuberculosis in selected healthcare facilities in three provinces of China. The consultation length and primary care quality of SPs were measured and compared with both international and national standards of care. Ordinary Least Squares (OLS) regressions for process quality (continuous dependent variable) and Logistic regressions for diagnosis quality (binary dependent variable) were performed to investigate the relationship between consultation length and primary care quality.

Results: The average consultation lengths among patients with classic symptoms of angina and those with symptoms of tuberculosis were approximately 4.33 min and 6.28 min, respectively. Providers who spent more time with patients were significantly more likely to complete higher percentage of recommended checklist items of both questions and examinations for angina (β = 1.39, 95%CI 1.01–1.78) and tuberculosis (β = 0.89, 95%CI 0.69–1.08). Further, providers who spent more time with patients were more likely to make correct diagnosis for angina (marginal effect = 0.014, 95%CI 0.002–0.026) and for tuberculosis (marginal effect = 0.013, 95%CI 0.005–0.021).

Conclusions: The average consultation length is extremely short among primary care providers in rural China. The longer consultation leads to both better process and diagnosis quality of primary care.

Practice Implications: We recommend primary care providers to increase the length of their communication with patients. To do so, government should implement healthcare reforms to clarify the requirements of affordable and reliable consultation length in medical care services. Moreover, such an experience can also be extended to other developing countries.

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.

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.

Scott Rozelle, Yuqing Zheng, and Chengfang Liu were the guest editors of this special issue on agriculture, the rural economy and China's growth in the 21st century. Scott Rozelle also authored a publication in this issue.

This study examines the prevalence of cognitive delay among infants and toddlers in rural China and its relationship with one of the potential sources of the observed delay: low levels of stimulating parenting practices (SPPs). Data were compiled from five distinct studies, resulting in a pooled sample of 4436 caregivers of 6–29-month-old infants. The sampling sites span five provinces in rural China. According to the data, on average, rates of delay are high—51 percent. The low rates of SPPs among our sample demonstrate that this may be one source of the high prevalence of delays. The results of the multivariate regression analysis reveal that reading books and singing songs are each significantly associated with an increase in infant cognitive score by 1.62 points (p = 0.003) and 2.00 points (p < 0.001), respectively. Telling stories to infants, however, is not significantly associated with infant cognitive scores. Our findings indicate that caregivers with different characteristics engage in various levels of stimulating practices and have infants with different rates of delay. Specifically, infants of better-educated mothers who have greater household assets are in families in which the caregivers provide more SPPs and have infants who score higher on the study’s cognitive abilities scales.

Previous studies have been limited by not directly comparing the quality of public and private CHCs using a standardized patient method (SP). This study aims to evaluate and compare the quality of the primary care provided by public and private CHCs using a standardized patient method in urban China. We recruited 12 standardized patients from the local community presenting fixed cases (unstable angina and asthma), including 492 interactions between physicians and standardized patients across 63 CHCs in Xi’an, China. We measured the quality of primary care on seven criteria: (1) adherence to checklists, (2) correct diagnosis, (3) correct treatment, (4) number of unnecessary exams and drugs, (5) diagnosis time, (6) expense of visit, (7) patient-centered communication. Significant quality differences were observed between public CHCs and private CHCs. Private CHC physicians performed 4.73 percentage points lower of recommended questions and exams in the checklist. Compared with private CHCs, public CHC providers were more likely to give a higher proportion of correct diagnosis and correct treatment. Private CHCs provided 1.42 fewer items of unnecessary exams and provided 0.32 more items of unnecessary drugs. Private CHC physicians received a 9.31 lower score in patient-centered communication. There is significant quality inequality in different primary care models. Public CHC physicians might provide a higher quality of service. Creating a comprehensive, flexible, and integrated health care system should be considered an effective approach towards optimizing the management of CHC models.

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.

Background:
Cognitive development after age three tends to be stable and can therefore predict cognitive skills in later childhood. However, there is evidence that cognitive development is less stable before age three. In rural China, research has found large shares of children under age three are developmentally delayed, yet little is known about the trajectories of cognitive development between 0 and 3 years of age or how developmental trajectories predict later cognitive skills. This study seeks to describe the trajectories of child cognitive development between the ages of 0–3 years and examine how different trajectories predict cognitive development at preschool age.

Methods:
We collected three waves of longitudinal panel data from 1245 children in rural Western China. Child cognitive development was measured by the Bayley Scales of Infant Development when the child was 6–12 months and 22–30 months, and by the Wechsler Preschool and Primary Scale of Intelligence-Fourth Edition when the child was 49–65 months. We used the two measures of cognitive development before age three to determine the trajectories of child cognitive development.

Results:
Of the children, 39% were never cognitively delayed; 13% were persistently delayed; 7% experienced improving cognitive development; and 41% experienced deteriorating development before age 3. Compared to children who had never experienced cognitive delay, children with persistent cognitive delay and those with deteriorating development before age 3 had significantly lower cognitive scores at preschool age. Children with improving development before age 3 showed similar levels of cognition at preschool age as children who had never experienced cognitive delay.

Conclusions:
Large shares of children under age 3 in rural Western China show deteriorating cognitive development from infancy to toddlerhood, which predict lower levels of cognition at preschool age. Policymakers should invest in improving cognitive development before age 3 to prevent long-term poor cognition among China’s rural children.

The home language environment is critical to early language development and subsequent skills. However, few studies have quantitatively measured the home language environment in low-income, developing settings. This study explores variations in the home language environment and child language skills among households in poor rural villages in northwestern China. Audio recordings were collected for 38 children aged 20–28 months and analyzed using Language Environment Analysis (LENA) software; language skills were measured using the MacArthur–Bates Mandarin Communicative Developmental Inventories expressive vocabulary scale. The results revealed large variability in both child language skills and home language environment measures (adult words, conversational turns, and child vocalizations) with 5- to 6-fold differences between the highest and lowest scores. Despite variation, however, the average number of adult words and conversational turns were lower than found among urban Chinese children. Correlation analyses did not identify significant correlations between demographic characteristics and the home language environment. However, the results do indicate significant correlations between the home language environment and child language skills, with conversational turns showing the strongest correlation. The results point to a need for further research on language engagement and ways to increase parent–child interactions to improve early language development among young children in rural China.

Universities contribute to economic growth and national competitiveness by equipping students with higher-order thinking and academic skills. Despite large investments in university science, technology, engineering and mathematics (STEM) education, little is known about how the skills of STEM undergraduates compare across countries and by institutional selectivity. Here, we provide direct evidence on these issues by collecting and analysing longitudinal data on tens of thousands of computer science and electrical engineering students in China, India, Russia and the United States. We find stark differences in skill levels and gains among countries and by institutional selectivity. Compared with the United States, students in China, India and Russia do not gain critical thinking skills over four years. Furthermore, while students in India and Russia gain academic skills during the first two years, students in China do not. These gaps in skill levels and gains provide insights into the global competitiveness of STEM university students across nations and institutional types.

Background: The educational resources that parents provide at home are crucial to their children’s development. In this study, we focused on home reading environment, a key contributor to success rates regarding the mastery of reading skills. We aimed to investigate students’ home reading environments and examine its effect on the reading development of primary school students in rural China. Methods: We draw on a dataset composed of 10,740 randomly selected primary school students and their households in rural areas of Jiangxi province in China. Surveys were administered by trained enumerators in May 2015. Results: The results show that students exhibited quite poor reading environments and reading outcomes. Specifically, we found the majority of the rural students lacked reading and learning resources in the context of their families and their parents did not enjoy reading or support their children’s reading. Moreover, our regression analysis documented students with poorer home reading environments are more likely to have worse reading performance. Conclusion: Our study supports the significance of the home reading environment in the reading development of students in the upper elementary grades in rural China. Furthermore, the results suggest that the home reading environments of rural Chinese students must be improved.

This paper examines the external validity of health intervention by comparing the impacts of providing free eyeglasses on the educational performance of nearsighted children in two settings: rural public schools in Western China and urban private migrant schools in Eastern China. The intervention significantly improves educational outcomes by 0.14 standard deviations in math in rural public schools but not in private migrant schools. The difference in measured impacts is due in part to lower quality schooling in migrant schools in Eastern China. Our findings show that only when school is providing a quality education, health interventions might increase student learnings.

Purpose:
Internet use has become particularly prevalent among adolescents, prompting much thought and concern about both its potential benefits and adverse effects on adolescent learning outcomes. Much of the empirical literature on the impact of Internet use on adolescent learning outcomes is mixed, and few studies examine the causal relationship between the two in rural China. In order to bridge these gaps, we use empirical analysis to investigate the effect of Internet use on the learning outcomes of adolescents in rural China.

Design/methodology/approach:
We use fixed effect models with samples drawn from a large nationally representative dataset (the China Family Panel Studies—CFPS) to identify the causal impacts of Internet use on the learning outcomes of three cohorts (Cohort A (N = 540), Cohort B (N = 287) and Cohort C (N = 827)) of adolescents in rural China.

Findings:
The results of the descriptive analysis show a continued increase in the number of adolescents accessing the Internet and the amount of time they spend online. The results of the fixed effect models show that Internet use has positive (in many of the analyses), but mostly insignificant impacts, on the learning outcomes of adolescents. In the sets of results that find significant associations between Internet use and learning outcomes, the measured effects are moderate.

Originality/value:
This study investigates the causal relationship between Internet use and adolescent learning outcomes in rural China. The findings claim that there is not a great need to worry about adverse effects of Internet use on adolescent learning development. Attention, however, should focus on seeking ways to improve the positive effects of the Internet use on adolescent learning outcomes. The study will provide a reference and experience for the development of education and the Internet in rural areas and promote the integrated development of urban and rural areas in China.