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Journal Article

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

Yuju Wu, Huan Zhou, Yaojiang Shi, Hao Xue, Chengchao Zhou, Hongmei Yi, Alexis Medina, Jason Li, Sean Sylvia
BMJ , 2019
Background: Medical records play a fundamental role in healthcare delivery, quality assessment and improvement. However, there is little objective evidence on the quality of medical records in low and middle-income countries. Objective: To provide an unbiased assessment of the quality of medical records for outpatient visits to rural facilities in China. Methods: A sample of 207 township health facilities across three provinces of China were enrolled. Unannounced standardised patients (SPs) presented to providers following standardised scripts. Three weeks later, investigators returned to collect medical records from each facility. Audio recordings of clinical interactions were then used to evaluate completeness and accuracy of available medical records. Results: Medical records were located for 210 out of 620 SP visits (33.8%). Of those located, more than 80% contained basic patient information and drug treatment when mentioned in visits, but only 57.6% recorded diagnoses. The most incompletely recorded category of information was patient symptoms (74.3% unrecorded), followed by non-drug treatments (65.2% unrecorded). Most of the recorded information was accurate, but accuracy fell below 80% for some items. The keeping of any medical records was positively correlated with the provider’s income (β 0.05, 95% CI 0.01 to 0.09). Providers at hospitals with prescription review were less likely to record completely (β −0.87, 95% CI −1.68 to 0.06). Significant variation by disease type was also found in keeping of any medical record and completeness. Conclusion: Despite the importance of medical records for health system functioning, many rural facilities have yet to implement systems for maintaining patient records, and records are often incomplete when they exist. Prescription review tied to performance evaluation should be implemented with caution as it may create disincentives for record keeping. Interventions to improve record keeping and management are needed. 
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Journal Article

Impact of Second-Parent Migration on Student Academic Performance in Northwest China and its Implications

Yu Bai, Michael Neubauer, Tong Ru, Yaojiang Shi, Kaleigh Kenny, Scott Rozelle
The Journal of Development Studies , 2019
ABSTRACT The migration of hundreds of millions of rural Chinese workers to the city has contributed substantially to China’s economic growth since the beginning of the country’s economic reform in 1978. However, this migration has also led to societal issues, including more than 60 million left-behind children. Empirical studies that seek to measure the impact of being left-behind on academic performance have led to inconsistent results, perhaps because the effects may be different for first-parent migration (migration during the first period of time in which one parent migrates) and second-parent migration (migration when the remaining parent leaves the home). Here we have examined how school performance changes before and after the second parent out-migrates. We use a panel dataset of over 5,000 students from 72 primary schools in rural China. Using a difference-in-difference approach, supported by a placebo test, we find that second-parent migration has statistically significant negative impacts on student performance. Importantly, our data provide convincing evidence that second-parent migration has a more negative impact on academic performance than first-parent migration. Our results have broad implications for China’s future economic growth and inequality.
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Working Paper

Manufacturing Productivity with Worker Turnover

Ken Moon, Patrick Bergemann, Daniel Brown, Andrew Chen, James Chu, Ellen Eisen, Gregory Fischer, Prashant Loyalka, Sungmin Rho, Joshua Cohen
2019

We find that rapid worker turnover significantly disrupts the productivity of responsive manufacturers. Our study uses a uniquely rich dataset drawn from China-based FATP (final assembly, testing, and packaging) facilities that produce millions of units of consumer electronic goods weekly yet exhibit high worker turnover exceeding 300% annually. The data cover the firm's weekly production plans, 52,214 workers' compensations and assignments, and assembly station productivity. To study managerial prescriptions, we extend the classical production planning problem to include endogenous worker turnover as an Experience-Based Equilibrium and use advances in reinforcement learning and approximate dynamic programming to estimate and simulate our model. Our empirical analyses exploit instrumental variables, including the firm's demand forecasts as demand shifters". We find that turnover's impact on yield waste is conservatively $146-178M, and that a well-calibrated wage increase reduces the manufacturer's variable production costs (including wages) by up to 21%, or $594M for the product we study. The wage increase reduces the firm's reliance on a larger workforce and overtime to hedge against yield disruptions from turnover; it stabilizes a leaner workforce and improves both production reliability and exibility. In settings where performance depends on workers repeating known tasks in coordinated groups, our results suggest that firms responsively matching supply to demand can pay a steep price for a disruptively turnover-prone workforce.

 

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Journal Article

The Returns to Education in Rural China: Some New Estimates

Chengfang Liu, Ye Li, Shaoping Li, Renfu Luo, Linxiu Zhang, Scott Rozelle, Spencer Hagist, Jack Hou
The Australian Journal of Agricultural and Resource Economics , 2019
We estimate the rates of return to education in rural China using primary survey data collected in 2016. Estimated average returns to education are 3.1 per cent. However, careful statistical analysis is required when estimating the returns to education. The paper demonstrates that when employment interruptions are accounted for, the measured returns to education rise. Our results also confirm that mismeasurement of the wage rate by using an hourly wage rate (versus daily or monthly earnings) raises the estimation of rates of return to education. Finally, our results suggest that the return to education is nonlinear in education levels but only when it reaches the tertiary level.
 
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Journal Article

Can School Feeding Programs Reduce Malnutrition in Rural China?

Huan Wang, Qiran Zhao, Matthew Boswell, Scott Rozelle
Journal of School Health , 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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Journal Article

Academic Achievement and Mental Health of Left-behind Children in Rural China

Lei Wang, Yaojia Zheng, Guirong Li, Yanyan Li, Zhenni Fang, Cody Abbey, Scott Rozelle
China Agricultural Economic Review , 2019
Purpose – China’s rapid pace of urbanization has resulted in millions of rural residents migrating from rural areas to urban areas for better job opportunities. Due to economic pressures and the nature of China’s demographic policies, many of these migrants have been forced to leave their children with relatives – typically paternal grandparents – at home in the countryside. Thus, while income for most migrant families has risen, a major unintended consequence of this labor movement has been the emergence of a potentially vulnerable sub-population of left-behind children (LBCs). The purpose of this paper is to examine the impacts of parental migration on both the academic performance and mental health of LBCs. Design/methodology/approach – Longitudinal data were drawn from three waves of a panel survey that . followed the same students and their families – including their migration behavior (i.e. whether both parents, one parent, no parent migrated) – between 2015 and 2016. The survey covers more than 33,000 students in one province of central China. The authors apply a student fixed-effects model that controls for both observable and unobservable confounding variables to explicate the causal effects of parental migration on the academic and mental health outcomes for LBC. The authors also employ these methods to test whether these effects differ by the type of migration or by gender of the child.
Findings – The authors found no overall impact of parental migration on either academic performance or mental health of LBCs, regardless of the type of migration behavior. The authors did find, however, that when the authors examined heterogeneous effects by gender (which was possible due to the large sample size), parental migration resulted in significantly higher anxiety levels for left-behind girls. The results suggest that parental migration affects left-behind boys and girls differently and that policymakers should take a more tailored approach to addressing the problems faced by LBCs.
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Journal Article

Heterogeneous Impacts of Basic Social Health Insurance on Medical Expenditure: Evidence from China's New Cooperative Medical Scheme

Conglong Fang, Chaofei He, Scott Rozelle, Qinghua Shi, Jiayin Sun, Ning Yu
Healthcare , 2019

This paper examines the effects of China’s New Cooperative Medical Scheme (NCMS) on medical expenditure. Utilizing the quasi-random rollout of the NCMS for a difference-in-difference analysis, we find that the NCMS increased medical expenditure by 12.3%. Most significantly, the good-health group witnessed a 22.1% rise in medical expenditure, and the high-income group saw a rise of 20.6%. The effects, however, were not significant among the poor-health or low-income groups. The findings are suggestive of the need for more help for the very poor and less healthy.

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Working Paper

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

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 Article

Using Community Health Workers to Deliver a Scalable Integrated Parenting Program in Rural China: A Cluster-Randomized Controlled Trial

Renfu Luo, Ai Yue, Dorien Emmers, Nele Warinnier, Scott Rozelle, Sean Sylvia
Social Science & Medicine , 2019

Inadequate care during early childhood can lead to long-term deficits in skill development. Parenting programs are promising tools for improving parenting practices and opportunities for healthy development. We implemented a non-masked cluster-randomized controlled trial in rural China in order to assess the effectiveness of an integrated home-visitation program that includes both psychosocial stimulation and health promotion at fostering development and health outcomes of infants and toddlers in rural China. All 6-18 month-old children of two rural townships and their main caregiver were enrolled. Villages were stratified by township and randomly assigned to intervention or control. Specifically, in September 2015 we assigned 43 clusters to treatment (21 villages, 222 caregiver-child dyads) or control (22 villages, 227 caregiver-child dyads). In the intervention group, community health workers delivered education and training on how to provide young children with psychosocial stimulation and health care (henceforth psychosocial stimulation and health promotion) during bi-weekly home visits over the period of one year. The control group received no home visits. Primary outcomes include measures of child development (i.e. the Bayley Scales of Infant and Toddler Development, third edition—or Bayley-III) and health (i.e. measures of morbidity, nutrition, and growth). Secondary outcomes are measures of parenting practices. Intention-to-treat (ITT) effects show that the intervention led to an improvement of 0·24 standard deviations (SD) [95% CI 0·04 SD-0·44 SD] in cognitive development and to a reduction of 8·1 [95% CI 3·8–12·4] percentage points in the risk of diarrheal illness. In addition, we find positive effects on parenting practices mirroring these results. We conclude that an integrated psychosocial stimulation and health promotion program improves development and health outcomes of infants and toddlers (6–30 month-old children) in rural China. Because of low incremental costs of adding program components (that is, adding health promotion to psychosocial stimulation programs), integrated programs may be cost-effective.

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Journal Article

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

Ai Yue, Qi Jiang, Biaoyue Wang, Cody Abbey, Alexis Medina, Yaojiang Shi, Scott Rozelle
PLoS ONE , 2019

Choosing a valid and feasible method to measure child developmental outcomes is key to addressing developmental delays, which have been shown to be associated with high levels of unemployment, participation in crime, and teen pregnancies. However, measuring early childhood development (ECD) with multi-dimensional diagnostic tests such as the Bayley Scales of Infant and Toddler Development III (Bayley-III) can be time-consuming and expensive; therefore, parental screening tools such as the Ages and Stages Questionnaire (ASQ-3) are frequently an alternative measure of early childhood development in largescale research. The ASQ is also becoming more frequently used as the first step to identify children at risk for developmental delays before conducting a diagnostic test to confirm. However, the effectiveness of the ASQ-3 is uncertain. In this study, we evaluate the accuracy of the ASQ-3 as a screening measure for children at risk of developmental delay in rural China by age group. To do so, we administered the Bayley-III, widely considered to be the “gold standard” of ECD diagnostic tests, to a sample of 1,831 five to twenty-four monthold children and also administered the ASQ-3 to their caregivers. We then compared the outcomes of the ASQ-3 test to those of the Bayley-III. We find that the ASQ-3 was significantly though weakly correlated with the Bayley-III and that the strength of this correlation increased with child age and was stronger when the mother was the primary caregiver (as compared to the grandmother). We also find that the sensitivity and specificity of ASQ-3 ranged widely. The overall findings suggest that the ASQ-3 may not be a very accurate screening tool for identifying developmentally delayed children, especially for children under 13 months of age or children whose primary caregiver is not the mother.

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Journal Article

The Landscape of Early Childhood Development in Rural China

Sarah-Eve Dill, Yue Ma, Andrew Sun, Scott Rozelle
The Asia-Pacific Journal , 2019

In China, low levels of early childhood development (ECD) in rural areas may inhibit economic development as the nation attempts to transition from a middle-income manufacturing-based economy to a high-income innovation economy. This paper surveys the recent literature on ECD among children ages 0-3 years in rural China, including rates of developmental delays, causes of delays, and implications for the future of China’s economy. Recent studies have found high rates of developmental delays among young children in rural China and point to poor nutrition and psychosocial stimulation as the primary causes. This review highlights the need for large-scale ECD interventions in rural China to raise human capital and support future economic growth.

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Journal Article

Dynamic Anemia Status from Infancy to Preschool-Age: Evidence from Rural China

Lei Wang, Mengjie Li, Sarah-Eve Dill, Yiwei Hu, Scott Rozelle
International Journal of Environmental Research and Public Health , 2019

Anemia is a serious nutritional deficiency among infants and toddlers in rural China. However, it is unclear how the anemia status changes among China’s rural children as they age. This study investigates the prevalence of anemia as children grow from infancy to preschool-age, as well as the dynamic anemia status of children over time. We conducted longitudinal surveys of 1170 children in the Qinba Mountain Area of China in 2013, 2015 and 2017. The results show that 51% of children were anemic in infancy (6–12 months), 24% in toddlerhood (22–30 months) and 19% at preschool-age (49–65 months). An even larger share of children (67%) suered from anemia at some point over the course of study. The data also show that although only 4% of children were persistently anemic from infancy to preschool-age, 8% of children saw their anemia status deteriorate. We further found that children may be at greater risk for developing anemia, or for having persistent anemia, during the period between toddlerhood and preschool-age. Combined with the finding that children with improving anemia status showed higher cognition than persistently anemic children, there is an urgent need for eective nutritional interventions to combat anemia as children grow, especially between toddlerhood and preschool age.

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Journal Article

The Prevalence of Parent-Teacher Interaction in Developing Countries and its Effect on Student Outcomes

Guirong Li, Millie Lin, Chengfang Liu, Angela Johnson, Yanyan Li, Prashant Loyalka
Teaching and Teacher Education , 2019

Empirical evidence from developed countries supports the idea that parent-teacher interaction is high and improves student outcomes. The evidence from developing countries is, however, decidedly mixed. Using longitudinal data from nearly 6000 students and their 600 teachers in rural China, we show the prevalence of parent-teacher interaction is generally much lower than that of developed countries. We also show parent-teacher interaction, when it exists, can have positive effects on raising academic achievement and reducing learning anxiety. We demonstrate that the prevalence and effectiveness of parent-teacher interaction in a developing country context varies considerably due to both demand-side and supply-side factors.

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Journal Article

Stuck in Place? A Field Experiment on the Effects of Reputational Information on Student Evaluations

James Chu, Guirong Li, Prashant Loyalka, Chengfang Liu, Leonardo Rosa, Yanyan Li
Oxford Academic , 2019

Studies suggest that students’ prior performance can shape subsequent teacher evaluations, but the magnitude of reputational effects and their implications for educational inequality remain unclear. Existing scholarship presents two major perspectives that exist in tension: do teachers primarily use reputational information as a temporary signal that is subsequently updated in response to actual student performance? Or do teachers primarily use reputational information as a filter that biases perception of subsequent evidence, thus crystallizing student reputations and keeping previously poor-performing students stuck in place? In a field experiment, we recruited a random sample of 832 junior high school teachers from the second-most populous province of China to grade a sequence of four essays written by the same student, and we randomly assign both the academic reputation of the student and the quality of the essays produced. We find that (1) reputational information influences how teachers grade, (2) teachers rely on negative information more heavily than positive information, and (3) negative reputations are crystallized by a single behavioral confirmation. These results suggest that students can escape their prior reputations, but to do so, they must contradict them immediately, with a single confirmation sufficient to crystallize a negative reputation.

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Journal Article

Does Teacher Training Actually Work? Evidence from a Large-Scare Randomized Evaluation of a National Teacher Training Program

Anna Popova, Guirong Li, Zhaolei Shi
American Economic Journal: Applied Economics , 2019
Despite massive investments in teacher professional development (PD) programs in developing countries, there is little evidence on their effectiveness. We present results of a large-scale, randomized evaluation of a national PD program in China in which teachers were randomized to receive PD; PD plus follow-up; PD plus evaluation of the command of PD content; or no PD. Precise estimates indicate PD and associated interventions failed to improve teacher and student outcomes after one year. A detailed analysis of the causal chain shows teachers find PD content to be overly theoretical, and PD delivery too rote and passive, to be useful.
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Journal Article

The Impact of Teacher Professional Development Programs on Student Achievement in Rural China: Evidence from Shaanxi Province

Meichen Lu, Yaojiang Shi, Fang Chang, Chengfang Liu, Scott Rozelle
Journal of Development Effectiveness , 2019

There is a significant gap in academic achievement between rural and urban students in China. Policymakers have sought to close this gap by improving the quality of teaching in rural areas through teacher professional development (PD) programs. However, there is limited evidence on the effectiveness of such programs. In this paper, we evaluate the impact of a PD program-National Teacher Training Program (NTTP)  and find that the NTTP has no effect on math achievement. We also find that while the program has a positive effect on math teaching knowledge of teachers, it has no significant effect on teaching practices in the classroom. Taken together, these results indicate that teachers may have improved their knowledge for teaching from NTTP, but did not apply what they learned to improve teaching practices or student learning.

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Journal Article

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

Ai Yue, Yaojiang Shi, Renfu Luo, Boya Wang, Ann Weber, Alexis Medina, Sarah Kotb, Scott Rozelle
Journal of Developmental and Behavioral Pediatrics , 2019
ABSTRACT: Objective: To provide an empirical overview of the parenting landscape in rural China, focusing on 18- to 30-month-old children and their caregivers in rural Shaanxi province. Methods: We collected unique data on 1442 caregiver-toddler dyads in rural areas of Shaanxi province and examined caregiver attitudes toward parenting, sources of information about parenting, and interactive parenting practices, and how each of these differed across generations. We measured how parenting attitudes and sources of information informed parenting practices. Finally, we measured levels of child development in our sample and the association between parenting practices and children’s developmental outcomes. Results: Most of the caregivers did not engage with children in a way that encouraged early development. Caregivers rarely told stories, sang, or used toys to play with their children. Grandmothers were more stressed by the children in their care and engaged significantly less than mothers did in the 3 stimulating interactions. Professional sources of information about parenting were underutilized by all caregivers. We found high rates of developmental delay in our sample and showed that these delays were associated with the lack of caregiver engagement. Conclusion: Our findings suggest that the major economic and social shifts occurring in rural China have not led to a widespread prevalence of stimulative parenting practices. Although caregivers report positive attitudes toward child-rearing, reliable sources of scientific information are lacking. Our results show a troubling generational disconnect between the information-seeking behaviors and parenting practices of rural caregivers.
 
Index terms: caregiver-child interaction, parenting, early child development.
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Journal Article

Pay by Design: Teacher Performance Pay Design and the Distribution of Student Achievement

Sean Sylvia, Chengfang Liu, James Chu, Yaojiang Shi
Journal of Labor Economics , 2019

Abstract: We present results of a randomized trial testing alternative approaches of mapping student achievement into rewards for teachers. Teachers in 216 schools in western China were assigned to performance pay schemes where teacher performance was assessed by one of three different methods. We find that teachers offered “pay-for-percentile” incentives (Barlevy and Neal 2012) outperform teachers offered simpler schemes based on class average achievement or average gains over a school year. Moreover, pay-for-percentile incentives produced broad-based gains across students within classes. That teachers respond to relatively intricate features of incentive schemes highlights the importance of close attention to performance pay design. 

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Journal Article

Better Cognition, Better School Performance? Evidence from Primary Schools in China

Qiran Zhao, Xiaobing Wang, Scott Rozelle
China Economic Review , 2019

Although students in rural and migrant schools in China generally have not performed well, a share of each cohort has been able to thrive in school and to test into academic high school and college. To understand the origins of persistence, specifically, why some students learn more than do others, researchers have identified certain sources of the problem. Few studies, however, have paid attention to the role that low levels of cognitive development of students play in their academic performance.

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Journal Article

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
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 Article

Old is Not Always Better: Evidence from Five Randomized Experiments in Rural Primary Schools in China

Lili Li, Fang Chang, Yaojiang Shi, Scott Rozelle
Journal of Development Effectiveness , 2019

In recent years, researchers have begun to focus attention on trying to identify systematic factors that cause interventions to have different impacts in different contexts. In this paper, we seek to understand whether the age of principals at schools implementing nutrition-based interventions has an impact on program outcomes. To explore the relative effectiveness of younger and older school principals, we use data from five large-scale, nutrition-related randomized controlled trials (RCTs) involving 12,595 primary school students in 336 schools in rural China. Our results, using two age cut-offs for distinguishing young principals from old ones, indicate that improvements in the health and nutrition outcomes of students were significantly higher in schools with younger principals than in schools run by older principals (when using a cutoff of 40 years old). When using a cut-off of 45 years old, the point estimates of the impacts similarly suggest that young principals are more effective, although the results are not significantly significant. The results are similar when we look at the impact of disaggregated interventions in schools managed by young and old principals. The findings are clear that the interventions implemented by older principals are not more effective than those implemented by younger principals.

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Journal Article

Past Successes and Future Challenges in Rural China’s Human Capital

Yu Bai, Siqi Zhang, Lei Wang, Ruirui Dang, Cody Abbey, Scott Rozelle
Journal of Contemporary China , 2019

This paper describes the current level of human capital in China and seeks to identify a number of education-related challenges that may slow down the nation’s economy from transitioning to high-income status. Relying on recent census-based data from OECD for the rest of the world and using data from the 2015 Micro-Census for China, the authors show that the low levels of education of China’s labour force is really a problem that has its roots in the past (in the 1970s, 1980s, and 1990s). In recent years (since 2000), China has been investing heavily in education as shown by the increasing the share of youth, including rural youth, attending high school. Despite this recent effort to raise the nation’s human capital, the education system still faces several challenges in trying to provide high-quality education for all youth. First, the government must figure out a way to overcome the relatively low rates of participation in high school by rural students. Second, there is concern that many vocational schools, especially those in rural areas, cannot deliver quality education. Finally, the paper will show that many rural students may be unprepared due to poor early childhood development outcomes.

 

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Journal Article

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

Yuju Wu, Huan Zhou, Qingzhi Wang, Min Cao, Alexis Medina, Scott Rozelle
BMC Health Services Research , 2019
Background: The use of maternal health services can markedly promote the maternal health and safety, but there has been a low utilization rate in the ethnic rural areas of western China. Furthermore, the correlated factors have not been well studied. This study aims to assess factors related to the use of maternal health services among women in these areas.
Methods: A cross-sectional study of 68 villages in China’s western Sichuan province was conducted in September 2014. All qualifying women from each sample village were involved. A structured questionnaire was administrated in households through face-to-face interviews by trained enumerators to obtain information of use of maternal health services and related factors. Structural equation modeling (SEM) was used to evaluate the direct and indirect relationships between use of maternal health services and correlated factors.
Results: A total of 760 women from 68 villages were enrolled. The proportion of antenatal care (ANC), hospital delivery and postpartum visits were 68.94, 48.29 and 28.42% respectively. The SEM analysis demonstrated that social economic status (SES) (β= − 0.75, β< 0.01), ANC (β=0.13, β< 0.01), and time from home to the nearest hospital (β= − 0.09, β< 0.05), were positively correlated to hospital delivery and postpartum care visits, while maternal care knowledge and perceived quality of hospital care did not have direct correlation. For ANC, SES (β= − 0.36, β< 0.01), time from home to the nearest hospital (β= − 0.13, β< 0.05), knowledge on maternal care (β=0.12, β< 0.01) and perceived quality of hospital care (β=0.10, β< 0.01) were all directly correlated factors. Treating ANC as an intermediate variable showed the indirect relationship that perceived quality of hospital care (β=0.01, β< 0.01) and maternal care knowledge (β=0.02, β< 0.01) had with hospital delivery and postpartum care rates.
Conclusions: Use of maternal health services is low among women in ethnic rural areas. ANC has important direct and intermediate effects on subsequent use of hospital delivery and postpartum care. Improving ANC behavior should be a priority of maternal health care reforms. Given the long travel times for these women, reforms must also prioritize breaking down practical barriers that prevent this population from accessing care.
Keywords: Maternal health services, Antenatal care, Ethnic areas, Western China
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Journal Article

Computer Science Skills Across China, India, Russia, and the United States

Prashant Loyalka, Ou Lydina Liu, Guirong Li, Igor Chirikov, Elena Kardanova, Lin Gu, Guangming Ling, Ningning Yu, Fei Guo, Liping Ma, Shangfeng Hu, Angela Sun Johnson, Ashutosh Bhuradia, Saurabh Khanna, Isak Froumin, Jinghuan Shi, Pradeep Kumar Choudhury, Tara Beteille, Francisco Marmolejo, Namrata Tognatta
Proceedings of the National Academy of Sciences of the United States of America , 2019

We assess and compare computer science skills among final-year computer science undergraduates (seniors) in four major economic and political powers that produce approximately half of the science, technology, engineering, and mathematics graduates in the world. We find that seniors in the United States substantially outperform seniors in China, India, and Russia by 0.76–0.88 SDs and score comparably with seniors in elite institutions in these countries. Seniors in elite institutions in the United States further outperform seniors in elite institutions in China, India, and Russia by ∼0.85 SDs. The skills advantage of the United States is not because it has a large proportion of high-scoring international students. Finally, males score consistently but only moderately higher (0.16–0.41 SDs) than females within all four countries.

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Journal Article

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

Huan Zhou, Qingzhi Wang, Junmin Zhou, Tiaoying Li, Alexis Medina, Stephen Felt, Scott Rozelle, John Openshaw
Environmental Research and Public Health , 2019

Neurocysticercosis (NCC) significantly contributes to morbidity in developing countries. We recently published a study of prevalence and risk factors in school-aged children in three mountainous areas in Sichuan province of western China. Using structural equation modeling (SEM) on data from that study to guide intervention planning, here we examine risk factors grouped into three broad interventional categories: sociodemographics, human behavior, and sources of pork and pig husbandry. Because neuroimaging is not easily available, using SEM allows for the use of multiple observed variables (serological tests and symptoms) to represent probable NCC cases. Data collected from 2608 students was included in this analysis. Within this group, seroprevalence of cysticercosis IgG antibodies was 5.4%. SEM results showed that sociodemographic factors (b = 0.33, p < 0.05), sources of pork and pig husbandry (b = 0.26, p < 0.001), and behavioral factors (b = 0.33, p < 0.05) were all directly related to probable NCC in school-aged children. Sociodemographic factors affected probable NCC indirectly via sources of pork and pig husbandry factors (b = 0.07, p < 0.001) and behavioral variables (b = 0.07, p < 0.001). Both sociodemographic factors (b = 0.07, p < 0.05) and sources of pork and pig husbandry factors (b = 0.10, p < 0.01) affected probable NCC indirectly via behavioral variables. Because behavioral variables not only had a large direct effect but also served as a critical bridge to strengthen the effect of sociodemographics and sources of pork and pig husbandry on probable NCC, our findings suggest that interventions targeting behavioral factors may be the most effective in reducing disease.

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