Yue Ma

All Publications

• Gap in protective behaviors between Han and minority ethnicities during COVID-19 pandemic in rural western China: A decomposition analysis. Preventive medicine reports Ye, R., Wu, Y., Sun, C., Wang, Q., Ma, Y., Chen, Y., Pappas, L., Feng, C., Rozelle, S., Zhou, H. 2024; 39: 102617

  Abstract

  Understanding the ethnic gap in protective behavior and its explanatory factors is a promising step for reducing pandemic-induced disparities. However, no studies have endeavored to identify the factors contributing to a gap in protective behaviors between Han and minority ethnicities during COVID-19 pandemic in rural China. We aimed to analyze the gap in protective behaviors between Han and minority residents in rural China. We conducted cross-sectional studies in multi-ethnic rural China in 2020. A total of 1640 participants from Han and minority groups were invited to participate. The decomposition method was applied to analyze the gap in protective behaviors and its associated factors between the Han and minority groups. Participants in the Han group had a higher protective behavioral score (9.26 ± 1.20) than the minority group (8.97 ± 1.50), yielding a significant gap in protective behaviors between Han and minority ethnicities of 0.29. Socio-demographic characteristics, health status, the degree of knowledge held about COVID-19, and psychological responses to COVID-19 explained 79.3 % (0.23/0.29) of the behavioral gap between the Han and minority groups. The difference in household asset levels was the largest explained contributor to the behavioral gap (52.17 %) (0.12/0.23), followed by fear felt for COVID-19 (-21.74 %) (-0.05/0.23). Differences in educational attainment, degree of knowledge held about COVID-19, and self-efficacy in response to COVID-19 each explained 17.4 % (0.04/0.23) of the behavioral gap. In conclusion, Han group show greater protective behaviors than minority ethnic groups. To drive better protective behavior in the most vulnerable communities, targeted, group-specific COVID-19 preventative messages deployed in public health communication strategies is suggested to enhance individual confidence in coping with the pandemic while creating a healthy amount of fear for public health crisis.

  View details for DOI 10.1016/j.pmedr.2024.102617

  View details for PubMedID 38370983

  View details for PubMedCentralID PMC10873723

• Generalizable evidence that computer assisted learning improves student learning: A systematic review of education technology in China COMPUTERS AND EDUCATION OPEN Abbey, C., Ma, Y., Akhtar, M., Emmers, D., Fairlie, R., Fu, N., Johnstone, H., Loyalka, P., Rozelle, S., Xue, H., Zhang, X. 2024; 6

  View details for DOI 10.1016/j.caeo.2024.100161

  View details for Web of Science ID 001175585200001

• Unraveling the Relationship Between Teachers' and Students' Mental Health: A One-to-One Matched Analysis JOURNAL OF EXPERIMENTAL EDUCATION Yan, W., Zhang, X., Wang, Y., Peng, K., Ma, Y. 2024

  View details for DOI 10.1080/00220973.2024.2306412

  View details for Web of Science ID 001180414500001

• Computer Assisted Learning and Academic Performance in Rural Taiwan JOURNAL OF RESEARCH ON EDUCATIONAL EFFECTIVENESS Ma, Y., Zhang, X., Abbey, C., Hu, D., Lee, O., Hung, W., Chang, C., Wu, C., Friesen, D., Rozelle, S. 2023

  View details for DOI 10.1080/19345747.2023.2279167

  View details for Web of Science ID 001117849000001

• Factors of parental investment in the home language environment in peri-urban China: A mixed methods study. PloS one Feng, T., Guo, J., Dill, S. E., Zhang, D., Liu, Y., Ma, Y., Pappas, L., Rozelle, S. 2023; 18 (11): e0294158

  Abstract

  The home language environment is a critical point of investment in early language skills. However, few studies have quantitatively measured the home language environment of low-socioeconomic-status households in non-western settings. This mixed methods study describes the home language environment and early child language skills among households in a low-socioeconomic-status, peri-urban district of Chengdu, China, and identifies factors influencing parental investment in the home language environment. Audio recordings were collected from 81 peri-urban households with children ages 18-24 months and analysed using the Language Environment Analysis (LENATM) system. The Mandarin version of the MacArthur-Bates Communicative Development Inventory was administered to each child's primary caregiver. The quantitative results revealed large variation in home language environments and child language skills among the sample, with relatively low average scores when compared to other Chinese samples. Qualitative interviews with a subset of 31 caregivers revealed that many caregivers face constraints on their knowledge of interactive parenting, compounded, in some households, by time constraints due to work or household responsibilities. The findings indicate a need for increased sources of credible parenting information for peri-urban caregivers of young children to promote investment in the home language environment.

  View details for DOI 10.1371/journal.pone.0294158

  View details for PubMedID 37956186

• Associations between urbanization and the home language environment: Evidence from a LENA study in rural and peri-urban China. Child development Ma, Y., Zhang, X., Pappas, L., Rule, A., Gao, Y., Dill, S. E., Feng, T., Zhang, Y., Wang, H., Cunha, F., Rozelle, S. 2023

  Abstract

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

  View details for DOI 10.1111/cdev.14034

  View details for PubMedID 37937886

• The home language environment and early childhood development: a LENA study from rural and peri-urban China APPLIED DEVELOPMENTAL SCIENCE Zhang, X., Liu, D., Pappas, L., Dill, S., Feng, T., Zhang, Y., Zhao, J., Rozelle, S., Ma, Y. 2023

  View details for DOI 10.1080/10888691.2023.2267440

  View details for Web of Science ID 001088097800001

• The Salience of Information: Evidence from a Health Information Campaign in Rural China ECONOMIC DEVELOPMENT AND CULTURAL CHANGE Ma, Y., Sylvia, S., Friesen, D., Overbey, K., Medina, A., Rozelle, S. 2023

  View details for DOI 10.1086/720005

  View details for Web of Science ID 001066220200001

• Education and EdTech during COVID-19: Evidence from a Large-Scale Survey during School Closures in China (vol 67, pg 53, 2023) COMPARATIVE EDUCATION REVIEW Li, G., Liu, D., Zhang, X., Ma, Y., Abbey, C., Fairlie, R. 2023

  View details for DOI 10.1086/725409

  View details for Web of Science ID 001024611400006

• Variations in the home language environment and early language development in a peri-urban community in China EARLY CHILDHOOD RESEARCH QUARTERLY Feng, T., Zhang, X., Zhou, L., Zhang, Y., Pappas, L., Dill, S., Rozelle, S., Ma, Y. 2023; 64: 199-215

  View details for DOI 10.1016/j.ecresq.2023.03.005

  View details for Web of Science ID 000975726200001

• The home language environment in rural China: variations across family characteristics. BMC public health Ma, Y., Jonsson, L., Yao, Z., Zhang, X., Friesen, D., Medina, A., Rozelle, S., Pappas, L. 2023; 23 (1): 354

  Abstract

  A rich language environment is an important element of a nurturing home environment. Despite their proven importance, vocabulary and conversation have been shown to vary widely across households-even within the same socio-economic class. One significant gap in the existing literature is its nearly exclusive geographic focus on Western and developed settings, with little attention given to poorer communities in lower/middle income countries. The purpose of this study was to empirically illustrate the characteristics of the home language environment in the low SES, non-Western cultural setting of rural China.Using Language Environment Analysis (LENA) automated language-analysis system, this study measured the home language environment of 38 children aged 20-27 months in Northwest rural China. Our primary measures of the home language environment were Adult Word Count (AWC), Conversational Turn Count (CTC) and Child Vocalization Count (CVC). Multivariate linear regression models were used to examine the association between home language environment and family/child characteristics, and language skills (Measured by MacArthur-Bates Communicative Developmental Inventory score).In this paper, by comparison, we found that the home language environment of our rural sample fell far behind that of urban households. We also identify significant, positive correlations between language skills and both AWC and CTC. Our analysis finds no significant correlations between home language environment and family/child characteristics.In this paper, we present the first ever findings using the LENA system to measure the home language environment of young children from poor rural communities in China. We found that the home language environment of lower-SES household was significantly worse than high-SES households, and demonstrated the importance of the home language environment to language skills, pointing to a need for more high-quality studies of the home language environment in rural China to better understand possible mechanisms behind low levels of parent-child language engagement and ways to improve the home language environment.

  View details for DOI 10.1186/s12889-023-15245-2

  View details for PubMedID 36797712

  View details for PubMedCentralID 5881401

• Education and EdTech during COVID-19: Evidence from a Large-Scale Survey during School Closures in China COMPARATIVE EDUCATION REVIEW Li, G., Zhang, X., Liu, D., Xue, H., Hu, D., Lee, O., Rilling, C., Ma, Y., Abbey, C., Fairlie, R., Loyalka, P., Rozelle, S. 2023

  View details for DOI 10.1086/723027

  View details for Web of Science ID 000911181200001

• How does the family environment affect toddlerhood language and cognitive development? Evidence from peri-urban China APPLIED DEVELOPMENTAL SCIENCE Ma, Y., Pappas, L., Zhang, X., Feng, T., Eve-Dill, S., Rozelle, S., Weber, A. 2023

  View details for DOI 10.1080/10888691.2023.2165077

  View details for Web of Science ID 000927489000001

• Family-level factors of early childhood development: Evidence from rural China. Infant behavior & development Ma, Y., Pappas, L., Zhang, X., Feng, T., Su, W. B., Wang, Q., Zeng, Y., Dill, S., Rozelle, S. 2022; 70: 101787

  Abstract

  Family-level factors that characterize the home environment are critical inputs to early language and cognitive development, and potential mechanisms for improving developmental outcomes in vulnerable populations. Many studies conducted in high-income and Western settings highlight stimulating parenting, the home language environment, and parental self-efficacy as possible mechanisms of early development, though less is known about how these family-level factors impact child development in low- or middle-income settings. Even less is known about these family-level factors and early childhood development in rural China, where rates of cognitive and language delay in children aged 0-3 years are as high as 45% and 46%, respectively. Using data collected from 77 rural households with children aged 18-24 months in Southwestern China, this study examines the associations between stimulating parenting, the home language environment, and parental self-efficacy, and early cognitive and language development. The results indicate that stimulating parenting was significantly associated with cognitive, language, and overall development; the home language environment was only significantly associated with language development; and parental self-efficacy was not significantly associated with any developmental outcomes. The implications of such findings reveal mechanisms for supporting healthy child development in rural China.

  View details for DOI 10.1016/j.infbeh.2022.101787

  View details for PubMedID 36399846

• Effect of Eyeglasses on Student Academic Performance: What Matters? Evidence from a Randomized Controlled Trial in China INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH Du, K., Wang, H., Ma, Y., Guan, H., Rozelle, S. 2022; 19 (17)

  Abstract

  Although eyeglasses have been considered a cost-effective way to combat myopia, the empirical evidence of its impacts on improving learning outcomes is inconsistent. This paper provides empirical evidence examining the effect of providing eyeglasses on academic performance between provinces with a different economic level in western China. Overall, we find a significant impact in Intention-to-Treat analysis and a large and significant local average treatment effect of providing free eyeglasses to students in the poor province but not in the other. The difference in impact between the two provinces is not a matter of experimental design, implementation, or partial compliance. Instead, we find that the lack of impact in the wealthier provinces is mainly due to less blackboard usage in class and wealthier households. Our study found that providing free eyeglasses to disadvantaged groups boosted their academic performance more than to their counterparts.

  View details for DOI 10.3390/ijerph191710923

  View details for Web of Science ID 000851114900001

  View details for PubMedID 36078633

• Academic Performance and the Link with Depressive Symptoms among Rural Han and Minority Chinese Adolescents. International journal of environmental research and public health Feng, T., Jia, X., Pappas, L., Zheng, X., Shao, T., Sun, L., Weisberg, C., Li, M. L., Rozelle, S., Ma, Y. 2022; 19 (10)

  Abstract

  The objectives of this paper were to examine the risk of depression and depressive symptoms among Han and minority children and adolescents in rural China, the links between academic performance and depressive symptoms, and the prevalence of these links among specific subgroups. A total of 8392 4th, 5th, and 6th grade students at 105 sample rural schools in eight low-income counties and districts in a prefectural-level city in Southwestern China were randomly selected using a three-step sampling strategy. A total of 51% of the sample were female (SD = 0.50), and the age range was 7 to 19 years (mean = 11.35 years; SD = 1.05). Using the Patient Health Questionnaire 8-item depression scale, the prevalence of depressive symptoms in the sample was assessed, while data on students' academic performance (standardized math test) and demographic characteristics were also collected. Our results show that the rates of major depression were 19% for Han students, 18% for Tibetan students, and 22% for Yi students; the rates of severe depression were 2% for Han and Tibetan students, and 3% for Yi students. Yi students were at significantly higher risks for major and severe depression than Han students. We conducted multivariate regression and heterogeneous analyses. Academic performance was negatively and significantly correlated to depressive symptoms. Across the whole sample, students with lower math scores, minority students, boys, younger students, and students with migrant parents were most vulnerable to depressive symptoms. The heterogeneous analysis suggests that among poor-performing students, subgroups at higher risk for depression include boys, non-boarding students, and students whose mothers had graduated from high school or above. These findings indicate a need to improve mental health outcomes of rural Han and minority primary school students, targeting academic performance for possible intervention.

  View details for DOI 10.3390/ijerph19106026

  View details for PubMedID 35627563

• Off the COVID-19 Epicentre: The Impact of Quarantine Controls on Employment, Education and Health in China's Rural Communities CHINA QUARTERLY Wang, H., Dill, S., Zhou, H., Ma, Y., Xue, H., Loyalka, P., Sylvia, S., Boswell, M., Lin, J., Rozelle, S. 2022

  View details for DOI 10.1017/S0305741021000989

  View details for Web of Science ID 000767144400001

• The impact of nonboarding on the development of disadvantaged boarding students in western rural China ASIA PACIFIC EDUCATION REVIEW Jia, X., Zhang, X., Jing, J., Zhou, M., Li, H., Friesen, D., Ma, Y. 2022

  View details for DOI 10.1007/s12564-022-09742-z

  View details for Web of Science ID 000748447300002

• The home language environment and early language ability in rural Southwestern China. Frontiers in psychology Zhang, X., Ma, Y., Feng, T., Zhang, V., Wu, X., Li, M., Li, Q., Thani, Z., Pappas, L., Dill, S., Rozelle, S. 2022; 13: 1010442

  Abstract

  Using premier Language Environment Analysis technology to measure and analyze the home language environment, this observational study aims to describe the home language environment and child language ability, drawing on empirical data from 77 households with children aged 18-24 months from rural China. The results show large variation in measures of the home language environment and early language ability, similar to other rural Chinese samples. Results also demonstrate significant correlations between child age and the home language environment, maternal employment and the home language environment, father's educational attainment and the home language environment, adult-child conversations and early language ability, and child vocalizations and early language ability.

  View details for DOI 10.3389/fpsyg.2022.1010442

  View details for PubMedID 37006716

• Early childhood development and parental training interventions in rural China: a systematic review and meta-analysis. BMJ global health Emmers, D., Jiang, Q., Xue, H., Zhang, Y., Zhang, Y., Zhao, Y., Liu, B., Dill, S., Qian, Y., Warrinnier, N., Johnstone, H., Cai, J., Wang, X., Wang, L., Luo, R., Li, G., Xu, J., Liu, M., Huang, Y., Shan, W., Li, Z., Zhang, Y., Sylvia, S., Ma, Y., Medina, A., Rozelle, S. 2021; 6 (8)

  Abstract

  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.TRIAL REGISTRATION NUMBER: This study was registered with PROSPERO (CRD42020218852).

  View details for DOI 10.1136/bmjgh-2021-005578

  View details for PubMedID 34417271

• Health, economic, and social implications of COVID-19 for China's rural population AGRICULTURAL ECONOMICS Wang, H., Dill, S., Zhou, H., Ma, Y., Xue, H., Sylvia, S., Smith, K., Boswell, M., Medina, A., Loyalka, P., Abby, C., Friesen, D., Rose, N., Guo, Y., Rozelle, S. 2021

  View details for DOI 10.1111/agec.12630

  View details for Web of Science ID 000648889700001

• Health, economic, and social implications of COVID-19 for China's rural population. Agricultural economics (Amsterdam, Netherlands) Wang, H., Dill, S. E., Zhou, H., Ma, Y., Xue, H., Sylvia, S., Smith, K., Boswell, M., Medina, A., Loyalka, P., Abby, C., Friesen, D., Rose, N., Guo, Y., Rozelle, S. 2021; 52 (3): 495-504

  Abstract

  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.

  View details for DOI 10.1111/agec.12630

  View details for PubMedID 34149132

  View details for PubMedCentralID PMC8207079

• Variations in the Home Language Environment and Early Language Development in Rural China INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH Ma, Y., Jonsson, L., Feng, T., Weisberg, T., Shao, T., Yao, Z., Zhang, D., Dill, S., Guo, Y., Zhang, Y., Friesen, D., Rozelle, S. 2021; 18 (5)

  Abstract

  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.

  View details for DOI 10.3390/ijerph18052671

  View details for Web of Science ID 000628183400001

  View details for PubMedID 33800901

• The impact of Internet use on adolescent learning outcomes: evidence from rural China CHINA AGRICULTURAL ECONOMIC REVIEW Li, L., Ma, Y., Friesen, D., Zhang, Z., Jin, S., Rozelle, S. 2021

  View details for DOI 10.1108/CAER-07-2020-0172

  View details for Web of Science ID 000619425600001

• The Impact of Online Computer Assisted Learning at Home for Disadvantaged Children in Taiwan: Evidence from a Randomized Experiment SUSTAINABILITY Tang, B., Ting, T., Wu, C., Ma, Y., Mo, D., Hung, W., Rozelle, S. 2020; 12 (23)

  View details for DOI 10.3390/su122310092

  View details for Web of Science ID 000597502100001

• Maternal health behaviors during pregnancy in rural Northwestern China. BMC pregnancy and childbirth Ma, Y., Gao, Y., Li, J., Sun, A., Wang, B., Zhang, J., Dill, S., Medina, A., Rozelle, S. 2020; 20 (1): 745

  Abstract

  BACKGROUND: Maternal health during pregnancy is a key input in fetal health and child development. This study aims to systematically describe the health behaviors of pregnant women in rural China and identify which subgroups of women are more likely to engage in unhealthy behaviors during pregnancy.METHODS: We surveyed 1088 pregnant women in rural northwestern China on exposure to unhealthy substances, nutritional behaviors, the timing and frequency of antenatal care, and demographic characteristics.RESULTS: Pregnant women were active in seeking antenatal care and had low rates of alcohol consumption (5.1%), exposure to toxins (4.8%), and exposure to radiation (2.9%). However, tobacco exposure was widespread (40.3%), as was low dietary diversity (61.8%), unhealthy weight gain (59.7%), unhealthy pre-pregnancy BMI (29.7%), and no folic acid intake (17.1%). Maternal education is closely linked to better health behaviors, whereas experience with a previous pregnancy is not.CONCLUSIONS: Tobacco exposure and unhealthy nutritional behaviors are common among pregnant women in rural northwestern China. The findings indicate that in the absence of professional health information, relying on experience of previous pregnancies alone may not help rural women avoid unhealthy maternal behaviors. Maternal health education campaigns targeting nutrition and tobacco exposure during pregnancy may improve maternal, fetal, and child health in rural China.

  View details for DOI 10.1186/s12884-020-03444-3

  View details for PubMedID 33256673

• Safety of eyeglasses wear for visual acuity among middle school students in northwestern rural China: a cluster-randomised controlled trial. BMJ open ophthalmology Ma, Y., Zhang, X., Li, H., Ma, X., Friesen, D., Rozelle, S., Pang, X., Zhou, M., Congdon, N. 2020; 5 (1): e000572

  Abstract

  To assess the effect of free eyeglasses provision on visual acuity among middle school students in northwestern rural China.Among 31 middle schools randomly selected from 47 middle schools in northwestern rural China, students were randomly allocated by school to one of two interventions: free eyeglasses (intervention group), and eyeglasses prescriptions given only to the parents (control group). The main outcome of this study is uncorrected visual acuity after 9 months, adjusted for baseline visual acuity.Among 2095 students from 31 middle schools, 995 (47.5%) failed the visual acuity screening, 515 (51.8%, 15 schools) of which were randomly assigned to the intervention group, with the remaining 480 students (48.2%, 16 schools) assigned to the control group. Among these, a total of 910 students were followed up and analysed. Endline eyeglasses wear in the intervention group was 44%, and 36% in the control group. Endline visual acuity of students in the intervention group was significantly better than students in the control group, adjusting for other variables (0.045 LogMAR units, 95% CI 0.006 to 0.084, equivalent to 0.45 lines, p=0.027), and insignificantly better only for baseline visual acuity (difference of 0.008 LogMAR units, 95% CI -0.018 to 0.034, equivalent to 0.08 lines).We found no evidence that receiving free eyeglasses worsened visual acuity among middle school students in northwestern rural China.ISRCTN17141957.

  View details for DOI 10.1136/bmjophth-2020-000572

  View details for PubMedID 33083554

  View details for PubMedCentralID PMC7528428

• Safety of eyeglasses wear for visual acuity among middle school students in northwestern rural China: a cluster-randomised controlled trial BMJ OPEN OPHTHALMOLOGY Ma, Y., Zhang, X., Li, H., Ma, X., Friesen, D., Rozelle, S., Pang, X., Zhou, M., Congdon, N. 2020; 5 (1)

  View details for DOI 10.1136/bmjophth-2020-000572

  View details for Web of Science ID 000576347300001

• Impact of spectacles wear on uncorrected visual acuity among urban migrant primary school children in China: a cluster-randomised clinical trial. The British journal of ophthalmology Zhang, X., Zhou, M., Ma, X., Yi, H., Zhang, H., Wang, X., Jin, L., Naidoo, K., Minto, H., Zou, H., Rozelle, S., Congdon, N., Ma, Y. 2020

  Abstract

  OBJECTIVE: To estimate the effect of providing free spectacles on uncorrected visual acuity (VA) among urban migrant Chinese school children.DESIGN: Exploratory analysis from a parallel cluster-randomised clinical trial.METHODS: After baseline survey and VA screening, eligible children were randomised by school to receive one of the two interventions: free glasses and a teacher incentive (tablet computer if ≥80% of children given glasses were wearing them on un-announced examination) (treatment group) or glasses prescription and letter to parents (control group). The primary outcome was uncorrected logarithm of the minimal angle of resolution (LogMAR) VA at study closeout, adjusted for baseline uncorrected VA.RESULTS: Among 4376 randomly selected children, 728 (16.6%, mean age 10.9years, 51.0% boys) at 94 schools failed VA screening and met eligibility criteria. Of these, 358 children (49.2%) at 47 schools were randomised to treatment and 370 children (50.8%) at 47 schools to control. Among these, 679 children (93.3%) completed follow-up and underwent analysis. Spectacle wear in the treatment and control groups was 68.3% and 29.3% (p<0.001), respectively. Uncorrected final VA for eyes of treatment children was significantly better than control children, adjusting only for baseline VA (difference of 0.039 LogMAR units, 95% CI: 0.008, 0.070, equivalent to 0.39 lines, p=0.014) or baseline VA and other baseline factors (0.040 LogMAR units, 95% CI 0.007 to 0.074, equivalent to 0.40 lines, p=0.020).CONCLUSION: We found no evidence that spectacles wear worsens children's uncorrected VA among urban migrant Chinese school children.

  View details for DOI 10.1136/bjophthalmol-2020-316213

  View details for PubMedID 32727732

• Depressive Symptoms and the Link with Academic Performance among Rural Taiwanese Children. International journal of environmental research and public health Gao, Y., Hu, D., Peng, E., Abbey, C., Ma, Y., Wu, C., Chang, C., Hung, W., Rozelle, S. 2020; 17 (8)

  Abstract

  Previous studies reflect a high prevalence of depressive symptoms among Taiwanese adolescents (ages 13-18), but there is an absence of literature related to the risk of depression of children in Taiwan (ages 6-12), particularly among potentially vulnerable subgroups. To provide insight into the distribution of depressive symptoms among children in rural Taiwan and measure the correlation between academic performance, we conducted a survey of 1655 randomly selected fourth and fifth-grade students at 92 sample schools in four relatively low-income counties or municipalities. Using the Center for Epidemiological Studies-Depression Scale (CES-D) we assessed the prevalence of depressive symptoms in this sample, in addition to collecting other data, such as performance on a standardized math test as well as information on a number of individual and household characteristics. We demonstrate that the share of children with clinically significant symptoms is high: 38% of the students were at risk of general depression (depression score ≥ 16) and 8% of the students were at risk of major depression (depression score > 28). The results of the multivariate regression and heterogeneous analysis suggest that poor academic performance is closely associated with a high prevalence of depressive symptoms. Among low-performing students, certain groups were disproportionately affected, including girls and students whose parents have migrated away for work. Results also suggest that, overall, students who had a parent who was an immigrant from another country were at greater risk of depression. These findings highlight the need for greater resource allocation toward mental health services for elementary school students in rural Taiwan, particularly for at-risk groups.

  View details for DOI 10.3390/ijerph17082778

  View details for PubMedID 32316516

• Visual impairment in rural and migrant Chinese school-going children: prevalence, severity, correction and associations. The British journal of ophthalmology Ma, Y. n., Zhang, X. n., He, F. n., Ma, X. n., Yi, H. n., Rose, N. n., Medina, A. n., Rozelle, S. n., Congdon, N. n. 2020

  Abstract

  To describe changes in the prevalence of visual impairment and glasses ownership with age and as associated with income and population density for visual impairment among rural and urban migrant Chinese students.Meta-analysis of 12 cross-sectional, school-based studies conducted between 2012 and 2017.Rural and urban migrant schools in seven Chinese provinces.A total of 83 273 rural and urban migrant Chinese students aged 6-17 years.Prevalence of visual impairment (uncorrected visual acuity ≤6/12 in either eye) rose from 19.0% at age 6 to 66.9% at 17, with the overall age-adjusted prevalence higher for girls (35.8%) than for boys (30.1%, p<0.001). The rate of glasses ownership among students who needed them increased from 13.0% at age 6 to 63.9% (p<0.001) at 17 and was significantly higher for girls (37.0%) than boys (34.7%, p<0.001). The unmet need for glasses as a proportion of the student population peaked in junior high school (31.8%). A 1% increase in per capita gross domestic product was associated with a 4.45% rise in uncorrected visual acuity (R2=0.057, p=0.020). Population density was significantly associated with glasses ownership among children (R2=0.359, p=0.012). A 1% population density increase was associated with an increase in the glasses ownership rate of 6.83%.Efforts are needed to improve vision screening coverage in China's schools, particularly junior high schools, as this is when many rural children leave school and glasses coverage is lowest.

  View details for DOI 10.1136/bjophthalmol-2020-317072

  View details for PubMedID 33127829

• The Landscape of Early Childhood Development in Rural China ASIA-PACIFIC JOURNAL-JAPAN FOCUS Dill, S., Ma, Y., Sun, A., Rozelle, S. 2019; 17 (16)

  View details for Web of Science ID 000481637200003

• Teachers' influence on purchase and wear of children's glasses in rural China: The PRICE study CLINICAL AND EXPERIMENTAL OPHTHALMOLOGY Wang, X., Ma, Y., Hu, M., Jin, L., Xiao, B., Ni, M., Yi, H., Ma, X., Wang, C., Varga, B., Huang, Y., Rozelle, S., Congdon, N. 2019; 47 (2): 179–86

  Abstract

  Uncorrected refractive error causes 90% of poor vision among Chinese children.Little is known about teachers' influence on children's glasses wear.Cohort study.Children at 138 randomly selected primary schools in Guangdong and Yunnan provinces, China, with uncorrected visual acuity (VA) ≤6/12 in either eye correctable to >6/12 in both eyes, and their teachers.Teachers and children underwent VA testing and completed questionnaires about spectacles use and attitudes towards children's vision.Children's acceptance of free glasses, spectacle purchase and wear.A total of 882 children (mean age 10.6 years, 45.5% boys) and 276 teachers (mean age 37.9 years, 67.8% female) participated. Among teachers, 20.4% (56/275) believed glasses worsened children's vision, 68.4% (188/275) felt eye exercises prevented myopia, 55.0% (151/275) thought children with modest myopia should not wear glasses and 93.1% (256/275) encouraged children to obtain glasses. Teacher factors associated with children's glasses-related behaviour included believing glasses harm children's vision (decreased purchase, univariate model: relative risk [RR] 0.65, 95% CI 0.43, 0.98, P < 0.05); supporting children's classroom glasses wear (increased glasses wear, univariate model: RR 2.20, 95% CI 1.23, 3.95, P < 0.01); and advising children to obtain glasses (increased free glasses acceptance, multivariate model: RR 2.74, 95% CI 1.29, 5.84, P < 0.01; increased wear, univariate model: RR 2.93, 95% CI 1.45, 5.90, P < 0.01), but not teacher's ownership/wear of glasses.Though teachers had limited knowledge about children's vision, they influenced children's glasses acceptance.

  View details for PubMedID 30117241

• Impact of a Local Vision Care Center on Glasses Ownership and Wearing Behavior in Northwestern Rural China: A Cluster-Randomized Controlled Trial. International journal of environmental research and public health Ma, Y., Gao, Y., Wang, Y., Li, H., Ma, L., Jing, J., Shi, Y., Guan, H., Congdon, N. 2018; 15 (12)

  Abstract

  Visual impairment is common among rural Chinese children, but fewer than a quarter of children who need glasses actually own and use them. To study the effect of rural county hospital vision centers (VC) on self-reported glasses ownership and wearing behavior (primary outcome) among rural children in China, we conducted a cluster-randomized controlled trial at a VC in the government hospital of Qinan County, a nationally-designated poor county. All rural primary schools (n = 164) in the county were invited to participate. Schools were randomly assigned to either the treatment group to receive free vision care and eyeglasses, if needed, or control group, who received glasses only at the end of the study. Among 2806 eligible children with visiual impairment (visual acuity ≤ 6/12 in either eye), 93 (3.31%) were lost to follow-up, leaving 2713 students (45.0% boys). Among these, glasses ownership at the end of the school year was 68.6% among 1252 treatment group students (82 schools), and 26.4% (p < 0.01) among 1461 controls (82 schools). The rate of wearing glasses was 55.2% in the treatment group and 23.4% (p < 0.01) among the control group. In logistic regression models, treatment group membership was significantly associated with spectacle ownership (Odds Ratio [OR] = 11.9, p < 0.001) and wearing behavior (OR = 7.2, p < 0.001). County hospital-based vision centers appear effective in delivering childrens' glasses in rural China.

  View details for PubMedID 30544793

• Impact of a Local Vision Care Center on Glasses Ownership and Wearing Behavior in Northwestern Rural China: A Cluster-Randomized Controlled Trial INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH Ma, Y., Gao, Y., Wang, Y., Li, H., Ma, L., Jing, J., Shi, Y., Guan, H., Congdon, N. 2018; 15 (12)

  View details for DOI 10.3390/ijerph15122783

  View details for Web of Science ID 000456527000174

• Effect of a Local Vision Care Center on Eyeglasses Use and School Performance in Rural China A Cluster Randomized Clinical Trial JAMA OPHTHALMOLOGY Ma, Y., Congdon, N., Shi, Y., Hogg, R., Medina, A., Boswell, M., Rozelle, S., Iyer, M. 2018; 136 (7): 731–37

  Abstract

  Visual impairment is common among children in rural China, but fewer than one-third of children with poor vision own and wear eyeglasses.To study the effect of hospital-based vision centers on academic performance, ownership of eyeglasses, and eyeglasses-wearing behavior in rural Chinese children.Cluster randomized, investigator-masked, clinical trial from September 2014 through June 2015. A vision center capable of providing refractive services was established in the Hospital of Yongshou County, a nationally designated poor county in rural Shaanxi Province, western China. All 31 rural primary schools in Yongshou County participated; participants were all children in grades 4 through 6 (aged approximately 10-12 years) with uncorrected visual acuity of Snellen 6/12 or worse in either eye (2613 children). Data analysis was conducted March through May 2016, and data were analyzed by the intention-to-treat principle.After teacher-led vision screening early in the school year (September-October 2014), schools were randomly assigned to either early referral (December 2014-February 2015) to the vision center for refraction and free eyeglasses if needed or late referral (March-June 2015) for the identical intervention.The primary outcome was score on a study-administered mathematics test (June 2015) adjusted for baseline score. Secondary outcomes were self-reported eyeglasses ownership and wear at final examination (June 2015).All 2613 children evaluated were of Han Chinese race/ethnicity, and 1209 (46.3%) were female. Twelve hundred children (45.9%) met the vision criteria. Among these, 543 (45.3%) were randomized to early screening and 657 (54.7%) to late screening; 433 (79.7%) of the early screening group and 516 (78.5%) of the late screening group completed the study. Of eligible children, 120 (27.7%) owned eyeglasses at baseline. The adjusted effect on test scores comparing early and late groups was 0.25 SD (95% CI, 0.01-0.48; 1-sided P = .04), with the point estimate equivalent to half a semester of additional learning. At the end of the study, 347 of the 433 participants in the early group (80%) reported owning eyeglasses and 326 (75%) reported wearing eyeglasses; among the 516 participants in the late group, 371 (61%) reported owning and 286 (55%) reported wearing eyeglasses.In this study, early provision of free eyeglasses was seen to improve children's academic performance and wearing of spectacles. These findings suggest that a county hospital-based vision center may be an effective way to improve children's educational opportunities in rural China.isrctn.org Identifier: ISRCTN03252665.

  View details for PubMedID 29801081

• Cluster-randomized controlled trial of the effects of free glasses on purchase of children's glasses in China: The PRICE (Potentiating Rural Investment in Children's Eyecare) study PLOS ONE Wang, X., Congdon, N., Ma, Y., Hu, M., Zhou, Y., Liao, W., Jin, L., Xiao, B., Wu, X., Ni, M., Yi, H., Huang, Y., Varga, B., Zhang, H., Cun, Y., Li, X., Yang, L., Liang, C., Huang, W., Rozelle, S., Ma, X. 2017; 12 (11): e0187808

  Abstract

  Offering free glasses can be important to increase children's wear. We sought to assess whether "Upgrade glasses" could avoid reduced glasses sales when offering free glasses to children in China.In this cluster-randomized, controlled trial, children with uncorrected visual acuity (VA)< = 6/12 in either eye correctable to >6/12 in both eyes at 138 randomly-selected primary schools in 9 counties in Guangdong and Yunnan provinces, China, were randomized by school to one of four groups: glasses prescription only (Control); Free Glasses; Free Glasses + offer of $15 Upgrade Glasses; Free Glasses + offer of $30 Upgrade Glasses. Spectacle purchase (main outcome) was assessed 6 months after randomization.Among 10,234 children screened, 882 (8.62%, mean age 10.6 years, 45.5% boys) were eligible and randomized: 257 (29.1%) at 37 schools to Control; 253 (28.7%) at 32 schools to Free Glasses; 187 (21.2%) at 31 schools to Free Glasses + $15 Upgrade; and 185 (21.0%) at 27 schools to Free Glasses +$30 Upgrade. Baseline ownership among these children needing glasses was 11.8% (104/882), and 867 (98.3%) children completed follow-up. Glasses purchase was significantly less likely when free glasses were given: Control: 59/250 = 23.6%; Free glasses: 32/252 = 12.7%, P = 0.010. Offering Upgrade Glasses eliminated this difference: Free + $15 Upgrade: 39/183 = 21.3%, multiple regression relative risk (RR) 0.90 (0.56-1.43), P = 0.65; Free + $30 Upgrade: 38/182 = 20.9%, RR 0.91 (0.59, 1.42), P = 0.69.Upgrade glasses can prevent reductions in glasses purchase when free spectacles are provided, providing important program income.ClinicalTrials.gov Identifier: NCT02231606. Registered on 31 August 2014.

  View details for PubMedID 29161286

• Cluster-randomized controlled trial of the effects of free glasses on glasses purchase in China: the PRICE (Potentiating Rural Investment in Children's Eyecare) study Congdon, N. G., Wang, X., Ma, Y., Liao, W., Xiao, B., Ni, M., Huang, Y., Yi, H., Ma, X., Rozelle, S. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2016

  View details for Web of Science ID 000394210604194

• Teachers' influence on glasses purchase and wear in China: the PRICE (Potentiating Rural Investment in Children's Eyecare) study Wang, X., Ma, Y., Zhou, Y., Jin, L., Xiao, B., Ni, M., Yi, H., Ma, X., Rozelle, S., Congdon, N. G. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2016

  View details for Web of Science ID 000394210604195

• Inequities in the allocation of medical resources in China's Township Health Centers CHINA AGRICULTURAL ECONOMIC REVIEW Ma, Y., Zhang, L., Boswell, M. 2016; 8 (4): 637-646

  View details for DOI 10.1108/CAER-11-2015-0170

  View details for Web of Science ID 000386790000007

• Dropping Out of Rural China's Secondary Schools: A Mixed-methods Analysis CHINA QUARTERLY Shi, Y., Zhang, L., Ma, Y., Yi, H., Liu, C., Johnson, N., Chu, J., Loyalka, P., Rozelle, S. 2015; 224: 1048-1069

  View details for DOI 10.1017/S0305741015001277

  View details for Web of Science ID 000366198200009

• Exploring the dropout rates and causes of dropout in upper-secondary technical and vocational education and training (TVET) schools in China INTERNATIONAL JOURNAL OF EDUCATIONAL DEVELOPMENT Yi, H., Zhang, L., Yao, Y., Wang, A., Ma, Y., Shi, Y., Chu, J., Loyalka, P., Rozelle, S. 2015; 42: 115-123

  View details for DOI 10.1016/j.ijedudev.2015.04.009

  View details for Web of Science ID 000357144500013