Huan Wang

All Publications

• Estimating the Impact of Rural <i>Hukou</i> Status on Earnings for College Graduates in China CHINA QUARTERLY Wang, H., Cousineau, C., Boswell, M., Li, H. 2024

  View details for DOI 10.1017/S0305741024000274

  View details for Web of Science ID 001200698600001

• Measurement of flourishing: a scoping review. Frontiers in psychology Rule, A., Abbey, C., Wang, H., Rozelle, S., Singh, M. K. 2024; 15: 1293943

  Abstract

  Flourishing is an evolving wellbeing construct and outcome of interest across the social and biological sciences. Despite some conceptual advancements, there remains limited consensus on how to measure flourishing, as well as how to distinguish it from closely related wellbeing constructs, such as thriving and life satisfaction. This paper aims to provide an overview and comparison of the diverse scales that have been developed to measure flourishing among adolescent and adult populations to provide recommendations for future studies seeking to use flourishing as an outcome in social and biological research.In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), we conducted a scoping review across PubMed and EMBASE of studies introducing original flourishing scales (defined as a previously unpublished measure of mental health or wellbeing that used "flourishing" in its definition). Studies focusing on adult populations that were published before April 28, 2023 were considered eligible for inclusion.Out of 781 studies retrieved, we identified seven eligible studies covering seven unique flourishing scales. We find that all seven scales are multidimensional and assess features over monthly or yearly intervals. While most of the scales (six out of seven) include indicators of both hedonic and eudaimonic wellbeing, the operationalization of these dimensions of wellbeing varies considerably between scales. Several of the scales have been translated and validated across multiple geographical contexts, including higher- and lower-income countries.Complementing self-report measures with other social, economic, regional, and biological indicators of flourishing may be useful to provide holistic and widely applicable measures of wellbeing. This review contributes to concept validation efforts that can guide strategies to sustain flourishing societies.

  View details for DOI 10.3389/fpsyg.2024.1293943

  View details for PubMedID 38362251

  View details for PubMedCentralID PMC10867253

• Skill levels and gains in university STEM education in China, India, Russia and the United States. Nature human behaviour Loyalka, P., Liu, O. L., Li, G., Kardanova, E., Chirikov, I., Hu, S., Yu, N., Ma, L., Guo, F., Beteille, T., Tognatta, N., Gu, L., Ling, G., Federiakin, D., Wang, H., Khanna, S., Bhuradia, A., Shi, Z., Li, Y. 2021

  Abstract

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

  View details for DOI 10.1038/s41562-021-01062-3

  View details for PubMedID 33649462

• Tracking the effects of COVID-19 in rural China over time. International journal for equity in health Wang, H. n., Zhang, M. n., Li, R. n., Zhong, O. n., Johnstone, H. n., Zhou, H. n., Xue, H. n., Sylvia, S. n., Boswell, M. n., Loyalka, P. n., Rozelle, S. n. 2021; 20 (1): 35

  Abstract

  China issued strict nationwide guidelines to combat the COVID-19 outbreak in January 2020 and gradually loosened the restrictions on movement in early March. Little is known about how these disease control measures affected the 600 million people who live in rural China. The goal of this paper is to document the quarantine measures implemented in rural China outside the epicenter of Hubei Province and to assess the socioeconomic effect of the measures on rural communities over time.We conducted three rounds of interviews with informants from 726 villages in seven provinces, accounting for over 25% of China's overall rural population. The survey collected data on rural quarantine implementation; COVID-19 infections and deaths in the survey villages; and effects of the quarantine on employment, income, education, health care, and government policies to address any negative impacts. The empirical findings of the work established that strict quarantine measures were implemented in rural villages throughout China in February.There was little spread of COVID-19 in rural communities: an infection rate of 0.001% and zero deaths reported in our sample. However, there were negative social and economic outcomes, including high rates of unemployment, falling household income, rising prices, and disrupted student learning. Health care was generally accessible, but many delayed their non-COVID-19 health care due to the quarantine measures. Only 20% of villagers received any form of local government aid, and only 11% of villages received financial subsidies. There were no reports of national government aid programs that targeted rural villagers in the sample areas.By examining the economic and social effects of the COVID-19 restrictions in rural communities, this study will help to guide other middle- and low-income countries in their containment and restorative processes. Without consideration for economically vulnerable populations, economic hardships and poverty will likely continue to have a negative impact on the most susceptible communities.

  View details for DOI 10.1186/s12939-020-01369-z

  View details for PubMedID 33446205

  View details for PubMedCentralID PMC7807215

• Do Resources Matter? Effects of an In-Class Library Project on Student Independent Reading Habits in Primary Schools in Rural China READING RESEARCH QUARTERLY Yi, H., Mo, D., Wang, H., Gao, Q., Shi, Y., Wu, P., Abbey, C., Rozelle, S. 2019; 54 (3): 383–411

  View details for DOI 10.1002/rrq.238

  View details for Web of Science ID 000472951500007

• Can Social-Emotional Learning Reduce School Dropout in Developing Countries? JOURNAL OF POLICY ANALYSIS AND MANAGEMENT Wang, H., Chu, J., Loyalka, P., Xin, T., Shi, Y., Qu, Q., Yang, C. 2016; 35 (4): 818-?

  View details for DOI 10.1002/pam.21915

  View details for Web of Science ID 000383668300005

• Survey using incognito standardized patients shows poor quality care in China's rural clinics. Health policy and planning Sylvia, S., Shi, Y., Xue, H., Tian, X., Wang, H., Liu, Q., Medina, A., Rozelle, S. 2015; 30 (3): 322-333

  Abstract

  Over the past decade, China has implemented reforms designed to expand access to health care in rural areas. Little objective evidence exists, however, on the quality of that care. This study reports results from a standardized patient study designed to assess the quality of care delivered by village clinicians in rural China. To measure quality, we recruited individuals from the local community to serve as undercover patients and trained them to present consistent symptoms of two common illnesses (dysentery and angina). Based on 82 covert interactions between the standardized patients and local clinicians, we find that the quality of care is low as measured by adherence to clinical checklists and the rates of correct diagnoses and treatments. Further analysis suggests that quality is most strongly correlated with provider qualifications. Our results highlight the need for policy action to address the low quality of care delivered by grassroots providers.

  View details for DOI 10.1093/heapol/czu014

  View details for PubMedID 24653216

• Mental health and dropout behavior: A cross-sectional study of junior high students in northwest rural China INTERNATIONAL JOURNAL OF EDUCATIONAL DEVELOPMENT Huan, W., Yang, C., Fei, H., Shi Yaojiang, Y. J., Qu, Q., Rozelle, S., Chu, J. 2015; 41: 1-12

  View details for DOI 10.1016/j.ijedudev.2014.12.005

  View details for Web of Science ID 000355368700002

• Impact of vision impairment and ocular morbidity and their treatment on quality of life in children: a systematic review. Ophthalmology Li, D., Chan, V. F., Virgili, G., Mavi, S., Pundir, S., Singh, M. K., She, X., Piyasena, P., Clarke, M., Whitestone, N., Patnaik, J. L., Xiao, B., Cherwek, D. H., Negash, H., O'Connor, S., Prakalapakorn, S. G., Huang, H., Wang, H., Boswell, M., Congdon, N. 2023

  Abstract

  This review summarizes existing evidence on the impact of vision impairment and ocular morbidity and their treatment on children's quality of life (QoL).Myopia and strabismus are associated with reduced QoL among children. Surgical treatment of strabismus significantly improves affected children's QoL.We conducted a systematic review and meta-analysis by screening articles in any language in nine databases published from inception through August 22, 2022, for publications addressing the impact of vision impairment, ocular morbidity and their treatment on QoL in children. We reported pooled standardized mean differences (SMDs) using random-effects meta-analysis models. Quality appraisal was done with the Joanna Briggs Institute (JBI) and American National Institutes of Health (NIH) tools. This study was registered with PROSPERO, number CRD42021233323.Our search identified 29 118 articles, of which 44 studies (0.15%) were included for analysis and included 32 318 participants from 14 countries between 2005 and 2022. Seventeen observational and four interventional studies concerned vision impairment, while 10 observational and 13 interventional studies described strabismus and other ocular morbidities. Twenty-one studies were included in the meta-analysis. The QoL scores did not differ between children with and without vision impairment. (standard mean difference [SMD]5, -1.04; 95% confidence interval [CI], -2.11, -0.03, p=0.06, 9 studies). Myopic children demonstrated significantly lower QoL scores than those with normal vision (SMD, -0.60; 95% CI, -1.09, -0.11, p=0.02, 7 studies). Children with strabismus showed a significantly lower QoL score compared to those without (SMD, -1.19; 95% CI, -1.66, -0.73, p<0.001, 7 studies). Strabismus surgery significantly improved QoL in children (SMD, 1.36; 95% CI, 0.48, 2.23, p<0.001,7 studies). No randomized controlled trials concerning refractive error and QoL were identified in this review. Among all included studies, 35 (79.5%) scored as low to moderate quality, the remaining met all quality appraisal tools criteria.Reduced QoL was identified in children with myopia and strabismus. Surgical correction of strabismus improves the QoL of affected children, which supports insurance coverage of strabismus surgery. Further studies, especially randomized controlled trials, investigating the impact of correction of myopia on QoL are needed.

  View details for DOI 10.1016/j.ophtha.2023.09.005

  View details for PubMedID 37696451

• Parenting stress and adolescent academic burnout: the chain mediating role of mental health symptoms and positive psychological traits CURRENT PSYCHOLOGY Liu, C., She, X., Lan, L., Wang, H., Wang, M., Abbey, C., Singh, M. K., Rozelle, S., Tong, L. 2023

  View details for DOI 10.1007/s12144-023-04961-y

  View details for Web of Science ID 001028438100006

• Perceived family support and student outcomes in rural China: a mediation analysis CURRENT PSYCHOLOGY Abbey, C., Xue, H., Kennedy, T., Barket, B., Dai, Q., Ly, T., Su, W., Rozelle, S., Wang, H., She, X., Singh, M. 2023

  View details for DOI 10.1007/s12144-023-04488-2

  View details for Web of Science ID 000975871900002

• What Can Students Gain from China's Higher Education? ASIAN ECONOMIC POLICY REVIEW Li, H., Wang, H., Cousineau, C., Boswell, M. 2023

  View details for DOI 10.1111/aepr.12426

  View details for Web of Science ID 000955523900001

• The Association Between Screen Time and Outdoor Time on Adolescent Mental Health and Academic Performance: Evidence from Rural China. Risk management and healthcare policy Wang, H., Abbey, C., Kennedy, T., Feng, E., Li, R., Liu, F., Zhu, A., Shen, S., Wadhavkar, P., Rozelle, S., Singh, M. K. 2023; 16: 369-381

  Abstract

  We examine how adolescent free time allocation-namely, screen time and outdoor time-is associated with mental health and academic performance in rural China.This paper used a large random sample of rural junior high school students in Ningxia (n = 20,375; age=13.22), with data collected from self-reported demographic questionnaires (to assess free time allocation), the Strengths and Difficulties Questionnaire (to assess mental health), and a standardized math test (to measure academic performance). We utilized a multivariate OLS regression model to examine associations between free time allocation and adolescent outcomes, controlling for individual and family characteristics.Our sample's screen time and outdoor time both averaged around 1 hour. About 10% of the sample adolescents reported behavioral difficulties, while a similar percentage (11%) reported abnormal prosocial behaviors. Adolescents with higher levels of screen time (>2 hours) were 3 percentage points more likely to have higher levels of behavioral difficulties (p<0.001), indicating that excessive screen time was associated with worse mental health. Meanwhile, outdoor time was associated with better mental health, and positive correlations were observed at all levels of outdoor time (compared to no outdoor time, decreasing the likelihood of higher levels of behavioral difficulties by between 3 and 4 percentage points and of lower prosocial scores by between 6 and 8 percentage points; all p's<0.001). For academic performance, average daily screen times of up to 1 hour and 1-2 hours were both positively associated with standardized math scores (0.08 SD, p<0.001; 0.07 SD, p<0.01, respectively), whereas there were no significant associations between outdoor time and academic performance.Using a large sample size, this study was the first to examine the association between adolescent free time allocation with mental health and academic performance, providing initial insights into how rural Chinese adolescents can optimize their free time.

  View details for DOI 10.2147/RMHP.S384997

  View details for PubMedID 36923495

  View details for PubMedCentralID PMC10010124

• Depression, anxiety, stress symptoms and their determinants among secondary students with vision impairment in rural Northwestern China during the COVID-19 pandemic. Frontiers in public health Li, D., Chan, V. F., Wang, H., Zhang, H., Virgili, G., Whitestone, N., Xiao, B., Singh, M. K., She, X., Mackenzie, G., Boswell, M., Mavi, S., Rozelle, S., Congdon, N. 2023; 11: 1282826

  Abstract

  The measures implemented to control the spread of Coronavirus disease 2019 (COVID-19) could affect children's mental and vision health. Youth particularly from minority and socioeconomically disadvantaged backgrounds were more likely to be impacted by these measures. This study aimed to examine the mental health of children with vision impairment and associated factors in North-western China during the COVID-19 pandemic.A cross-sectional study was conducted among 2,036 secondary school children living in Ningxia Hui Autonomous Region. Participants completed a survey on sociodemographic and lifestyle information and answered the Chinese version of the 21-item Depression Anxiety Stress Scales (DASS-21) questionnaire. Presenting visual acuity was measured by a trained enumerator. Multivariate logistic regression analysis was used to identify potential risk factors for mental health problems.Responses from 1,992 (97.8%) children were included in the analysis after excluding those with incomplete mental health outcome data. The prevalence of depression, anxiety and stress symptoms within the dataset were 28.9, 46.4, and 22.3%, respectively. The distribution of children with different stress levels differed significantly between those with and without vision impairment (p = 0.03). Multivariable logistic regression analyses revealed that depression symptoms decreased with higher parental education (OR, 0.76, 95% confidence intervals (CI):0.63-0.96), longer sleep duration (OR, 0.90, 95% CI: 0.81-0.97) and longer study time (OR, 0.82, 95% CI: 0.74-0.91), whereas they increased with higher recreational screen time (OR, 1.19, 95% CI: 1.08-1.32). Anxiety symptoms decreased with higher parental education (OR, 0.80, 95% CI: 0.66-0.96) and increased with higher recreational screen time (OR, 1.15, 95% CI: 1.04-1.27) and being a left-behind child (OR, 1.26, 95% CI: 1.04-1.54). In addition, stress symptoms decreased with longer sleep duration (OR, 0.92, 95%CI: 0.85-0.99) and increased with higher number of siblings (OR, 1.10, 95% CI: 1.01-1.19), higher recreational screen time (OR, 1.15, 95% CI: 1.04-1.28) and older age (OR,1.12, 95% CI: 1.004-1.24).A considerable proportion of our sample experienced mental health problems during the pandemic. Healthcare planners in China should consider interventions such as reducing recreational screen time, ensuring sufficient sleep, and timely detection of mental health symptoms among socioeconomically disadvantaged groups.

  View details for DOI 10.3389/fpubh.2023.1282826

  View details for PubMedID 38328549

  View details for PubMedCentralID PMC10847594

• The Association between Video Game Time and Adolescent Mental Health: Evidence from Rural China. International journal of environmental research and public health Li, L., Abbey, C., Wang, H., Zhu, A., Shao, T., Dai, D., Jin, S., Rozelle, S. 2022; 19 (22)

  Abstract

  As digital devices like computers become more widely available in developing countries, there is a growing need to understand how the time that adolescents spend using these devices for recreational purposes such as playing video games is linked with their mental health outcomes. We measured the amount of time that adolescents in rural China spent playing video games and the association of video game time with their mental health. We collected data from primary and junior high schools in a poor, rural province in northwest China (n = 1603 students) and used the Depression, Anxiety, and Stress Scales (DASS-21) to measure mental health symptoms. The results indicated that the average video game time was about 0.69 h per week. There was a significant association between adolescent video game time and poorer mental health. Each additional hour of playing video games also increased the chance of having moderate or above symptoms. Moreover, boys and non-left-behind children had worse mental health if they played more video games. Our study contributes to literature on the links between recreational screen time and mental health, and it sheds light on an issue addressed by recent government legislation to limit the video game time of minors in China.

  View details for DOI 10.3390/ijerph192214815

  View details for PubMedID 36429534

• The Role of Self-Esteem in the Academic Performance of Rural Students in China. International journal of environmental research and public health Yu, W., Qian, Y., Abbey, C., Wang, H., Rozelle, S., Stoffel, L. A., Dai, C. 2022; 19 (20)

  Abstract

  The self-esteem of students may be significantly associated with their academic performance. However, past research in developing contexts on this issue is limited, particularly among early adolescents. Using a sample of 3101 students from rural primary and junior high schools in China, this study measured their self-esteem by the Rosenberg Self-Esteem Scale (RSES) and explored its association with academic performance. Our findings indicate that students in rural China had both significantly lower self-esteem and a higher prevalence of low self-esteem when compared to past studies of similarly aged students both from urban China and internationally. Furthermore, there was a strong positive correlation between a student's self-esteem and academic performance. A one-SD increase in RSES score (indicating better self-esteem) was associated with an increase of 0.12 SD in standardized math scores (p < 0.001), and students with low self-esteem (RSES score < 25) scored lower on math tests by 0.14 SD (p < 0.001), which were robust and consistent when employing the propensity score matching method. Our study expands the growing body of empirical evidence on the link between self-esteem and academic performance among rural youth in developing countries and emphasizes the need to improve their self-esteem with the aim of helping them achieve academically.

  View details for DOI 10.3390/ijerph192013317

  View details for PubMedID 36293898

• Impact of Teacher Incentive Intervention on Students' Vision Healthcare Uptake: A Cluster-Randomized Controlled Trial. International journal of environmental research and public health Zhao, J., Wang, H., Guan, H., Du, K., Zhang, Y., Congdon, N. 2022; 19 (19)

  Abstract

  Less than one-third of rural Chinese children with refractive error own or wear eyeglasses. To study the effect of teacher incentives on the acceptance of vision care offered to rural students with uncorrected refractive error, we conducted a cluster-randomized controlled trial in 18 townships in one county in Shaanxi Province. Primary and junior high schools within each township were assigned to either intervention (all teachers received an incentive) or control (no teacher incentives were offered) groups. A total of 42 schools were assigned to either the intervention group (13 schools) or the control group (29 schools). Teachers in the intervention group could elect to receive high-value (sunglasses worth USD 148), moderate-value (eyeglasses worth USD 89), or cash incentives (USD 35) if ≥70% of eligible students (uncorrected visual acuity (VA) ≤ 6/12 in both eyes and corrected VA ≤ 6/9.5 in both eyes) in the teacher's class visited a program-affiliated vision center (VC) within 60 days after their vision screening. Among 8238 students, 3401 (41.2%, of which 53.0% were girls with a mean age of 12 (SD 1.75)) met the enrollment criteria and were randomly allocated to the intervention (n = 1645, 49.0%) and control groups (n = 1579, 51.0%). Among these, 3224 (94.8%) completed the study and underwent analysis. Nearly equal numbers of students had classroom teachers selecting the high-value (n = 524, 31.9%), moderate-value (n = 582, 35.4%), and cash incentives (n = 539, 32.8%). The rate of the acceptance of offered vision care was significantly higher in the intervention group (382/1645 = 23.2%) compared to the control group (172/1579 = 10.9%, 95% confidence interval for observed difference 12.3%, p < 0.001). Teacher incentives appeared effective in improving Chinese rural school-aged children's uptake rate of vision services provided by county hospital-based VCs.

  View details for DOI 10.3390/ijerph191912727

  View details for PubMedID 36232037

• 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

• Behavioral Strengths and Difficulties and Their Associations with Academic Performance in Math among Rural Youth in China. Healthcare (Basel, Switzerland) Yu, W., Abbey, C., Qian, Y., Wang, H., Rozelle, S., Singh, M. K. 2022; 10 (9)

  Abstract

  Behavioral strengths and difficulties among children and adolescents may be significantly associated with their academic performance; however, the evidence on this issue for rural youth in developing contexts is limited. This study explored the prevalence and correlates of mental health from three specific dimensions-internalizing problems, externalizing problems, and prosocial behavior-measured by the Strengths and Difficulties Questionnaire (SDQ), and the association of these dimensions with academic performance in math among a sample of 1500 students in rural China. Our findings indicated that students in rural China had worse behavioral difficulties and poorer prosocial skills when compared to most past studies conducted inside and outside of China. In addition, total difficulties and prosocial scores on the SDQ were significantly associated with student math test scores, as students whose externalizing, internalizing, and prosocial scores were in the abnormal range scored lower in math by 0.35 SD, 0.23 SD, and 0.33 SD, respectively. The results add to the growing body of empirical evidence related to the links between social environment, mental health, and academic performance in developing countries, highlighting the importance of students' mental health for their academic performance, and of understanding risk factors in the social environment among rural youth in developing countries.

  View details for DOI 10.3390/healthcare10091642

  View details for PubMedID 36141254

• Association between mental health and executive dysfunction and the moderating effect of urban-rural subpopulation in general adolescents from Shangrao, China: a population-based cross-sectional study. BMJ open Lin, Q., Abbey, C., Zhang, Y., Wang, G., Lu, J., Dill, S. E., Jiang, Q., Singh, M. K., She, X., Wang, H., Rozelle, S., Jiang, F. 2022; 12 (8): e060270

  Abstract

  To examine the association between mental health and executive dysfunction in general adolescents, and to identify whether home residence and school location would moderate that association.A population-based cross-sectional study.A subsample of the Shanghai Children's Health, Education, and Lifestyle Evaluation-Adolescents project. 16 sampled schools in Shangrao city located in downstream Yangtze River in southeast China (December 2018).1895 adolescents (48.8% male) which were divided into three subpopulations: (A) adolescents who have urban hukou (ie, household registration in China) and attend urban schools (UU, n=292); (B) adolescents who have rural hukou and attend urban schools (RU, n=819) and (C) adolescents who have rural hukou and attend rural schools (RR, n=784).The Depression Anxiety and Stress Scale-21 was used to assess adolescent mental health symptoms, and the Behaviour Rating Inventory of Executive Function (parent form) was applied to measure adolescent executive dysfunction in nature setting.Mental health symptoms were common (depression: 25.2%, anxiety: 53.0%, stress: 19.7%) in our sample, and the prevalence rates were lower among UU adolescents than those among the RR and RU, with intersubgroup differences in screen exposure time explaining most of the variance. We found the three types of symptoms were strongly associated with executive dysfunction in general adolescents. We also observed a marginal moderating effect of urban-rural subgroup on the associations: UU adolescents with depression (OR 6.74, 95% CI 3.75 to 12.12) and anxiety (OR 5.56, 95% CI 1.86 to 16.66) had a higher executive dysfunction risk when compared with RR youths with depression (OR 1.93, 95% CI 0.91 to 4.12) and anxiety (OR 1.80, 95% CI 1.39 to 2.33), respectively.Rural adolescents experienced more mental health symptoms, whereas urban individuals with mental health problems had a higher executive dysfunction risk.

  View details for DOI 10.1136/bmjopen-2021-060270

  View details for PubMedID 35998954

• The Role of Village Doctors in Residents' Uptake of Eye Screening: Evidence from Ageing Residents in Rural China. Healthcare (Basel, Switzerland) Huang, J., Du, K., Guan, H., Ding, Y., Zhang, Y., Wang, D., Wang, H. 2022; 10 (7)

  Abstract

  The lack of formal eye screening is the main reason for insufficient eye care utilization in rural China. Cataract, in particular, is increasingly prevalent with the aging population, but the treatment rate is relatively low. Village doctors are the most accessible health care resource for rural residents, receiving few empirical investigations into their role in eye care. This study aims to assess the role of village doctors in residents' uptake of eye screening (vision and cataract screening), the first step of cataract treatment. Data come from a community-based, cross-sectional survey conducted in 35 villages of a county of the Gansu Province, Northwestern China, in 2020. Among 1010 residents aged ≥ 50 and 35 village doctors, the multivariate logistic regression shows that village doctors' age, time spent on public health service, and service population were positively associated with residents' uptake of vision and cataract screening. Village doctors were capable of playing an active role in primary eye health services due to their richer knowledge about cataracts than residents (accuracy rate 86.75% vs. 63.50%, p < 0.001), but less than half of them were willing to undertake eye screening. This study highlights the positive role of village doctors in aging residents' eye screening and the potential role in improving the uptake of eye screening by offering health education.

  View details for DOI 10.3390/healthcare10071197

  View details for PubMedID 35885723

• Impact of vision impairment and ocular morbidity and their treatment on depression and anxiety in children: A systematic review. Ophthalmology Li, D., Chan, V. F., Virgili, G., Piyasena, P., Negash, H., Whitestone, N., O'Connor, S., Xiao, B., Clarke, M., Cherwek, D. H., Singh, M. K., She, X., Wang, H., Boswell, M., Prakalapakorn, S. G., Patnaik, J. L., Congdon, N. 2022

  Abstract

  TOPIC: This systematic review and meta-analysis summarizes existing evidence to establish whether vision impairment, ocular morbidity and their treatment are associated with depression and anxiety in children.CLINICAL RELEVANCE: Understanding and quantifying these associations support early detection and management of mental health symptoms in children with vision impairment and ocular morbidity. Additionally, this review provides evidence in favour of insurance coverage for timely strabismus surgery.METHODS: We searched nine electronic databases from inception to February 18, 2021, including observational and interventional studies assessing whether vision impairment and/or ocular morbidity and their treatment are associated with depression and/or anxiety in children. We used narrative synthesis and meta-analysis with the residual maximum likelihood method. A protocol was registered and published on The International Prospective Register of Systematic Reviews (PROSPERO, CRD42021233323).RESULTS: Among 28,992 studies, 28,956 (99.9%) were excluded as duplicates or unrelated content. Among 36 remaining studies, 21 (58.3%) were observational studies concerning vision impairment, eight (22.2%) were observational studies concerning strabismus, and seven (19.4%) were interventional studies. Vision-impaired children experienced significantly higher scores of depression (Standard Mean Difference [SMD] 0.57, 95% Confidence Interval (CI) 0.26-0.89, 11 studies) and anxiety (SMD 0.61, 95% CI 0.40-0.821, 14 studies) than normally-sighted children. In particular, myopic children experienced higher scores of depression (SMD 0.59, 95% CI 0.36-0.81, six studies) than normally-sighted children. Strabismus surgery significantly improved symptoms of depression (SMD: 0.59 95% CI 0.12-1.06, three studies) and anxiety (SMD: 0.69 95% CI 0.24-1.14, four studies) in children.DISCUSSION: Among children, vision impairment is associated with greater symptoms of depression and anxiety. Surgical treatment of strabismus improved these symptoms. Further randomized controlled trials exploring the impact of public health measures for myopia correction on mental health in children are needed. Scaling up access to strabismus surgery could improve the mental health of affected children.

  View details for DOI 10.1016/j.ophtha.2022.05.020

  View details for PubMedID 35660416

• Depressive and Anxiety Symptoms among Children and Adolescents in Rural China: A Large-Scale Epidemiological Study. International journal of environmental research and public health Jiang, Q., She, X., Dill, S., Sylvia, S., Singh, M. K., Wang, H., Boswell, M., Rozelle, S. 2022; 19 (9)

  Abstract

  Although children living in low- and middle-income countries (LMICs) account for 90% of the global population of children, depression, and anxiety among children in LMICs have been understudied. This study examines the prevalence of depression and anxiety and their associations with biological and psychosocial factors among children across China, with a focus on rural areas. We conducted a large-scale epidemiological study of depression and anxiety among 53,421 elementary and junior high school-aged children across China. The results show that 20% are at risk for depression, 6% are at risk for generalized anxiety, and 68% are at risk for at least one type of anxiety. Girls and junior high school students show a higher risk for both depression and anxiety symptoms, while socioeconomic status has varying associations to depression and anxiety symptoms. Our results also show consistent correlations between depression and anxiety symptoms and standard math test scores. These findings underscore the importance of identification, prevention, and treatment of youth depression and anxiety in underdeveloped areas. As China constitutes 15% of the global population of children under age 18, this study offers valuable information to the field of global mental health.

  View details for DOI 10.3390/ijerph19095026

  View details for PubMedID 35564422

• The Effect of Faculty Research on Student Learning in College EDUCATIONAL RESEARCHER Loyalka, P., Shi, Z., Li, G., Kardanova, E., Chirikov, I., Yu, N., Hu, S., Wang, H., Ma, L., Guo, F., Liu, O., Bhuradia, A., Khanna, S., Li, Y., Murray, A. 2022

  View details for DOI 10.3102/0013189X221090229

  View details for Web of Science ID 000776656300001

• Exploring Teacher Job Satisfaction in Rural China: Prevalence and Correlates. International journal of environmental research and public health Wang, H., Cousineau, C., Wang, B., Zeng, L., Sun, A., Kohrman, E., Li, N., Tok, E., Boswell, M., Rozelle, S. 2022; 19 (6)

  Abstract

  Extant research continues to establish the importance of teacher job satisfaction to student performance, yet teacher job satisfaction remains under-investigated in rural China. In this paper, we examine the prevalence and correlates of teacher job satisfaction. Using data from 634 teachers across 120 schools in rural China, we find an alarmingly high prevalence of teacher job dissatisfaction: roughly 21% of rural teachers were less than satisfied with their jobs. In addition, we find that several individual- and school-level characteristics, including being a male teacher, being a homeroom teacher, not having a management role in school, being a middle-aged teacher, and a school's boarding status, are correlated with teacher job dissatisfaction. In sum, the results demonstrate a need for further research and policy interventions to improve teacher job satisfaction in rural schools.

  View details for DOI 10.3390/ijerph19063537

  View details for PubMedID 35329221

• 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

• Gender equity in vision care seeking behavior among caregivers: evidence from a randomized controlled trial in rural China. International journal for equity in health Wang, H., Cousineau, C., Fan, Y., Dill, S., Boswell, M., Rozelle, S., Ma, X. 2022; 21 (1): 26

  Abstract

  BACKGROUND: Despite rising incomes and rapid economic growth, there remains a significant gender gap in health outcomes among rural children in China. This study examines whether the gender gap in child health is related to the behavior of caregivers when seeking healthcare, and whether healthcare subsidies help to bridge the gender gap in rural health outcomes.METHODS: Focusing on vision care specifically, we draw on data from a randomized controlled trial of 13,100 children in Gansu and Shaanxi provinces in China that provided subsidized eyeglasses to myopic children in one set of schools (henceforth, referred to as the treatment schools) and provided prescription information but not subsidized eyeglasses to myopic children in another set of schools (control schools).RESULTS: The baseline results reveal that while female students generally have worse vision than male students, they are significantly less likely than male students to be taken by their caregivers to a vision exam. The experimental results indicate, however, that caregivers respond positively to both health information and subsidized healthcare, regardless of the gender of their children. When prescription information is paired with a subsidy voucher for healthcare (a free pair of eyeglasses), the uptake rate rises dramatically.CONCLUSIONS: The gender gap in healthcare can be minimized by implementing subsidized healthcare policies.TRIAL REGISTRATION: The protocol for this study was approved in full by Institutional Review Boards at Stanford University (Palo Alto, California, USA) and the Zhongshan Ophthalmic Center of Sun Yat-sen University (ZOC, Guangzhou, China). Permission was received from local Boards of Education in each region and from the principals of all schools. The principles of the Declaration of Helsinki were followed throughout. The original trial (Registration site: http://isrctn.org . Registration number: ISRCTN03252665 ) was designed to study the effect of providing free spectacles on children's educational performance. The original trial was retrospectively registered on 09/25/2012.

  View details for DOI 10.1186/s12939-022-01625-4

  View details for PubMedID 35183168

• Factors Associated with the Spectacle Wear Compliance among Primary School Students with Refractive Error in Rural China OPHTHALMIC EPIDEMIOLOGY Du, K., Zhu, J., Guan, H., Zhang, Y., Wang, H., Wang, D., Shi, Y. 2022: 1-10

  Abstract

  To study the factors determining spectacle-wear compliance and reasons for non-wear among students in rural China.This study was based on a spectacle intervention trial among 162 schools in rural China. Students with refractive errors were randomly assigned to either a free or voucher group to receive spectacles at baseline. Spectacle-wear compliance was assessed through an unannounced follow-up 7 months after spectacles were distributed. Students not wearing spectacles were also asked their reasons for non-wear. The collected data underwent descriptive, bivariate, and logistic regression analyses.A total of 1904 students received spectacles at baseline, 1826 (95.9%) of whom were present at the 7-month follow-up. Among those students, 41.7% wore their spectacles. There was no significant difference in compliance rates between the free and voucher groups. Predictors of wearing spectacles at follow-up included older age (Odds ratio = 1.56, 95% CI: 1.12-2.19), the severity of refractive error (3.68, 2.23-6.07), wearing spectacles before baseline (3.91, 2.53-6.04) and having friends who wore spectacles (1.87, 1.32-2.63). When students could see the blackboard from their seats (0.68, 0.51-0.89) and thought that wearing spectacles was bad looking (0.76, 0.57-1.00), they were reluctant to wear spectacles. The two main reasons for non-wear were the widespread perception that wearing spectacles would weaken eyesight (32.8%) and the inconvenience of wearing spectacles during activities (23.6%).The main reason that accounts for the low compliance of spectacle wear was misconceptions around spectacle. School-based spectacle programs should consider enhancing the compliance rates to maximize the benefits of spectacle wear.

  View details for DOI 10.1080/09286586.2022.2028295

  View details for Web of Science ID 000743794300001

  View details for PubMedID 35038950

• Bullying Victims in Rural Primary Schools: Prevalence, Correlates, and Consequences. International journal of environmental research and public health Wang, H., Tang, J., Dill, S., Xiao, J., Boswell, M., Cousineau, C., Rozelle, S. 1800; 19 (2)

  Abstract

  School bullying is a widely recognized problem in developed countries, but remains under-investigated in developing countries, especially in remote rural areas. In this paper, we examine the prevalence, correlates, and consequences of bullying victimization and its relation to educational performance and creative attitudes. Using data from 10,528 students across 120 primary schools in rural China, we find an alarmingly high prevalence of bullying victimization and that several individual, family, and school characteristics are correlated with bullying victimization. Analyses indicate students who are bullied frequently score lower in Chinese, reading, and math tests and creative attitudes. Taken together, the results demonstrate a need for further research and policy interventions to reduce bullying in schools.

  View details for DOI 10.3390/ijerph19020765

  View details for PubMedID 35055587

• A deep learning-based system for survival benefit prediction of tyrosine kinase inhibitors and immune checkpoint inhibitors in stage IV non-small cell lung cancer patients: A multicenter, prognostic study eClinicalMedicine Deng, K., Wang, L., Liu, Y., Li, X., Hou, Q., Cao, M., Ng, N. N., Wang, H., Chen, H., Yeom, K. W., Zhao, M., Wu, N., Gao, P., Shi, J., Liu, Z., Li, W., Tian, J., Song, J. 2022; 51: 1-14

  View details for DOI 10.1016/j.eclinm.2022.101541

• Examining the Relation between Caregiver Mental Health and Student Outcomes in Rural China. International journal of environmental research and public health Wang, H., Cousineau, C., Hu, Y. A., Hu, G., Qi, S., Sun, A., Wu, H., Rozelle, S., Singh, M. 2021; 18 (23)

  Abstract

  Research continues to highlight the central relationship between caregivers' mental health and their children's development. This study examined the relation between primary caregivers' mental health and school-aged children's outcomes, including student mental health, resilience, and academic performance, in rural China. Using cross-sectional data from economically poor areas in the Gansu province, 2989 students (mean age = 11.51, 53.33% male, 46.67% female) and their primary caregivers (74.2% female) completed the 21-item, self-report Depression Anxiety Stress Scale. Students also completed the 25-item Connor-Davidson Resilience Scale and a standardized math test. The results indicated a high prevalence of caregiver depression (31%), stress (39%), and anxiety (24%). Characteristics that were significantly correlated with caregiver mental health issues included being a grandparent, having a low socioeconomic status and low education level, and living in a household with at least one migrant worker. Apart from caregiver stress and student resilience, caregiver mental health issues were negatively correlated with all student outcomes, including student mental health, resilience, and academic performance. Although additional empirical research is needed to investigate the associations between caregiver mental health and student outcomes, our results suggest that rural communities could benefit greatly from programs focused on improving the mental health of caregivers and this, in turn, may have a positive impact on student outcomes.

  View details for DOI 10.3390/ijerph182312613

  View details for PubMedID 34886336

• Attention Deficit Hyperactivity Disorder (ADHD) among elementary students in rural China: Prevalence, correlates, and consequences. Journal of affective disorders Pang, X., Wang, H., Dill, S., Boswell, M., Pang, X., Singh, M., Rozelle, S. 2021; 293: 484-491

  Abstract

  BACKGROUND: Attention deficit hyperactivity disorder (ADHD) is a widely recognized mental health problem in developed countries but remains under-investigated in developing settings. This study examines the prevalence, correlates, and consequences of ADHD symptoms among elementary school students in rural China.METHODS: Cross-sectional data were collected from 6,719 students across 120 rural primary schools in China on ADHD symptoms, demographic characteristics, and academic performance in reading and math. ADHD symptoms were evaluated using the caregiver-reported ADHD Rating Scale-IV.RESULTS: The prevalence of ADHD symptoms was 7.5% in our sample. Male students, students in lower grade levels, and students with lower cognitive ability showed a significantly higher prevalence of ADHD symptoms (ORs=2.56, 2.06, and 1.84, respectively; p<0.05). Left-behind children showed a significantly lower prevalence of ADHD symptoms than did children who were living with their parents (OR=0.74, p < 0.05). Adjusted regressions show that students with ADHD symptoms scored 0.12 standardized deviations lower in reading (p < 0.05) and 0.19 standardized deviations lower in math (p < 0.01).LIMITATIONS: The ADHD Rating Scale-IV is a screening scale rather than a diagnostic test. Caregiver self-report measures also may underestimate ADHD symptoms for our sample.CONCLUSIONS: ADHD is a common disorder among rural students in China and appears to be contributing to poor academic outcomes. The higher prevalence of ADHD among students with low cognitive ability also suggests that many rural children in China face multifactorial learning challenges. Taken together, the findings indicate a need for educators and policymakers in rural China to develop programs to reduce risk and support students with ADHD symptoms.

  View details for DOI 10.1016/j.jad.2021.06.014

  View details for PubMedID 34280772

• Association of Child Mental Health with Child and Family Characteristics in Rural China: A Cross-Sectional Analysis. International journal of environmental research and public health Wang, H., Abbey, C., She, X., Rozelle, S., Ma, X. 2021; 18 (10)

  Abstract

  Assessing the mental health problems encountered by school children and understanding the contributing factors are crucial to inform strategies aimed at improving mental health in low-resource contexts. However, few studies have investigated the mental health problems among disadvantaged children in poorer countries. This study examines the prevalence of mental health problems in rural China and their association with child and family characteristics. The study uses survey data from 9696 children in 120 rural primary schools and measures child mental health using the Strengths and Difficulties Questionnaire (SDQ). Overall, 17.9% of the sample children were found to be in the abnormal range of the SDQ total difficulties scores. The mean score was 12.93 (SD = 4.94). Abnormal scores were associated with child and family characteristics, including older child age (Odds Ratio, OR = 0.704, 95% CI: 0.611, 0.810; p < 0.001), gender (OR = 1.235, 95% CI: 1.112, 1.371; p < 0.001), and academic performance (OR = 0.421, 95% CI: 0.369, 0.480; p < 0.001). Reading time was found to be protective for mental health. Risk factors include excessive screen time (OR = 1.685, 95% CI: 1.409, 2.016; p < 0.001) and being bullied (OR = 3.695, 95% CI: 3.301, 4.136; p < 0.001). Our study suggests that future mental health illness prevention programs in rural China should consider targeting different aspects of children's social contexts.

  View details for DOI 10.3390/ijerph18105107

  View details for PubMedID 34065853

• 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

• Author Correction: Skill levels and gains in university STEM education in China, India, Russia and the United States. Nature human behaviour Loyalka, P., Liu, O. L., Li, G., Kardanova, E., Chirikov, I., Hu, S., Yu, N., Ma, L., Guo, F., Beteille, T., Tognatta, N., Gu, L., Ling, G., Federiakin, D., Wang, H., Khanna, S., Bhuradia, A., Shi, Z., Li, Y. 2021

  View details for DOI 10.1038/s41562-021-01102-y

  View details for PubMedID 33824515

• Building the mental health management system for children post COVID-19 pandemic: an urgent focus in China. European child & adolescent psychiatry Li, Y., Deng, H., Wang, H., Abbey, C., Zheng, Y., Chen, J., An, N., Zhang, P., Xiao, X., Chu, J., Li, Y., Cui, Y. 2021

  View details for DOI 10.1007/s00787-021-01763-0

  View details for PubMedID 33755820

• Improving learning by improving vision: evidence from two randomized controlled trials of providing vision care in China JOURNAL OF DEVELOPMENT EFFECTIVENESS Ma, X., Wang, H., Shi, Y., Sylvia, S., Wang, L., Qian, Y., Rozelle, S. 2021

  View details for DOI 10.1080/19439342.2021.1876139

  View details for Web of Science ID 000622315700001

• The prevalence and correlates of vision impairment and glasses ownership among ethnic minority and Han schoolchildren in rural China. PloS one Wang, H., Barket, B., Du, S., Friesen, D., Kohrman, E., Tok, E., Xiao, B., Huang, W., Chan, V. F., MacKenzie, G., Congdon, N. 2021; 16 (8): e0256565

  Abstract

  PURPOSE: To determine the prevalence of visual impairment and glasses ownership among Han Chinese and Hui minority junior high school children in Ningxia Hui Autonomous Region, China.DESIGN: Population-based cross-sectional study.METHODS: Vision screening was conducted on 20,376 children (age 12-15 years) in all 124 rural junior high schools in Ningxia. Personal and family characteristics, glasses ownership, and academic performance were assessed through a survey questionnaire and standardized mathematics test, respectively.RESULTS: The prevalence of visual acuity (VA) ≤6/12 in either eye was significantly higher among Han (54.5%) than Hui (45.2%) children (P<0.001), and was significantly positively associated with age, female sex, Han ethnicity, parental outmigration for work, shorter time spent outside during recess, shorter time spent watching television and higher time spent studying. Among children with VA≤6/12 in both eyes, only 56.8% of Han and 41.5% of Hui children had glasses (P<0.001). Glasses ownership was significantly associated with worse vision, greater family wealth, female sex, higher test scores, age, parental outmigration for work, understanding of myopia and glasses, higher time spent studying and Han ethnicity.CONCLUSION: One of the first of its kind, this report on Han and Hui ethnic schoolchildren confirms a high prevalence of visual impairment among both populations, but slightly higher among the Han. Both groups, especially the Hui, have low rates of glasses ownership. Future interventions and policies designed to improve glasses usage should focus on populations with lower incomes and seek to correct erroneous beliefs about the safety of glasses and efficacy of traditional eye exercises.

  View details for DOI 10.1371/journal.pone.0256565

  View details for PubMedID 34460851

• Cognitive ability and academic performance among left-behind children: evidence from rural China COMPARE-A JOURNAL OF COMPARATIVE AND INTERNATIONAL EDUCATION He, X., Wang, H., Friesen, D., Shi, Y., Chang, F., Liu, H. 2022; 52 (7): 1033-1049

  View details for DOI 10.1080/03057925.2020.1848520

  View details for Web of Science ID 000600002000001

• Independent reading in rural China's elementary schools: A mixed-methods analysis INTERNATIONAL JOURNAL OF EDUCATIONAL DEVELOPMENT Wang, H., Guan, H., Yi, H., Seevak, E., Manheim, R., Boswell, M., Rozelle, S., Kotb, S. 2020; 78

  View details for DOI 10.1016/j.ijedudev.2020.102241

  View details for Web of Science ID 000573305600012

• The impact of pay-for-percentile incentive on low-achieving students in rural China ECONOMICS OF EDUCATION REVIEW Chang, F., Wang, H., Qu, Y., Zheng, Q., Loyalka, P., Sylvia, S., Shi, Y., Dill, S., Rozelle, S. 2020; 75

  View details for DOI 10.1016/j.econedurev.2020.101954

  View details for Web of Science ID 000527962900006

• Effect of Chinese eye exercises on change in visual acuity and eyeglasses wear among school-aged children in rural China: a propensity-score-matched cohort study. BMC complementary medicine and therapies Wang, H., Qian, Y., Congdon, N., Boswell, M., Rozelle, S., Ma, X. 2020; 20 (1): 82

  Abstract

  BACKGROUND: Daily "eye exercises," massaging of periocular acupuncture pressure points, have been part of China's national vision care policy in schools for some 50years. However, the effect of eye exercises on myopia progression and eyeglasses wear has not been definitively investigated. This study evaluates the effectiveness of eye exercises on visual acuity and the propensity of rural children to wear eyeglasses.METHODS: Cohort study in 252 randomly-selected rural schools with baseline in September 2012 and follow up surveys 9 and 21months later. Outcomes were assessed using propensity-score matching (PSM), multivariate linear regression and logistic regression to adjust for differences between children performing and not performing eye exercises.RESULTS: Among 19,934 children randomly selected for screening, 2374 myopic (spherical equivalent refractive error≤-0.5 diopters in either eye) children (11.9%, mean age 10.5 [Standard Error 1.08] years, 48.5% boys) had VA in either eye ≤6/12 without eyeglasses correctable to >6/12 with eyeglasses. Among these who completed the 21-month follow up, 1217 (58.2%) children reported practicing eye exercises on school days and 874 (41.8%) did not. After propensity-score matching, 1652 (79%) children were matched: 826 (50%) in the Eye Exercises group and 826 (50%) in the No Exercise group. Performing eye exercises was not associated with change in LogMAR uncorrected visual acuity and wear of eyeglasses, using either logistic regression or PSM at 9 or 21months.CONCLUSIONS: We found no evidence for an effect of eye exercises on change in vision or eyeglasses wear.TRIAL REGISTRATION: The original trial (Registration site: http://isrctn.org. Registration number: ISRCTN03252665) was retrospectively registered 25/09/2012.

  View details for DOI 10.1186/s12906-020-2878-9

  View details for PubMedID 32164649

• Factors linked to cultivating successful readers: Evidence from rural China INTERNATIONAL JOURNAL OF EDUCATIONAL RESEARCH Wang, N., Wang, H., Chang, F., Lu, F., Dill, S. 2020; 103

  View details for DOI 10.1016/j.ijer.2020.101636

  View details for Web of Science ID 000576965600028

• Can School Feeding Programs Reduce Malnutrition in Rural China? The Journal of school health Wang, H., Zhao, Q., Boswell, M., Rozelle, S. 2019

  Abstract

  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.

  View details for DOI 10.1111/josh.12849

  View details for PubMedID 31707745

• Effect of Chinese Eye Exercises on Change in Visual Acuity and Eyeglasses Wear Among School-aged Children in Rural China Boswell, M., Wang, H., Jan, C., Qian, Y., Congdon, N. G., Rozelle, S. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2019

  View details for Web of Science ID 000488800701084

• The cost-effectiveness of alternative vision screening models among preschool children in rural China ACTA OPHTHALMOLOGICA Wang, L., Congdon, N., Hogg, R. E., Zhang, S., Li, M., Shi, Y., Jin, L., He, F., Wang, H., Boswell, M., Iyer, M. 2019; 97 (3): E419–E425

  View details for DOI 10.1111/aos.13954

  View details for Web of Science ID 000465095200027

• 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 PLOS ONE Guan, H., Yu, N., Wang, H., Boswell, M., Shi, Y., Rozelle, S., Congdon, N. 2019; 14 (4)

  View details for DOI 10.1371/journal.pone.0215827

  View details for Web of Science ID 000465846200021

• 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. PloS one Guan, H. n., Yu, N. N., Wang, H. n., Boswell, M. n., Shi, Y. n., Rozelle, S. n., Congdon, N. n. 2019; 14 (4): e0215827

  Abstract

  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.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.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.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.

  View details for PubMedID 31026279

• The Effect of Providing Free Eyeglasses on Children's Mental Health Outcomes in China: A Cluster-Randomized Controlled Trial. International journal of environmental research and public health Guan, H., Wang, H., Du, K., Zhao, J., Boswell, M., Shi, Y., Qian, Y. 2018; 15 (12)

  Abstract

  If children with common vision problems receive and use eyeglasses, their educational performance rises. Without proper treatment, visually impaired children may not achieve educational gains and could suffer from poor mental health. We use a randomized controlled trial to study the impact of an eyeglasses promotion program in rural China on the mental health of myopic primary school students. Three measures of mental health are used: learning anxiety, physical anxiety, and scores on the Mental Health Test (MHT). Our empirical analysis showed that on average, the treatment has small and insignificant for learning anxiety and MHT, and a small but significant reduction in physical anxiety. However, subgroup analysis reveals that myopic students who study more intensively see their learning anxiety and physical anxiety reduced after being provided with eyeglasses. In contrast, students with the lower study intensity suffer a rise in learning anxiety after receiving eyeglasses. A potential mechanism for the differing impacts is the increase in teasing reported among low study-intensity students that does not occur for high study-intensity students. Care should be taken to maximize the benefits and minimize the costs of in-school vision programs.

  View details for PubMedID 30563118

• The Effect of Providing Free Eyeglasses on Children's Mental Health Outcomes in China: A Cluster-Randomized Controlled Trial INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH Guan, H., Wang, H., Du, K., Zhao, J., Boswell, M., Shi, Y., Qian, Y. 2018; 15 (12)

  View details for DOI 10.3390/ijerph15122749

  View details for Web of Science ID 000456527000140

• Can reading programs improve reading skills and academic performance in rural China? CHINA ECONOMIC REVIEW Gao, Q., Wang, H., Mo, D., Shi, Y., Kenny, K., Rozelle, S. 2018; 52: 111–25

  View details for DOI 10.1016/j.chieco.2018.07.001

  View details for Web of Science ID 000453639900007

• The cost-effectiveness of alternative vision screening models among preschool children in rural China. Acta ophthalmologica Wang, L., Congdon, N., Hogg, R. E., Zhang, S., Li, M., Shi, Y., Jin, L., He, F., Wang, H., Boswell, M., Iyer, M. 2018

  Abstract

  PURPOSE: To explore the accuracy and cost-effectiveness of three vision screening models among preschool children in rural China.METHODS: Vision screening was carried out among children aged 4-5years in 65 preschools in two counties in Northwest China, using Crowded Single Lea Symbols to test visual acuity. Children were assigned randomly by school to one of three screening models: screening by teachers (15 schools, 1835 children), local optometrists (30 schools, 1718 children) or volunteers (20 schools, 2183 children). Children identifying ≥2 symbols incorrectly in either eye failed screening. Accuracy of screening was compared with screenings executed by experienced optometrists among 141 children selected randomly from the three screening models. Direct and indirect costs for each model were assessed. Costs to detect a true case failed screening were estimated.RESULTS: The sensitivity for three models ranged from 76.9% to 87.5%, specificity from 84.9% to 86.7% and standardized positive predictive value from 83.7% to 85.7%. None differed significantly between models. The costs per case detected were $37.53, $59.14 and $52.19 for the teachers, local optometrists and volunteers. In producing the cost estimates for teacher screening and local optometrist screening models, we used a salary payment that was identical for both models (with the salary being equal to that of the optometrist). The teacher screening model was the most cost-effective.CONCLUSION: Accuracy of screening by teachers, local optometrists and volunteers was the same in this setting, but the use of teachers was most cost-effective, reducing the cost per case detected by almost 40%.

  View details for PubMedID 30345728

• Health Seeking Behavior among Rural Left-Behind Children: Evidence from Shaanxi and Gansu Provinces in China INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH Guan, H., Wang, H., Huang, J., Du, K., Zhao, J., Boswell, M., Shi, Y., Iyer, M., Rozelle, S. 2018; 15 (5)

  Abstract

  More than 60 million children in rural China are “left-behind”—both parents live and work far from their rural homes and leave their children behind. This paper explores differences in how left-behind and non-left-behind children seek health remediation in China’s vast but understudied rural areas. This study examines this question in the context of a program to provide vision health care to myopic rural students. The data come from a randomized controlled trial of 13,100 students in Gansu and Shaanxi provinces in China. The results show that without a subsidy, uptake of health care services is low, even if individuals are provided with evidence of a potential problem (an eyeglasses prescription). Uptake rises two to three times when this information is paired with a subsidy voucher redeemable for a free pair of prescription eyeglasses. In fact, left-behind children who receive an eyeglasses voucher are not only more likely to redeem it, but also more likely to use the eyeglasses both in the short term and long term. In other words, in terms of uptake of care and compliance with treatment, the voucher program benefitted left-behind students more than non-left-behind students. The results provide a scientific understanding of differential impacts for guiding effective implementation of health policy to all groups in need in developing countries.

  View details for PubMedID 29710797

• Assessing college critical thinking: preliminary results from the Chinese HEIghten (R) Critical Thinking assessment HIGHER EDUCATION RESEARCH & DEVELOPMENT Liu, O., Shaw, A., Gu, L., Li, G., Hu, S., Yu, N., Ma, L., Xu, C., Guo, F., Su, Q., Kardanovaj, E., Chirikov, I., Shi, J., Shi, Z., Wang, H., Loyalka, P. 2018; 37 (5): 999–1014

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