Currently available data on myopia and spectacle wear are drawn largely from China’s richer and middle-income areas, and little is known about refractive error and spectacle wear in the lowest income provinces. Studies from China and elsewhere suggest that large differences in myopia prevalence may exist between areas of different socioeconomic status within countries, but reasons for these differences are not well understood. The current report details the prevalence and predictors of myopia measured using the identical protocols and equipment in adjoining provinces of western China, middle-income Shaanxi and low-income Gansu. Study methods including institutional review board approvals and consent have been described elsewhere.

This paper examines the prevalence of vision problems and accessibility to and quality of vision care in rural China. We obtained data from 4 sources: 1) the National Rural Vision Care Survey; 2) the Private Optometrists Survey; 3) the County Hospital Eye Care Survey; and 4) the Rural School Vision Care Survey. The data from each of the surveys were collected by the authors during 2012. Thirty-three percent of the rural population surveyed self-reported vision problems. Twenty-two percent of subjects surveryed had ever had a vision exam. Among those who self-reported vision problems, 34% did not wear eyeglasses. Fifty-four percent of those with vision problems who had eyeglasses did not have a vision exam prior to receiving glasses. However, having a vision exam did not always guarantee access to quality vision care. Four channels of vision care service were assessed. The school vision examination program did not increase the usage rate of eyeglasses. Each county-hospital was staffed with three eye-doctors having one year of education beyond high school, serving more than 400,000 residents. Private optometrists often had low levels of education and professional certification. In conclusion, our findings shows that the vision care system in rural China is inadequate and ineffective in meeting the needs of the rural population sampled.

Anemia is one of the most prevalent public health problems among infants and iron deficiency anemia has been related to many adverse consequences. The overall goal of this study is to examine the prevalence of anemia among infants in poor rural China and to identify correlates of anemia. In April 2013, we randomly sampled 948 infants aged 6–11 months living in 351 villages across 174 townships in nationally-designated poverty counties in rural areas of southern Shaanxi Province, China. Infants were administered a finger prick blood test for hemoglobin (Hb). Anthropometric measurement and household survey of demographic characteristics and feeding practices were conducted in the survey. We found that 54.3% of 6–11 month old infants in poor rural China are anemic, and 24.3% of sample infants suffer from moderate or severe anemia. We find that children still breastfed over 6 months of age had lower Hb concentrations and higher anemia prevalence than their non-breastfeeding counterparts (p < 0.01), and that children who had ever been formula-fed had significantly higher Hb concentrations and lower anemia prevalence than their non-formula-fed counterparts (p < 0.01). The results suggest the importance of iron supplementation or home fortification while breastfeeding. 

We respond to Anning Hu's commentary on our report “College is a rich, Han, urban, male club: Research notes from a census survey of four tier one colleges in China.” The topic of assessing disparities in college access in China (and other developing countries undergoing major transitions in their higher education systems) is an important one. We hope that our China Quarterly article, Hu’s commentary and our response will stimulate more research and dialogue on this topic in China and elsewhere.

Junior high dropout rates are up to 25% in poor, rural areas of China. Although existing studies have examined how factors such as high tuition and opportunity costs contribute to dropout, fewer studies have explored the relationship between dropout rates and mental health in rural China. The overall goal of this study is to examine the relationship between dropout and mental health problems in rural Chinese junior high schools. Correlational analysis was conducted among 4,840 students across 38 junior high schools in rural China. Ordinary least squares (OLS) regressions were used to determine the types of students most at risk for mental health problems and whether mental health problems are correlated with dropout behavior. Our measure for mental health is based on the Children’s Manifest Anxiety Scale. Mental health problems are widespread in the sample of rural children, with 74% of students at risk for mental health problems. The student and family characteristics that correlate with dropout (poverty and low achievement) also correlate with mental health problems. More importantly, even after controlling for these background characteristics, mental health problems remain correlated with dropout rates. Mental health problems, especially among low-achieving poor students, may be contributing to the high dropout rates in rural China today. This finding suggests that interventions focusing on mental health in rural areas may also help reduce dropout.

Researchers typically explain inequalities in access to elite high schools by looking at gaps that appear before the high school admissions process. However, even when disadvantaged students reach the stage of high school admissions with identical qualifications as advantaged students, mechanisms particular to the high school admissions process may prevent disadvantaged students from accessing elite high schools. The overall goal of this paper is to examine the degree to which the high school admissions process deters disadvantaged students from accessing elite high schools. To fulfill this goal, we analyze longitudinal, administrative data on approximately 24,000 students in one region of China. In this setting, according to our data, the rural-urban gap in elite high school attendance can be larger than 50 percentage points (even though rural students comprise well more than half of the high school student population). Our results show that the five subject exams of the high school entrance exam (HSEE) are biased against rural students. If the HSEE dropped two of the most biased subject exams from the HSEE, access to elite high schools among rural students would increase by 4 percentage points (or 8 percent). Furthermore, conditional on HSEE scores, rural students are 13 percentage points less likely than urban students to apply for elite high schools. Finally, conditional on HSEE scores and application choices, the existence of an alternative admissions channel that charges extra admissions fees further reduces rural access by 18 percentage points.

An alarming number of students drop out of junior high school in developing countries. In this study, we examine the impacts of providing a social–emotional learning (SEL) program on the dropout behavior and learning anxiety of students in the first two years of junior high. We do so by analyzing data from a randomized controlled trial involving 70 junior high schools and 7,495 students in rural China. After eight months, the SEL program reduces dropout by 1.6 percentage points and decreases learning anxiety by 2.3 percentage points. Effects are no longer statistically different from zero after 15 months, perhaps due to decreasing student interest in the program. However, we do find that the program reduces dropout among students at high risk of dropping out (older students and students with friends who have already dropped out), both after eight and 15 months of exposure to the SEL program.

Teacher quality is an important factor in improving student achievement. As such, policymakers have constructed a number of different credentials to identify high quality teachers. Unfortunately, few of the credentials used in developing countries have been validated (in terms of whether teachers holding such credentials actually improve student achievement). In this study, we employ a student-fixed effects model to estimate the impact of teacher credentials on student achievement in the context of the biggest education system in the world: China. We find that having a teacher with the highest rank (a credential based on annual assessments by local administrators) has positive impacts on student achievement relative to having a teacher who has not achieved the highest rank. We further find that teacher rank has heterogeneous impacts, benefiting economically poor students more than non-poor students. However, other credentials (whether the teacher attended college or held teaching awards) have no impact on student achievement. 

Although vocational schooling is responsible for educating a large share of students in the world today, there is little evidence about what factors matter for vocational student learning. Using data on approximately 1,400 vocational students in one eastern province in China, we employ a student fixed effects model to identify whether teacher enterprise experience—believed to be one of the most important factors for vocational student learning—increases students’ technical skills. We find that enterprise experience has a substantial positive impact on students’ technical skills. Furthermore, the impacts are concentrated on high-achieving students. In contrast, policies to provide teachers with “professional certifications” (given to teachers who participate in short-term trainings) have no positive impact.