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Effectively Targeting Perinatal Home Visiting Interventions: Estimating Heterogeneous Treatment Effects on Infant Hemoglobin, Breastfeeding, and Diet Using Sorted Effects


Speaker: Siva Balakrishnan, PhD, University of Nevada, Reno

In this paper, we explore heterogenous treatment effects (HTE) of a stage-based home counseling intervention on exclusive breastfeeding (EBF), child hemoglobin and dietary diversity (DDS). In a cluster randomized controlled trial, pregnant women and caregivers of infants <6 months of age were enrolled in intervention or control arms in rural Sichuan, China. Community health workers delivered educational modules tailored to participants’ stage of development for 12 months. A novel sorted effects method was used to estimate HTE. Individual treatment effects were modeled by regressing baseline characteristics, treatment, and interactions thereof on outcomes. Characteristics of the 20% most and 20% least affected families were compared using multiple t-tests and adjusted p-values to identify those associated with HTE. Evidence of HTE on outcomes was strong with significant individual CATE on EBF and DDS among the 20% most affected families. Mothers with higher baseline caregiving knowledge or who gave birth vaginally saw greatest increases in EBF. Mothers pregnant at baseline or with less social support saw the most benefits on hemoglobin. Mothers with lower caregiving knowledge had greatest increases in DDS. The evidence supports the use of stage-based curricula and targeting mothers from pregnancy to obtain the greatest increases in child hemoglobin. To improve overall effects on EBF, breastfeeding modules may need to adjust content for first-time mothers and those with low caregiving knowledge. Partnering with hospital staff may improve EBF, particularly after c-section. Engaging family members to strengthen maternal social support may improve infant DDS.


About the Workshops


Our Young Researcher Workshops offer emerging China scholars an opportunity to engage directly with interdisciplinary faculty and peers from across campus to discuss and receive feedback on their research. Each workshop features one or several PhD students presenting their latest empirical findings on issues related to China’s economy. Past topics have included college major selection as an obstacle to socioeconomic mobility, the effect of a cooling-off period on marriage outcomes, and factors contributing to government corruption. Faculty and senior scholars provide comments and feedback for improvement. This event series helps to build and strengthen Stanford’s community of young researchers working on China.

Workshops are held on select Fridays from 12 - 1 pm. Lunch will be provided! 

Visit the Young Researcher Workshops webpage for more information on the content and format of the series and to learn how to sign up to present. 

Goldman Room, Encina Hall, E409

Siva Balakrishnan, PhD, University of Nevada, Reno
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Imagine one test deciding your future. For millions of students in China every year, that test is the gaokao—the national university entrance exam and one of the most competitive educational systems in the world. Published by Harvard University Press in Fall 2025, The Highest Exam: How the Gaokao Shapes China, takes readers inside this high-stakes exam and uncovers how it has shaped families, careers, and even the nation itself.

Written by leading scholars Ruixue Jia and Hongbin Li, with writer and researcher Claire Cousineau, the book combines rigorous research with compelling personal narratives to reveal how the gaokao has become much more than a test: it is a tool to shape China’s society and economy.

The gaokao has long been considered one of the world’s most consequential educational exams. Each year, tens of millions of students sit for this high-stakes test that determines access to universities, career opportunities, and pathways of social mobility. The Highest Exam traces the gaokao’s historical origins and evolution, showing how it became deeply intertwined with China’s governance, social strata, and economy. 

Through empirical analysis and personal narrative, the book illustrates how the exam system reflects broader themes in Chinese society: the pursuit of meritocracy, the tension between equality and advantage, and the state’s reliance on education to reinforce legitimacy. The authors aptly identify China’s education system as a centralized hierarchical tournament, returning to this framework in each section of the book: familystate, and society

The Highest Exam also brings a comparative lens, contrasting China’s exam-driven system with education practices in the United States and beyond. It raises urgent questions about fairness, access, and the role of education in shaping societies—questions that resonate far beyond China’s borders.

Engaging and deeply researched, The Highest Exam is essential reading for anyone interested in education, global society, or the forces shaping the next generation.



About the Authors
 

Ruixue Jia is Professor of Economics at the School of Global Policy and Strategy, University of California, San Diego.

Hongbin Li is Co-director of Stanford Center on China's Economy and Institutions, and a Senior Fellow of Stanford Institute for Economic Policy Research (SIEPR) and the Freeman Spogli Institute for International Studies (FSI) at Stanford University.

Claire Cousineau is a writer and former researcher at the Stanford Center on China’s Economy and Institutions, she is currently pursuing her MBA at Duke University.



Availability


The Highest Exam: How the Gaokao Shapes China is available now for purchase from Amazon and elsewhere.  



Upcoming Book Event


Join us on Tuesday, October 21 at 4 PM (Pacific) for a fireside chat with co-authors Ruixue Jia and Hongbin Li. The fireside chat will be held in-person in the Bechtel Conference Center and livestreamed for virtual attendees. Learn More & Register
 


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Book cover: Institutional Genes: Origins of China's Institutions and Totalitarianism by Chenggang Xu
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"The Highest Exam: How the Gaokao Shapes China", written by Ruixue Jia, Hongbin Li, and Claire Cousineau, combines rigorous research with compelling personal narratives to reveal how the gaokao has become much more than a test: it is a tool to shape China’s society and economy.

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Join us for a fireside chat with co-authors Ruixue Jia and Hongbin Li who will discuss their most recent book, The Highest Exam: How the Gaokao Shapes China. The fireside chat will be held in-person in the Bechtel Conference Center and livestreamed for virtual attendees. After the fireside chat, we invite in-person attendees to join us for a light reception and book signing with Hongbin Li. Order your copy of the book here.

Join the webinar to watch the event live:

Webinar ID: 985 1962 7327
Passcode: 361163
 


The Highest Exam book cover.

Each year, more than ten million students across China pin their hopes on the gaokao, the nationwide college entrance exam. Unlike in the United States, where standardized tests are just one factor, in China college admission is determined entirely by gaokao performance. It is no wonder the test has become a national obsession.

Drawing on extensive surveys, historical research, and economic analysis, and informed by Ruixue Jia and Hongbin Li’s own experiences of the gaokao gauntlet, The Highest Exam reveals how China’s education system functions as a centralized tournament that serves the needs of the Chinese Communist Party and drives much of the country’s economic growth. The book examines the gaokao’s far-reaching effects on China’s society and beyond. As Chinese-American families bring the expectations of the highest exam with them, their calls for objective, transparent metrics in the education system increasingly clash with the more holistic measures of achievement used by American schools and universities.



About the Authors
 

Hongbin Li

Hongbin Li is the Co-director of Stanford Center on China's Economy and Institutions, and a Senior Fellow of Stanford Institute for Economic Policy Research and the Freeman Spogli Institute for International Studies. Li obtained his Ph.D. in economics from Stanford University in 2001 before joining the economics department at the Chinese University of Hong Kong (CUHK). He was also one of the two founding directors of the Institute of Economics and Finance at the CUHK. He taught at Tsinghua University from 2007 to 2016 in the School of Economics and Management and was the founder and Executive Associate Director of the China Social and Economic Data Center. 

Li’s research has been focused on the transition and development of the Chinese economy, and the evidence-based research results have been both widely covered by media outlets and well read by policy makers around the world. He is currently the co-editor of the Journal of Comparative Economics and co-author of the book, The Highest Exam: How the Gaokao Shapes China, published by Harvard University Press.
 

Ruixue Jia headshot.

Ruixue Jia is a professor of economics at the School of Global Policy and Strategy at UC San Diego. She also serves as Co-director of the China Data Lab, executive secretary of the Association of Comparative Economic Studies (ACES) and co-chair of the China Economic Summer Institute (CESI). 

Jia’s research lies at the intersections of economics, history and politics, with a focus on how power structures evolve and shape economic development. Her recent work examines the political economy of idea formation and diffusion, including the interplay between the state, education, science and technology. She is the co-author of The Highest Exam, a book that explores how China’s education system both mirrors and molds its society.
 

Headshot of Claire Cousineau.

Claire Cousineau  is a writer and former researcher at the Stanford Center on China’s Economy and Institutions, she is currently pursuing her MBA at Duke University.

Since studying and working in Beijing and Kunming, Claire is passionate about fostering a deeper public understanding of China’s role on the global stage and creating cross-cultural relationships. Claire is the co-author of the book, The Highest Exam: How the Gaokao Shapes China, along with Hongbin Li and Ruixue Jia, published by Harvard University Press in 2025. 
 



Bechtel Conference Center
Encina Hall
616 Jane Stanford Way, Stanford University

or via Livestream

Ruixue Jia

John A. and Cynthia Fry Gunn Building, 366 Galvez Street
Stanford, CA 94305-6015

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Faculty Co-director of the Stanford Center on China's Economy and Institutions
Professor, by courtesy, of Economics
Senior Fellow at the Freeman Spogli Institute for International Studies
Senior Fellow at the Stanford Institute for Economic Policy Research
Director of the China, Labor, Income, and Population Research Program, Stanford Center on China's Economy and Institutions
Faculty Affiliate at the King Center of Global Development
Faculty Affiliate at Stanford Institute for Human-Centered Artificial Intelligence
5268-hongbinli.png PhD

Hongbin Li is a Senior Fellow of Stanford Institute for Economic Policy Research (SIEPR) and the Freeman Spogli Institute for International Studies (FSI).

Hongbin obtained Ph.D. in economics from Stanford University in 2001 and joined the economics department of the Chinese University of Hong Kong (CUHK), where he became full professor in 2007. He was also one of the two founding directors of the Institute of Economics and Finance at the CUHK. He taught at Tsinghua University in Beijing 2007-2016 and was C.V. Starr Chair Professor of Economics in the School of Economics and Management. He also founded and served as the Executive Associate Director of the China Social and Economic Data Center at Tsinghua University. He founded the Chinese College Student Survey (CCSS) in 2009 and the China Employer-Employee Survey (CEES) in 2014.

Hongbin’s research has been focused on the transition and development of the Chinese economy, and the evidence-based research results have been both widely covered by media outlets and well read by policy makers around the world. He is currently the co-editor of the Journal of Comparative Economics and co-author of the forthcoming book, “The Highest Exam: How the Gaokao Shapes China” published by Harvard University Press.

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For years the Rural Education Action Program (REAP) has been working to improve early childhood development outcomes across rural China. One of the most impactful programs has been the development and implementation of  REAP’s parenting curriculum and parenting centers. The centers expand upon our parenting curriculum by providing free and accessible spaces where caregivers and their young children can read, play, and explore together using developmentally appropriate toys and books that promote cognitive development. REAP has now supported the development of over 150 centers at county, township, and village levels across multiple provinces. 

Recently, REAP helped establish a parenting center at the Zhengzhou Foxconn Facility serving migrant factory employees and their families. Since opening, the center has already hosted over 10,000 child visits and supported over 350 families. Following the REAP model, this parenting center combines a research-based curriculum for early childhood development with local needs. The new center has received positive media attention across several outlets in China, including Henan DailyGlobal Times, and Zhenggang News. The success of this parenting center introduces new opportunities for future parenting center collaborations that better serve manufacturing communities across China. 
 


Discover more REAP research projects on early childhood development (ECD).

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REAP helped establish a parenting center at the Zhengzhou Foxconn Facility serving migrant factory employees and their families. The center implements a research-based curriculum for early childhood development to better meet local needs. The new center has recently received positive media attention across several outlets in China.

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Group photo of students, staff, and faculty in China during the 2025 SCCEI China Study Program.
Students visited the U.S. Embassy in Beijing.

In June 2025, twenty Stanford undergraduate and graduate students traveled across China on a two-week immersive program designed to deepen their understanding of the country’s economy, culture, and international relations. Led by Stanford faculty members, the program took students to eight cities across three regions in China—Hong Kong, Shenzhen, Dongguan, Guangzhou, Yiwu, Hangzhou, Shanghai, and Beijing—combining academic exchanges, site visits to leading companies and institutions, and rich cultural experiences.

The itinerary included more than a dozen in-depth site visits, giving students direct exposure to the technological, manufacturing, and financial sectors that shape China’s economy. Highlights included factory tours of OPPO and XPeng electric vehicle plant; conversations with senior executives at Tencent, Alibaba, ByteDance, and Goldman Sachs; as well as a discussion with Hong Kong’s finance under secretary. Students toured the world-famous electronics markets in Shenzhen and trade markets in Yiwu, where they spoke directly with small business owners, gaining insight into the entrepreneurial networks that fuel global supply chains. One of the program’s most impactful experiences came in Beijing, where participants visited the U.S. Embassy for a conversation with diplomatic officers about U.S.–China relations. 

Garry Piepenbrock, an economics and political science student, said that “seeing the variety of companies in China” was his favorite part of the program. He added, “there are a lot of big tech firms that we've had the privilege to visit, but also some of my favorite visits were the smaller manufacturers that had really interesting human stories behind them. The people working there and also the people running them. It's a difficult business. It's very competitive. And seeing that side of the Chinese economy was really cool.” 

There are a lot of big tech firms that we've had the privilege to visit, but also some of my favorite visits were the smaller manufacturers that had really interesting human stories behind them.
Garry Piepenbrock

Throughout the program AI emerged as a hot topic and focal area for China’s technological and economic advancement goals. Zane Sabbagh, a computer science and symbolic systems student, shared his insights on AI development in China, “given China's lag in the AI race, their model is to let one Chinese company win by open sourcing a lot of their models and then hosting other companies' models on their platform. So for example, Tencent’s chatbot and Alibaba chatbot both host DeepSeek’s models on their own app, which is super weird because ChatGPT would never host Anthropic or xAI on its own native iPhone app. That’s something I found super interesting.” 

Students also had the opportunity to compare their own academic experience through visits to multiple academic institutions in China. At the University of Hong Kong, students participated in a lecture given by Professor Zhiwu Chen on understanding Hong Kong’s history. At Peking University, students engaged with Vice Dean Li-An Zhou who gave a brief introduction on China’s economy. In addition to university exchanges, students also visited a migrant school in Beijing where they learned about the education system and connected with the young migrant students. Nazli Dakad, an earth systems student, reflected on the program and shared that, “one of my favorite parts of the trip was the migrant school. I thought that was super eye opening and contrasting to the tech focus that we've had, because it gave me a little more insight into the education system in China.”

Throughout the program students had the opportunity to engage with locals in various settings, from top executives, to factory workers, to locals out and about conducting their daily routines. Students also met with Stanford alumni based in China and learned about their career trajectories after graduation. Several students shared that building connections with people in China has been a highlight for them. Biology major Eva Shen shared, “being Chinese I feel like I've been very disconnected from China in the US, so being able to talk to all these people here [in Chinese] has been the best part for me…getting to hear their perspective, and actually getting to know them as people, has been my favorite part. When we did our interviews in the market back in Shenzhen, and we got to talk to older ladies, they reminded me of my own grandma.”

Cultural immersion was also woven throughout the journey. Students tried their hand at traditional arts such as paper cutting, brush calligraphy, and tea pan-frying; dressed in historical attire for an opera performance in Yiwu and a palace banquet in Hangzhou; and learned crafts like umbrella-making and handmade paper production. These activities provided a tangible connection to China’s long cultural heritage alongside its modern economic dynamism.

The learnings from this trip will definitely be something that I carry with me in all the ways that I think about what I want to do in my work for the rest of my career.
Adeline Liao

By the end of the program, participants had gained a multifaceted perspective on China—its economic drivers, its cultural traditions, and its evolving role on the world stage. “This program was about more than just observation—it was about engagement,” said SCCEI Co-director Hongbin Li. “Our students came away with firsthand experiences and conversations that will shape how they think about China for years to come.”

Discover more on our program page including student reflection videos, program photos, and more.


Watch the Program Highlights Reel

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Led by Stanford faculty members, 20 Stanford students traveled across China engaging in academic exchanges, site visits to leading companies and institutions, and rich cultural experiences to gain a deeper understanding of the country’s economy, culture, and international relations.

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SCCEI Senior Research Scholar Chenggang Xu’s latest book, Institutional Genes: Origins of China's Institutions and Totalitarianism, offers a reinterpretation of China’s political and institutional development. Drawing from decades of research, Xu introduces the concept of "institutional genes"—the enduring foundational structures that shape and constrain how institutions evolve. Through this lens, he examines the emergence and evolution of China’s current communist totalitarian institution, contending that substantial parts of its "institutional genes" were implanted by Soviet Russia, building upon a longstanding tradition of authoritarian rule dating back to imperial China.

Book cover: Institutional Genes: Origins of China's Institutions and Totalitarianism by Chenggang Xu

With insights spanning political economy, institutional economics, and history, Institutional Genes presents a compelling account of why China’s institutions have taken their particular form—why they have resisted democratization—and why its economic reforms have risen and fallen. Xu’s work will appeal to scholars, policymakers, and general readers seeking a deeper understanding of how China’s past continues to shape its political trajectory today. 

Institutional Genes: Origins of China's Institutions and Totalitarianism, previously published in Chinese, is currently available for pre-order and will be published and available to the public on August 21, 2025. For more from Xu, read his recent essay, The Origins of China’s Institutions and Totalitarianism, based on his forthcoming book.


    

Headshot of Dr. Chenggang Xu.

Chenggang Xu

Senior Research Scholar, Stanford Center on China's Economy and Institutions
About the Author

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SCCEI Senior Research Scholar Chenggang Xu’s latest book, "Institutional Genes: Origins of China's Institutions and Totalitarianism", explores the origins and evolution of China's institutions and communist totalitarianism.

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Sustainability and energy transition research program banner with text superimposed a city landscape in China half greenery, half skyscrapers, and a road leading through the middle.

The Stanford Center on China’s Economy and Institutions (SCCEI) is pleased to announce the launch of the Sustainability and Energy Transition (SET) research program led by Professor Shanjun Li. As China navigates pressing sustainability challenges, the SET program aims to generate empirical research to understand the trade-offs, impacts, and institutional dynamics of the country’s sustainability efforts and develop effective evidence-based solutions to the challenges China and the world face. 

The program will focus on three key areas: sustainability challenges, energy transition, and policy solutions. Researchers will aim to identify and understand the underlying economic drivers of sustainability challenges, such as environmental degradation, resource stress, energy insecurity, and urban traffic congestion, and the consequences for growth, equity, and resilience. They will also examine the shift from fossil fuels to clean energy and how and why China has emerged as a global leader in the field. Through the use of high resolution data and rigorous empirical methods, SET researchers aim to generate evidence on the economic and social impacts of sustainability threats across regions and populations, as well as the mechanisms and effectiveness of adaptation. 

Through close collaboration with scholars in China, across Stanford University, and beyond, the SET program aims to inform both academic debates and policy decisions. Its work will support efforts to balance economic growth with environmental protection and aims to contribute to the global conversation on energy transitions across emerging economies.



The Sustainability and Energy Transition research program is led by Shanjun Li, Senior Fellow at the Freeman Spogli Institute for International Studies and Professor at the Doerr School of Sustainability. A leading scholar in environmental and energy economics, Li brings deep expertise on the economic and institutional drivers of sustainable development, with a particular focus on China. His research has informed policy debates on emissions pricing, electric vehicle adoption, and clean energy transitions.

To learn more about the program, visit the SET research page.

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SCCEI's newest research program addresses the pressing sustainability challenges facing China and examines their broader global implications. Grounded in rigorous empirical analysis and economic modeling, researchers aim to inform the development of effective evidence-based policy solutions as well as uncover valuable lessons for other countries navigating similar economic and energy transitions.

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SCCEI awarded competitive research fellowships to two Stanford Ph.D. candidates, Alica R. Chen and Matthew DeButts, for the 2025-26 academic year. The award recipients will receive funding for two quarters and will conduct research on diverse topics focused on prominent issues in today’s society. 

Alicia Chen headshot

Alicia R. Chen, PhD Candidate in Political Science, Stanford University
Research Topic: Roads to (No) Influence: Domestic Incentives and the Distribution of Chinese Aid

Alicia Chen is a PhD candidate in the political science department at Stanford University. Chen’s research focuses on conflict, development, and international economics, with an empirical focus on Chinese development aid. Chen holds an MA in international policy from Stanford University and a BA in political science from the University of Southern California. Prior to doctoral studies, Chen was a Research Specialist at the Empirical Studies of Conflict (ESOC) project at Princeton University. 

Q: What advice would you give to someone just starting out in your field of research?
A: I encourage everyone to do fieldwork in the countries they are interested in studying as early as possible. Media coverage (and even data) often doesn’t capture the full picture, and it was immensely helpful to see for myself what the situation is on the ground.

Q: If you could snap your fingers and have one part of your research magically completed, what would it be?
A: Data collection… Many fieldwork trips end up taking much longer than expected because of bureaucratic delays, and there is not much that can be done to speed up the process.


 

Matthew DeButts headshot

Matthew DeButts, PhD Candidate in Communication, Stanford University
Research Topic: PRC Influence and Chinese Diasporic Media in the Digital Age

Matt DeButts is a PhD candidate in communication, studying Chinese media, censorship, and propaganda. Before coming to Stanford, Matt wrote about Chinese economics and politics for The Economist Intelligence Unit in Beijing, covered culture as a special correspondent for the Los Angeles Times, and edited the foreign affairs newsletter Legation Quarter. At Stanford, he was a 2023-24 Human-Centered Artificial Intelligence (HAI) fellow, and a graduate research assistant at the Stanford Internet Observatory. His academic work has been published in the Journal of Communication, Social Media+ Society, and EMNLP Findings.

Q: What advice would you give to someone just starting out in your field of research?

Trust your curiosity. Disciplinary and methodological training are vital, but curiosity is what makes research breathe — it keeps your work alive and keeps you interested in pursuing it.
Matt DeButts

Q: How would you describe your research to a fifth grader?
A: My research looks into how powerful people, like governments, try to get people to believe things. Sometimes, governments treat you like a grown-up, explaining things and allowing you to decide for yourself. But other times, they treat you like a kid, always thinking they know what’s best for you. My research looks into how and why they do that.



SCCEI offers grants to support exceptional researchers conducting data-driven research related to China's economy. We accept proposals two times per year, Fall and Winter. Visit the SCCEI Research Grants and Fellowships webpage for more details and current opportunities.

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SCCEI awarded Alicia Chen and Matthew DeButts with competitive research fellowships for the 2025-26 academic year to pursue research on China.

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This article was published by Stanford Daily. Please click below to read the full article.

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Stanford Daily reporter Kayla Chan spotlights Scott Rozelle, REAP Program Director, and the research he has conducted over his 40 years studying agriculture and development in China.

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Achieving minimum dietary diversity (MDD), a crucial indicator of infant and young child diet quality, remains a challenge in rural China, especially for infants aged 6–11 months. This study examined the rate of MDD attainment in rural China, identified its determinants using the Capability, Opportunity, Motivation, and Behavior (COM-B) model and Bayesian network analysis, and estimated the potential impact of improving each modifiable determinant. A multi-stage sampling design selected 1328 caregivers of infants aged 6–11 months across 77 rural townships in China. Data were collected through a cross-sectional survey via in-person household interviews. Bayesian network analysis identified key factors influencing MDD attainment and their interrelationships, while Bayesian inference estimated MDD attainment probabilities. Results showed that only 22.2 % of the sample infants attained MDD. Bayesian network analysis revealed that caregiver knowledge (a proxy of capability), self-efficacy and habits (proxies of motivation), and infant age directly influenced MDD attainment. Social support (a proxy of opportunity) indirectly promoted MDD attainment by boosting self-efficacy and habit. Notably, simultaneous improvements in knowledge, self-efficacy, and habit could increase MDD attainment by 17.6 %, underscoring the potential effectiveness of interventions focused on enhancing caregiver capability and motivation. The critically low MDD attainment rate among rural Chinese infants highlights the urgent need for targeted interventions. Strategies should prioritize enhancing caregiver feeding knowledge, self-efficacy, and habit formation to improve infant dietary diversity. Addressing these key factors could substantially boost MDD attainment in rural China.

Journal Publisher
Journal of Appetite
Authors
Hanwen Zhang
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