Scott Rozelle

All Publications

• Parental investment, school choice, and the persistent benefits of an early childhood intervention? JOURNAL OF DEVELOPMENT ECONOMICS Wang, L., Qian, Y., Warrinnier, N., Attanasio, O., Rozelle, S., Sylvia, S. 2023; 165

  View details for DOI 10.1016/j.jdeveco.2023.103166

  View details for Web of Science ID 001073104100001

• 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

• FROM QUANTITY TO QUALITY: DELIVERING A HOME-BASED PARENTING INTERVENTION THROUGH CHINA'S FAMILY PLANNING CADRES ECONOMIC JOURNAL Sylvia, S., Warrinnier, N., Luo, R., Yue, A., Attanasio, O., Medina, A., Rozelle, S. 2021; 131 (635): 1365-1400

  View details for DOI 10.1093/ej/ueaa114

  View details for Web of Science ID 000649389500013

• Can Bureaucrats Really Be Paid Like Ceos? Substitution Between Incentives and Resources Among School Administrators in China. Journal of the European Economic Association Luo, R. n., Miller, G. n., Rozelle, S. n., Sylvia, S. n., Vera-Hernández, M. n. 2020; 18 (1): 165–201

  Abstract

  Unlike performance incentives for private sector managers, little is known about performance incentives for managers in public sector bureaucracies. Through a randomized trial in rural China, we study performance incentives rewarding school administrators for reducing student anemia-as well as complementarity between incentives and orthogonally assigned discretionary resources. Large (but not small) incentives and unrestricted grants both reduced anemia, but incentives were more cost-effective. Although unrestricted grants and small incentives do not interact, grants fully crowd-out the effect of larger incentives. Our findings suggest that performance incentives can be effective in bureaucratic environments, but they are not complementary to discretionary resources.

  View details for DOI 10.1093/jeea/jvy047

  View details for PubMedID 32161517

  View details for PubMedCentralID PMC7053554

• Dynamic Anemia Status from Infancy to Preschool-Age: Evidence from Rural China. International journal of environmental research and public health Wang, L., Li, M., Dill, S., Hu, Y., Rozelle, S. 2019; 16 (15)

  Abstract

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

  View details for DOI 10.3390/ijerph16152761

  View details for PubMedID 31382413

• The gender gap in early language development among children from peri-urban China EARLY CHILDHOOD RESEARCH QUARTERLY Ma, Y., Jia, X., Pappas, L., Guo, Y., Feng, T., Feng, J., Rozelle, S. 2025; 70: 154-166

  View details for DOI 10.1016/j.ecresq.2024.09.008

  View details for Web of Science ID 001333074700001

• Do the pathways of child development before age three matter for development at primary school? Evidence from rural China HUMANITIES & SOCIAL SCIENCES COMMUNICATIONS Wang, L., Zhang, S., Rozelle, S. 2024; 11 (1)

  View details for DOI 10.1057/s41599-024-04104-z

  View details for Web of Science ID 001359498900001

• Adaptation and psychometric evaluation of the breastfeeding self-efficacy scale to assess exclusive breastfeeding: a cross-sectional study in rural China. BMC pregnancy and childbirth Li, L., Cai, Z., Zhou, X., Feng, J., Sun, C., Wu, Y., Rozelle, S., Zhou, H. 2024; 24 (1): 749

  Abstract

  Despite the benefits of exclusive breastfeeding, the proportion of exclusively breastfed children remains low in rural China. Self-efficacy is one of the most crucial modifiable factors predicting breastfeeding behavior. However, existing instruments in China do not specifically measure self-efficacy for exclusive breastfeeding but rather measure self-efficacy for any breastfeeding. Furthermore, they have been validated only in high-income Chinese settings. We sought to adapt and validate an instrument to measure exclusive breastfeeding self-efficacy within rural Chinese contexts.We introduced relevant items to Dennis' Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF), which can assess maternal self-efficacy for exclusive breastfeeding. It was then implemented in a multistage random cluster sampling design and cross-sectional survey with home-visit interviews among women 0-6 months postpartum (n = 654) in the rural areas of four counties in Sichuan, China. We performed item-total and adjusted item-total correlations, as well as exploratory factor analysis to remove redundant items and determine the latent factor structure. We further applied confirmatory factor analysis to test the dimensionality of the scale. We then assessed the reliability of the scale and conducted tests of predictive and divergent validity. Known group comparisons were made by primiparous status and breastfeeding support level. We compared the validated Exclusive Breastfeeding Self-Efficacy Scale with the BSES-SF in terms of reliability and validity to explore the added value of scale modification.Our modification of the BSES-SF to target exclusive breastfeeding produced 19 items. This was further reduced to 15 items based on adjusted item-total correlations and exploratory factor analysis, forming the Exclusive Breastfeeding Self-Efficacy Scale. This scale had three dimensions: "Breast milk supply and quality," "Breastfeeding skills," and "Exclusive breastfeeding" subscales. The Exclusive Breastfeeding Self-Efficacy Scale demonstrated strong internal consistency and overall reliability with a Cronbach's alpha coefficient of 0.91. Predictive and divergent validity and known group comparison assessments supported its validity. Robust psychometric evaluations demonstrated enhanced validity and reliability compared to the original BSES-SF.Our Exclusive Breastfeeding Self-Efficacy Scale is valid and reliable for measuring exclusive breastfeeding self-efficacy within rural Chinese contexts and is ready for adaptation and validation for clinical and programmatic use elsewhere, particularly within LMICs.

  View details for DOI 10.1186/s12884-024-06948-4

  View details for PubMedID 39538194

  View details for PubMedCentralID 7427769

• Preschool quality and developmental outcomes of preschool children in rural China: Evidence from longitudinal and subgroup analyses CHILDREN AND YOUTH SERVICES REVIEW Wang, L., Jiang, D., Pang, J., Yang, C., Zhang, S., Rozelle, S. 2024; 166

  View details for DOI 10.1016/j.childyouth.2024.107956

  View details for Web of Science ID 001334641600001

• Chain mediating role of self-esteem and resilience in the association between screen time and depression symptoms among Chinese children and adolescents CURRENT PSYCHOLOGY Liu, W., Yu, J., She, X., Wang, H., Wang, M., Abbey, C., Singh, M. K., Rozelle, S., Tong, L. 2024

  View details for DOI 10.1007/s12144-024-06642-w

  View details for Web of Science ID 001347116000001

• The association between visual impairment, educational outcomes, and mental health: insights from eyeglasses usage among junior high school students in rural China. Scientific reports Pang, X., Wang, H., Qian, Y., Zhu, S., Hu, Y. A., Rozelle, S., Congdon, N., Jiang, J. 2024; 14 (1): 24244

  Abstract

  This study examined the association between visual impairment, visual impairment corrected by wearing eyeglasses, academic performance, and mental health among junior high school students in rural China. Visual acuity assessments were conducted on 19,425 junior high school students by trained medical and research professionals to determine the presence of visual impairment. All sample students were surveyed with a questionnaire that asked about individual and family characteristics, eyeglasses ownership, and educational aspirations and included a standardized math test. Students then completed an official Chinese simplified version of the Strengths and Difficulties Questionnaire (SDQ) to assess their mental health multidimensionally. Among our sample, 37.2% of them suffered from visual impairment, but only 43.4% of the visually impaired students wore proper eyeglasses. Approximately 9.3% of students were categorized as high risk for mental health problems based on their SDQ score. A significant positive association existed between impaired vision and poorer mental health, and eyeglasses usage was associated with better mental health among visually impaired students. For students with better academic performance, eyeglasses usage associated with better mental health. Eyeglasses usage shows a positive association with higher education aspiration both for students with better and worse academic performance. The significant positive relationship between eyeglasses usage and mental health may guide future interventions and policies designed to improve student mental health by supplying them with eyeglasses.

  View details for DOI 10.1038/s41598-024-72119-2

  View details for PubMedID 39414798

  View details for PubMedCentralID 4172821

• Depression Takes a Toll on Academic Performance: Evidence from Rural Students in China. Risk management and healthcare policy Yan, R., Jin, S., Ji, C., Feng, C., Wang, H., Lyu, J., Rozelle, S. 2024; 17: 2209-2227

  Abstract

  Depression is a growing public health concern around the world. For adolescents, depression not only impedes healthy development, but is negatively associated with academic performance. The purpose of this paper is to examine the prevalence of adolescent depressive symptoms in a sample of rural primary and junior high school students. Additionally, we examine various factors to identify subgroups within the sample that may be more vulnerable to depression. Finally, we explore the extent to which depression correlates with academic performance and conduct a series of heterogeneity analyses.We utilize cross-sectional data derived from 30 schools in underdeveloped regions of rural China encompassing primary and junior high school students (n = 1,609).We find a high prevalence of depression, with 23% and 9% of students experiencing general depression (depression score ≥ 14) and severe depression (depression score ≥ 21), respectively. Female gender, elevated stress and anxiety levels, boarding at school, exposure to bullying, and having depressed caregiver(s) are positively correlated with depressive symptoms, while high social support exhibits a negative association. Importantly, our analyses consistently show a significantly negative link between depression and academic performance, which is measured using standardized math tests. For instance, transitioning from a non-depressed state to a state of general depression (depression score ≥ 14) is linked to a decline of 0.348-0.406 standard deviations in math scores (p < 0.01). Heterogeneity analyses reveal that this adverse relationship is more pronounced for male students, boarding students, those with lower social support, individuals with more educated mothers, and those with lower family assets.Our findings underscore the high prevalence of depression in rural schools and the detrimental impact on academic performance. We advocate for the implementation of policies aimed at reducing student depression, particularly within vulnerable populations and subgroups.

  View details for DOI 10.2147/RMHP.S469836

  View details for PubMedID 39309122

  View details for PubMedCentralID PMC11416776

• Paths of cognitive and social-emotional delays before age three in rural China: Predictive power on skills at preschool age. PloS one Wang, L., Jiang, D., Chen, Y., Zhang, S., Rozelle, S. 2024; 19 (9): e0310016

  Abstract

  Cognitive and social-emotional development in the first three years of life is associated with later skills. However, little is known about the paths of developmental delays in both cognitive and social-emotional skills before age 3 or to what extent these paths predict later developmental outcomes. The aim of this study is to examine the associations between the different paths of developmental delays in both cognitive and social-emotional skills of children before age 3 and the levels of development of the children when they are preschool age. Using a longitudinal data collected at three time points from 1245 children and their caregivers in rural China, we identified four different paths of developmental delays in cognitive and social-emotional before age 3 and examined how these paths are associated with different levels of developmental outcomes at preschool age. We used a non-parametric standardization approach and an ordinary least squares model to perform our analyses. Findings show that rates of developmental delays in either cognitive or social-emotional domain or both domains are high at all different time points, ranging from 20% to 55% for cognitive delays and 42% to 61% for social-emotional delays. Over half of children experienced deteriorating levels of either cognitive or social-emotional development before age 3. A large share of children was found to be persistently delayed in either domain. Only a small share of children raised their levels of development in either domain before age 3. In addition, we identified certain socioeconomic status of the family that are associated with never or deteriorating path of child developmental delays. More importantly, we revealed that different paths of developmental delays before age 3 have predictive power on different levels of developmental outcomes at preschool age. Our results suggest that actions are needed at the earliest times to improve child development when children are still infants or toddlers.

  View details for DOI 10.1371/journal.pone.0310016

  View details for PubMedID 39240865

  View details for PubMedCentralID PMC11379282

• Primary care quality and provider disparities in China: a standardized-patient-based study LANCET REGIONAL HEALTH-WESTERN PACIFIC Huang, M., Rozelle, S., Cao, Y., Wang, J., Zhang, Z., Duan, Z., Song, S., Sylvia, S. 2024; 50

  View details for DOI 10.1016/j.lanwpc.2024.101161

  View details for Web of Science ID 001300163200001

• Primary care quality and provider disparities in China: a standardized-patient-based study. The Lancet regional health. Western Pacific Huang, M., Rozelle, S., Cao, Y., Wang, J., Zhang, Z., Duan, Z., Song, S., Sylvia, S. 2024; 50: 101161

  Abstract

  Primary health care is the foundation of high-performing health systems. Achieving an improved primary care system requires a thorough understanding of the current quality of care among various providers within the system. As the world's largest developing country, China has made significant investments in primary care over the past decade. This study evaluates the quality of primary care across different provider types in China, offering in-sights for enhancing China's primary care system.We merged data from four standardized patient (SP) research projects to compare the quality of five major primary care providers in China: rural clinics, county hospitals, migrant clinics, urban community health cen-ters (CHCs), and online platforms. We evaluated quality of care across process quality (e.g., checklist completion), diagnosis quality (e.g., diagnostic accuracy), and case management (e.g., correct medication), employing multiple regression analyses to explore quality differences by provider type, and their associations with physician characteristics.We document a poor quality of primary care in China, with no-table disparities across different providers. CHCs emerge as relatively reliable primary care providers in terms of process quality, diagnostic accuracy, and cor-rect medication prescriptions. Online platforms outpace rural clinics, county hospitals, and migrant clinics in many areas, showcasing their potential to en-hance access to quality healthcare resources in under-resourced rural regions. We observe a positive association between the qualifications of physicians and the quality of primary care, underscoring the necessity for a greater presence of more highly qualified practitioners.Primary care quality in China varies greatly among providers, reflecting inequalities in healthcare access. While online platforms indicate po-tential for improving care in under-resourced areas, their high referral rates suggest they cannot completely substitute traditional care. The findings em-phasize the need for more qualified practitioners and stringent regulation to enhance care quality and reduce unnecessary treatments.No founders had a role in the study design, data collection, data analysis, data interpretation, or writing of the report. We have acknowledged this in the revised manuscript.

  View details for DOI 10.1016/j.lanwpc.2024.101161

  View details for PubMedID 39253593

  View details for PubMedCentralID PMC11381900

• The Connection between Sleep Patterns and Mental Health: Insights from Rural Chinese Students. Healthcare (Basel, Switzerland) Lyu, J., Jin, S., Ji, C., Yan, R., Feng, C., Rozelle, S., Wang, H. 2024; 12 (15)

  Abstract

  The association between sleep patterns and young students' mental health, which is crucial for their development, remains understudied in rural China. Therefore, the relationship between sleep patterns and mental health among primary and junior high school students in rural China was examined.A total of 1592 primary and junior high school students from rural areas of Gansu Province were surveyed, and the Depression Anxiety and Stress Scale (DASS) was utilized to assess mental health, alongside self-reported data on their daily sleep patterns.Significant sleep inadequacies were identified: 28% of students received less than 8 h of sleep on weekdays, and 19% went to bed later than recommended. On weekends, 38% of students had delayed bedtimes, though only 7.2% received less than 8 h of sleep. Notably, a "U-shaped" relationship was uncovered between sleep duration and mental health for students on weekends, with optimal mental health correlated with receiving 10-11 h of sleep, while both shorter and longer sleep durations on weekends worsened outcomes. This pattern is absent on weekdays. Additionally, adequate sleep and an earlier bedtime was linked to a 6-8% decrease in mental health risks.These findings provide valuable insights for policymakers seeking to enhance student mental well-being in rural settings, emphasizing the importance of implementing measures that promote balanced sleep habits among young students.

  View details for DOI 10.3390/healthcare12151507

  View details for PubMedID 39120210

• Associations of parental divorce with student mental health and academic outcomes: A quantitative study in rural China. Journal of affective disorders Pang, X., Wang, H., Feng, C., Xue, H., Rozelle, S. 2024

  Abstract

  This paper examines the prevalence, correlates, and developmental consequences of divorce among junior high school students in rural China. Specifically, we investigate the connections between parental divorce and student mental health and academic performance, while also examining whether a student's living arrangement after divorce influences these outcomes.Data were collected from 17,955 students across 122 rural junior high schools in China on their mental health, characteristics, and academic performance. Mental health was measured using the self-reported Strengths and Difficulties Questionnaire.About 8.4 % of the students had divorced parents, with increased risk observed for students who were only children, had migrant mothers, or had higher educated mothers (ORs = 4.35, 3.20, and 1.78, respectively; Bonferroni-adjusted p < 0.05). Students with divorced parents exhibited a higher likelihood of internalizing (0.031), externalizing (0.5) abnormality (Bonferroni-adjusted p < 0.001) and scored 0.203 SD lower on the math test (Bonferroni-adjusted p < 0.001). Living arrangements post-divorce, either with a mother or a father, equally negatively impacted student mental health and academic performance, with a mitigating effect observed when grandparental childcare was provided.Our study faced limitations in assessing the influence of grandparental childcare on coping with parental divorce due to challenges in gauging the extent of such support for students residing with a parent after divorce.Parental divorce among young students in rural China is associated with adverse developmental outcomes. These findings underscore the importance of implementing targeted programs in rural China to mitigate these risks and provide support for young students with divorced parents.

  View details for DOI 10.1016/j.jad.2024.07.059

  View details for PubMedID 39025442

• Heterogeneity of Item-Treatment Interactions Masks Complexity and Generalizability in Randomized Controlled Trials JOURNAL OF RESEARCH ON EDUCATIONAL EFFECTIVENESS Ahmed, I., Bertling, M., Zhang, L., Ho, A. D., Loyalka, P., Xue, H., Rozelle, S., Domingue, B. W. 2024

  View details for DOI 10.1080/19345747.2024.2361337

  View details for Web of Science ID 001268996500001

• Effects of Mindfulness and Life-Skills Training on Emotion Regulation and Anxiety Symptoms in Chinese Migrant Children: A Randomized Controlled Trial. The Journal of adolescent health : official publication of the Society for Adolescent Medicine Lan, L., Liu, W., Liu, C., Wang, H., Wang, M., Abbey, C., Singh, M. K., Rozelle, S., She, X., Tong, L. 2024

  Abstract

  China's rapid urbanization has been associated with increased mental health challenges, especially in rural-to-urban migrant children. This study evaluates the effects of mindfulness and life-skills (LS) training on emotional regulation and anxiety symptoms from a randomized controlled trial aimed at improving the mental health of Chinese migrant children.Two intervention arms-mindfulness training (MT) and MT plus LS mentorship (MT + LS)-were compared to a waitlist control group of 368 migrant children aged 9-17 years. Volunteers were trained to deliver interventions to 285 migrant children in small groups of 15 for eight weeks weekly. Social integration varied: migrant children mixed with local children at public schools were considered highly integrated, those in migrant-only classrooms at public schools had intermediate levels of integration, and children in private migrant schools had low integration. Emotion regulation and anxiety symptoms were assessed preintervention, postintervention, and three months postintervention.Postintervention and compared to the control group, children with high social integration in the MT arm showed increased cognitive reappraisal ability (p < .05) but higher physical anxiety (p < .01). Children with high social integration in the MT + LS arm had lower anxiety symptoms of harm avoidance (p < .01) and physical anxiety (p < .05). Children with low social integration in the MT + LS arm showed lower cognitive reappraisal (p < .01) and poorer overall emotion regulation abilities (p < .01). Three months later, children with intermediate integration in the MT + LS arm had lower separation anxiety (p < .05) and harm avoidance anxiety (p < .05). No other groups showed significant improvements in emotion regulation or reducing in anxiety symptoms three months postintervention.Mindfulness and LS training may benefit Chinese migrant children who have higher levels of social integration but increase anxiety in those with lower social integration. Future research should consider the sociocultural context in which a treatment is implemented.

  View details for DOI 10.1016/j.jadohealth.2024.05.024

  View details for PubMedID 38970607

• Isolating the "Tech" from EdTech: Experimental Evidence on Computer-Assisted Learning in China ECONOMIC DEVELOPMENT AND CULTURAL CHANGE Ma, Y., Fairlie, R., Loyalka, P., Rozelle, S. 2024

  View details for DOI 10.1086/726064

  View details for Web of Science ID 001237301800001

• Can a Teacher Salary Increase Promote Students' Educational Performance? CHINA & WORLD ECONOMY Liu, T., Su, B., Wang, J., Rozelle, S. 2024; 32 (4): 114-145

  View details for DOI 10.1111/cwe.12543

  View details for Web of Science ID 001271702400007

• Electronic media exposure, parental language input, and child vocalizations in rural and peri-urban China APPLIED DEVELOPMENTAL SCIENCE Jia, X., Zhou, M., Pang, Z., Rule, A., Rozelle, S., Ma, Y. 2024

  View details for DOI 10.1080/10888691.2024.2373727

  View details for Web of Science ID 001263271800001

• Rural-urban differences in the intergenerational transmission of cognitive capabilities in China: evidence from a Northwestern province of China CHINA AGRICULTURAL ECONOMIC REVIEW Wang, L., Emmers, D., Sylvia, S., Bai, Y., Rozelle, S. 2024

  View details for DOI 10.1108/CAER-12-2023-0374

  View details for Web of Science ID 001246226000001

• Association between anxiety, depression symptoms, and academic burnout among Chinese students: the mediating role of resilience and self-efficacy. BMC psychology Liu, W., Zhang, R., Wang, H., Rule, A., Wang, M., Abbey, C., Singh, M. K., Rozelle, S., She, X., Tong, L. 2024; 12 (1): 335

  Abstract

  To explore the associations between anxiety and depression symptoms and academic burnout among children and adolescents in China, and to examine the role of resilience and self-efficacy in addressing academic burnout.A total of 2,070 students in grades 4-8 were recruited from two primary and three middle schools in Shanghai, completed the Elementary School Student Burnout Scale (ESSBS), the Multidimensional Anxiety Scale for Children-Chinese (MASC-C), the Center for Epidemiological Studies Depression Scale (CES-D), the Connor-Davidson Resilience Scale (CD-RISC), and the General Self-Efficacy Scale (GSES), with 95.04% effective response rate. Multivariable regression analyses examining the associations between anxiety / depression symptoms and academic burnout (as well as the associations between resilience / self-efficacy and academic burnout) were performed using STATA 16.0 and SmartPLS 3.0.Anxiety symptoms (β = 0.124, p < 0.01) and depression symptoms (β = 0.477, p < 0.01) were positively correlated with academic burnout. Resilience partially mediated the association between depression symptoms and academic burnout (β = 0.059, p < 0.01), with a mediation rate of 12.37%. Self-efficacy partially mediated the associations between anxiety symptoms and academic burnout (β = 0.022, p < 0.01) and between depression symptoms and academic burnout (β = 0.017, p < 0.01), with mediation rates of 17.74% and 3.56%, respectively. Resilience and self-efficacy together (β = 0.041, p < 0.01) formed a mediating chain between depression symptoms and academic burnout, with a mediation rate of 8.6%.Anxiety and depression symptoms were positively associated with academic burnout. Resilience and self-efficacy were found to mediate the associations partially.

  View details for DOI 10.1186/s40359-024-01823-5

  View details for PubMedID 38849921

  View details for PubMedCentralID PMC11162059

• general psychopathology factor in Chinese adolescents and its correlation with trans-diagnostic protective psycho-social factors. Journal of affective disorders Cai, Y., She, X., Singh, M. K., Wang, H., Wang, M., Abbey, C., Rozelle, S., Tong, L. 2024

  Abstract

  Comorbidity in mental disorders is prevalent among adolescents, with evidence suggesting a general psychopathology factor ("p" factor) that reflects shared mechanisms across different disorders. However, the association between the "p" factor and protective factors remains understudied. The current study aimed to explore the "p" factor, and its associations with psycho-social functioning, in Chinese adolescents.2052 students, aged 9-17, were recruited from primary and secondary schools in Shanghai, China. Multiple rating scales were used to assess psychological symptoms and psycho-social functioning. Confirmatory factor analysis was conducted to verify the fit of models involving different psychopathology domains such as externalizing, internalizing, and the "p" factor. Subsequently, structural equation models were used to explore associations between the extracted factors and psycho-social functioning, including emotion regulation, mindful attention awareness, self-esteem, self-efficacy, resilience, and perceived support.The bi-factor model demonstrated a good fit, with a "p" factor accounting for 46 % of symptom variation, indicating that the psychological symptoms of Chinese adolescents could be explained by internalizing, externalizing, and the "p" factor. Psychologically, a higher "p" was positively correlated with emotion suppression and negatively correlated with mindful attention awareness, emotion reappraisal, self-esteem, and resilience. Socially, a higher "p" was associated with decreased perceived support.Only common symptoms were included as this study was conducted at school. Furthermore, the cross-sectional design limited our ability to investigate causal relationships.A "p" factor exists among Chinese adolescents. Individuals with higher "p" factor levels were prone to experience lower levels of psycho-social functions.

  View details for DOI 10.1016/j.jad.2024.05.149

  View details for PubMedID 38848970

• Willingness-to-pay for early childhood development: A field experiment in Western China CHINA ECONOMIC REVIEW Wang, L., Song, C., Xian, Y., Sylvia, S., Rozelle, S. 2024; 85

  View details for DOI 10.1016/j.chieco.2024.102146

  View details for Web of Science ID 001217712100001

• Caregivers' parenting beliefs, practices, and child developmental outcomes: Evidence from randomized controlled trials in rural China WORLD DEVELOPMENT Wang, L., Jiang, D., Zhang, S., Rozelle, S. 2024; 178

  View details for DOI 10.1016/j.worlddev.2024.106596

  View details for Web of Science ID 001220985500001

• Comparing the payoff to vocational and academic secondary education in China over time INTERNATIONAL JOURNAL OF EDUCATIONAL DEVELOPMENT Liu, H., Xu, Y., Zhang, R., Nie, J., Rule, A., Rozelle, S., Yuan, L. 2024; 107

  View details for DOI 10.1016/j.ijedudev.2024.103038

  View details for Web of Science ID 001234125700001

• Parenting style and child mental health at preschool age: evidence from rural China. BMC psychiatry Wang, L., Tian, J., Rozelle, S. 2024; 24 (1): 314

  Abstract

  Mental health problems among children at preschool age are a common issue across the world. As shown in literature, a caregiver's parenting style can play a critical role in child development. This study aims to examine the associations between a caregiver's parenting style and the mental health problems (or not) of their child when he/she is at preschool age in rural China.Participants were children, aged 49 to 65 months, and their primary caregivers. The primary caregivers of the sample children completed the Parenting Styles and Dimensions Questionnaire, Short Version, the Strengths and Difficulties Questionnaire, and a questionnaire that elicited their socio-demographic characteristics. The level of cognitive development of each sample child was assessed using the Wechsler Preschool and Primary Scale of Intelligence, Fourth Edition. Pearson correlation analysis, linear regression analysis, and multivariable regression analysis were used to analyze the data.The prevalence of mental health problems among sample children at preschool age was high (31.6%). If a caregiver practices an authoritative parenting style, it was found to be negatively associated with the mental health problems of their child. In contrast, a caregiver's authoritarian parenting style was positively associated with the mental health problems of their child. Compared to those in a subgroup of primary caregivers that used a combination of low authoritative and low authoritarian parenting style, primary caregivers that used a combination of high authoritarian and low authoritative or a combination of high authoritative and high authoritarian were found to have positive association with child health problems. A number of demographic characteristics were found to be associated with the adoption of different parenting styles.Different parenting styles (including authoritative, authoritarian, and combination of authoritative and authoritarian) of the sample caregivers had different associations with the mental health problems of the sample children. Parenting programs that aim to improve the parenting styles (favoring authoritative parenting styles) should be promoted in an effort to improve the status of child mental health in rural China.

  View details for DOI 10.1186/s12888-024-05707-1

  View details for PubMedID 38658866

  View details for PubMedCentralID 7092613

• 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

• Process quality, diagnosis quality, and patient satisfaction of primary care in Rural Western China: A study using standardized patients. Patient education and counseling Wu, Y., Liang, Y., Cai, Z., Li, L., Sun, C., Sylvia, S., Zhou, H., Feng, J., Rozelle, S. 2024; 123: 108208

  Abstract

  Patient satisfaction is an essential indicator of the doctor-patient relationship. This study aimed to investigate the relationship between primary care quality and patient satisfaction for non-communicable diseases (NCDs) in rural western China.The study utilized the standardized patients (SPs) approach to present typical symptoms of unstable angina and diabetes to rural healthcare providers. After the consultations, the SPs completed a satisfaction survey. Ordinary least squares and quantile regression were used to examine the association between quality of primary care and patient satisfaction.We examined 178 anonymous SPs visits. The results showed that higher process quality for angina SPs was correlated with stronger satisfaction for provider ability at a low quantile of ability satisfaction. For diabetes SPs, higher process quality increased overall satisfaction at a low quantile of overall satisfaction, whereas a correct diagnosis significantly contributed to communication satisfaction at a high quantile of communication satisfaction.The study found positive associations between process and diagnosis quality and SPs satisfaction. Notably, the influence of process quality was most significant among patients with lower satisfaction levels.Provider's process quality could be a key area of improving the satisfaction levels, especially for patients with lower levels of satisfaction.

  View details for DOI 10.1016/j.pec.2024.108208

  View details for PubMedID 38377708

• Supporting cognitive catch-up: The effects of cluster-randomized psychosocial stimulation interventions on preterm low birthweight children in rural China. Child development Emmers, D., Yu, W., Shen, Y., Feng, C., Misra, M., Peng, A., Wang, J., Wu, F., Ye, S., Rozelle, S. 2024

  Abstract

  Improved survival of preterm low birthweight (LBW) infants due to advances in neonatal care has brought issues such as postnatal development trajectories to the foreground. This study pools evidence from three cluster-randomized experiments evaluating community-based psychosocial stimulation programs conducted from 2014 to 2017 that included 3571 rural Chinese children aged 6-24months (51.1% male, 96.2% Han Chinese). The risk of severe cognitive delay was found to be 26.5 percentage points higher for preterm LBW children than for their peers at age 2.5, with a prevalence rate of 48.3%. Results show that psychosocial stimulation interventions can improve child cognitive development at scale, with beneficial impacts on child cognition disproportionately larger for preterm LBW children, helping them to catch up developmentally.

  View details for DOI 10.1111/cdev.14068

  View details for PubMedID 38353466

• Investing in disadvantaged children for common prosperity in China CHINESE SOCIOLOGICAL REVIEW Emmers, D., Wang, H., Wang, L., Zhang, S., Qian, Y., Zhang, J., Zhang, Y., Zhang, J., Jiang, F., Rozelle, S. 2024

  View details for DOI 10.1080/21620555.2024.2307484

  View details for Web of Science ID 001161182400001

• The medium-term impact of a micronutrient powder intervention on anemia among young children in Rural China. BMC public health Zhang, S., Wang, L., Luo, R., Rozelle, S., Sylvia, S. 2024; 24 (1): 426

  Abstract

  BACKGROUND: Poor development of young children is a common issue in developing countries and it is well established that iron deficiency anemia is one of the risk factors. Research has shown that iron deficiency is a common micronutrient deficiency among children in rural China and can result in anemia. A previous paper using data from the same trial as those used in the current study, but conducted when sample children were younger, found that after 6months of providing caregivers of children 6-11months of age free access to iron-rich micronutrient powder (MNP) increased the hemoglobin concentrations (Hb) of their children. However, no effects were found 12 and 18months after the intervention. The current study followed up the children four years after the start of the original intervention (when the children were 4-5years old) and aims to assess the medium-term impacts of the MNP program on the nutritional status of the sample pre-school-aged children, including their levels of Hb, the prevalence of anemia, and the dietary diversity of the diets of the children.METHODS: At baseline, this study sampled 1,802 children aged 6-11months in rural Western China. The intervention lasted 18months. In this medium-term follow-up study that successfully followed 81% (n=1,464) of children (aged 49-65months) from the original study population 4years after the start of the intervention, we used both intention-to-treat (ITT) effect and average treatment on the treated effect (ATT) analyses to assess the medium-term impacts of the MNP distribution program on the nutritional status of sample children.RESULTS: The ITT analysis shows that the MNP intervention decreased the prevalence of anemia of young children in the medium run by 8% (4 percentage points, p<0.1). The ATT analysis shows that consuming 100 (out of 540) MNP sachets during the initial intervention led to a decrease in anemia of 4% (2 percentage points, p<0.1). Among children with moderate anemia at baseline (Hb<100g/L), the intervention reduced the probability of anemia by 45% (9 percentage points, p<0.1), and, for those families that complied by consuming 100 (out of 540) sachets, a 25% (5 percentage points, p<0.05) reduction in the anemia rate was found. The MNP intervention also led to a persistent increase in dietary diversity among children that were moderately anemic at baseline. The results from the quantile treatment effect analysis demonstrated that children with lower Hb levels at baseline benefited relatively more from the MNP intervention.CONCLUSIONS: The findings of the current study reveal that the MNP intervention has medium-term effects on the nutritional status of children in rural China. The impacts of the MNP program were relatively higher for children that initially had more severe anemia levels. Hence, the implications of this study are that programs that aim to increase caregiver knowledge of nutrition and improve their feeding practices should be encouraged across rural China. Families, policymakers, and China's society overall need to continue to pay more attention to problems of childhood anemia in rural areas. This is particularly crucial for families with moderately anemic children at an early age as it can significantly contribute to improving the anemia status of children across rural areas of China.TRIAL REGISTRATION: ISRCTN44149146 (15/04/2013).

  View details for DOI 10.1186/s12889-024-17895-2

  View details for PubMedID 38336627

• 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

• 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

• Barriers to uptake of cataract surgery among elderly patients in rural China: a cross-sectional study. BMJ open Ma, X., Hao, J., Jan, C., Wan, Y., Xie, Y., Liu, C., Shi, Y., Hu, A., Cao, K., Congdon, N., Rozelle, S., Dong, Z., Wang, N. 2024; 14 (1): e076116

  Abstract

  To investigate factors that differentiate elderly adults in rural China who accept free vision screening and cataract surgery from those who could benefit from vision care but refuse it when offered.We conducted a population-based, cross-sectional study between October and December 2016. Logistic regression models were used to examine the predictors of accepting free vision screening and cataract surgery.Rural communities in Handan, China.Adults aged 50 years or older, with presenting visual acuity ≤6/18 in the better seeing eye, suspected by examining ophthalmologist to be due to cataract.Among 613 persons with cataract identified on a population basis, 596 (97.2%) completed the household survey (mean (SD) age, 71.5 (10.0) years; 79.8% female). A total of 214 persons (35.9%) refused participation, while 382 (64.1%) took part in the vision screening. A total of 193 (50.5%) participants were found eligible for surgery, while 189 (49.5%) were not. Among 99 randomly selected participants who were offered immediate free surgery, surgery was accepted by 77 participants (77.8%) and refused by 22 (22.2%). In the multivariate model, being engaged in income-generating activities (p<0.01), self-reported better physical capacity (p<0.001) and having had a recent physical examination (p=0.01) were significantly associated with acceptance of vision screening. The only variable significantly associated with acceptance of surgery was presenting visual acuity, with better vision inversely associated with acceptance of surgery (p<0.05) models.Our results suggest that refusal of basic eye examinations may be at least as important a determinant of low surgical rates in rural China as lack of acceptance of surgery itself.

  View details for DOI 10.1136/bmjopen-2023-076116

  View details for PubMedID 38171622

• Market structure, resource allocation, and industry productivity growth: Firm-level evidence from China's steel industry CHINA ECONOMIC REVIEW Sheng, Y., Xu, X., Rozelle, S. 2024; 83

  View details for DOI 10.1016/j.chieco.2023.102102

  View details for Web of Science ID 001152271100001

• In-Hospital Formula Feeding Hindered Exclusive Breastfeeding: Breastfeeding Self-Efficacy as a Mediating Factor. Nutrients Liu, L., Wu, Y., Xian, X., Feng, J., Mao, Y., Balakrishnan, S., Weber, A. M., Darmstadt, G. L., Chen, Y., Sylvia, S., Zhou, H., Rozelle, S. 2023; 15 (24)

  Abstract

  Breastfeeding self-efficacy (BSE), defined as a mother's confidence in her ability to breastfeed, has been confirmed to predict the uptake of exclusive breastfeeding (EBF). Early experiences during the birth hospital stay, especially in-hospital formula feeding (IHFF), can impact both EBF and maternal breastfeeding confidence. Therefore, our objective was to examine the association between IHFF and EBF outcomes and investigate whether this association is influenced by BSE. The study included 778 infants from a larger cohort study conducted in 2021, with a one-year follow-up in rural areas of Sichuan Province, China. We used a causal mediation analysis to estimate the total effect (TE), natural direct (NDE), and nature indirect effects (NIE) using the paramed command in Stata. Causal mediation analyses revealed that IHFF was negatively associated with EBF (TE odds ratio = 0.47; 95% CI, 0.29 to 0.76); 28% of this association was mediated by BSE. In the subgroup analysis, there were no significant differences in the effects between parity subgroups, as well as between infant delivery subgroups. Our study found that IHFF hindered later EBF and that BSE mediated this association. Limiting the occurrence of in-hospital formula feeding or improving maternal breastfeeding self-efficacy is likely to improve exclusive breastfeeding outcomes.

  View details for DOI 10.3390/nu15245074

  View details for PubMedID 38140332

  View details for PubMedCentralID PMC10746093

• Community Mindfulness and Mentorship Preventive Intervention in Migrant Chinese Children: A Randomized Controlled Trial. JAACAP open She, X., Tong, L., Wang, H., Lan, L., Wang, M., Abbey, C., Singh, M. K., Rozelle, S. 2023; 1 (4): 295-305

  Abstract

  Objective: To test the feasibility and effectiveness of a mindfulness-based intervention in rural-to-urban migrant Chinese children using trained community volunteers.Method: Migrant students ages 9 to 16 from 5 schools in Shanghai (N= 653) were randomly assigned to a mindfulness only group (n= 167), a mindfulness plus life skills group (n= 118), or a waitlist control group (n= 368). The first 2 groups received an 8-week mindfulness intervention delivered 1 hour weekly by trained community volunteers. The mindfulness plus life skills group received 8 additional hours of skills-based mentorship. Measurements on mindfulness, resilience, and anxiety and depression symptoms were collected before and after intervention. Multivariable regression analyses compared the intervention vs control groups.Results: Before intervention, there were no significant demographic or outcome measure differences between groups except that students in the intervention groups were slightly older. Students had relatively low levels of mindfulness and prosociality difficulties and similar degrees of depression and anxiety symptoms compared with prior studies. After intervention, no statistically significant differences were found in mean scores for mindfulness, resilience, anxiety, or depression in the intervention vs control groups.Conclusion: A volunteer-led mindfulness intervention did not significantly benefit migrant Chinese children after 8 weeks. More implementation research is needed for low-cost, scalable, and contextually effective mental health prevention programs.Clinical trial registration information: Planting Seeds for Resilience-a Pilot Mindfulness and Mentorship Program in Migrant Chinese Children; http://www.chictr.org.cn; ChiCTR2100012027.Diversity & Inclusion Statement: We worked to ensure that the study questionnaires were prepared in an inclusive way. We worked to ensure sex and gender balance in the recruitment of human participants. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work.

  View details for DOI 10.1016/j.jaacop.2023.08.004

  View details for PubMedID 39553450

• 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

• Effectiveness of a government-led, multiarm intervention on early childhood development and caregiver mental health: a study protocol for a factorial cluster-randomised trial in rural China. BMJ open Jiang, Q., Wang, B., Qian, Y., Emmers, D., Li, S., Pappas, L., Tsai, E., Sun, L., Singh, M., Fernald, L., Rozelle, S. 2023; 13 (11): e076644

  Abstract

  The high incidences of both the developmental delay among young children and the mental health problems of their caregivers are major threats to public health in low-income and middle-income countries. Parental training interventions during early childhood have been shown to benefit early development, yet evidence on strategies to promote caregiver mental health remains limited. In addition, evidence on the optimal design of scalable interventions that integrate early child development and maternal mental health components is scarce.We design a single-blind, factorial, cluster-randomised controlled, superiority trial that will be delivered and supervised by local agents of the All China Women's Federation (ACWF), the nationwide, government-sponsored social protection organisation that aims to safeguard the rights and interests of women and children. We randomise 125 villages in rural China into four arms: (1) a parenting stimulation arm; (2) a caregiver mental health arm; (3) a combined parenting stimulation and caregiver mental health arm and (4) a pure control arm. Caregivers and their children (aged 6-24 months at the time of baseline data collection) are selected and invited to participate in the 12-month-long study. The parenting stimulation intervention consists of weekly, one-on-one training sessions that follow a loose adaptation of the Reach Up and Learn curriculum. The caregiver mental health intervention is comprised of fortnightly group activities based on an adaptation of the Thinking Healthy curriculum from the WHO. Primary outcomes include measures of child development and caregiver mental health. Secondary outcomes include a comprehensive set of physical, psychological and behavioural outcomes. This protocol describes the design and evaluation plan for this programme.This study received approval from the Institutional Review Board of Stanford University (IRB Protocol #63680) and the Institutional Review Board of the Southwestern University of Finance and Economics in Chengdu, Sichuan, China. Informed oral consent will be obtained from all caregivers for their own and their child's participation in the study. The full protocol will be publicly available in an open-access format. The study findings will be published in economics, medical and public health journals, as well as Chinese or English policy briefs.AEA RCT Registry (AEARCTR-0010078) and ISRCTN registry (ISRCTN84864201).

  View details for DOI 10.1136/bmjopen-2023-076644

  View details for PubMedID 38016796

• 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

• Dietary Diversity and Its Contribution to the Magnitude of Anaemia among Pregnant Women: Evidence from Rural Areas of Western China. Nutrients Cai, Z., Li, L., Feng, J., Raat, H., Wu, Y., Zhou, H., Rozelle, S. 2023; 15 (17)

  Abstract

  Prenatal anaemia causes serious consequences for both mother and foetus, and dietary factors are suggested to be associated with anaemia. However, research in pregnant women living in rural areas is limited. We aim to assess the contribution of dietary diversity to the magnitude of prenatal anaemia in rural China and identify the interactions between dietary diversity and several sociodemographic and maternal characteristics in relation to anaemia.A multi-stage random cluster sampling method was used to select pregnant women in rural western China. The Woman's Dietary Diversity Score was created to measure dietary diversity, which was recoded into terciles. Multinomial logistic regression models were used to assess the associations between dietary diversity score terciles and the magnitude of prenatal anaemia. Multiplicative interactions were tested by adding the product term of dietary diversity and several sociodemographic and maternal characteristics into the regression models.Out of 969 participants, 54.3% were measured as anaemic, with 28.6% mildly anaemic and 25.7% moderately to severely anaemic. There was an absence of agreement between self-reported and measured anaemia status (κ = 0.28, 95% CI [0.22-0.34]). Participants in the highest dietary diversity score tercile had lower odds of being moderately to severely anaemic after adjusting for potential confounders (RRR = 0.65, 95% CI [0.44, 0.98]). In participants with moderate to severe anaemia, significant interactions were found between dietary diversity score terciles, age, and parity (p for interaction < 0.05).The prevalence of prenatal anaemia in rural China remains high, and pregnant women living in these areas are insufficiently aware of their anaemia status. Improving dietary diversity is needed to manage prenatal anaemia in rural areas.

  View details for DOI 10.3390/nu15173714

  View details for PubMedID 37686751

• Maternal Dietary Diversity and Small for Gestational Age: The Effect Modification by Pre-Pregnancy Body Mass Index and Gestational Weight Gain in a Prospective Study within Rural Sichuan, China (2021-2022). Nutrients Sun, C., Wu, Y., Cai, Z., Li, L., Feng, J., van Grieken, A., Raat, H., Rozelle, S., Zhou, H. 2023; 15 (17)

  Abstract

  Infants born small for gestational age (SGA) remains a significant global public health concern, with potential interconnections among maternal diet, pre-pregnancy BMI, gestational weight gain (GWG), and SGA. This prospective study investigated the association between dietary diversity (DD) during pregnancy and the risk of SGA, as well as the synergistic effect of DD with pre-pregnancy BMI and GWG on SGA. Maternal dietary intake during pregnancy was assessed using 24 h dietary recalls, and dietary diversity scores (DDS) were calculated based on the FAO's Minimum Dietary Diversity for Women index. Infant information was followed up. The Poisson regression model was employed to determine the association between maternal DD and SGA. Interactions between DD and pre-pregnancy BMI or GWG were evaluated under additive and multiplicative models. Among the 560 singleton live births, 62 (11.07%) were classified as SGA. After adjusting for potential confounders, the DDS exhibited a protective effect against SGA (aRR: 0.76; 95% CI: 0.62-0.95). DD modified the association between being underweight prior to pregnancy and SGA on the additive scale (interaction contrast ratio = 7.39; 95% CI: 5.84, 8.94). These findings suggest that improving dietary diversity during pregnancy, particularly among women with a low pre-pregnancy BMI, may be a feasible strategy to reduce the risk of SGA newborns.

  View details for DOI 10.3390/nu15173669

  View details for PubMedID 37686701

• 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

• Impact of online computer assisted learning on education: Experimental evidence from economically vulnerable areas of China ECONOMICS OF EDUCATION REVIEW Bai, Y., Tang, B., Wang, B., Mo, D., Zhang, L., Rozelle, S., Auden, E., Mandell, B. 2023; 94

  View details for DOI 10.1016/j.econedurev.2023.102385

  View details for Web of Science ID 000962507400001

• Teaching training among rural and urban in-service teachers in central China EDUCATIONAL RESEARCH FOR POLICY AND PRACTICE Wang, M., Rozelle, S. 2023

  View details for DOI 10.1007/s10671-023-09347-2

  View details for Web of Science ID 000979832000001

• 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

• 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 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

• Comparison of mothers' perceptions of hunger cues in 3-month-old infant under different feeding methods. BMC public health Zhao, F., Sun, Y., Zhang, Y., Xu, T., Wang, N., Yan, S., Zeng, T., Zhang, F., Gao, J., Yue, Q., Rozelle, S. 2023; 23 (1): 444

  Abstract

  BACKGROUND: Mothers' perception of infant hunger cues is a critical content of responsive feeding, which is central to the promotion of early childhood development. However, only a few studies have examined responsive feeding in China, especially lacking the studies on perceptions of infant hunger cues. Consider the cultural differences, the aim of this study was to describe the perceptions of infant hunger cues of Chinese mothers for infants aged 3 months, and explore the relationship between maternal perceptions of infant hunger cues and different feeding methods.METHODS: A cross-sectional study was conducted with a sample of 326 mothers of healthy 3-month-old infants, including 188 exclusive breastfeeding (EBF) mothers and 138 formula feeding (FF) mothers. It was implemented in four provincial and municipal maternal and child health hospitals. The mothers' perceptions of infant hunger cues were surveyed by self-reporting questionnaires. Chi-square tests and logistic analysis were applied to analyze the differences in maternal perceptions of infant hunger cues, including the number of hunger cues and the specific cues, between EBF group and FF group by controlling sociodemographic variables and the daily nursing indicators.RESULTS: We found that a higher proportion of EBF mothers could perceive multiple hunger cues (≥2) than FF mothers (66.5% vs.55.1%). For specific cues, the EBF mothers had higher perceptions of infant's "hand sucking" (67.6% vs. 53.6%) and "moving head frantically from side to side" (34.6% vs. 23.9%), all p<0.05. Regression analysis revealed that EBF might support mothers to perceive infant hunger cues than FF mothers, with the number of infant hunger cues (OR=1.70, 95% CI: 1.01-2.85), "hand sucking" (OR=1.72, 95% CI: 1.04-2.87), "moving head frantically from side to side" (OR=2.07, 95% CI: 1.19-3.62). The number of infant hunger cues perceived by mothers was also associated with their educational level and family structure.CONCLUSION: EBF mothers of 3-month-old infants may be more likely to perceive infant hunger cues than FF mothers in China. It is necessary to increase the health education about infant hunger and satiety cues to caregivers in China, especially among mothers with lower education levels, mothers living in nuclear families, and FF mothers.

  View details for DOI 10.1186/s12889-023-15325-3

  View details for PubMedID 36882770

• 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

• 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

• Effect of the mHealth-supported Healthy Future programme delivered by community health workers on maternal and child health in rural China: study protocol for a cluster randomised controlled trial. BMJ open Chen, Y., Wu, Y., Dill, S. E., Guo, Y., Westgard, C. M., Medina, A., Weber, A. M., Darmstadt, G. L., Zhou, H., Rozelle, S., Sylvia, S. 2023; 13 (1): e065403

  Abstract

  Millions of young rural children in China still suffer from poor health and malnutrition, partly due to a lack of knowledge about optimal perinatal and child care among rural mothers and caregivers. Meanwhile, there is an urgent need to improve maternal mental health in rural communities. Comprehensive home visiting programmes delivered by community health workers (CHWs) can bridge the caregiver knowledge gap and improve child health and maternal well-being in low-resource settings, but the effectiveness of this approach is unknown in rural China. Additionally, grandmothers play important roles in child care and family decision-making in rural China, suggesting the importance of engaging multiple caregivers in interventions. The Healthy Future programme seeks to improve child health and maternal well-being by developing a staged-based curriculum that CHWs deliver to mothers and caregivers of young children through home visits with the assistance of a tablet-based mHealth system. This protocol describes the design and evaluation plan for this programme.We designed a cluster-randomised controlled trial among 119 rural townships in four nationally designated poverty counties in Southwestern China. We will compare the outcomes between three arms: one standard arm with only primary caregivers participating in the intervention, one encouragement arm engaging primary and secondary caregivers and one control arm with no intervention. Families with pregnant women or infants under 6 months of age are invited to enrol in the 12-month study. Primary outcomes include children's haemoglobin levels, exclusive breastfeeding rates and dietary diversity in complementary feeding. Secondary outcomes include a combination of health, behavioural and intermediate outcomes.Ethical approval has been provided by Stanford University, Sichuan University and the University of Nevada, Reno. Trial findings will be disseminated through national and international peer-reviewed publications and conferences.ISRCTN16800789.

  View details for DOI 10.1136/bmjopen-2022-065403

  View details for PubMedID 36669837

• 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

• The predictive role of caregiver's language richness in child development outcomes in rural China EARLY CHILDHOOD RESEARCH QUARTERLY Gao, J., Wang, T., Chen, Y., He, Y., Liu, C., Rozelle, S., Luo, R. 2023; 65: 306-316

  View details for DOI 10.1016/j.ecresq.2023.07.007

  View details for Web of Science ID 001044873100001

• Using standardized patients to assess the quality of type 2 diabetes care among primary care providers and the health system: Evidence from rural areas of western China. Frontiers in public health Wu, Y., Ye, R., Sun, C., Meng, S., Cai, Z., Li, L., Sylvia, S., Zhou, H., Pappas, L., Rozelle, S. 2022; 10: 1081239

  Abstract

  Improving type 2 diabetes (T2D) care is key to managing and reducing disease burden due to the growing prevalence of diabetes worldwide, but research on this topic, specifically from rural areas, is limited. This study uses standardized patients (SPs) to assess T2D care quality among primary care providers to access the healthcare system in rural China.Using multi-stage random sampling, health facilities, providers, and households were selected. SPs were used to evaluate providers' T2D care quality and a questionnaire survey was used to collect patient sorting behaviors from households. Logistic regression was used to explore factors correlated with T2D care quality. Provider referral and treatment rates were combined with patient sorting behaviors to assess the overall quality of T2D management by rural China's healthcare system.A total of 126 providers, 106 facilities, and 750 households were enrolled into this study. During SP interactions, 20% of rural providers followed the national guidelines for T2D consultation, 32.5% gave correct treatment, and 54.7% provided lifestyle suggestions. Multi-variable regression results showed that providers who had earned practicing certificates (β = 1.56, 95% CI: 0.44, 2.69) and saw more patients (β = 0.77, 95%: 0.25, 1.28) were more likely to use a higher number of recommended questions and perform better examinations, whereas providers who participated in online training were less likely to practice these behaviors (β = -1.03, 95%: -1.95, -0.11). The number of recommended questions and examination (NRQE) was the only significant correlated factor with correct treatment (marginal effect = 0.05, 95%: 0.01, 0.08). Throughout the rural healthcare system, 23.7% of T2D patients were treated correctly.The quality of T2D care in rural western China, especially throughout the consultation and treatment process during a patient's first visit, is poor. Online training may not improve T2D care quality and low patient volume was likely to indicate poor care quality. Further research is needed to explore interventions for improving T2D care quality in rural China's healthcare system.

  View details for DOI 10.3389/fpubh.2022.1081239

  View details for PubMedID 36620284

  View details for PubMedCentralID PMC9815030

• Back to Cheap Labour? Increasing Employment and Wage Disparities in Contemporary China CHINA QUARTERLY Xia, Y., Friesen, D., Cohen, N., Lu, C., Rozelle, S. 2022

  View details for DOI 10.1017/S0305741022001692

  View details for Web of Science ID 000893725200001

• Adherence to micronutrient powder for home fortification of foods among infants and toddlers in rural China: a structural equation modeling approach. BMC public health Sun, C., Ye, R., Akhtar, M., Dill, S., Yuan, P., Zhou, H., Rozelle, S. 2022; 22 (1): 2250

  Abstract

  BACKGROUND: The WHO recommends daily use of micronutrient powder for infants and toddlers at risk of micronutrient deficiencies in low-and-middle-income countries. China has established a micronutrient powder distribution program in many rural townships and villages, yet adherence to micronutrient powder remains suboptimal; a little is known about the behavioral inputs that may influence adherence. This study examines direct and indirect behavioral inputs in micronutrient powder adherence among caregivers in rural western China following the Integrated Behavioral Model (IBM) framework.METHODS: Cross-sectional data were collected from April to May 2019 among 958 caregivers of children aged 6 to 24 months in six counties. Data were collected on micronutrient powder adherence behavior, direct behavioral inputs (knowledge and skills, intention, salience, environmental constraints, and habits), and indirect behavioral inputs (attitudes, perceived social norms, and personal agency). Structural equation modeling (SEM) adjusted for sociodemographic covariates was used to evaluate the IBM framework.RESULTS: Mean micronutrient powder adherence in the previous seven days was 53.02%, and only 22.86% of caregivers consistently fed micronutrient powder from the start of micronutrient powder distribution at six months of age. The SEM model revealed small- to medium-sized effects of salience (beta=0.440, P<0.001), intention (beta=0.374, P<0.001), knowledge and skills (beta=0.214, P<0.001), personal agency (st. effect=0.172, P<0.001), environmental constraints (beta=-0.142, P<0.001), and caregiver generation (beta=0.119, P<0.05) on micronutrient powder adherence. Overall, 54.7% of the variance in micronutrient powder adherence was explained by the IBM framework. Salience had the largest impact on micronutrient powder adherence (Cohen's f 2=0.227). Compared to parent caregivers, grandparents had a higher degree of micronutrient powder adherence on average (P<0.001), and behavioral inputs were consistent among both parent and grandparent caregivers.CONCLUSION: There is a need to improve micronutrient powder adherence among rural caregivers. The IBM framework showed a high degree of explanatory power in predicting micronutrient powder adherence behavior. The findings suggest that increased reminders from doctors regarding micronutrient powder and coaching to improve personal agency in micronutrient powder feeding may increase adherence.

  View details for DOI 10.1186/s12889-022-14731-3

  View details for PubMedID 36461056

• 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

• 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

• Structural Determinants of Child Health in Rural China: The Challenge of Creating Health Equity. International journal of environmental research and public health Chen, Y., Sylvia, S., Dill, S., Rozelle, S. 2022; 19 (21)

  Abstract

  Over the past two decades, the literature has shown a clear gradient between child health and wealth. The same health-wealth gradient is also observed among children in China, with a large gap in health between rural and urban children. However, there are still unanswered questions about the main causes of China's rural-urban child health inequality. This paper aims to review the major factors that have led to the relatively poor levels of health among China's rural children. In addition to the direct income effect on children's health, children in rural areas face disadvantages compared with their urban counterparts from the beginning of life: Prenatal care and infant health outcomes are worse in rural areas; rural caregivers have poor health outcomes and lack knowledge and support to provide adequate nurturing care to young children; there are large disparities in access to quality health care between rural and urban areas; and rural families are more likely to lack access to clean water and sanitation. In order to inform policies that improve health outcomes for the poor, there is a critical need for research that identifies the causal drivers of health outcomes among children. Strengthening the pediatric training and workforce in rural areas is essential to delivering quality health care for rural children. Other potential interventions include addressing the health needs of mothers and grandparent caregivers, improving parenting knowledge and nurturing care, improving access to clean water and sanitation for remote families, and most importantly, targeting poverty itself.

  View details for DOI 10.3390/ijerph192113845

  View details for PubMedID 36360724

• 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

• Challenges and Opportunities in Aligning Conservation with Development in China's National Parks: A Narrative Literature Review. International journal of environmental research and public health Rule, A., Dill, S., Sun, G., Chen, A., Khawaja, S., Li, I., Zhang, V., Rozelle, S. 2022; 19 (19)

  Abstract

  As part of its effort to balance economic development with environmental objectives, China has established a new national park system, with the first five locations formally established in 2021. However, as the new parks all host or are proximate to human populations, aligning the socioeconomic needs and aspirations of local communities with conservation aims is critical for the long-term success of the parks. In this narrative review, the authors identify the ecological priorities and socioeconomic stakeholders of each of the five national parks; explore the tensions and synergies between these priorities and stakeholders; and synthesize the policy recommendations most frequently cited in the literature. A total of 119 studies were reviewed. Aligning traditional livelihoods with conservation, limiting road construction, promoting education and environmental awareness, and supporting the development of a sustainable tourism industry are identified as important steps to balance conservation with economic development in the new national parks.

  View details for DOI 10.3390/ijerph191912778

  View details for PubMedID 36232085

• The impact of COVID-19 on employment and income of vocational graduates in China: Evidence from surveys in January and July 2020. China economic review Liang, X., Rozelle, S., Yi, H. 2022; 75: 101832

  Abstract

  The COVID-19 pandemic shocked the economy of China in early 2020. Strict lockdown measures were implemented nationwide to prevent the further spread of the virus. During the lockdown period, many economic activities were affected, which had repercussions for the nation's overall employment. Vocational graduates were among the most affected by the crisis. To estimate the causal effects of COVID-19 on the full-time employment of vocational high school graduates as well as their monthly income and hours worked by week, we exploit variations in the intensity of the pandemic in time and across space using survey data from vocational schools from six provinces in China. The results of the difference-in-differences (DID) estimates indicate that being located in counties with high pandemic intensity significantly reduced both the employment in full-time jobs of vocational graduates as well as their monthly income. Our study's analysis demonstrates that the effects of COVID-19 on the labor market can be attributed to the large-scale contraction of labor demand of the enterprises that were hiring vocational graduates. To cope with this situation, vocational graduates took various measures, including reducing consumption, drawing on their savings, searching for new jobs, taking on part-time jobs, borrowing money, and attending new training programs. In addition, the empirical analysis finds that there were heterogeneous effects with respect to gender, family social capital, the industry in which the vocational graduate was participating, and whether the individual was in a management position.

  View details for DOI 10.1016/j.chieco.2022.101832

  View details for PubMedID 35844486

• 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

• Postnatal mental health, breastfeeding beliefs, and breastfeeding practices in rural China. International breastfeeding journal Jiang, Q., Zhang, E., Cohen, N., Ohtori, M., Zhu, S., Guo, Y., Johnstone, H. F., Dill, S. E., Zhou, H., Rozelle, S. D. 2022; 17 (1): 60

  Abstract

  The importance of breastfeeding in low- and middle- income countries is well recognized, yet the importance of postnatal mental health on breastfeeding practices and beliefs in these settings has been understudied. This study investigates the associations between maternal mental health problems, breastfeeding beliefs and breastfeeding practices in rural China.Cross-sectional data were collected in November and December 2019 from 742 mothers of infants under 6 months old in rural Sichuan Province, China. Maternal mental health (depression, anxiety, and stress symptoms) was assessed using the Depression, Anxiety, and Stress Scale (short form). Breastfeeding beliefs were assessed using the Iowa Infant Feeding Attitude Scale and Breastfeeding Self-Efficacy Scale (short form). Breastfeeding practices were assessed through a 24-h dietary recall questionnaire. Ordinary least squares regression, multiple logistic regression and heterogeneous effects analyses were used to identify associations between symptoms of mental health problems and breastfeeding outcomes.The average age of sample infants was 2.7 months. Among mothers, 13% showed symptoms of depression, 16% anxiety, and 9% stress. The prevalence of exclusive breastfeeding in the previous 24 h was 38.0%. Depression symptoms were significantly associated with breastfeeding attitude (𝛽= - 1.11, 95% CI: - 2.07, - 0.14) and breastfeeding self-efficacy (𝛽= - 3.19, 95% CI: - 4.93, - 1.45). Anxiety and stress symptoms were significantly associated with breastfeeding self-efficacy (𝛽= - 1.81, 95% CI: - 3.43, - 0.18 and 𝛽 = - 2.88, 95% CI: - 4.98, - 0.78, respectively). There were no significant associations between symptoms of mental health problems and exclusive breastfeeding. The heterogeneous effects analyses revealed that less educated mothers with symptoms of stress had lower odds of exclusive breastfeeding than educated mothers without symptoms of stress (OR: 0.53, 95% CI: 0.25,1.10). Mothers of younger infants had higher odds of exclusive breastfeeding than the mother of older infants, regardless of depression, anxiety, or stress symptoms.Symptoms of maternal mental health problems are significantly associated with breastfeeding attitude and self-efficacy; however, these symptoms are not associated with breastfeeding practices. Maternal educational level and infant age may play a role in mothers' breastfeeding practices. To improve breastfeeding practices, interventions should employ a multi-dimensional approach that focuses on improving maternal mental well-being and considers demographic characteristics.

  View details for DOI 10.1186/s13006-022-00504-6

  View details for PubMedID 35987837

• The know-do gap in quality of health for chronic non-communicable diseases in rural China FRONTIERS IN PUBLIC HEALTH Meng, S., Wang, Q., Wu, Y., Xue, H., Li, L., Ye, R., Chen, Y., Pappas, L., Akhtar, M., Dill, S., Sylvia, S., Zhou, H., Rozelle, S. 2022; 10: 953881

  Abstract

  Proper management of non-communicable diseases (NCDs) is a severe challenge to China's rural health system. This study investigates what influences the poor medical treatment of NCDs (diabetes and angina) by evaluating the "know-do gap" between provider knowledge and practice. To determine whether low levels of provider knowledge low quality of patient care is the primary constraint on the quality of NCDs diagnosis and treatment in rural China. Providers from Village Clinics (VC) and Township Health Centers (THC), and Standardized Patients (SP) were selected by a multi-stage random sampling method. Clinical vignettes were administered to 306 providers from 103 VCs and 50 THCs in rural Sichuan Province. SPs presented diabetes symptoms completed 97 interactions with providers in 46 VCs and 51 THCs; SPs presented angina symptoms completed 100 interactions with providers in 50 VCs and 50 THCs. Process quality, diagnosis quality, and treatment quality were assessed against national standards for diabetes and angina. Two-tailed T-tests and tests of proportions for continuous outcomes and tests of proportions for binary dependent variables were used to compare vignette and SP results. Differences between vignette and SP data calculated the know-do gap. Regression analyses were used to examine the providers/facility characteristics and knowledge/practice associations. THC providers demonstrated significantly more knowledge in vignettes and better practices in SP visits than VC providers. However, levels of knowledge were low overall: 48.2% of THC providers and 28.2% of VC providers properly diagnosed type 2 diabetes, while 23.8% of THC providers and 14.7% of VC providers properly diagnosed angina. With SPs, 2.1% of THC providers and 6.8% of VC providers correctly diagnosed type 2 diabetes; 25.5% of THC providers and 12.8% of VC providers correctly diagnosed angina. There were significant know-do gaps in diagnosis process quality, diagnosis quality, and treatment quality for diabetes (p < 0.01), and in diagnosis process quality (p < 0.05) and treatment quality for angina (p < 0.01). Providers in rural China display low levels of knowledge when treating diabetes and angina. Despite low knowledge, evidence of the know-do gap indicates that low-quality healthcare is the primary constraint on the quality of NCD diagnosis and treatment in rural China. Our research findings provide a new perspective for the evaluation of the medical quality and a technical basis for the development of new standardized cases in the future.

  View details for DOI 10.3389/fpubh.2022.953881

  View details for Web of Science ID 000849119500001

  View details for PubMedID 36062129

  View details for PubMedCentralID PMC9435052

• Prevalence of Anemia and Associated Factors among Infants under Six Months in Rural China. Public health nutrition Du, Y., Durstenfeld, A., Dill, S., Wang, Q., Zhou, H., Xue, H., Kache, S., Medina, A., Rozelle, S. 2022: 1-27

  Abstract

  OBJECTIVE: To examine haemoglobin level and anaemia status among infants under six months of age in rural China.DESIGN: A cross-sectional survey collected data among infants under six months and their primary caregivers in Sichuan, China. Anaemia was defined using both the WHO and China Pediatrics Association thresholds. Multivariable linear regression was used to identify relevant factors among two age groups (<4 months; 4-5 months).SETTING: 80 townships were selected in Sichuan, China from November to December 2019.PARTICIPANTS: 942 infants under six months, while haemoglobin level were tested for 577 infants.RESULTS: The overall mean (±SD) haemoglobin level was 106.03 (± 12.04) g/L. About 62.6% (95%CI: 58.5, 66.6) of sample infants were anemic using the WHO threshold, and 20.5% (95%CI: 17.3, 24.1) were anemic using the China Pediatrics Association thresholds. Anaemia rates rose with increasing age in months. Multivariable linear regressions revealed that lower haemoglobin levels were significantly associated with lower birth weight (<4 months: b = 4.14, 95% CI: 0.19, 8.08; 4-5 months: b = 6.60, 95% CI: 2.94, 10.27) and delivery by cesarean section (<4 months: b = -4.64, 95%CI: -7.79, -1.49; 4-5 months: b = -4.58, 95%CI: -7.45, -1.71).CONCLUSION: A large share of infants under six months in rural western China are anemic. Infants with low-birth-weight and cesarean-delivered should be prioritized for anaemia testing. Future studies should move the point of focus forward to at least 4 months of age and examine the link between cesarean-section and anaemia to promote health and development in infancy.

  View details for DOI 10.1017/S1368980022001616

  View details for PubMedID 35920295

• The association between micronutrient powder delivery patterns and caregiver feeding behaviors in rural China. BMC public health Liu, R., Ye, R., Wang, Q., Pappas, L., Dill, S. E., Rozelle, S., Zhou, H. 2022; 22 (1): 1366

  Abstract

  High adherence and proper usage of micronutrient powder (MNP) influence child nutritional outcomes, yet few studies explore the role of delivery patterns. This study explores the association between MNP delivery patterns and MNP feeding behaviors among Han and minority caregivers in rural Western China.In August 2019, a total of 1021 caregiver-child pairs were selected through a four-stage cluster sampling process. A cross-sectional survey collected information on caregiver demographics, MNP delivery patterns (channel and frequency), and MNP feeding behaviors (proper usage and adherence). Using logistic regression, we examined which delivery channels and delivery frequencies were associated with proper usage and high adherence.The results indicated that minority caregivers had lower levels of proper MNP usage than did Han caregivers (89.2%), with Tibetan caregivers' reporting the lowest rates of adherence (32.6%). Logistic regression revealed that that township-based channel was significantly correlated with proper usage among Tibetan and Yi caregivers (Odds Ratio, OR = 2.0, p < 0.01; and OR = 3.5, p < 0.001). Overall, the township-based and home-visit channels were significantly correlated with high adherence (OR = 1.7 and OR = 2.3, respectively; p < 0.001); delivery frequency was significantly correlated with high adherence (2 months: OR = 2.2, p < 0.001 and ≤ 1 month: OR = 3.5, p < 0.001) but not correlated with proper usage among the whole sample and individual ethnic groups.In conclusion, the study finds evidence of a correlation between MNP delivery channel and both proper usage and high adherence as well as a correlation between MNP delivery frequency and high adherence.

  View details for DOI 10.1186/s12889-022-13726-4

  View details for PubMedID 35842633

• Parenting style and the cognitive development of preschool-aged children: Evidence from rural China. Journal of experimental child psychology Wang, L., Xian, Y., Dill, S., Fang, Z., Emmers, D., Zhang, S., Rozelle, S. 2022; 223: 105490

  Abstract

  The correlation between parenting style and child cognitive development has been widely documented in Western societies. There has been far less research, however, in non-Western societies and none at all in rural China. This study aimed to investigate the association between parenting style and child cognitive development in rural China. Participants were 1272 preschool-aged children and their primary caregivers. Children were 49 to 65months old (51% male), and all were ethnically Han. Primary caregivers reported their parenting style, and children were assessed on their cognitive skills. Two alternative approaches (two dimensions and four categories) were used to examine the correlation between parenting style and child cognitive development. The results show a positive correlation between an authoritative parenting style and child cognitive development and show a negative correlation between an authoritarian parenting style and development. When the mother is the primary caregiver, more educated, or from a wealthier family, she is more likely to use an authoritative parenting style and less likely to use an authoritarian one. In addition, the authoritative style has a stronger correlation with the cognitive developmental outcomes of girls than of boys. The findings encourage researchers to conduct future work on how to implement parenting training interventions that are able to ascertain whether parents in rural China can be taught to adopt an authoritative parenting style. Future research should also seek to identify whether an authoritative parenting style produces (in a causal manner) any significant long-term benefits to the cognitive development of children in rural China.

  View details for DOI 10.1016/j.jecp.2022.105490

  View details for PubMedID 35792509

• Provider competence in hypertension management and challenges of the rural primary healthcare system in Sichuan province, China: a study based on standardized clinical vignettes. BMC health services research Wu, Y., Ye, R., Wang, Q., Sun, C., Meng, S., Sylvia, S., Zhou, H., Friesen, D., Rozelle, S. 2022; 22 (1): 849

  Abstract

  BACKGROUND: Improving primary care providers' competence is key to detecting and managing hypertension, but evidence to guide this work has been limited, particularly for rural areas. This study aimed to use standardized clinical vignettes to assess the competence of providers and the ability of the primary healthcare system to detect and manage hypertension in rural China.METHODS: A multi-stage random sampling method was administered to select target health facilities, providers, and households. The clinical vignette script was developed to evaluate provider competence in managing first-visit patients with symptoms of hypertension. Logistic regression was used to explore the factors correlated with provider competence. Provider referral and management rates were combined with patients' facility sorting behaviors to assess the ability of the rural healthcare system to manage hypertension in three policy scenarios.RESULTS: A total of 306 providers and 153 facilities were enrolled in our study. In the 306 clinical vignette interactions, 25.9% of providers followed the national guidelines for hypertension consultation. The correct diagnosis was achieved by only 10.1% of providers, and 30.4% of providers were able to prescribe the correct treatment. Multi-variable regression results showed that younger providers (OR=0.85, 95%CI: 0.73, 0.98) and those who work in township health centers (OR=4.47, 95%: 1.07, 18.67) were more likely to provide a correct diagnosis. In a free-selection scenario, 29.8% of patients with hypertension were managed correctly throughout the rural system. When all patients first visit village clinics, system-level correct management is reduced to 20.5% but increases to 45.0% when all patients first visit township health centers.CONCLUSIONS: Rural primary care providers do not have enough competence to detect and treat hypertension cases in China to an acceptable degree. Policy constraints may limit the competence of the rural healthcare system. Research to improve detection and treatment competence in hypertension and optimize health policy is needed.

  View details for DOI 10.1186/s12913-022-08179-9

  View details for PubMedID 35778732

• Education Universalization, Rural School Participation, and Population Density CHINA & WORLD ECONOMY Zhang, X., Rozelle, S. 2022; 30 (4): 4-30

  View details for DOI 10.1111/cwe.12426

  View details for Web of Science ID 000827087400002

• Impact of Parental Beliefs on Child Developmental Outcomes: A Quasi-Experiment in Rural China. International journal of environmental research and public health Wang, L., Yang, C., Jiang, D., Zhang, S., Jiang, Q., Rozelle, S. 2022; 19 (12)

  Abstract

  This paper examines the impact of parental beliefs on child development outcomes (for both cognitive and social-emotional skills) based on a three-wave longitudinal survey in rural China. The survey waves were conducted when the sample children were 18-30 months, 22-36 months, and 49-65 months, respectively. A total of 815 children and their primary caregivers who participated in all three wave surveys were enrolled in this study. Using difference-in-differences and propensity score matching approaches, the results indicate that strengthened parental beliefs have a positive and significant impact on child social-emotional development. Specifically, between the periods of the Wave 1 survey (when children were 18-30 months old) and the Wave 3 survey (when children were 49-65 months old), and between the Wave 2 survey (when children were 22-36 months old) and the Wave 3 survey, strengthened parental beliefs were causally associated with more favorable child social-emotional scores by 0.44 SD (p < 0.01) and 0.49 SD (p < 0.01), respectively. No significant impact, however, was found between the period of the Wave 1 survey and the Wave 2 survey. In contrast, weakened parental beliefs had a negative and significant impact on child social-emotional development. Specifically, weakened parental beliefs were causally associated with worse child social-emotional abilities by 0.35 SD (p < 0.01), 0.30 SD (p < 0.01), and 0.22 (p < 0.05) for the time period of the Wave 1 to Wave 2, Wave 1 to Wave 3, and Wave 2 to Wave 3, respectively. No significant impact of parental beliefs, however, was found on child cognitive development. In addition, the findings of the mediation analysis show that only a marginal impact of parental beliefs on child social-emotional development can be indirectly explained by parental beliefs through parenting practices. This study calls on policy makers to improve parental beliefs and parenting practices in the hope that it will lead to better child development in rural China.

  View details for DOI 10.3390/ijerph19127240

  View details for PubMedID 35742490

• 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

• Stuck in the middle school rut: can anything improve academic achievement in rural Chinese middle schools? JOURNAL OF DEVELOPMENT EFFECTIVENESS Qin, F., Hu, H., Loyalka, P., Dill, S., Rozelle, S. 2022

  View details for DOI 10.1080/19439342.2022.2067890

  View details for Web of Science ID 000789833200001

• Parenting centers and caregiver mental health: Evidence from a large-scale randomized controlled trial in China. Child development Jiang, Q., Dill, S., Sylvia, S., Singh, M. K., She, X., Wang, E., Medina, A., Rozelle, S. 2022

  Abstract

  This study conducts an exploratory analysis of the impacts of a center-based early childhood development intervention on the mental health of caregivers, using data from a cluster-randomized controlled trial of 1664 caregivers (Mage =36.87years old) of 6- to 24-month-old children in 100 villages in rural China. Caregivers and children in 50 villages received individual parenting training, group activities and open play space in village parenting centers. The results show no significant overall change in caregiver-reported mental health symptoms after 1year of intervention. Subgroup analyses reveal heterogeneous effects by caregiver socioeconomic status and identity (mother vs. grandmother). Findings suggest that early childhood development interventions without targeted mental health components may not provide sufficient support to improve caregiver mental health.

  View details for DOI 10.1111/cdev.13782

  View details for PubMedID 35481708

• 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

• 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

• Ordeal mechanisms, information, and the cost-effectiveness of strategies to provide subsidized eyeglasses. Journal of health economics Sylvia, S., Ma, X., Shi, Y., Rozelle, S. 2022; 82: 102594

  Abstract

  The cost-effectiveness of policies providing subsidized health goods is often compromised by limited use of the goods provided. Through a randomized trial involving 251 primary schools in western China, we tested two approaches to improve the cost-effectiveness of a program distributing free eyeglasses to myopic children. Relative to delivery of free eyeglasses to schools, we find that providing vouchers redeemable in local optical shops modestly improved the targeting of eyeglasses to those who would use them without reducing effective coverage. Information provided through a health education campaign increased eyeglass use when eyeglasses were delivered to schools, but had no effect when requiring voucher redemption or when families were only given a prescription for eyeglasses to be purchased on the market. Though most expensive, free delivery to schools with a health education campaign was the most socially cost-effective approach tested and increased effective coverage of eyeglasses by 18.5 percentage points after seven months.

  View details for DOI 10.1016/j.jhealeco.2022.102594

  View details for PubMedID 35193056

• Paths of social-emotional development before 3years old and child development after 5years old: Evidence from rural China. Early human development Wang, L., Chen, Y., Zhang, S., Rozelle, S. 1800; 165: 105539

  Abstract

  BACKGROUND: Social-emotional development during the first three years of life is associated with later social-emotional development and cognitive development. In rural China, research has found large shares of children under age three are developmentally delayed, yet little is known about the paths of social-emotional development before age 3 or how developmental paths predict later social-emotional skills and cognitive skills.AIMS: To investigate the paths of child social-emotional development during ages 0-3 and examine how different paths predict social-emotional development and cognitive development at preschool age.METHODS: Three waves of longitudinal panel data from 1245 children in rural Western China was collected. Child social-emotional development was measured by the Ages and Stages Questionnaire: Social-Emotional. Child cognitive development was measured by the Bayley Scales of Infant Development and by the Wechsler Preschool and Primary Scale of Intelligence-Fourth Edition. Four paths of child social-emotional development were classified: "never" social-emotionally delayed; "persistently" social-emotionally delayed; "improving," or "deteriorating."RESULTS: 331 (27%) were never social-emotionally delayed; 373 children (30%) were persistently social-emotionally delayed; 149 children (12%) experienced improving social-emotional development; and 392 children (31%) experienced deteriorating social-emotional development. Children who were never social-emotionally delayed or who were on an "improving" path had higher social-emotional development at preschool age (p<.01). Children who were persistently social-emotionally delayed (p<.5) and on a deteriorating path (p<.01) had lower social-emotional development at preschool age. Children on the persistently delay path also were shown to have lower levels of cognitive development at preschool age (p<.01).CONCLUSIONS: Different paths of child social-emotional development before age 3 are associated with different social-emotional and cognitive development at preschool age.

  View details for DOI 10.1016/j.earlhumdev.2022.105539

  View details for PubMedID 35038625

• 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

• Passive versus active service delivery: Comparing the effects of two parenting interventions on early cognitive development in rural China WORLD DEVELOPMENT Sylvia, S., Luo, R., Zhong, J., Dill, S., Medina, A., Rozelle, S. 2022; 149

  View details for DOI 10.1016/j.worlddev.2021.105686

  View details for Web of Science ID 000698630900004

• 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 Parenting Interventions to Foster Human Capital in Developing Countries ANNUAL REVIEW OF RESOURCE ECONOMICS Emmers, D., Caro, J., Rozelle, S., Sylvia, S. 2022; 14: 169-192

  View details for DOI 10.1146/annurev-resource-111220-010215

  View details for Web of Science ID 000865583800008

• Parental Self-Perception, Parental Investment, and Early Childhood Developmental Outcomes: Evidence From Rural China. Frontiers in public health Wang, L., Wang, T., Li, H., Guo, K., Hu, L., Zhang, S., Rozelle, S. 2022; 10: 820113

  Abstract

  Using a three-wave longitudinal survey conducted in 815 households in rural Western China, this study aims to examine the association between parental self-perception and early childhood development and the mediation effect of parental investment on the association between parental self-perception and child development when the sample children are at different ages in the early childhood (18-30, 22-36, and 49-65 months). The results demonstrate that parental self-perception are positively and significantly associated with child social-emotional development in all three ages of childhood (from 18 to 65 months). Positive and significant association between parental self-perception and child cognitive development is found in the ages from 22 to 65 months. In addition, findings of this study show that parental investment plays a mediating role in the association between parental self-perception and child cognitive development. The study calls on policymakers to help to strengthen parental self-perception and parental investment related to early childhood development, which should result in better child development in rural China.

  View details for DOI 10.3389/fpubh.2022.820113

  View details for PubMedID 35433599

• Determinants of breastfeeding self-efficacy among postpartum women in rural China: A cross-sectional study. PloS one Li, L., Wu, Y., Wang, Q., Du, Y., Friesen, D., Guo, Y., Dill, S., Medina, A., Rozelle, S., Zhou, H. 2022; 17 (4): e0266273

  Abstract

  BACKGROUND: Breastfeeding self-efficacy is known to positively influence breastfeeding behaviors. While previous research has studied the determinants of breastfeeding self-efficacy in general, these determinants are unstudied among postpartum women in rural China. This study aims to describe the breastfeeding self-efficacy of postpartum women in rural China and identify determinants of breastfeeding self-efficacy using the Dennis breastfeeding self-efficacy framework.METHODS: Using a multi-stage random cluster sampling design, cross-sectional survey data were collected from 787 women within the 0-6 months postpartum period in 80 rural townships. Surveys collected data on breastfeeding self-efficacy, characteristics related to the Dennis breastfeeding self-efficacy framework, and demographic characteristics. Multiple linear regression analysis was used to identify determinants of breastfeeding self-efficacy.RESULTS: Participants reported a moderate level of breastfeeding self-efficacy, with an item mean score of 3.50. Self-efficacy was lowest for exclusive breastfeeding. Breastfeeding attitudes (beta = 0.088, P< 0.001), breastfeeding family support (beta = 0.168, P< 0.001), and social support from significant others (beta = 0.219, P< 0.001) were positively associated with breastfeeding self-efficacy. Breastfeeding problems, including trouble with latching (beta = -0.170, P< 0.001), not producing enough milk (beta = -0.148, P< 0.001), and milk taking too long to secrete (beta = -0.173, P< 0.001) were negatively associated with breastfeeding self-efficacy.CONCLUSION: The findings indicate that positive attitudes, breastfeeding family support and social support contribute to greater breastfeeding self-efficacy in rural China, whereas difficulties with breastfeeding are associated with reduced self-efficacy. Researchers and practitioners should investigate effective strategies to improve social support and family support for breastfeeding, promote positive attitudes towards breastfeeding, and provide women with actionable solutions to breastfeeding problems.

  View details for DOI 10.1371/journal.pone.0266273

  View details for PubMedID 35390044

• Irrational Use of Medicine in the Treatment of Presumptive Asthma Among Rural Primary Care Providers in Southwestern China. Frontiers in pharmacology Liu, H., Li, H., Teuwen, D. E., Sylvia, S., Shi, H., Rozelle, S., Yi, H. 2022; 13: 767917

  Abstract

  Poor knowledge, scarce resources, and lack of or misaligned incentives have been widely documented as drivers of the irrational use of medicine (IUM), which significantly challenges the efficiency of health systems across the globe. However, there is limited understanding of the influence of each factor on IUM. We used detailed data on provider treatment of presumptive asthma cases in rural China to assess the contributions of provider knowledge, resource constraints, and provider behavior on IUM. This study enrolled 370 village providers from southwest China. All providers responded to a clinical vignette to test their knowledge of how to treat presumptive asthma. Resource constraints ("capacity") were defined as the availability of the prescribed medicines in vignette. To measure provider behavior ("performance"), a subset of providers (104 of 370) were randomly selected to receive unannounced visits by standardized patients (SPs) who performed of presumptive asthma symptoms described in the vignette. We found that, 54% (201/370) of providers provided the vignette-based patients with prescriptions. Moreover, 67% (70/104) provided prescriptions for the SPs. For the vignette, only 10% of the providers prescribed the correct medicines; 38% prescribed only unnecessary medicines (and did not provide correct medicine); 65% prescribed antibiotics (although antibiotics were not required); and 55% prescribed polypharmacy prescriptions (that is, they prescribed five or more different types of drugs). For the SP visits, the numbers were 12%, 51%, 63%, and 0%, respectively. The lower number of medicines in the SP visits was due, in part, to the injections' not being allowed based on ethical considerations (in response to the vignette, however, 65% of providers prescribed injections). The difference between provider knowledge and capacity is insignificant, while a significant large gap exists between provider performance and knowledge/capacity (for 11 of 17 indicators). Our analysis indicated that capacity constraints play a minor role in driving IUM compared to provider performance in the treatment of asthma cases in rural China. If similar findings hold for other disease cases, this suggests that policies to reduce the IUM in rural China have largely been unsuccessful, and alternatives for improving aligning provider incentives with appropriate drug use should be explored.

  View details for DOI 10.3389/fphar.2022.767917

  View details for PubMedID 35242030

• Passive versus active service delivery: Comparing the effects of two parenting interventions on early cognitive development in rural China. World development Sylvia, S., Luo, R., Zhong, J., Dill, S. E., Medina, A., Rozelle, S. 2022; 149: 105686

  Abstract

  We present the results of a cluster-randomized controlled trial that evaluates the effects of a free, center-based parenting intervention on early cognitive development and parenting practices in 100 rural villages in China. We then compare these effects to a previous trial of a home-based intervention conducted in the same region, using the same parenting curriculum and public service system, accounting for potential differences between the studies. We find that the center-based intervention did not have a significant impact on child development outcomes, but did lead to increases in the material investments, time investments, and parenting skills of caregivers. The average impact of the center-based intervention on child skills and investments in children was significantly smaller than the home-visiting intervention. Analysis of the possible mechanisms suggests that the difference in effects was driven primarily by different patterns of selection into program participation.

  View details for DOI 10.1016/j.worlddev.2021.105686

  View details for PubMedID 34980940

  View details for PubMedCentralID PMC8566276

• 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

• Health Communication Patterns and Adherence to a Micronutrient Home Fortification Program in Rural China. Journal of nutrition education and behavior Ye, R., Wu, Y., Sun, C., Wang, Q., Mao, Y., Raat, H., Rozelle, S., Johnstone, H., Zhou, H. 2021

  Abstract

  OBJECTIVES: Examine the association between ethnic health communication patterns and adherence to a micronutrient home fortification program in rural China among 3 distinct ethnic groups.DESIGN: Cross-sectional survey conducted in rural western China.SETTING: Enrolled 283 villages across 6 national poverty counties in rural western China.PARTICIPANTS: A total of 1,358 caregiver-children pairs with Han, Tibetan, or Yi ethnic backgrounds.VARIABLES MEASURED: A structured questionnaire was used to collect information on caregiver demographics, program adherence, and health communication about the program.ANALYSIS: Logistic regression model was used to examine the associations between health communication patterns and adherence to the program.RESULTS: Adherence rates across all ethnic groups were low, 55.5% (229/413) of Han, 55.0% (186/338) of Tibetan, and 47.2% (178/377) of Yi caregivers adhered to the program. Increased adherence was correlated with how each ethnic group received health information. Han caregivers were most influenced by mass media (odds ratio [OR], 1.87; 95% confidence interval [CI], 1.05-3.31), Tibetan caregivers by family (OR, 4.86; 95% CI, 1.45-16.29), and Yi caregivers by village doctors (OR, 6.63; 95% CI, 3.46-12.73).CONCLUSIONS AND IMPLICATIONS: Implementing culturally sensitive health communication strategies will likely improve adherence to home fortification programs among caregivers with distinct ethnic backgrounds.

  View details for DOI 10.1016/j.jneb.2021.07.014

  View details for PubMedID 34690077

• Does paternal involvement matter for early childhood development in rural China? APPLIED DEVELOPMENTAL SCIENCE Wang, L., Li, H., Dill, S., Zhang, S., Rozelle, S. 2021

  View details for DOI 10.1080/10888691.2021.1990061

  View details for Web of Science ID 000712123000001

• Consultation length, process quality and diagnosis quality of primary care in rural China: A cross-sectional standardized patient study. Patient education and counseling Wang, Q., Adhikari, S. P., Wu, Y., Sunil, T. S., Mao, Y., Ye, R., Sun, C., Shi, Y., Zhou, C., Sylvia, S., Rozelle, S., Zhou, H. 2021

  Abstract

  OBJECTIVE: Consultation length, the time spent between patient and health care provider during a visit, is an essential element in measuring quality of health care patients receive from a primary care facility. However, the linkage between consultation length and process quality and diagnosis quality of primary care is still uncertain. This study aims to examine the role consultation length plays in delivering process quality and diagnosis quality, two central components of overall primary care quality, in rural China.METHODS: We recruited unannounced standardized patients (SPs) to present classic symptoms of angina and tuberculosis in selected healthcare facilities in three provinces of China. The consultation length and primary care quality of SPs were measured and compared with both international and national standards of care. Ordinary Least Squares (OLS) regressions for process quality (continuous dependent variable) and Logistic regressions for diagnosis quality (binary dependent variable) were performed to investigate the relationship between consultation length and primary care quality.RESULTS: The average consultation lengths among patients with classic symptoms of angina and those with symptoms of tuberculosis were approximately 4.33min and 6.28min, respectively. Providers who spent more time with patients were significantly more likely to complete higher percentage of recommended checklist items of both questions and examinations for angina (beta=1.39, 95%CI 1.01-1.78) and tuberculosis (beta=0.89, 95%CI 0.69-1.08). Further, providers who spent more time with patients were more likely to make correct diagnosis for angina (marginal effect = 0.014, 95%CI 0.002-0.026) and for tuberculosis (marginal effect = 0.013, 95%CI 0.005-0.021).CONCLUSIONS: The average consultation length is extremely short among primary care providers in rural China. The longer consultation leads to both better process and diagnosis quality of primary care.PRACTICE IMPLICATIONS: We recommend primary care providers to increase the length of their communication with patients. To do so, government should implement healthcare reforms to clarify the requirements of affordable and reliable consultation length in medical care services. Moreover, such an experience can also be extended to other developing countries.

  View details for DOI 10.1016/j.pec.2021.08.006

  View details for PubMedID 34391601

• Grassland ecological compensation policy in China improves grassland quality and increases herders' income. Nature communications Hou, L., Xia, F., Chen, Q., Huang, J., He, Y., Rose, N., Rozelle, S. 2021; 12 (1): 4683

  Abstract

  Many countries have undertaken large and high-profile payment-for-ecosystem-services (PES) programs to sustain the use of their natural resources. Nevertheless, few studies have comprehensively examined the impacts of existing PES programs. Grassland Ecological Compensation Policy (GECP) is one of the few pastorally focused PES programs with large investments and long duration, which aim to improve grassland quality and increase herder income. Here we present empirical evidence of the effects of GECP on grassland quality and herder income. Through a thorough and in-depth econometric analysis of remote sensing and household survey data, we find that, although GECP improves grassland quality (albeit to only a small extent) and has a large positive effect on income, it exacerbates existing income inequality among herders within their local communities. The analysis demonstrates that the program has induced herders to change their livestock production behavior. Heterogeneity analysis emphasizes the importance of making sure the programs are flexible and are adapted to local resource circumstances.

  View details for DOI 10.1038/s41467-021-24942-8

  View details for PubMedID 34344876

• 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

• Infant Cognitive Development and Stimulating Parenting Practices in Rural China. International journal of environmental research and public health Johnstone, H., Yang, Y., Xue, H., Rozelle, S. 2021; 18 (10)

  Abstract

  This study examines the prevalence of cognitive delay among infants and toddlers in rural China and its relationship with one of the potential sources of the observed delay: low levels of stimulating parenting practices (SPPs). Data were compiled from five distinct studies, resulting in a pooled sample of 4436 caregivers of 6-29-month-old infants. The sampling sites span five provinces in rural China. According to the data, on average, rates of delay are high-51 percent. The low rates of SPPs among our sample demonstrate that this may be one source of the high prevalence of delays. The results of the multivariate regression analysis reveal that reading books and singing songs are each significantly associated with an increase in infant cognitive score by 1.62 points (p = 0.003) and 2.00 points (p < 0.001), respectively. Telling stories to infants, however, is not significantly associated with infant cognitive scores. Our findings indicate that caregivers with different characteristics engage in various levels of stimulating practices and have infants with different rates of delay. Specifically, infants of better-educated mothers who have greater household assets are in families in which the caregivers provide more SPPs and have infants who score higher on the study's cognitive abilities scales.

  View details for DOI 10.3390/ijerph18105277

  View details for PubMedID 34063561

• 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

• Comparing the Quality of Primary Care between Public and Private Providers in Urban China: A Standardized Patient Study. International journal of environmental research and public health Su, M., Zhou, Z., Si, Y., Sylvia, S., Chen, G., Su, Y., Rozelle, S., Wei, X. 2021; 18 (10)

  Abstract

  Previous studies have been limited by not directly comparing the quality of public and private CHCs using a standardized patient method (SP). This study aims to evaluate and compare the quality of the primary care provided by public and private CHCs using a standardized patient method in urban China. We recruited 12 standardized patients from the local community presenting fixed cases (unstable angina and asthma), including 492 interactions between physicians and standardized patients across 63 CHCs in Xi'an, China. We measured the quality of primary care on seven criteria: (1) adherence to checklists, (2) correct diagnosis, (3) correct treatment, (4) number of unnecessary exams and drugs, (5) diagnosis time, (6) expense of visit, (7) patient-centered communication. Significant quality differences were observed between public CHCs and private CHCs. Private CHC physicians performed 4.73 percentage points lower of recommended questions and exams in the checklist. Compared with private CHCs, public CHC providers were more likely to give a higher proportion of correct diagnosis and correct treatment. Private CHCs provided 1.42 fewer items of unnecessary exams and provided 0.32 more items of unnecessary drugs. Private CHC physicians received a 9.31 lower score in patient-centered communication. There is significant quality inequality in different primary care models. Public CHC physicians might provide a higher quality of service. Creating a comprehensive, flexible, and integrated health care system should be considered an effective approach towards optimizing the management of CHC models.

  View details for DOI 10.3390/ijerph18105060

  View details for PubMedID 34064733

• Infant Cognitive Development and Stimulating Parenting Practices in Rural China INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH Johnstone, H., Yang, Y., Xue, H., Rozelle, S. 2021; 18 (10)

  View details for DOI 10.3390/ijerph18105277

  View details for Web of Science ID 000654825400001

• 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

• Comparing the Quality of Primary Care between Public and Private Providers in Urban China: A Standardized Patient Study INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH Su, M., Zhou, Z., Si, Y., Sylvia, S., Chen, G., Su, Y., Rozelle, S., Wei, X. 2021; 18 (10)

  View details for DOI 10.3390/ijerph18105060

  View details for Web of Science ID 000654890900001

• Trajectories of child cognitive development during ages 0-3 in rural Western China: prevalence, risk factors and links to preschool-age cognition. BMC pediatrics Wang, L., Chen, Y., Sylvia, S., Dill, S., Rozelle, S. 2021; 21 (1): 199

  Abstract

  BACKGROUND: Cognitive development after age three tends to be stable and can therefore predict cognitive skills in later childhood. However, there is evidence that cognitive development is less stable before age three. In rural China, research has found large shares of children under age three are developmentally delayed, yet little is known about the trajectories of cognitive development between 0 and 3years of age or how developmental trajectories predict later cognitive skills. This study seeks to describe the trajectories of child cognitive development between the ages of 0-3years and examine how different trajectories predict cognitive development at preschool age.METHODS: We collected three waves of longitudinal panel data from 1245 children in rural Western China. Child cognitive development was measured by the Bayley Scales of Infant Development when the child was 6-12months and 22-30months, and by the Wechsler Preschool and Primary Scale of Intelligence-Fourth Edition when the child was 49-65months. We used the two measures of cognitive development before age three to determine the trajectories of child cognitive development.RESULTS: Of the children, 39% were never cognitively delayed; 13% were persistently delayed; 7% experienced improving cognitive development; and 41% experienced deteriorating development before age 3. Compared to children who had never experienced cognitive delay, children with persistent cognitive delay and those with deteriorating development before age 3 had significantly lower cognitive scores at preschool age. Children with improving development before age 3 showed similar levels of cognition at preschool age as children who had never experienced cognitive delay.CONCLUSIONS: Large shares of children under age 3 in rural Western China show deteriorating cognitive development from infancy to toddlerhood, which predict lower levels of cognition at preschool age. Policymakers should invest in improving cognitive development before age 3 to prevent long-term poor cognition among China's rural children.

  View details for DOI 10.1186/s12887-021-02650-y

  View details for PubMedID 33902510

• Complicating China's Rise: Rural Underemployment WASHINGTON QUARTERLY Rozelle, S., Boswell, M. 2021; 44 (2): 61-74

  View details for DOI 10.1080/0163660X.2021.1932097

  View details for Web of Science ID 000662690100004

• Publishing and assessing the research of economists: Lessons from public health CHINA ECONOMIC REVIEW Sylvia, S., Rozelle, S. 2021; 66

  View details for DOI 10.1016/j.chieco.2021.101601

  View details for Web of Science ID 000633494700011

• 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

• 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 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

• Alarmingly high malnutrition in childhood and its associated factors: A study among children under 5 in Yemen. Medicine Al-Zangabila, K., Poudel Adhikari, S., Wang, Q., Sunil, T. S., Rozelle, S., Zhou, H. 2021; 100 (5): e24419

  Abstract

  ABSTRACT: Childhood malnutrition is a serious public health problem in Yemen. However, there is a limited information regarding association of malnutrition with different socio-economic factors. This study examines the correlates of socioeconomic and maternal behavioral factors on malnutrition in Yemeni children under 5 years of age.Our study focuses on the nutritional status of children under 5 years of age, and uses the data provided by the cross-sectional study namely Yemen National Demographic and Health Survey. Three anthropometric indicators: stunting, wasting, and underweight were selected for the evaluation of malnutrition. Independent variables include personal and maternal characteristics, socioeconomic and behavioral factors, and illness conditions. The study used the Chi-Squared test to test the significant association between independent variables and logistic regression to estimate the odds of being malnourished.A total of 13,624 Yemeni children under 5 years of age were included in the study. The results show the high malnutrition level - the prevalence of stunting was 47%, wasting was 16%, and underweight was 39%. There is a statistically significant association between socioeconomic status, behavioral factors, and child malnutrition. The odds of malnutrition decreased with the increase in the level of mother's education, economic status, and frequency of prenatal visits. The odds of malnutrition were least for children whose mothers had highest level of education (OR = 0.64; 95%CI = 0.55-0.76), who belonged to highest wealth index (OR = 0.41; 95%CI = 0.36-0.47). Moreover, the likelihood of malnutrition was less among the children whose mother had highest number of prenatal visits during the pregnancy (OR = 0.67; 95%CI = 0.59-0.76).The high prevalence of stunting, wasting, and undernutrition were found in Yemeni children. Different factors such as regional variations, socio-economic disparities, and maternal education and health care utilization behavior are found to be associated with high malnutrition. These findings provide important policy implications to improving childhood malnutrition in Yemen.

  View details for DOI 10.1097/MD.0000000000024419

  View details for PubMedID 33592890

• Early Childhood Reading in Rural China and Obstacles to Caregiver Investment in Young Children: A Mixed-Methods Analysis. International journal of environmental research and public health Li, R., Rose, N., Zheng, Y. M., Chen, Y., Sylvia, S., Wilson-Smith, H., Medina, A., Dill, S., Rozelle, S. 2021; 18 (4)

  Abstract

  Studies have shown that nearly half of rural toddlers in China have cognitive delays due to an absence of stimulating parenting practices, such as early childhood reading, during the critical first three years of life. However, few studies have examined the reasons behind these low levels of stimulating parenting, and no studies have sought to identify the factors that limit caregivers from providing effective early childhood reading practices (EECRP). This mixed-methods study investigates the perceptions, prevalence, and correlates of EECRP in rural China, as well as associations with child cognitive development. We use quantitative survey results from 1748 caregiver-child dyads across 100 rural villages/townships in northwestern China and field observation and interview data with 60 caregivers from these same sites. The quantitative results show significantly low rates of EECRP despite positive perceptions of early reading and positive associations between EECRP and cognitive development. The qualitative results suggest that low rates of EECRP in rural China are not due to the inability to access books, financial or time constraints, or the absence of aspirations. Rather, the low rate of book ownership and absence of reading to young children is driven by the insufficient and inaccurate knowledge of EECRP among caregivers, which leads to their delayed, misinformed reading decisions with their young children, ultimately contributing to developmental delays.

  View details for DOI 10.3390/ijerph18041457

  View details for PubMedID 33557178

• Rural minimum living standard guarantee (rural Dibao) program boosts children's education outcomes in rural China CHINA AGRICULTURAL ECONOMIC REVIEW He, Z., Fang, X., Rose, N., Zheng, X., Rozelle, S. 2021; 13 (1): 223–46

  View details for DOI 10.1108/CAER-05-2020-0085

  View details for Web of Science ID 000609355200001

• 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

• Perinatal Mental Health Problems in Rural China: The Role of Social Factors. Frontiers in psychiatry Jiang, Q., Guo, Y., Zhang, E., Cohen, N., Ohtori, M., Sun, A., Dill, S., Singh, M. K., She, X., Medina, A., Rozelle, S. D. 1800; 12: 636875

  Abstract

  Background: Perinatal mental health is important for the well-being of the mother and child, so the relatively high prevalence of perinatal mental health problems in developing settings poses a pressing concern. However, most studies in these settings focus on the demographic factors associated with mental health problems, with very few examing social factors. Hence, this study examines the prevalence of the depressive, anxiety and stress symptoms among pregnant women and new mothers in rural China, and the associations between these mental health problems and social factors, including decision-making power, family conflicts, and social support. Methods: Cross-sectional data were collected from 1,027 women in their second trimester of pregnancy to 6 months postpartum in four low-income rural counties in Sichuan Province, China. Women were surveyed on symptoms of mental health problems using the Depression, Anxiety, and Stress Scale (DASS-21) and social risk factors. Multivariate logistic regression analyses were conducted to examine social risk factors associated with maternal mental health problems, with results reported as odds ratios (OR) and 95% confidence intervals (CI). Results: Among all respondents, 13% showed symptoms of depression, 18% showed symptoms of anxiety, 9% showed symptoms of stress, and 23% showed symptoms of any mental health problem. Decision-making power was negatively associated with showing symptoms of depression (OR = 0.71, CI: 0.60-0.83, p < 0.001) and stress (OR = 0.76, CI: 0.63-0.90, p = 0.002). Family conflict was positively associated with depression (OR = 1.53, CI: 1.30-1.81, p < 0.001), anxiety (OR = 1.34, CI: 1.15-1.56, p < 0.001), and stress (OR = 1.68, CI: 1.41-2.00, p < 0.001). In addition, social support was negatively associated with depression (OR = 0.56, CI: 0.46-0.69, p < 0.001), anxiety (OR = 0.76, CI: 0.63-0.91, p = 0.002), and stress (OR = 0.66, CI: 0.53-0.84, p < 0.001). Subgroup analyses revealed that more social risk factors were associated with symptoms of anxiety and stress among new mothers compared to pregnant women. Conclusion: Perinatal mental health problems are relatively prevalent among rural women in China and are strongly associated with social risk factors. Policies and programs should therefore promote individual coping methods, as well as target family and community members to improve the social conditions contributing to mental health problems among rural women.

  View details for DOI 10.3389/fpsyt.2021.636875

  View details for PubMedID 34950062

• Postnatal Mental Health, Hand Washing Practices, and Infant Illness in Rural China. Frontiers in global women's health Jiang, Q., Cohen, N., Ohtori, M., Gao, J., Wang, Q., Zhang, E., Zhu, S., Johnstone, H., Guo, Y., Dill, S., Zhou, H., Rozelle, S. 2021; 2: 735264

  Abstract

  Background: Maternal mental health problems play an important role in infant well-being. Although western countries have extensively studied the associations between maternal mental disorders, hygiene practices and infant health, little is known in developing settings. This study investigates the correlations between postnatal mental health problems, hand washing practices and infant illness in rural western China. Methods: A total of 720 mothers of infants aged 0-6 months from four poor counties in rural western China were included in the survey. Mental health symptoms were assessed using the Depression, Anxiety, and Stress Scale-21 (DASS-21). Questions about infant illness and hand washing practices followed evaluative surveys from prior studies. Adjusted ordinary least squares regressions were used to examine correlations between postnatal mental health (depression, anxiety, and stress) symptoms, hand washing practices, and infant illness outcomes. Results: Maternal depression, anxiety and stress symptoms were significantly associated with reduced hand washing overall and less frequent hand washing after cleaning the infant's bottom. Mental health symptoms were also associated with a higher probability of infants showing two or more illness symptoms and visiting a doctor for illness symptoms. Individual hand washing practices were not significantly associated with infant illness; however, a composite measure of hand washing practices was significantly associated with reduced probability of infant illness. Conclusion: Postnatal mental health problems are prevalent in rural China and significantly associated with infant illness. Policy makers and practitioners should investigate possible interventions to improve maternal and infant well-being.

  View details for DOI 10.3389/fgwh.2021.735264

  View details for PubMedID 34870276

• 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

• Moving Beyond Lewis: Employment and Wage Trends in China's High- and Low-Skilled Industries and the Emergence of an Era of Polarization (vol 62, pg 555, 2020) COMPARATIVE ECONOMIC STUDIES Rozelle, S., Xia, Y., Friesen, D., Vanderjack, B., Cohen, N. 2020

  View details for DOI 10.1057/s41294-020-00141-0

  View details for Web of Science ID 000590902300001

• The Impacts of Highly Resourced Vocational Schools on Student Outcomes in China CHINA & WORLD ECONOMY Li, G., Xu, J., Li, L., Shi, Z., Yi, H., Chu, J., Kardanova, E., Li, Y., Loyalka, P., Rozelle, S. 2020; 28 (6): 125–50

  View details for DOI 10.1111/cwe.12358

  View details for Web of Science ID 000596480800006

• Early child development and caregiver subjective well-being in rural China CHINA AGRICULTURAL ECONOMIC REVIEW Luo, R., Lyu, Q., Rozelle, S., Wang, S. 2020

  View details for DOI 10.1108/CAER-05-2020-0106

  View details for Web of Science ID 000586774300001

• Moving Beyond Lewis: Employment and Wage Trends in China's High- and Low-Skilled Industries and the Emergence of an Era of Polarization: Presidential Address for the 2020 Association for Comparative Economic Studies Meetings. Comparative economic studies Rozelle, S., Xia, Y., Friesen, D., Vanderjack, B., Cohen, N. 2020: 1–35

  Abstract

  One of the defining features of China's economy over the two decades between 1995 and 2015 was the persistent rise of wages for workers and professionals in nearly every segment of the economy-with wage rates for labor-intensive jobs in manufacturing, construction, and the informal service sector rising the fastest. Recently, however, the economic environment in China has begun to change, including changes in both employment and wages. We identify recent employment/wage trends throughout China's economy and postulate the sources of these trends as well as possible future consequences if they continue. We use official, nationally aggregated data to examine employment and wages in multiple sectors and industries. Our findings indicate that China may have entered a new phase of economic development in the mid-2010s. According to the data, in recent years, wage growth has begun to polarize: Rising for professionals employed in formal skill-intensive industries; and falling for workers in the informal labor-intensive service sector. We attribute this increase in skill-intensive wages to an increase in demand for skill-intensive employment, due to the emergence of a large middle class in China, for whom the demand for high technology, finance, banking, health, and higher education industries is increasing while, at least in the recent short term, the supply of experienced, high-skilled professionals has not kept up. The employment/wage trend in the informal (low-wage) service sector, however, is following a different pattern. While there is a rising demand for services in China's economy, the growth, due to a number of factors (e.g., large shares of GDP targeted by policymakers to investment; high rates of savings by consumers), is relatively slow. In contrast, due to a number of economic forces, including globalization and automation, the supply of labor into the service sector of the informal economy is being fueled by the flow of labor out of manufacturing and construction (two industries that that have experienced employment declines since 2013). These supply and demand trends, in turn, are leading to the fall in the growth rate of wages in the informal service sector. We conclude by discussing the possible longer-term consequences of these emerging polarization trends based on an examination of recent experience with wage polarization occurring in both middle- and high-income countries, as well as its consequences. We also present policy recommendations for greater investment in education and human capital, as well as for the development of a more comprehensive set of social safety nets for different segments of China's population.

  View details for DOI 10.1057/s41294-020-00137-w

  View details for PubMedID 33100516

• 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

• 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

• 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

• What constrains mechanization in Chinese agriculture? Role of farm size and fragmentation CHINA ECONOMIC REVIEW Wang, X., Yamauchi, F., Huang, J., Rozelle, S. 2020; 62

  View details for DOI 10.1016/j.chieco.2018.09.002

  View details for Web of Science ID 000567842300002

• 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

• "At three years of age, we can see the future": Cognitive skills and the life cycle of rural Chinese children DEMOGRAPHIC RESEARCH Zhou, H., Ye, R., Sylvia, S., Rose, N., Rozelle, S. 2020; 43: 169–82

  View details for Web of Science ID 000552283800001

• "At three years of age, we can see the future": Cognitive skills and the life cycle of rural Chinese children. Demographic research Zhou, H., Ye, R., Sylvia, S., Rose, N., Rozelle, S. 2020; 43 (7): 169-182

  Abstract

  While the Chinese education system has seen massive improvements over the past few decades, there still exists large academic achievement gaps between rural and urban areas, which threaten China's long-term development. Additionally, recent literature has underscored the importance of early childhood development (ECD) in later-life human capital development.We analyze the lifecycle of cognitive development and learning outcomes in rural Chinese children by first examining if ECD outcomes affect cognition levels, then seeing if cognitive delays persist as children grow, and finally exploring connections between cognition and education outcomes.We combine data from four recent studies examining different age groups (0-3, 4-5, 10-11, 13-14) to track cognitive outcomes.First, we find that ECD outcomes for children in rural China are poor, with almost one-in-two children being cognitively delayed. Second, we find that these cognitive delays seem to persist into middle school, with almost 37% of rural junior high school students being cognitively delayed. Finally, we show that cognition has a close relationship to academic achievement.Our results suggest that urban/rural gaps in academic achievement originate at least in part from differences in ECD outcomes.While many papers have analyzed ECD, human capital, and inequality separately, this is the first paper to explicitly connect and combine these topics to analyze the lifecycle of cognitive development in the context of rural China.

  View details for DOI 10.4054/DemRes.2020.43.7

  View details for PubMedID 33732092

  View details for PubMedCentralID PMC7963364

• School Quality and Peer Effects: Explaining Differences in Academic Performance between China's Migrant and Rural Students JOURNAL OF DEVELOPMENT STUDIES Wang, X., Yuan, Z., Min, S., Rozelle, S. 2020

  View details for DOI 10.1080/00220388.2020.1769074

  View details for Web of Science ID 000544791200001

• Conditional cash transfers, uptake of maternal and child health services, and health outcomes in western rural China. BMC public health Zhou, H., Wu, Y., Liu, C., Sun, C., Shi, Y., Zhang, L., Medina, A., Rozelle, S. 2020; 20 (1): 870

  Abstract

  BACKGROUND: Empirical evidence suggests that the uptake of maternal and child health (MCH) services is still low in poor rural areas of China. There is concern that this low uptake may detrimentally affect child health outcomes. Previous studies have not yet identified the exact nature of the impact that a conditional cash transfer (CCT) has on the uptake of MCH services and, ultimately, on child health outcomes. The objective of this study is to examine the relationship between CCT, uptake of MCH services, and health outcomes among children in poor rural areas of western China.METHODS: We designated two different sets of villages and households that were used as comparisons against which outcomes of the treated households could be assessed. In 2014, we conducted a large-scale survey of 1522 households in 75 villages (including 25 treatment and 50 comparison) from nine nationally designated poverty counties in two provinces of China. In each village, 21 households were selected based on their eligibility status for the CCT program. Difference-in-difference analyses were used to assess the impact of CCT on outcomes in terms of both intention-to-treat (ITT) and average-treatment-effects-on-the-treated (ATT).RESULTS: Overall, the uptake of MCH services in the sample households were low, especially in terms of postpartum care visits, early breastfeeding, exclusive breastfeeding, and physical examination of the baby. The uptake of the seven types of MCH services in the CCT treatment villages were significantly higher than that in the comparison villages. The results from both the ITT and ATT analyses showed that the CCT program had a positive, although small, impact on the uptake of MCH services and the knowledge of mothers of MCH health issues. Nonetheless, the CCT program had no noticeable effect on child health outcomes.CONCLUSIONS: The CCT program generated modest improvements in the uptake of MCH services and mothers' knowledge of MCH services in poor rural areas of Western China. These improvements, however, did not translate into substantial improvements in child health outcomes for two potential reasons: poor CCT implementation and the low quality of rural health facilities.

  View details for DOI 10.1186/s12889-020-08996-9

  View details for PubMedID 32503554

• Why aren't rural children completing compulsory education? A survey-based study in China, 2003 to 2011 CHINA AGRICULTURAL ECONOMIC REVIEW Liu, X., Rozelle, S. 2020

  View details for DOI 10.1108/CAER-11-2019-0206

  View details for Web of Science ID 000532859100001

• 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

• 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

• Epidemiology, causes, clinical manifestation and diagnosis, prevention and control of coronavirus disease (COVID-19) during the early outbreak period: a scoping review. Infectious diseases of poverty Adhikari, S. P., Meng, S., Wu, Y., Mao, Y., Ye, R., Wang, Q., Sun, C., Sylvia, S., Rozelle, S., Raat, H., Zhou, H. 2020; 9 (1): 29

  Abstract

  BACKGROUND: The coronavirus disease (COVID-19) has been identified as the cause of an outbreak of respiratory illness in Wuhan, Hubei Province, China beginning in December 2019. As of 31 January 2020, this epidemic had spread to 19 countries with 11791 confirmed cases, including 213 deaths. The World Health Organization has declared it a Public Health Emergency of International Concern.METHODS: A scoping review was conducted following the methodological framework suggested by Arksey and O'Malley. In this scoping review, 65 research articles published before 31 January 2020 were analyzed and discussed to better understand the epidemiology, causes, clinical diagnosis, prevention and control of this virus. The research domains, dates of publication, journal language, authors' affiliations, and methodological characteristics were included in the analysis. All the findings and statements in this review regarding the outbreak are based on published information as listed in the references.RESULTS: Most of the publications were written using the English language (89.2%). The largest proportion of published articles were related to causes (38.5%) and a majority (67.7%) were published by Chinese scholars. Research articles initially focused on causes, but over time there was an increase of the articles related to prevention and control. Studies thus far have shown that the virus' origination is in connection to a seafood market in Wuhan, but specific animal associations have not been confirmed. Reported symptoms include fever, cough, fatigue, pneumonia, headache, diarrhea, hemoptysis, and dyspnea. Preventive measures such as masks, hand hygiene practices, avoidance of public contact, case detection, contact tracing, and quarantines have been discussed as ways to reduce transmission. To date, no specific antiviral treatment has proven effective; hence, infected people primarily rely on symptomatic treatment and supportive care.CONCLUSIONS: There has been a rapid surge in research in response to the outbreak of COVID-19. During this early period, published research primarily explored the epidemiology, causes, clinical manifestation and diagnosis, as well as prevention and control of the novel coronavirus. Although these studies are relevant to control the current public emergency, more high-quality research is needed to provide valid and reliable ways to manage this kind of public health emergency in both the short- and long-term.

  View details for DOI 10.1186/s40249-020-00646-x

  View details for PubMedID 32183901

• 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

• Parental Migration and Early Childhood Development in Rural China. Demography Yue, A., Bai, Y., Shi, Y., Luo, R., Rozelle, S., Medina, A., Sylvia, S. 2020

  Abstract

  Nearly one-quarter of all children under age 2 in China are left behind in the countryside as parents migrate to urban areas for work. We use a four-wave longitudinal survey following young children from 6 to 30 months of age to provide first evidence on the effects of parental migration on development, health, and nutritional outcomes in the critical first stages of life. We find that maternal migration has a negative effect on cognitive development: migration before children reach 12 months of age reduces cognitive development by 0.3 standard deviations at age 2. Possible mechanisms include reduced dietary diversity and engagement in stimulating activities, both known to be causally associated with skill development in early life. We find no effects on other dimensions of physical and social-emotional health.

  View details for DOI 10.1007/s13524-019-00849-4

  View details for PubMedID 32166535

• Visual impairment and spectacles ownership among upper secondary school students in northwestern China. Hong Kong medical journal = Xianggang yi xue za zhi Zhao, J., Guan, H., Du, K., Wang, H., Boswell, M., Shi, Y., Rozelle, S., Congdon, N., Osborn, A. 2020; 26 (1)

  Abstract

  PURPOSE: To assess the prevalence of visual impairment and spectacles ownership among academic and vocational upper secondary school students in rural China.METHODS: This cross-sectional study included 5583 students from four academic upper secondary schools (AUSSs) and two vocational upper secondary schools (VUSSs) in Mei and Qianyang counties, Baoji Prefecture, Shaanxi Province. In March and April 2016, students underwent assessment of visual acuity (VA) and completed a questionnaire regarding spectacles use and family characteristics. Students with visual impairment (presenting VA ≤6/12 in the better eye) and students needing spectacles (uncorrected VA ≤6/12 in the better eye, which could be improved to >6/12 with refraction) were identified.RESULTS: Among 5583 students (54% boys, mean age 16.4±1.0 years) in grades 10 and grade 11 attending AUSSs (n=4549) and VUSSs (n=1034), visual impairment was detected in 4026 students. Among the AUSS students, 3425 (75%) needed spectacles; 2551 (75%) had them. Among the VUSS students, 601 (58%) needed spectacles; this proportion was significantly smaller (P=0.004), as was the proportion who had spectacles (n=212, 35%, P<0.001), compared with the AUSS students. Multivariate analysis showed that ownership of spectacles among children who needed them was associated with worse uncorrected VA (P<0.001), male sex (P<0.001), and residence in an urban area (P<0.034). Spectacles ownership was also strongly associated with AUSS education (P<0.001).CONCLUSION: There is a high rate of unmet need in visual care among upper secondary school students. Lack of spectacles ownership among children who needed them was significantly associated with VUSS education.

  View details for DOI 10.12809/hkmj197926

  View details for PubMedID 32051332

• Seeing Is Believing: Experimental Evidence on the Impact of Eyeglasses on Academic Performance, Aspirations, and Dropout among Junior High School Students in Rural China ECONOMIC DEVELOPMENT AND CULTURAL CHANGE Nie, J., Pang, X., Wang, L., Rozelle, S., Sylvia, S. 2020; 68 (2): 335–55

  View details for DOI 10.1086/700631

  View details for Web of Science ID 000510202700001

• Effects of baby-friendly practices on breastfeeding duration in China: a case-control study. International breastfeeding journal Zhang, Y. n., Yang, J. n., Li, W. n., Wang, N. n., Ye, Y. n., Yan, S. n., Wang, S. n., Zeng, T. n., Huang, Z. n., Zhang, F. n., Li, Y. n., Yao, S. n., Wang, H. n., Rozelle, S. n., Xu, T. n., Jin, X. n. 2020; 15 (1): 92

  Abstract

  The Baby-Friendly Hospital Initiative is generally considered an effective way to promote breastfeeding. Although China has the largest number of baby-friendly hospitals in the world, research on baby-friendly practices in China is limited, and the rate of exclusive breastfeeding (EBF) at 6 months, 20.7%, compared to the 2025 global goal of 50% is low. It is, therefore, important to determine the factors that remain significant barriers to EBF in China. To explore how the key baby-friendly practices affect EBF duration in China, we used a case-control study to compare the effects of baby-friendly-related practices on both EBF and non-breastfeeding (NBF) mothers at 3 months and to investigate the effects of both single and comprehensive baby-friendly practices in promoting EBF duration at 3 months, which is one step toward EBF at 6 months.Participants were recruited from four maternal and child health hospitals in western (Chongqing), eastern (Qingdao), southern (Liuzhou), and central China (Maanshan). A total of 421 mothers (245 in the EBF group, 176 in the NBF group) of infants aged 3 months were surveyed through a self-reported questionnaire from April 2018 to March 2019. The experience of baby-friendly practices and breastfeeding during hospitalization were assessed with yes/no questions. Socio-demographic factors that influenced breastfeeding at 3 months were analyzed using bivariate and multivariate logistic regression analyses.Of mothers in the EBF group, 65.57% reported engaging in at least seven baby-friendly practices compared to 47.72% of mothers in the NBF group. Significantly more mothers in the EBF group engaged in baby-friendly practices than in the NBF group. These practices included "breastfeeding within one hour after birth" (74.29% vs. 59.09%), "breastfeeding on demand" (86.48% vs. 75.00%), and "never use a pacifier" (46.53% vs. 31.25%). After adjusting for confounding variables, we found that the mothers who engaged in fewer than seven baby-friendly practices were about 1.7 times less likely to breastfeed than were those who engaged in seven or more baby-friendly practices (odds ratio [OR] 1.720, 95% confidence interval [CI] 1.106, 2.667). Further, the mothers who did not breastfeed on demand were as likely to not breastfeed up to 3 months (OR 2.263, 95% CI 1.265, 4.049), as were mothers who did not breastfeed during hospitalization (OR 4.379, 95% CI 1.815, 10.563).These data from hospitals in China suggest that higher compliance with baby-friendly practices may have a positive impact on EBF at 3 months, particularly in terms of promoting the implementation of breastfeeding on demand and breastfeeding during hospitalization in China.

  View details for DOI 10.1186/s13006-020-00334-4

  View details for PubMedID 33143740

• 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

• Correlates of participation in community-based interventions: Evidence from a parenting program in rural China. PloS one Qian, Y. n., Zheng, Y. M., Dill, S. E., Rozelle, S. n. 2020; 15 (9): e0238841

  Abstract

  A growing body of literature has documented that community-based early childhood development (ECD) interventions can improve child developmental outcomes in vulnerable communities. One critical element of effective community-based programs is consistent program participation. However, little is known about participation in community-based ECD interventions or factors that may affect participation. This paper examines factors linked to program participation within a community-based ECD program serving 819 infants and their caregivers in 50 rural villages in northwestern China. The results find that more than half of families did not regularly attend the ECD program. Both village-level social ties within the program and proximity to the program significantly predict program participation. Increased distance from the program site is linked with decreased individual program participation, while the number of social ties is positively correlated with participation. The average program participation rates among a family's social ties is also positively correlated with individual participation, indicating strong peer effects. Taken together, our findings suggest that attention should be given to promoting social interactions and reducing geographic barriers among households in order to raise participation in community-based ECD programs.

  View details for DOI 10.1371/journal.pone.0238841

  View details for PubMedID 32898156

• Agricultural and rural development in China during the past four decades: an introduction AUSTRALIAN JOURNAL OF AGRICULTURAL AND RESOURCE ECONOMICS Huang, J., Rozelle, S., Zhu, X., Zhao, S., Sheng, Y. 2019

  View details for DOI 10.1111/1467-8489.12352

  View details for Web of Science ID 000502571500001

• Impact of Second-Parent Migration on Student Academic Performance in Northwest China and its Implications JOURNAL OF DEVELOPMENT STUDIES Bai, Y., Neubauer, M., Ru, T., Shi, Y., Kenny, K., Rozelle, S. 2019

  View details for DOI 10.1080/00220388.2019.1690136

  View details for Web of Science ID 000498374300001

• The returns to education in rural China: Some new estimates AUSTRALIAN JOURNAL OF AGRICULTURAL AND RESOURCE ECONOMICS Liu, C., Li, Y., Li, S., Luo, R., Zhang, L., Rozelle, S., Hagist, S., Hou, J. 2019

  View details for DOI 10.1111/1467-8489.12350

  View details for Web of Science ID 000495856800001

• 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

• Heterogeneous Impacts of Basic Social Health Insurance on Medical Expenditure: Evidence from China's New Cooperative Medical Scheme. Healthcare (Basel, Switzerland) Fang, C., He, C., Rozelle, S., Shi, Q., Sun, J., Yu, N. 2019; 7 (4)

  Abstract

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

  View details for DOI 10.3390/healthcare7040131

  View details for PubMedID 31684191

• Academic achievement and mental health of left-behind children in rural China A causal study on parental migration CHINA AGRICULTURAL ECONOMIC REVIEW Wang, L., Zheng, Y., Li, G., Li, Y., Fang, Z., Abbey, C., Rozelle, S. 2019; 11 (4): 569–82

  View details for DOI 10.1108/CAER-09-2018-0194

  View details for Web of Science ID 000490814100001

• Passive parenting and its Association with Early Child Development EARLY CHILD DEVELOPMENT AND CARE Luo, R., Jia, F., Yue, A., Zhang, L., Lyu, Q., Shi, Y., Yang, M., Medina, A., Kotb, S., Rozelle, S. 2019; 189 (10): 1709–23

  View details for DOI 10.1080/03004430.2017.1407318

  View details for Web of Science ID 000478056100011

• 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

• 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

• 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 impact of teacher professional development programs on student achievement in rural China: evidence from Shaanxi Province JOURNAL OF DEVELOPMENT EFFECTIVENESS Lu, M., Loyalka, P., Shi, Y., Chang, F., Liu, C., Rozelle, S. 2019

  View details for DOI 10.1080/19439342.2019.1624594

  View details for Web of Science ID 000472415100001

• Better cognition, better school performance? Evidence from primary schools in China CHINA ECONOMIC REVIEW Zhao, Q., Wang, X., Rozelle, S. 2019; 55: 199–217

  View details for DOI 10.1016/j.chieco.2019.04.005

  View details for Web of Science ID 000469165600013

• Are infant/toddler developmental delays a problem across rural China? JOURNAL OF COMPARATIVE ECONOMICS Wang, L., Liang, W., Zhang, S., Jonsson, L., Li, M., Yu, C., Sun, Y., Ma, Q., Bai, Y., Abbey, C., Luo, R., Yue, A., Rozelle, S. 2019; 47 (2): 458–69

  View details for DOI 10.1016/j.jce.2019.02.003

  View details for Web of Science ID 000500225800011

• Assessing the quality of primary healthcare in seven Chinese provinces with unannounced standardised patients: protocol of a cross-sectional survey BMJ OPEN Xu, D., Hu, M., He, W., Liao, J., Cai, Y., Sylvia, S., Hanson, K., Chen, Y., Pan, J., Zhou, Z., Zhang, N., Tang, C., Wang, X., Rozelle, S., He, H., Wang, H., Chan, G., Melipillan, E., Zhou, W., Gong, W. 2019; 9 (2)

  View details for DOI 10.1136/bmjopen-2018-023997

  View details for Web of Science ID 000471124600102

• 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

• Parental migration, educational achievement, and mental health of junior high school students in rural China CHINA ECONOMIC REVIEW Chang, F., Jiang, Y., Loyalka, P., Chu, J., Shi, Y., Osborn, A., Rozelle, S. 2019; 54: 337–49

  View details for DOI 10.1016/j.chieco.2019.01.007

  View details for Web of Science ID 000464630100022

• Old is not always better: evidence from five randomized experiments in rural primary schools in China JOURNAL OF DEVELOPMENT EFFECTIVENESS Li, L., Chang, F., Shi, Y., Rozelle, S. 2019

  View details for DOI 10.1080/19439342.2019.1595086

  View details for Web of Science ID 000466232100001

• Past Successes and Future Challenges in Rural China's Human Capital JOURNAL OF CONTEMPORARY CHINA Bai, Y., Zhang, S., Wang, L., Dang, R., Abbey, C., Rozelle, S. 2019: 1–16

  View details for DOI 10.1080/10670564.2019.1594102

  View details for Web of Science ID 000463989500001

• Use of maternal health services among women in the ethnic rural areas of western China. BMC health services research Wu, Y., Zhou, H., Wang, Q., Cao, M., Medina, A., Rozelle, S. 2019; 19 (1): 179

  Abstract

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

  View details for PubMedID 30890133

• Use of maternal health services among women in the ethnic rural areas of western China BMC HEALTH SERVICES RESEARCH Wu, Y., Zhou, H., Wang, Q., Cao, M., Medina, A., Rozelle, S. 2019; 19

  View details for DOI 10.1186/s12913-019-3996-2

  View details for Web of Science ID 000462326300001

• Structural Equation Modeling (SEM) of Cysticercosis in School-Aged Children in Tibetan Rural Farming Areas of Western China: Implications for Intervention Planning. International journal of environmental research and public health Zhou, H., Wang, Q., Zhou, J., Li, T., Medina, A., Felt, S. A., Rozelle, S., Openshaw, J. J. 2019; 16 (5)

  Abstract

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

  View details for PubMedID 30836642

• Understanding the Situation of China's Left-Behind Children: A Mixed-Methods Analysis DEVELOPING ECONOMIES Chang, F., Shi, Y., Shen, A., Kohrman, A., Li, K., Wan, Q., Kenny, K., Rozelle, S. 2019; 57 (1): 3–35

  View details for DOI 10.1111/deve.12188

  View details for Web of Science ID 000458266400001

• Structural Equation Modeling (SEM) of Cysticercosis in School-Aged Children in Tibetan Rural Farming Areas of Western China: Implications for Intervention Planning INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH Zhou, H., Wang, Q., Zhou, J., Li, T., Medina, A., Felt, S. A., Rozelle, S., Openshaw, J. J. 2019; 16 (5)

  View details for DOI 10.3390/ijerph16050780

  View details for Web of Science ID 000462664200105

• 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

• Peer relations and dropout behavior: Evidence from junior high school students in northwest rural China INTERNATIONAL JOURNAL OF EDUCATIONAL DEVELOPMENT Gao, S., Yang, M., Wang, X., Min, W., Rozelle, S. 2019; 65: 134–43

  View details for DOI 10.1016/j.ijedudev.2018.04.001

  View details for Web of Science ID 000459520300013

• Assessing the quality of primary healthcare in seven Chinese provinces with unannounced standardised patients: protocol of a cross-sectional survey. BMJ open Xu, D. R., Hu, M., He, W., Liao, J., Cai, Y., Sylvia, S., Hanson, K., Chen, Y., Pan, J., Zhou, Z., Zhang, N., Tang, C., Wang, X., Rozelle, S., He, H., Wang, H., Chan, G., Melipillan, E. R., Zhou, W., Gong, W. 2019; 9 (2): e023997

  Abstract

  INTRODUCTION: Primary healthcare (PHC) serves as the cornerstone for the attainment of universal health coverage (UHC). Efforts to promote UHC should focus on the expansion of access and on healthcare quality. However, robust quality evidence has remained scarce in China. Common quality assessment methods such as chart abstraction, patient rating and clinical vignette use indirect information that may not represent real practice. This study will send standardised patients (SP or healthy person trained to consistently simulate the medical history, physical symptoms and emotional characteristics of a real patient) unannounced to PHC providers to collect quality information and represent real practice.METHODS AND ANALYSIS: 1981 SP-clinician visits will be made to a random sample of PHC providers across seven provinces in China. SP cases will be developed for 10 tracer conditions in PHC. Each case will include a standard script for the SP to use and a quality checklist that the SP will complete after the clinical visit to indicate diagnostic and treatment activities performed by the clinician. Patient-centredness will be assessed according to the Patient Perception of Patient-Centeredness Rating Scale by the SP. SP cases and the checklist will be developed through a standard protocol and assessed for content, face and criterion validity, and test-retest and inter-rater reliability before its full use. Various descriptive analyses will be performed for the survey results, such as a tabulation of quality scores across geographies and provider types.ETHICS AND DISSEMINATION: This study has been reviewed and approved by the Institutional Review Board of the School of Public Health of Sun Yat-sen University (#SYSU 2017-011). Results will be actively disseminated through print and social media, and SP tools will be made available for other researchers.

  View details for PubMedID 30765399

• Social Engagement and Elderly Health in China: Evidence from the China Health and Retirement Longitudinal Survey (CHARLS). International journal of environmental research and public health Liu, J., Rozelle, S., Xu, Q., Yu, N., Zhou, T. 2019; 16 (2)

  Abstract

  This study examines the impact of social engagement on elderly health in China. A two-stage residual inclusion (2SRI) regression approach was used to examine the causal relationship. Our dataset comprises 9253 people aged 60 or above from the China Health and Retirement Longitudinal Survey (CHARLS) conducted in 2011 and 2013. Social engagement significantly improved the self-rated health of the elderly and reduced mental distress, but had no effect on chronic disease status. Compared with the rural areas, social engagement played a more important role in promoting the elderly health status in urban areas. Social engagement could affect the health status of the elderly through health behavior change and access to health resources. To improve the health of the elderly in China and promote healthy aging, the government should not only improve access to effective medical care but also encourage greater social engagement of the elderly.

  View details for PubMedID 30669415

• Social Engagement and Elderly Health in China: Evidence from the China Health and Retirement Longitudinal Survey (CHARLS) INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH Liu, J., Rozelle, S., Xu, Q., Yu, N., Zhou, T. 2019; 16 (2)

  View details for DOI 10.3390/ijerph16020278

  View details for Web of Science ID 000459112100113

• 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

• What Kind of Senior Secondary Education Does China Need? CHINESE RESEARCH PERSPECTIVES ON EDUCATIONAL DEVELOPMENT, VOL 4 Ke Jin, Shi Yaojiang, Zhang Linxiu, Rozelle, S., Dongping, Y. 2019; 4: 49–59

  View details for DOI 10.1163/9789004389021_005

  View details for Web of Science ID 000518910800004

• Optimal Allocation of Groundwater Resources: Managing Water Quantity and Quality APPLIED METHODS FOR AGRICULTURE AND NATURAL RESOURCE MANAGEMENT: A FESTSCHRIFT IN HONOR OF RICHARD E. HOWITT Huang, Q., Rozelle, S. D., Howitt, R. E., Wilen, J. E., Msangi, S., MacEwan, D. 2019; 50: 89–114

  View details for DOI 10.1007/978-3-030-13487-7_6

  View details for Web of Science ID 000485111200008

• Using community health workers to deliver a scalable integrated parenting program in rural China: A cluster-randomized controlled trial. Social science & medicine (1982) Luo, R. n., Emmers, D. n., Warrinnier, N. n., Rozelle, S. n., Sylvia, S. n. 2019; 239: 112545

  Abstract

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

  View details for DOI 10.1016/j.socscimed.2019.112545

  View details for PubMedID 31568997

• The academic performance of primary school students from rural China Distribution and correlates CHINA AGRICULTURAL ECONOMIC REVIEW Liu, H., Xue, H., Shi, Y., Rozelle, S. 2019; 11 (2): 253–79

  View details for DOI 10.1108/CAER-11-2016-0181

  View details for Web of Science ID 000484206800003

• Concurrent validity of the Ages and Stages Questionnaire and the Bayley Scales of Infant Development III in China. PloS one Yue, A. n., Jiang, Q. n., Wang, B. n., Abbey, C. n., Medina, A. n., Shi, Y. n., Rozelle, S. n. 2019; 14 (9): e0221675

  Abstract

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

  View details for DOI 10.1371/journal.pone.0221675

  View details for PubMedID 31487302

• Stimulation and Early Child Development in China: Caregiving at Arm's Length. Journal of developmental and behavioral pediatrics : JDBP Yue, A. n., Shi, Y. n., Luo, R. n., Wang, B. n., Weber, A. n., Medina, A. n., Kotb, S. n., Rozelle, S. n. 2019

  Abstract

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

  View details for DOI 10.1097/DBP.0000000000000678

  View details for PubMedID 31107768

• Caregiver Depression and Early Child Development: A Mixed-Methods Study From Rural China. Frontiers in psychology Yue, A., Gao, J., Yang, M., Swinnen, L., Medina, A., Rozelle, S. 2018; 9: 2500

  Abstract

  Half of rural toddlers aged 0-3 years in China's Qinling Mountainous region are cognitively delayed. While recent studies have linked poor child development measures to the absence of positive parenting behaviors, much less is known about the role that caregiver depression might play in shaping child development. In this paper, a mixed methods analysis is used to explore the prevalence of depression; measure the association between caregiver depression and children's developmental delays, correlates of depression, and the potential reasons for caregiver depression among women in rural China. The analysis brings together results from a large-scale survey of 1,787 caregivers across 118 villages in one northwestern province, as well as information from in-depth interviews with 55 female caregivers from these same study sites. Participants were asked to respond to the Depression, Anxiety and Stress Scale-21 (DASS-21) as well as a scale to measure children's social-emotional development, the Ages and Stages Questionnaire: Social-Emotional (ASQ-SE). We also administered a test of early childhood development, the Bayley Scales of Infant and Toddler Development (BSID-III), to all of the study household's infants and toddlers. The results show that the prevalence of depression may be as high as 23.5 percent among all female caregivers (defined as scoring in the mild or higher category of the DASS-21). Grandmothers have higher prevalence of depression than mother caregivers (p < 0.01). Caregiver depression also is significantly associated with a 0.53 SD worsening of children's social-emotional development (p < 0.01) and a 0.12 SD decrease in children's language development (p < 0.05). Our qualitative findings reveal six predominant reasons for caregiver depression: lack of social support from family and friends; the burden of caregiving; lack of control and agency within the household; within-family conflict; poverty; the perception of material wealth as a measure of self-worth. Our findings show a serious lack of understanding of mental health issues among rural women, and suggest that rural communities could benefit greatly from an educational program concerning mental health and its influence on child development. Our findings confirm the need for a comprehensive approach toward rural health, with particular attention paid to mental health awareness and support to elderly caregivers.

  View details for DOI 10.3389/fpsyg.2018.02500

  View details for PubMedID 30618931

  View details for PubMedCentralID PMC6295552

• Caregiver Depression and Early Child Development: A Mixed-Methods Study From Rural China FRONTIERS IN PSYCHOLOGY Yue, A., Gao, J., Yang, M., Swinnen, L., Medina, A., Rozelle, S. 2018; 9

  View details for DOI 10.3389/fpsyg.2018.02500

  View details for Web of Science ID 000452661100001

• 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

• Effect of Caregiver's Mental Health on Early Childhood Development across Different Rural Communities in China INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH Zhang, S., Dang, R., Yang, N., Bai, Y., Wang, L., Abbey, C., Rozelle, S. 2018; 15 (11)

  View details for DOI 10.3390/ijerph15112341

  View details for Web of Science ID 000451640500015

• Effect of Caregiver's Mental Health on Early Childhood Development across Different Rural Communities in China. International journal of environmental research and public health Zhang, S., Dang, R., Yang, N., Bai, Y., Wang, L., Abbey, C., Rozelle, S. 2018; 15 (11)

  Abstract

  Previous research has found that there are high rates of developmental delays among infants and toddlers in rural areas of China. Caregiver mental health problems might be one significant predictor of developmental delays among infants and toddlers, as has been found in other areas of the world. One way that the mental health of caregivers could affect early childhood development is through its effect on parenting practices. In this study, we used data from four major subpopulations of rural China to measure the correlation of caregiver mental health problems with the developmental outcomes of infants and toddlers. To do so, the study used the Bayley Scales of Infant Development III (BSID III) to examine the rates of developmental delays among 2514 rural infants/toddlers aged 6⁻30 months old. The results of the testing demonstrate that 48% of the sample's infants/toddlers have cognitive delays; 52% have language delays; 53% have social-emotional delays; and 30% have motor delays. The data collection team also assessed caregiver mental health by using the Depression Anxiety Stress Scales (DASS-21) questionnaire. According to the findings, 39% of caregivers in the sample have symptoms of at least one kind of mental health problem (depression, anxiety, or stress). We also found that most caregivers do not engage in positive parenting practices, while a significant share of caregivers engage in negative parenting practices. The statistical analysis found that showing signs of mental health problems is significantly and negatively associated with infant/toddler developmental outcomes. The study also found that caregivers who show signs of mental health problems are significantly less likely to engage in interactive parenting practices. The study confirms that society needs to pay more attention to caregiver mental health problems in order to improve infant/toddler developmental outcomes in rural China and increase human capital accumulation in China as a whole.

  View details for PubMedID 30360569

• The relationship between birth season and early childhood development: Evidence from northwest rural China PLOS ONE Bai, Y., Shang, G., Wang, L., Sun, Y., Osborn, A., Rozelle, S. 2018; 13 (10)

  View details for DOI 10.1371/journal.pone.0205281

  View details for Web of Science ID 000447173500058

• Do Infant Feeding Practices Differ Between Grandmothers and Mothers in Rural China? Evidence From Rural Shaanxi Province. Family & community health Yue, A., Zhang, N., Liu, X., Tang, L., Luo, R., Yang, M., Rozelle, S., Medina, A. 2018; 41 (4): 233–43

  Abstract

  The overall goal of this study is to examine whether infant feeding practices differ between mothers and grandmothers in rural China. We randomly sampled 1383 caregivers of infants aged 18 to 30 months living in 351 villages across 174 townships in nationally designated poverty counties in rural areas. Results show that a high fraction of caregivers of 18- to 30-month-old children living in low-income areas of rural China do not regularly engage in positive infant feeding practices. Only 30% of children in our sample achieved adequate dietary diversity. Only 49% of children in our sample were fed meat in the day prior to survey administration. Few caregivers reported giving any vitamin supplements (such as calcium or iron supplements) to their children. We find that 33% of the children were cared for by grandmothers rather than mothers, and that grandmothers feed a less diversified diet to children than do mothers. Most (84%) caregivers rely solely on their own experiences, friends, and family members in shaping their feeding behaviors. Overall infant feeding practices are poor in rural China. Grandmothers engage in poorer feeding practices than do mothers. Grandmothers have improved their feeding practices compared to when their own children were young. Our results suggest shortcomings in the quality of infant feeding practices, at least in part due to an absence of reliable information sources.

  View details for PubMedID 30134338

• Do Infant Feeding Practices Differ Between Grandmothers and Mothers in Rural China? Evidence From Rural Shaanxi Province FAMILY & COMMUNITY HEALTH Yue, A., Zhang, N., Liu, X., Tang, L., Luo, R., Yang, M., Rozelle, S., Medina, A. 2018; 41 (4): 233-243

  View details for DOI 10.1097/FCH.0000000000000198

  View details for Web of Science ID 000442742700006

• Anxiety in Rural Chinese Children and Adolescents: Comparisons across Provinces and among Subgroups INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH Liu, H., Shi, Y., Auden, E., Rozelle, S. 2018; 15 (10)

  Abstract

  China's competitive education system has produced notably high learning outcomes, but they may be costly. One potential cost is high levels of anxiety. China has launched several initiatives aimed at improving student mental health. However, little is known about how effective these programs and policies are. The goal of this paper was to examine anxiety levels among children and adolescents in rural China, and to identify which subpopulations were particularly vulnerable to anxiety. Data were aggregated from 10 different school-level surveys conducted in rural areas of five provinces between 2008 and 2015. In total, 50,361 students were evaluated using the 100-item, nine-subcategory Mental Health Test (a variation of the Children's Manifest Anxiety Scale). Seven percent of students were at risk for overall anxiety. However, over half of students were at risk for at least one subcategory of anxiety. Students at higher risk for anxiety included students from poorer counties and families, female students, secondary school students, and students with lower levels of academic performance. Many students in rural China are at risk for anxiety, and certain student subpopulations are particularly vulnerable. We suggest that China's government review and update student mental health programs and policies.

  View details for PubMedID 30248994

• Anemia and student's educational performance in rural Central China: Prevalence, correlates and impacts Li, L., Huang, L., Shi, Y., Luo, R., Yang, M., Rozelle, S. ELSEVIER SCIENCE INC. 2018: 283–93

  View details for DOI 10.1016/j.chieco.2017.07.006

  View details for Web of Science ID 000449039100020

• Is Infant/Toddler Anemia a Problem across Rural China? A Mixed-Methods Analysis INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH Wang, L., Sun, Y., Liu, B., Zheng, L., Li, M., Bai, Y., Osborn, A., Lee, M., Rozelle, S. 2018; 15 (9)

  Abstract

  In the past, iron-deficiency anemia in children has had a widespread presence in rural China. Given the recent economic growth in China, it is unclear if anemia among infants/toddlers remains a problem. The objective of this study is to measure the anemia rate in rural Chinese infants/toddlers across four major subpopulations and attempt to discover the sources of anemia. We use a mixed-methods approach combining quantitative data on 2909 rural Chinese infants/toddlers and their families with qualitative interviews with 84 caregivers of infants aged 6 to 30 months. Quantitative analysis indicates that the overall prevalence of anemia (43%) within sampled infants/toddlers was high, especially in comparison to the low rates of stunting (2⁻5%), being underweight (2%), and wasting (2⁻4%). These findings suggest that in rural China, anemia stems from the poor quality of the diets of infants/toddlers, rather than insufficient quantities of food being consumed. Qualitative analysis illustrates the factors that are contributing to anemia. Caregivers do not understand the causes of this condition, the symptoms that would lead one to recognize this condition, or the steps needed to treat their child with this condition. The findings offer a comprehensive understanding of the limited awareness of anemia among rural Chinese caregivers.

  View details for PubMedID 30142959

• Medical waste management in three areas of rural China PLOS ONE Gao, Q., Shi, Y., Mo, D., Nie, J., Yang, M., Rozelle, S., Sylvia, S. 2018; 13 (7): e0200889

  Abstract

  The purpose of this paper is to describe current practices of medical waste management, including its generation, investments, collection, storage, segregation, and disposal, and to explore the level of support from upper tiers of the government and health care system for medical waste management in rural China.The authors draw on a dataset comprised of 209 randomly selected rural township health centers (THCs) in 21 counties in three provinces of China: Anhui, Shaanxi and Sichuan. Surveys were administered to health center administrators in sample THCs in June 2015.The results show that the generation rate of medical waste was about 0.18 kg/bed, 0.15 kg/patient, or 0.13 kg/person per day on average. Such per capita levels are significant given China's large rural population. Although investments of medical waste facilities and personnel in THCs have improved, results show that compliance with national regulations is low. For example, less than half of hazardous medical waste was packed in sealed containers or containers labeled with bio-hazard markings. None of the THCs segregated correctly according to the categories required by formal Chinese regulations. Many THCs reported improper disposal methods of medical waste. Our results also indicate low levels of staff training and low rates of centralized disposal in rural THCs.Medical waste is a serious environmental issue that is rising on the agenda of policymakers. While a large share of THCs has invested in medical waste facilities and personnel, it appears that actual compliance remains low. Using evidence of low rates of training and centralized disposal, we surmise that a lack of support from upper tiers of management is one contributing factor. Given these findings, we recommend that China's policymakers should enhance support from upper tiers and improve monitoring as well as incentives in order to improve medical waste management.

  View details for PubMedID 30028841

• 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

• Human Capital and the Middle Income Trap: How Many of China's Youth are Going to High School? DEVELOPING ECONOMIES Wang, L., Li, M., Abbey, C., Rozelle, S. 2018; 56 (2): 82–103

  View details for DOI 10.1111/deve.12165

  View details for Web of Science ID 000433595300003

• Parental Migration and Left-Behind Children's Depressive Symptoms: Estimation Based on a Nationally-Representative Panel Dataset INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH Zhou, M., Sun, X., Huang, L., Zhang, G., Kenny, K., Xue, H., Auden, E., Rozelle, S. 2018; 15 (6)

  Abstract

  China's rapid urbanization in the past several decades have been accompanied by rural labor migration. An important question that has emerged is whether rural labor migration has a positive or negative impact on the depressive symptoms of children left behind in the countryside by their migrating parents. This paper uses a nationally representative panel dataset to investigate whether parental migration impacts the prevalence of depressive symptoms among left-behind children in China. Using DID and PSM-DID methods, our results show that parental migration significantly increases the depression scores of 10 and 11-year-old children by 2 points using the CES-D depression scale. Furthermore, we also find that the negative effect of decreased parental care is stronger than the positive effect of increased income in terms of determining the depressive symptoms status of children in rural China.

  View details for PubMedID 29795049

• Revisiting the Role of Human Capital in Development: Discussion DEVELOPING ECONOMIES Fuwa, N., Kudo, Y., Otsuka, K., Thisse, J., Rozelle, S. 2018; 56 (2): 140–44

  View details for DOI 10.1111/deve.12168

  View details for Web of Science ID 000433595300006

• 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

• Prevalence and risk factors for Taenia solium cysticercosis in school-aged children: A school based study in western Sichuan, People's Republic of China PLOS NEGLECTED TROPICAL DISEASES Openshaw, J. J., Medina, A., Felt, S. A., Li, T., Huan, Z., Rozelle, S., Luby, S. P. 2018; 12 (5)

  View details for DOI 10.1371/journal.pntd.0006465

  View details for Web of Science ID 000434021900026

• Depressive Symptoms of Chinese Children: Prevalence and Correlated Factors among Subgroups INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH Zhou, M., Zhang, G., Rozelle, S., Kenny, K., Xue, H. 2018; 15 (2)

  Abstract

  Economic growth and socioeconomic changes have transformed nearly every aspect of childhood in China, and many are worried by the increasing prevalence of mental health issues among children, particularly depression. To provide insight into the distribution of depressive symptoms among children in China and identify vulnerable groups, we use data from the 2012 China Family Panel Survey (CFPS), a survey that collected data from a large, nationally representative sample of the Chinese population. Using the CFPS data, we construct a sample of 2679 children aged 10-15 years old from 25 provinces in China. According to our results, the incidence of depression varies by geographic area. Specifically, we find that rates of depressive symptoms are significantly lower in urban areas (14% of sample children) than in rural areas (23% of sample children). Our results also show that children from ethnic minorities, from poorer families, and whose parents are depressed are more likely to be depressed than other children. In contrast, we find that depressive symptoms do not vary by gender.

  View details for PubMedID 29414881

• Using daily text messages to improve adherence to infant micronutrient powder (MNP) packets in rural western China: A cluster-randomized controlled trial PLOS ONE Wang, X., Luo, R., Liu, C., Zhang, L., Yue, A., Medina, A., Rozelle, S. 2018; 13 (1): e0191549

  Abstract

  To evaluate the effectiveness of daily text messages as a means to improve caregivers' adherence to infant micronutrient powder (MNP) in rural Shaanxi Province of China.638 infants aged 6-11 months in 234 villages were involved in a cluster-randomized controlled trial (RCT). All caregivers were given free infant MNP packets at baseline in April 2013 and the follow-up survey was in July 2013. We randomly assigned 318 infants in 117 villages to treatment group (receiving daily text message) and 320 infants in the other 117 villages as control group.On average, daily text messages increased the number of MNP packets fed (marginal effect = 4.63; 95% confidence interval (CI) = 0.16, 9.10). The text message is more likely to increase the consumption of MNP packets if the primary caregiver was the mother (marginal effect = 12.19; 95% CI = 0.69, 23.68). Receiving the text message appears to significantly increase the likelihood of full adherence when the primary caregiver can either check (odds ratio = 2.93; 95% CI = 1.34, 6.40) or knows how to send (odds ratio = 3.26; 95% CI = 1.53, 6.97) text messages.Daily text messages improved the consumption of infant MNP packets. However, the impact was not large enough to increase the probability of caregivers being fully adherent to the feeding instruction, which is to feed 5-7 packets per week as recommended. In addition, when the mother is the caregiver and when the caregiver can check or knows how to send text messages there is greater adherence by the primary caregivers.http://www.isrctn.com/ISRCTN44149146.

  View details for PubMedID 29352304

• Prevalence and risk factors for Taenia solium cysticercosis in school-aged children: A school based study in western Sichuan, People's Republic of China. PLoS neglected tropical diseases Openshaw, J. J., Medina, A. n., Felt, S. A., Li, T. n., Huan, Z. n., Rozelle, S. n., Luby, S. P. 2018; 12 (5): e0006465

  Abstract

  Taenia solium cysticercosis affects millions of impoverished people worldwide and can cause neurocysticercosis, an infection of the central nervous system which is potentially fatal. Children may represent an especially vulnerable population to neurocysticercosis, due to the risk of cognitive impairment during formative school years. While previous epidemiologic studies have suggested high prevalence in rural China, the prevalence in children as well as risk factors and impact of disease in low-resource areas remain poorly characterized.Utilizing school based sampling, we conducted a cross-sectional study, administering a questionnaire and collecting blood for T. solium cysticercosis antibodies in 2867 fifth and sixth grade students across 27 schools in west Sichuan. We used mixed-effects logistic regression models controlling for school-level clustering to study associations between risk factors and to characterize factors influencing the administration of deworming medication. Overall prevalence of cysticercosis antibodies was 6%, but prevalence was significantly higher in three schools which all had prevalences of 15% or higher. Students from households owning pigs (adjusted odds ratio [OR] 1.81, 95% CI 1.08-3.03), from households reporting feeding their pigs human feces (adjusted OR 1.49, 95% CI 1.03-2.16), and self-reporting worms in their feces (adjusted OR 1.85, 95% CI 1.18-2.91) were more likely to have cysticercosis IgG antibodies. Students attending high prevalence schools were more likely to come from households allowing pigs to freely forage for food (OR 2.26, 95% CI 1.72-2.98) and lacking a toilet (OR 1.84, 95% CI 1.38-2.46). Children who were boarding at school were less likely to have received treatment for gastrointestinal worms (adjusted OR 0.58, 95% CI 0.42-0.80).Our study indicates high prevalences of cysticercosis antibodies in young school aged children in rural China. While further studies to assess potential for school-based transmission are needed, school-based disease control may be an important intervention to ensure the health of vulnerable pediatric populations in T. solium endemic areas.

  View details for PubMedID 29738570

  View details for PubMedCentralID PMC5959190

• China's 40 years of agricultural development and reform CHINA'S 40 YEARS OF REFORM AND DEVELOPMENT 1978-2018 Huang, J., Rozelle, S., Garnaut, R., Song, L., Fang, C. 2018: 487-506

  View details for Web of Science ID 000518631300024

• EVIDENCE CONSISTENT WITH SCHOOL BASED TRANSMISSION OF <it>TAENIA SOLIUM</it> CYSTICERCOSIS IN PRIMARY SCHOOLS, SOUTHWEST CHINA Openshaw, J., Chedid, C., Medina, A., Felt, S., Li, T., Huan, Z., Rozelle, S., Luby, S. AMER SOC TROP MED & HYGIENE. 2018: 7

  View details for Web of Science ID 000461386602022

• Ability tracking and social trust in China's rural secondary school system SCHOOL EFFECTIVENESS AND SCHOOL IMPROVEMENT Li, F., Loyalka, P., Yi, H., Shi, Y., Johnson, N., Rozelle, S. 2018; 29 (4): 545–72

  View details for DOI 10.1080/09243453.2018.1480498

  View details for Web of Science ID 000449356000003

• The relationship between birth season and early childhood development: Evidence from northwest rural China. PloS one Bai, Y., Shang, G., Wang, L., Sun, Y., Osborn, A., Rozelle, S. 2018; 13 (10): e0205281

  Abstract

  OBJECTIVE: To examine the correlation between birth season and early childhood development.BACKGROUND: Almost all previous studies that examine the effect of birth season on early childhood development were conducted in developed countries with a limited sample size. The present study was conducted in poor, rural areas of western China, a developing region with a continental monsoon climate.METHOD: We administered a hemoglobin test to 650 infants (52% boys), aged 8-10 months, using a Hemocue Hb 201+ finger prick system, and assessed the cognitive and psychomotor development of sample infants using Bayley Scales of Infant Development.RESULTS: Infants born in winter have higher Hb concentrations (t = 3.63, p < 0.001) compared to infants born in summer. Similarly, cognitive development scores (t = 5.17, p < 0.001) and psychomotor development scores (t = 10.60, p < 0.001) were significantly higher among winter-born infants.CONCLUSION: The findings point to the involvement of birth season in early childhood development and suggest that aspects of the environment shape the experiences that contribute to early childhood development. Policy suggestions such as providing infants with ample opportunities for movement and stimulation during the cold season are discussed.

  View details for PubMedID 30307998

• Effect of Parental Migration on the Academic Performance of Left Behind Children in North Western China JOURNAL OF DEVELOPMENT STUDIES Bai, Y., Zhang, L., Liu, C., Shi, Y., Mo, D., Rozelle, S. 2018; 54 (7): 1154–70

  View details for DOI 10.1080/00220388.2017.1333108

  View details for Web of Science ID 000430489200007

• Rural education across China's 40 years of reform: past successes and future challenges CHINA AGRICULTURAL ECONOMIC REVIEW Yue, A., Tang, B., Shi, Y., Tang, J., Shang, G., Medina, A., Rozelle, S. 2018; 10 (1): 93–118

  View details for DOI 10.1108/CAER-11-2017-0222

  View details for Web of Science ID 000419733400008

• Ethnicity and MCH outcomes: widening gaps across time and space LANCET GLOBAL HEALTH Wang, L., Rozelle, S. 2018; 6 (1): E2–E3

  View details for PubMedID 29153767

• Migration, Schooling Choice, and Student Outcomes in China POPULATION AND DEVELOPMENT REVIEW Wang, X., Bai, Y., Zhang, L., Rozelle, S. 2017; 43 (4): 625-+

  View details for DOI 10.1111/padr.12101

  View details for Web of Science ID 000418096800002

• Tuberculosis detection and the cost of integrated care in rural China: a cross-sectional standardised patient study Sylvia, S., Xue, H., Zhou, C., Shi, Y., Yi, H., Zhou, H., Rozelle, S., Pai, M., Das, J. ELSEVIER SCIENCE INC. 2017: S60

  View details for Web of Science ID 000440459400061

• The quality of primary care and correlates among grassroots providers in rural China: a cross-sectional standardised patient study Shi, Y., Yi, H., Zhou, H., Zhou, C., Xue, H., Rozelle, S., Medina, A., Sylvia, S. ELSEVIER SCIENCE INC. 2017: S16

  View details for Web of Science ID 000440459400017

• High prevalence of Taenia solium taeniasis and cysticercosis in Tibetan schoolchildren in western Sichuan, China: a cross-sectional study Li, T., Openshaw, J. J., Chen, X., Medina, A. C., Felt, S. A., Zhou, H., Rozelle, S. D., Luby, S. P. ELSEVIER SCIENCE INC. 2017: S89

  View details for Web of Science ID 000440459400090

• 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

• TAENIA SOLIUM AND NEUROCYSTICERCOSIS BURDEN AND DECREASED ACADEMIC PERFORMANCE ASSOCIATED WITH BRAIN INFECTION IN SCHOOL AGED CHILDREN, SOUTHWEST CHINA Openshaw, J. J., Medina, A., Felt, S. A., Li, T., Huan, Z., Rozelle, S., Luby, S. P. AMER SOC TROP MED & HYGIENE. 2017: 139–40

  View details for Web of Science ID 000412851501447

• Tuberculosis detection and the challenges of integrated care in rural China: A cross-sectional standardized patient study PLOS MEDICINE Sylvia, S., Xue, H., Zhou, C., Shi, Y., Yi, H., Zhou, H., Rozelle, S., Pai, M., Das, J. 2017; 14 (10): e1002405

  Abstract

  Despite recent reductions in prevalence, China still faces a substantial tuberculosis (TB) burden, with future progress dependent on the ability of rural providers to appropriately detect and refer TB patients for further care. This study (a) provides a baseline assessment of the ability of rural providers to correctly manage presumptive TB cases; (b) measures the gap between provider knowledge and practice and; (c) evaluates how ongoing reforms of China's health system-characterized by a movement toward "integrated care" and promotion of initial contact with grassroots providers-will affect the care of TB patients.Unannounced standardized patients (SPs) presenting with classic pulmonary TB symptoms were deployed in 3 provinces of China in July 2015. The SPs successfully completed 274 interactions across all 3 tiers of China's rural health system, interacting with providers in 46 village clinics, 207 township health centers, and 21 county hospitals. Interactions between providers and standardized patients were assessed against international and national standards of TB care. Using a lenient definition of correct management as at least a referral, chest X-ray or sputum test, 41% (111 of 274) SPs were correctly managed. Although there were no cases of empirical anti-TB treatment, antibiotics unrelated to the treatment of TB were prescribed in 168 of 274 interactions or 61.3% (95% CI: 55%-67%). Correct management proportions significantly higher at county hospitals compared to township health centers (OR 0.06, 95% CI: 0.01-0.25, p < 0.001) and village clinics (OR 0.02, 95% CI: 0.0-0.17, p < 0.001). Correct management in tests of knowledge administered to the same 274 physicians for the same case was 45 percentage points (95% CI: 37%-53%) higher with 24 percentage points (95% CI: -33% to -15%) fewer antibiotic prescriptions. Relative to the current system, where patients can choose to bypass any level of care, simulations suggest that a system of managed referral with gatekeeping at the level of village clinics would reduce proportions of correct management from 41% to 16%, while gatekeeping at the level of the township hospital would retain correct management close to current levels at 37%. The main limitations of the study are 2-fold. First, we evaluate the management of a one-time new patient presenting with presumptive TB, which may not reflect how providers manage repeat patients or more complicated TB presentations. Second, simulations under alternate policies require behavioral and statistical assumptions that should be addressed in future applications of this method.There were significant quality deficits among village clinics and township health centers in the management of a classic case of presumptive TB, with higher proportions of correct case management in county hospitals. Poor clinical performance does not arise only from a lack of knowledge, a phenomenon known as the "know-do" gap. Given significant deficits in quality of care, reforms encouraging first contact with lower tiers of the health system can improve efficiency only with concomitant improvements in appropriate management of presumptive TB patients in village clinics and township health centers.

  View details for PubMedID 29040263

• The effect of a micronutrient powder home fortification program on anemia and cognitive outcomes among young children in rural China: a cluster randomized trial BMC PUBLIC HEALTH Luo, R., Yue, A., Zhou, H., Shi, Y., Zhang, L., Martorell, R., Medina, A., Rozelle, S., Sylvia, S. 2017; 17: 738

  Abstract

  Anemia early in life has been associated with delayed cognitive and motor development. The WHO recommends home fortification using multiple micronutrient powders (MNPs) containing iron as a strategy to address anemia in children under two. We evaluated the effects of a program freely distributing MNP sachets to caregivers of infants in rural China.We conducted a cluster-randomized controlled trial in Shaanxi province, enrolling all children aged 6-11 months in target villages. Following a baseline survey, investigators randomly assigned each village/cluster to a control or treatment group. In the treatment group, caregivers were instructed to give MNPs daily. Follow-up was after 6, 12, and 18 months of intervention. Primary outcomes were hemoglobin concentrations and scores on the Bayley Scales of Infant Development.One thousand, eight hundred and-two eligible children and their caregivers were enrolled. At baseline 48% (870) of children were anemic and 29% (529) were developmentally delayed. Six hundred and-ten children (117 villages) were assigned to the control group and 1192 children (234 villages) were assigned to the treatment group. Assignment to the treatment group was associated with an improvement in hemoglobin levels (marginal effect 1.77 g/L, 95% CI 0.017-3.520, p-value = 0.048) and cognitive development (marginal effect 2.23 points, 95% CI 0.061-4.399, p-value = 0.044) after 6 months but not thereafter. There were no significant effects on motor development. Zero effects after the first 6 months were not due to low compliance, low statistical power, or changes in feeding behavior. Hemoglobin concentrations improved in both the treatment and control groups over the course of the study; however, 22% (325) of children remained anemic at endline, and 48% (721) were cognitively delayed.Providing caregivers with MNP sachets modestly hastened improvement in hemoglobin levels that was occurring absent intervention; however, this improvement did not translate into improved developmental outcomes at endline.ISRCTN44149146 ; prospectively registered on 15th April 2013.

  View details for PubMedID 28946866

• Local governance and the quality of local infrastructure: Evidence from village road projects in rural China JOURNAL OF PUBLIC ECONOMICS Wong, H., Wang, Y., Luo, R., Zhang, L., Rozelle, S. 2017; 152: 119–32

  View details for DOI 10.1016/j.jpubeco.2017.06.006

  View details for Web of Science ID 000407184700010

• China's Invisible Crisis: Cognitive Delays among Rural Toddlers and the Absence of Modern Parenting CHINA JOURNAL Yue, A., Shi, Y., Luo, R., Chen, J., Garth, J., Zhang, J., Medina, A., Kotb, S., Rozelle, S. 2017; 78: 50–80

  View details for DOI 10.1086/692290

  View details for Web of Science ID 000402990900003

• The Impact of an Academic High School Tuition Relief Program on Students' Matriculation into High Schools in Rural China CHINA ECONOMIC REVIEW Bai, Y., Zhang, L., Yi, H., Zheng, L., Rozelle, S. 2017; 43: 16-28

  View details for DOI 10.1016/j.chieco.2016.12.003

  View details for Web of Science ID 000399269100002

• Rural Solid Waste Management in China: Status, Problems and Challenges SUSTAINABILITY Wang, A., Zhang, L., Shi, Y., Rozelle, S., Osborn, A., Yang, M. 2017; 9 (4)

  View details for DOI 10.3390/su9040506

  View details for Web of Science ID 000402090300029

• The impact of conditional cash transfers on the matriculation of junior high school students into rural China's high schools JOURNAL OF DEVELOPMENT EFFECTIVENESS Li, F., Song, Y., Yi, H., Wei, J., Zhang, L., Shi, Y., Chu, J., Johnson, N., Loyalka, P., Rozelle, S. 2017; 9 (1): 41-60

  View details for DOI 10.1080/19439342.2016.1231701

  View details for Web of Science ID 000392506400003

• Off-farm employment and agricultural specialization in China CHINA ECONOMIC REVIEW Wang, X., Huang, J., Rozelle, S. 2017; 42: 155-165

  View details for DOI 10.1016/j.chieco.2016.09.004

  View details for Web of Science ID 000394631600010

• Effect of Deworming on Indices of Health, Cognition, and Education among Schoolchildren in Rural China: A Cluster-Randomized Controlled Trial. The American journal of tropical medicine and hygiene Liu, C., Lu, L., Zhang, L., Luo, R., Sylvia, S., Medina, A., Rozelle, S., Smith, D. S., Chen, Y., Zhu, T. 2017

  Abstract

  Soil-transmitted helminths (STHs) infect over one billion people worldwide. There is concern that chronic infection with STHs among school-aged children may detrimentally affect their development, including their health, cognition, and education. However, two recent Cochrane reviews examining the impact of deworming drugs for STH on nutrition, hemoglobin, and school performance found that randomized controlled trials (RCTs) in the literature provide an insufficient evidence base to draw reliable conclusions. This study uses a cluster-RCT to add to existing evidence by assessing the impact of a deworming intervention on nutrition, cognition, and school performance among schoolchildren in rural China. The intervention, implemented by local health practitioners in a setting with a baseline infection prevalence of 41.9% (95% confidence interval [CI] = 39.8%, 43.9%) and infection intensity of 599.5 eggs per gram of feces among positive-tested schoolchildren (95% CI = 473.2, 725.8), consisted of distributing a 400-mg dose of albendazole accompanied with educational training about STH infection, treatment, and prevention. The intervention was conducted twice over the course of the study-at baseline in May 2013 and later in November 2013. We found that the deworming intervention reduced both infection prevalence and infection intensity, but these declines in infection were not accompanied by an impact on outcomes of nutrition, cognition, or school performance. Our interpretation is that the impact of deworming was attenuated by the light infection intensity in our sample population. Evidence from future RCTs is needed to assess the effect of deworming on key outcomes in areas with moderate and severe worm infections.

  View details for DOI 10.4269/ajtmh.16-0354

  View details for PubMedID 28093533

• The impact of investment on drinking water quality in rural China CHINA AGRICULTURAL ECONOMIC REVIEW Yue, A., Shi, Y., Luo, R., Zhang, L., Johnson, N., Rozelle, S., Zhao, Q. 2017; 9 (2): 255-269

  View details for DOI 10.1108/CAER-05-2015-0062

  View details for Web of Science ID 000401004900007

• The Education Gap of China's Migrant Children and Rural Counterparts JOURNAL OF DEVELOPMENT STUDIES Wang, X., Luo, R., Zhang, L., Rozelle, S. 2017; 53 (11): 1865–81

  View details for DOI 10.1080/00220388.2016.1274395

  View details for Web of Science ID 000414712000006

• More Poop, More Precision: Improving Epidemiologic Surveillance of Soil-Transmitted Helminths with Multiple Fecal Sampling using the Kato-Katz Technique AMERICAN JOURNAL OF TROPICAL MEDICINE AND HYGIENE Liu, C., Lu, L., Zhang, L., Bai, Y., Medina, A., Rozelle, S., Smith, D., Zhou, C., Zang, W. 2017; 97 (3): 870–75

  Abstract

  Soil-transmitted helminths, or parasitic intestinal worms, are among the most prevalent and geographically widespread parasitic infections in the world. Accurate diagnosis and quantification of helminth infection are critical for informing and assessing deworming interventions. The Kato-Katz thick smear technique, the most widely used laboratory method to quantitatively assess infection prevalence and infection intensity of helminths, has often been compared with other methods. Only a few small-scale studies, however, have considered ways to improve its diagnostic sensitivity. This study, conducted among 4,985 school-age children in an area of rural China with moderate prevalence of helminth infection, examines the effect on diagnostic sensitivity of the Kato-Katz technique when two fecal samples collected over consecutive days are examined and compared with a single sample. A secondary aim was to consider cost-effectiveness by calculating an estimate of the marginal costs of obtaining an additional fecal sample. Our findings show that analysis of an additional fecal sample led to increases of 23%, 26%, and 100% for Ascaris lumbricoides, Trichuris trichiura, and hookworm prevalence, respectively. The cost of collecting a second fecal sample for our study population was approximately USD4.60 per fecal sample. Overall, the findings suggest that investing 31% more capital in fecal sample collection prevents an underestimation of prevalence by about 21%, and hence improves the diagnostic sensitivity of the Kato-Katz method. Especially in areas with light-intensity infections of soil-transmitted helminths and limited public health resources, more accurate epidemiological surveillance using multiple fecal samples will critically inform decisions regarding infection control and prevention.

  View details for PubMedID 28722571

  View details for PubMedCentralID PMC5590569

• Human Capital and China's Future Growth JOURNAL OF ECONOMIC PERSPECTIVES Li, H., Loyalka, P., Rozelle, S., Wu, B. 2017; 31 (1): 25-48

  View details for DOI 10.1257/jep.31.1.25

  View details for Web of Science ID 000393699100002

• China's Looming Human Capital Crisis: Upper Secondary Educational Attainment Rates and the Middle-income Trap CHINA QUARTERLY Khor, N., Pang, L., Liu, C., Chang, F., Mo, D., Loyalka, P., Rozelle, S. 2016; 228: 905-926

  View details for DOI 10.1017/S0305741016001119

  View details for Web of Science ID 000393109200003

• More is not always better: evidence from a randomised experiment of computer-assisted learning in rural minority schools in Qinghai JOURNAL OF DEVELOPMENT EFFECTIVENESS Lai, F., Zhang, L., Bai, Y., Liu, C., Shi, Y., Chang, F., Rozelle, S. 2016; 8 (4): 449-472

  View details for DOI 10.1080/19439342.2016.1220412

  View details for Web of Science ID 000387762200001

• The gender gap among school children in poor rural areas of western China: evidence from a multi-province dataset INTERNATIONAL JOURNAL FOR EQUITY IN HEALTH Zhou, H., Mo, D., Zhou, C., Medina, A., Shi, Y., Zhang, L., Rozelle, S. 2016; 15

  Abstract

  The gender gap remains a major impediment in the path towards equality and it is especially wide in low-income countries. Up to the early 2000s, many studies documented extensive inequalities in China: girls had poorer health, less nutrition and less education than their male counterparts. The goal of this study is to examine whether the gender gap persists, given that China is now making the transition into the ranks of upper-middle income countries. We consider educational outcomes, mental and physical health status, as well as non-cognitive outcomes.We draw on a dataset containing 69,565 observations constructed by combining data from 7 different school-level surveys spanning 5 provinces. The surveys were all conducted by the authors between 2008 and 2013 using uniform survey instruments and data collection protocols in randomly selected schools across western provinces in rural China. The sample children range in age from 9 to 14 years (with 79 % of the sample being aged 10 to 12). Our analysis compares rural girls with rural boys in terms of 13 different indicators.With the exception of anemia rates, the health outcomes of girls are equal to those of boys. Girls and boys are statistically identical in terms of weight-for-age, height-for-age, and prevalence of intestinal worm infections. Girls performed better than boys on five of six cognitive and educational performance indicators. Girls performed worse than boys on all mental health indicators. All estimates are robust to the inclusion of different age ranges, controlling for the level of household assets, ethnic minority status, as well as the addition of provincial dummies.Our findings suggest that with the exception of non-cognitive outcomes, anemia and standardized math test scores, the gender gap in our study areas in China appears to be diminishing.

  View details for DOI 10.1186/s12939-016-0442-5

  View details for Web of Science ID 000384376800004

  View details for PubMedID 27686497

  View details for PubMedCentralID PMC5041561

• 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

• Impact of Text Message Reminders on Caregivers' Adherence to a Home Fortification Program Against Child Anemia in Rural Western China: A Cluster-Randomized Controlled Trial AMERICAN JOURNAL OF PUBLIC HEALTH Zhou, H., Sun, S., Luo, R., Sylvia, S., Yue, A., Shi, Y., Zhang, L., Medina, A., Rozelle, S. 2016; 106 (7): 1256-1262

  Abstract

  To test whether text message reminders sent to caregivers improve the effectiveness of a home micronutrient fortification program in western China.We carried out a cluster-randomized controlled trial in 351 villages (clusters) in Shaanxi Province in 2013 and 2014, enrolling children aged 6 to 12 months. We randomly assigned each village to 1 of 3 groups: free delivery group, text messaging group, or control group. We collected information on compliance with treatments and hemoglobin concentrations from all children at baseline and 6-month follow-up. We estimated the intent-to-treat effects on compliance and child anemia using a logistic regression model.There were 1393 eligible children. We found that assignment to the text messaging group led to an increase in full compliance (marginal effect = 0.10; 95% confidence interval [CI] = 0.03, 0.16) compared with the free delivery group and decrease in the rate of anemia at end line relative to the control group (marginal effect = -0.07; 95% CI = -0.12, -0.01), but not relative to the free delivery group (marginal effect = -0.03; 95% CI = -0.09, 0.03).Text messages improved compliance of caregivers to a home fortification program and children's nutrition.

  View details for DOI 10.2105/AJPH.2016.303140

  View details for Web of Science ID 000377939700048

  View details for PubMedID 27077354

  View details for PubMedCentralID PMC4984765

• Who drops out from primary schools in China? Evidence from minority-concentrated rural areas ASIA PACIFIC EDUCATION REVIEW Lu, M., Cui, M., Shi, Y., Chang, F., Mo, D., Rozelle, S., Johnson, N. 2016; 17 (2): 235-252

  View details for DOI 10.1007/s12564-016-9421-1

  View details for Web of Science ID 000376414300005

• Gender and Off-farm Employment: Evidence from Rural China CHINA & WORLD ECONOMY Wang, X., Han, L., Huang, J., Zhang, L., Rozelle, S. 2016; 24 (3): 18-36

  View details for DOI 10.1111/cwe.12156

  View details for Web of Science ID 000379957200003

• Introduction: China's Rural Economy And Human Captial CHINA & WORLD ECONOMY Rozelle, S., Zhang, L. 2016; 24 (3): 1-2

  View details for DOI 10.1111/cwe.12154

  View details for Web of Science ID 000379957200001

• Effects of Parental Migration on Mental Health of Left-behind Children: Evidence from Northwestern China CHINA & WORLD ECONOMY Shi, Y., Bai, Y., Shen, Y., Kenny, K., Rozelle, S. 2016; 24 (3): 105-122

  View details for DOI 10.1111/cwe.12161

  View details for Web of Science ID 000379957200008

• Are Children with Siblings Really More Vulnerable Than Only Children in Health, Cognition and Non-cognitive Outcomes? Evidence from a Multi-province Dataset in China CHINA & WORLD ECONOMY Zhou, H., Mo, D., Luo, R., Yue, A., Rozelle, S. 2016; 24 (3): 3-17

  View details for DOI 10.1111/cwe.12155

  View details for Web of Science ID 000379957200002

• The impact of integrating ICT with teaching: Evidence from a randomized controlled trial in rural schools in China COMPUTERS & EDUCATION Bai, Y., Mo, D., Zhang, L., Boswell, M., Rozelle, S. 2016; 96: 1-14

  View details for DOI 10.1016/j.compedu.2016.02.005

  View details for Web of Science ID 000373869200001

• Reply. American journal of ophthalmology Ma, X., Congdon, N., Yi, H., Pang, X., Zhou, Z., Meltzer, M. E., He, M., Yizhi, L., Shi, Y., Rozelle, S. 2016; 163: 196-197

  View details for DOI 10.1016/j.ajo.2015.12.022

  View details for PubMedID 26774336

• Are China's Farms Growing? CHINA & WORLD ECONOMY Ji, X., Rozelle, S., Huang, J., Zhang, L., Zhang, T. 2016; 24 (1): 41-62

  View details for DOI 10.1111/cwe.12143

  View details for Web of Science ID 000373001200003

• Trends and determinants of rural residential solid waste collection services in China CHINA AGRICULTURAL ECONOMIC REVIEW Wang, A., Shi, Y., Gao, Q., Liu, C., Zhang, L., Johnson, N., Rozelle, S. 2016; 8 (4): 698-710

  View details for DOI 10.1108/CAER-08-2015-0101

  View details for Web of Science ID 000386790000011

• The new rural social pension program in rural China: participation and its correlates CHINA AGRICULTURAL ECONOMIC REVIEW Zhao, Q., Brosig, S., Luo, R., Zhang, L., Yue, A., Rozelle, S. 2016; 8 (4): 647-661

  View details for DOI 10.1108/CAER-07-2016-0116

  View details for Web of Science ID 000386790000008

• Parental migration and smoking behavior of left-behind children: evidence from a survey in rural Anhui, China. International journal for equity in health Yang, T., Li, C., Zhou, C., Jiang, S., Chu, J., Medina, A., Rozelle, S. 2016; 15 (1): 127-?

  Abstract

  Parental migration is most an important factor affecting children's behaviors. Few studies have addressed the association between parental migration and children's smoking behavior in China. This study aims to estimate the current smoking prevalence among children, evaluate the association of parental migration and the smoking behavior of children and identify factors associated with smoking behavior among left-behind children (LBC).A cross-sectional study was conducted in 6 cities in Anhui province during July and August, 2012. All participants were interviewed face-to-face using a standardized questionnaire. Only children 10 to 14 years old that live in rural villages for at least 6 months during the previous year were included in the study.A total of 1343 children met the sampling criteria and participated in the study. Of these, 56 % are LBC and 44 % live with both parents. The average rate of smoking is 3.4 %. The rate of smoking is statistically higher for LBC with both parents out (rate = 6.1 %; OR = 5.59, P < 0.001) than for children living with both parents (1.4 %). Similarly, the rate of LBC with father home only (rate = 5.0 %; OR = 5.60, P = 0.005) is also statistically higher than for children living with both parents when controlling other variables. Factors affecting the smoking behavior of LBC, include gender (i.e., boys), (perceived) school performance and primary caregiver.Parental migration is associated with a significant increase in smoking behavior among children. Intervention studies that target LBC would help to develop strategies to reduce smoking among rural children. Gender-specific strategies and anti-smoking education also appears to be needed to reduce tobacco use among rural LBC.

  View details for DOI 10.1186/s12939-016-0416-7

  View details for PubMedID 27491773

  View details for PubMedCentralID PMC4974696

• Maternal health services in China's western rural areas: uptake and correlates CHINA AGRICULTURAL ECONOMIC REVIEW Liu, C., Zhang, L., Shi, Y., Zhou, H., Medina, A., Rozelle, S. 2016; 8 (2): 250-276

  View details for DOI 10.1108/CAER-12-2014-0148

  View details for Web of Science ID 000376119300005

• Nutritional Deficiencies, the Absence of Information and Caregiver Shortcomings: A Qualitative Analysis of Infant Feeding Practices in Rural China. PloS one Yue, A., Marsh, L., Zhou, H., Medina, A., Luo, R., Shi, Y., Zhang, L., Kenny, K., Rozelle, S. 2016; 11 (4)

  Abstract

  Development during the first two years of life is critical and has a lasting impact on a child's health. Poor infant and child nutrition can lead to deficiencies in essential micronutrients, which may cause a weakened immune system and lasting effects on children's growth and development. Recent studies in rural Shaanxi Province found an anemia prevalence of 54.3% among rural children aged six to twelve months. While new large-scale, quantitative research has begun to catalogue the extent of child malnutrition and anemia, no effort has yet been made to look more closely at the potential reasons for rural children's nutritional deficiencies through qualitative analysis. This study aims to elucidate some of the fundamental causes of poor complementary feeding practices that may lead to anemia among children in rural Shaanxi Province, China.We interviewed sixty caregivers participating in a large survey on child health and nutrition. We conducted three waves of interviews with children's primary caregivers in seventeen rural villages within four nationally-designated poverty counties in the southern part of Shaanxi Province.The qualitative analysis reveals that poor complementary feeding practices are common across our sample. Information gathered from our interviews suggests that complementary feeding practices are impeded by two constraints: absence of understanding topics related to infant health and nutrition under caregivers, as well as inadequate sources of information on these topics. Poverty does not appear to constrain child feeding practices.Our results uncover lack of proper knowledge on infant and child nutrition among rural caregivers in China. This situation causes them to fail incorporating micronutrient rich foods in their children's diet. Age-appropriate complementary feeding can stimulate children's physical and cognitive development, but in its absence it leads to iron-deficiency anemia. We suggest that steps be taken to educate caregivers to improve complementary feeding of their infants and children.

  View details for DOI 10.1371/journal.pone.0153385

  View details for PubMedID 27073864

  View details for PubMedCentralID PMC4830571

• 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

• Population Prevalence of Need for Spectacles and Spectacle Ownership Among Urban Migrant Children in Eastern China. JAMA ophthalmology Wang, X., Yi, H., Lu, L., Zhang, L., Ma, X., Jin, L., Zhang, H., Naidoo, K. S., Minto, H., Zou, H., Rozelle, S., Congdon, N. 2015; 133 (12): 1399-406

  Abstract

  The number of urban migrants in China is 300 million and is increasing rapidly in response to government policies. Urban migrants have poor access to health care, but little is known about rates of correction of refractive error among migrant children. This is of particular significance in light of recent evidence demonstrating the educational impact of providing children with spectacles.To measure prevalence of spectacle need and ownership among Chinese migrant children.Population-based, cross-sectional study among children who failed vision testing (uncorrected visual acuity ≤6/12 in either eye) between September 15 and 30, 2013, at 94 randomly selected primary schools in predominantly migrant communities in Shanghai, Suzhou, and Wuxi, China.Refractive error by cycloplegic refraction; spectacle ownership, defined as producing glasses at school, having been told to bring them; and needing glasses, defined as uncorrected visual acuity of 6/12 or less correctable to greater than 6/12 in either eye, with myopia of -0.5 diopters (D) or less, hyperopia of +2.0 D or greater, or astigmatism of 0.75 D or greater in both eyes.Among 4409 children, 4376 (99.3%) completed vision screening (mean [SD] age, 11.0 [0.81] years; 55.3% boys; 4225 [96.5%] migrant and 151 [3.5%] local). Among 1204 children failing vision testing (total, 27.5%; 1147 migrant children [27.1%] vs 57 local children [37.7%]; P = .003), 850 (70.6%) completed refraction. Spectacle ownership in migrant children needing glasses (147 of 640 children [23.0%]) was less than among local children (12 of 34 children [35.3%]) (odds ratio = 0.55; 95% CI, 0.32-0.95; P = .03). Having uncorrected visual acuity less than 6/18 in both eyes was associated positively with baseline spectacle ownership (odds ratio = 5.73; 95% CI, 3.81-8.62; P < .001), but parental education and family wealth were not.Among urban migrant children, there was a high prevalence of need for spectacles and a very low rate of spectacle ownership. Spectacle distribution programs are needed specifically targeting migrant children.

  View details for DOI 10.1001/jamaophthalmol.2015.3513

  View details for PubMedID 26426113

• Persistence of learning gains from computer assisted learning: Experimental evidence from China JOURNAL OF COMPUTER ASSISTED LEARNING Mo, D., Zhang, L., Wang, J., Huang, W., Shi, Y., Boswell, M., Rozelle, S. 2015; 31 (6): 562-581

  View details for DOI 10.1111/jcal.12106

  View details for Web of Science ID 000367655100006

• Population Prevalence of Need for Spectacles and Spectacle Ownership Among Urban Migrant Children in Eastern China JAMA OPHTHALMOLOGY Wang, X., Yi, H., Lu, L., Zhang, L., Ma, X., Jin, L., Zhang, H., Naidoo, K. S., Minto, H., Zou, H., Rozelle, S., Congdon, N. 2015; 132 (12): 1399-1406

  Abstract

  The number of urban migrants in China is 300 million and is increasing rapidly in response to government policies. Urban migrants have poor access to health care, but little is known about rates of correction of refractive error among migrant children. This is of particular significance in light of recent evidence demonstrating the educational impact of providing children with spectacles.To measure prevalence of spectacle need and ownership among Chinese migrant children.Population-based, cross-sectional study among children who failed vision testing (uncorrected visual acuity ≤6/12 in either eye) between September 15 and 30, 2013, at 94 randomly selected primary schools in predominantly migrant communities in Shanghai, Suzhou, and Wuxi, China.Refractive error by cycloplegic refraction; spectacle ownership, defined as producing glasses at school, having been told to bring them; and needing glasses, defined as uncorrected visual acuity of 6/12 or less correctable to greater than 6/12 in either eye, with myopia of -0.5 diopters (D) or less, hyperopia of +2.0 D or greater, or astigmatism of 0.75 D or greater in both eyes.Among 4409 children, 4376 (99.3%) completed vision screening (mean [SD] age, 11.0 [0.81] years; 55.3% boys; 4225 [96.5%] migrant and 151 [3.5%] local). Among 1204 children failing vision testing (total, 27.5%; 1147 migrant children [27.1%] vs 57 local children [37.7%]; P = .003), 850 (70.6%) completed refraction. Spectacle ownership in migrant children needing glasses (147 of 640 children [23.0%]) was less than among local children (12 of 34 children [35.3%]) (odds ratio = 0.55; 95% CI, 0.32-0.95; P = .03). Having uncorrected visual acuity less than 6/18 in both eyes was associated positively with baseline spectacle ownership (odds ratio = 5.73; 95% CI, 3.81-8.62; P < .001), but parental education and family wealth were not.Among urban migrant children, there was a high prevalence of need for spectacles and a very low rate of spectacle ownership. Spectacle distribution programs are needed specifically targeting migrant children.

  View details for DOI 10.1001/jamaophthalmol.2015.3513

  View details for Web of Science ID 000367091300007

• Computer technology in education: Evidence from a pooled study of computer assisted learning programs among rural students in China CHINA ECONOMIC REVIEW Mo, D., Huang, W., Shi, Y., Zhang, L., Boswell, M., Rozelle, S. 2015; 36: 131-145

  View details for DOI 10.1016/j.chieco.2015.09.001

  View details for Web of Science ID 000366342500009

• Impact of Free Glasses and a Teacher Incentive on Children's Use of Eyeglasses: A Cluster-Randomized Controlled Trial AMERICAN JOURNAL OF OPHTHALMOLOGY Yi, H., Zhang, H., Ma, X., Zhang, L., Wang, X., Jin, L., Naidoo, K., Minto, H., Zou, H., Lu, L., Rozelle, S., Congdon, N. 2015; 160 (5): 889-896

  Abstract

  To study the effect of free glasses combined with teacher incentives on in-school glasses wear among Chinese urban migrant children.Cluster-randomized controlled trial.Children with visual acuity (VA) ≤6/12 in either eye owing to refractive error in 94 randomly chosen primary schools underwent randomization by school to receive free glasses, education on their use, and a teacher incentive (Intervention), or glasses prescriptions only (Control). Intervention group teachers received a tablet computer if ≥80% of children given glasses wore them during unannounced visits 6 weeks and 6 months (main outcome) after intervention.Among 4376 children, 728 (16.7%, mean age 10.9 years, 51.0% boys) met enrollment criteria and were randomly allocated, 358 (49.2%, 47 schools) to Intervention and 370 (50.8%, 47 schools) to Control. Among these, 693 children (95.2%) completed the study and underwent analysis. Spectacle wear was significantly higher at 6 months among Intervention children (Observed [main outcome]: 68.3% vs 23.9%, adjusted odds ratio [OR] = 11.5, 95% confidence interval [CI] 5.91-22.5, P < .001; Self-reported: 90.6% vs 32.1%, OR = 43.7, 95% CI = 21.7-88.5, P < .001). Other predictors of observed wear at 6 months included baseline spectacle wear (P < .001), uncorrected VA <6/18 (P = .01), and parental spectacle wear (P = .02). The 6-month observed wear rate was only 41% among similar-aged children provided free glasses in our previous trial without teacher incentives.Free spectacles and teacher incentives maintain classroom wear in the large majority of children needing glasses over a school year. Low wear among Control children demonstrates the need for interventions.

  View details for DOI 10.1016/j.ajo.2015.08.006

  View details for Web of Science ID 000363914800007

  View details for PubMedID 26275472

• Safety of Spectacles for Children's Vision: A Cluster-Randomized Controlled Trial AMERICAN JOURNAL OF OPHTHALMOLOGY Ma, X., Congdon, N., Yi, H., Zhou, Z., Pang, X., Meltzer, M. E., Shi, Y., He, M., Liu, Y., Rozelle, S. 2015; 160 (5): 897-904

  Abstract

  To study safety of children's glasses in rural China, where fear that glasses harm vision is an important barrier for families and policy makers.Exploratory analysis from a cluster-randomized, investigator-masked, controlled trial.Among primary schools (n = 252) in western China, children were randomized by school to 1 of 3 interventions: free glasses provided in class, vouchers for free glasses at a local facility, or glasses prescriptions only (Control group). The main outcome of this analysis is uncorrected visual acuity after 8 months, adjusted for baseline acuity.Among 19 934 children randomly selected for screening, 5852 myopic (spherical equivalent refractive error ≤-0.5 diopters) eyes of 3001 children (14.7%, mean age 10.5 years) had VA ≤6/12 without glasses correctable to >6/12 with glasses, and were eligible. Among these, 1903 (32.5%), 1798 (30.7%), and 2151 (36.8%) were randomized to Control, Voucher, and Free Glasses, respectively. Intention-to-treat analyses were performed on all 1831 (96.2%), 1699 (94.5%), and 2007 (93.3%) eyes of children with follow-up in Control, Voucher, and Free Glasses groups. Final visual acuity for eyes of children in the treatment groups (Free Glasses and Voucher) was significantly better than for Control children, adjusting only for baseline visual acuity (difference of 0.023 logMAR units [0.23 vision chart lines, 95% CI: 0.03, 0.43]) or for other baseline factors as well (0.025 logMAR units [0.25 lines, 95% CI 0.04, 0.45]).We found no evidence that spectacles promote decline in uncorrected vision with aging among children.

  View details for DOI 10.1016/j.ajo.2015.08.013

  View details for PubMedID 26284747

• China's Left-Behind Children: Impact Of Parental Migration On Health, Nutrition, And Educational Outcomes. Health affairs Zhou, C., Sylvia, S., Zhang, L., Luo, R., Yi, H., Liu, C., Shi, Y., Loyalka, P., Chu, J., Medina, A., Rozelle, S. 2015; 34 (11): 1964-1971

  Abstract

  China's rapid development and urbanization have induced large numbers of rural residents to migrate from their homes to urban areas in search of better job opportunities. Parents typically leave their children behind with a caregiver, creating a new, potentially vulnerable subpopulation of left-behind children in rural areas. A growing number of policies and nongovernmental organization efforts target these children. The primary objective of this study was to examine whether left-behind children are really the most vulnerable and in need of special programs. Pulling data from a comprehensive data set covering 141,000 children in ten provinces (from twenty-seven surveys conducted between 2009 and 2013), we analyzed nine indicators of health, nutrition, and education. We found that for all nine indicators, left-behind children performed as well as or better than children living with both parents. However, both groups of children performed poorly on most of these indicators. Based on these findings, we recommend that special programs designed to improve health, nutrition, and education among left-behind children be expanded to cover all children in rural China.

  View details for DOI 10.1377/hlthaff.2015.0150

  View details for PubMedID 26526256

• When will we ever learn ... to change policy: current state of impact evaluation JOURNAL OF DEVELOPMENT EFFECTIVENESS Shi, Y., Zhang, L., Rozelle, S. 2015; 7 (4): 402-422

  View details for DOI 10.1080/19439342.2015.1123757

  View details for Web of Science ID 000366685100002

• Assessment of human-natural system characteristics influencing global freshwater supply vulnerability ENVIRONMENTAL RESEARCH LETTERS Padowski, J. C., Gorelick, S. M., Thompson, B. H., Rozelle, S., Fendorf, S. 2015; 10 (10)

  View details for DOI 10.1088/1748-9326/10/10/104014

  View details for Web of Science ID 000367180300019

• EFFECT OF DEWORMING ON NUTRITIONAL INDICATORS, COGNITIVE ABILITIES AND SCHOOL PERFORMANCE AMONG SCHOOLCHILDREN IN RURAL CHINA: A CLUSTERRANDOMIZED CONTROLLED TRIAL Lu, L., Liu, C., Medina, A., Smith, D., Zhang, L., Rozelle, S. AMER SOC TROP MED & HYGIENE. 2015: 16–17

  View details for Web of Science ID 000412844101050

• Intended And Unintended Consequences Of China's Zero Markup Drug Policy HEALTH AFFAIRS Yi, H., Miller, G., Zhang, L., Li, S., Rozelle, S. 2015; 34 (8): 1391-1398

  Abstract

  Since economic liberalization in the late 1970s, China's health care providers have grown heavily reliant on revenue from drugs, which they both prescribe and sell. To curb abuse and to promote the availability, safety, and appropriate use of essential drugs, China introduced its national essential drug list in 2009 and implemented a zero markup policy designed to decouple provider compensation from drug prescription and sales. We collected and analyzed representative data from China's township health centers and their catchment-area populations both before and after the reform. We found large reductions in drug revenue, as intended by policy makers. However, we also found a doubling of inpatient care that appeared to be driven by supply, instead of demand. Thus, the reform had an important unintended consequence: China's health care providers have sought new, potentially inappropriate, forms of revenue.

  View details for DOI 10.1377/hlthaff.2014.1114

  View details for Web of Science ID 000361141000020

• Intended And Unintended Consequences Of China's Zero Markup Drug Policy. Health affairs (Project Hope) Yi, H., Miller, G., Zhang, L., Li, S., Rozelle, S. 2015; 34 (8): 1391-8

  Abstract

  Since economic liberalization in the late 1970s, China's health care providers have grown heavily reliant on revenue from drugs, which they both prescribe and sell. To curb abuse and to promote the availability, safety, and appropriate use of essential drugs, China introduced its national essential drug list in 2009 and implemented a zero markup policy designed to decouple provider compensation from drug prescription and sales. We collected and analyzed representative data from China's township health centers and their catchment-area populations both before and after the reform. We found large reductions in drug revenue, as intended by policy makers. However, we also found a doubling of inpatient care that appeared to be driven by supply, instead of demand. Thus, the reform had an important unintended consequence: China's health care providers have sought new, potentially inappropriate, forms of revenue.

  View details for DOI 10.1377/hlthaff.2014.1114

  View details for PubMedID 26240254

• Does computer-assisted learning improve learning outcomes? Evidence from a randomized experiment in migrant schools in Beijing ECONOMICS OF EDUCATION REVIEW Lai, F., Luo, R., Zhang, L., Huang, X., Rozelle, S. 2015; 47: 34-48

  View details for DOI 10.1016/j.econedurev.2015.03.005

  View details for Web of Science ID 000359171800003

• Non-use of health care service among empty-nest elderly in Shandong, China: a cross-sectional study BMC HEALTH SERVICES RESEARCH Zhou, C., Ji, C., Chu, J., Medina, A., Li, C., Jiang, S., Zheng, W., Liu, J., Rozelle, S. 2015; 15

  Abstract

  Empty-nest elderly refers to those elderly with no children or whose children have already left home. Few studies have focused on healthcare service use among empty-nest seniors, and no studies have identified the prevalence and profiles of non-use of healthcare services among empty-nest elderly. The purpose of this study is to compare the prevalence of non-use of healthcare services between empty-nest and non-empty-nest elderly and identify risk factors for the non-use of healthcare services among empty-nest seniors.Four thousand four hundred sixty nine seniors (60 years and above) were draw from a cross-sectional study conducted in three urban districts and three rural counties of Shandong Province in China. Non-visiting within the past 2 weeks and non-hospitalization in previous year are used to measure non-use of healthcare services. Chi-square test is used to compare the prevalence of non-use between empty-nesters and non-empty-nesters. Multivariate logistic regression analysis is employed to identify the risk factors of non-use among empty-nest seniors.Of 4469 respondents, 2667(59.7 %) are empty-nesters. Overall, 35.5 % of the participants had non-visiting and 34.5 % had non-hospitalization. Non-visiting rate among empty-nest elderly (37.7 %) is significantly higher than that among non-empty-nest ones (32.7 %) (P = 0.008). Non-hospitalization rate among empty-nesters (36.1 %) is slightly higher than that among non-empty-nesters (31.6 %) (P = 0.166). Financial difficulty is the leading cause for both non-visiting and non-hospitalization of the participants, and it exerts a larger negative effect on access to healthcare for empty-nest elderly than non-empty-nest ones. Both non-visiting and non-hospitalization among empty-nest seniors are independently associated with low-income households, health insurance status and non-communicable chronic diseases. The non-visiting rate is also found to be higher among the empty-nesters with lower education and those from rural areas.Our findings indicate that empty-nest seniors have higher non-use rate of healthcare services than non-empty-nest ones. Financial difficulty is the leading cause of non-use of health services. Healthcare policies should be developed or modified to make them more pro-poor and also pro-empty-nested.

  View details for DOI 10.1186/s12913-015-0974-1

  View details for Web of Science ID 000358566700001

  View details for PubMedCentralID PMC4517420

• Teaching the Language of Wider Communication, Minority Students, and Overall Educational Performance: Evidence from a Randomized Experiment in Qinghai Province, China ECONOMIC DEVELOPMENT AND CULTURAL CHANGE Lai, F., Zhang, L., Qu, Q., Hu, X., Shi, Y., Boswell, M., Rozelle, S. 2015; 63 (4): 753-776

  View details for DOI 10.1086/681233

  View details for Web of Science ID 000355827200005

• Soil-Transmitted Helminths in Southwestern China: A Cross-Sectional Study of Links to Cognitive Ability, Nutrition, and School Performance among Children. PLoS neglected tropical diseases Liu, C., Luo, R., Yi, H., Zhang, L., Li, S., Bai, Y., Medina, A., Rozelle, S., Smith, S., Wang, G., Wang, J. 2015; 9 (6)

  Abstract

  Empirical evidence suggests that the prevalence of soil-transmitted helminth (STH) infections in remote and poor rural areas is still high among children, the most vulnerable to infection. There is concern that STH infections may detrimentally affect children's healthy development, including their cognitive ability, nutritional status, and school performance. Medical studies have not yet identified the exact nature of the impact STH infections have on children. The objective of this study is to examine the relationship between STH infections and developmental outcomes among a primary school-aged population in rural China.We conducted a large-scale survey in Guizhou province in southwest China in May 2013. A total of 2,179 children aged 9-11 years living in seven nationally-designated poverty counties in rural China served as our study sample. Overall, 42 percent of the sample's elementary school-aged children were infected with one or more of the three types of STH-Ascaris lumbricoides (ascaris), Trichuris trichuria (whipworm) and the hookworms Ancylostoma duodenale or Necator americanus. After controlling for socioeconomic status, we observed that infection with one or more STHs is associated with worse cognitive ability, worse nutritional status, and worse school performance than no infection. This study also presents evidence that children with Trichuris infection, either infection with Trichuris only or co-infected with Trichuris and Ascaris, experience worse cognitive, nutritional and schooling outcomes than their uninfected peers or children infected with only Ascaris.We find that STH infection still poses a significant health challenge among children living in poor, rural, ethnic areas of southwest China. Given the important linkages we find between STH infection and a number of important child health and educational outcomes, we believe that our results will contribute positively to the debate surrounding the recent Cochrane report.

  View details for DOI 10.1371/journal.pntd.0003877

  View details for PubMedID 26110518

  View details for PubMedCentralID PMC4481344

• Population prevalence of vision impairment and spectacle wear among urban migrant children in China Congdon, N. G., Yi, H., Zhang, H., Ma, X., Zhang, L., Wang, X., Naidoo, K., Minto, H., Zou, H., Rozelle, S. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2015

  View details for Web of Science ID 000362882207097

• Impact of a Teacher Incentive on Children's Use of Eyeglasses: A Cluster-Randomized Controlled Trial Yi, H., Zhang, H., Ma, X., Zhang, L., Congdon, N. G., Wang, X., Naidoo, K., Minto, H., Zou, H., Rozelle, S. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2015

  View details for Web of Science ID 000362882207113

• Soil-Transmitted Helminths in Southwestern China: A Cross-Sectional Study of Links to Cognitive Ability, Nutrition, and School Performance among Children. PLoS neglected tropical diseases Liu, C., Luo, R., Yi, H., Zhang, L., Li, S., Bai, Y., Medina, A., Rozelle, S., Smith, S., Wang, G., Wang, J. 2015; 9 (6): e0003877

  Abstract

  Empirical evidence suggests that the prevalence of soil-transmitted helminth (STH) infections in remote and poor rural areas is still high among children, the most vulnerable to infection. There is concern that STH infections may detrimentally affect children's healthy development, including their cognitive ability, nutritional status, and school performance. Medical studies have not yet identified the exact nature of the impact STH infections have on children. The objective of this study is to examine the relationship between STH infections and developmental outcomes among a primary school-aged population in rural China.We conducted a large-scale survey in Guizhou province in southwest China in May 2013. A total of 2,179 children aged 9-11 years living in seven nationally-designated poverty counties in rural China served as our study sample. Overall, 42 percent of the sample's elementary school-aged children were infected with one or more of the three types of STH-Ascaris lumbricoides (ascaris), Trichuris trichuria (whipworm) and the hookworms Ancylostoma duodenale or Necator americanus. After controlling for socioeconomic status, we observed that infection with one or more STHs is associated with worse cognitive ability, worse nutritional status, and worse school performance than no infection. This study also presents evidence that children with Trichuris infection, either infection with Trichuris only or co-infected with Trichuris and Ascaris, experience worse cognitive, nutritional and schooling outcomes than their uninfected peers or children infected with only Ascaris.We find that STH infection still poses a significant health challenge among children living in poor, rural, ethnic areas of southwest China. Given the important linkages we find between STH infection and a number of important child health and educational outcomes, we believe that our results will contribute positively to the debate surrounding the recent Cochrane report.

  View details for DOI 10.1371/journal.pntd.0003877

  View details for PubMedID 26110518

  View details for PubMedCentralID PMC4481344

• Impact of urbanization on cultivated land changes in China LAND USE POLICY Deng, X., Huang, J., Rozelle, S., Zhang, J., Li, Z. 2015; 45: 1-7

  View details for DOI 10.1016/j.landusepol.2015.01.007

  View details for Web of Science ID 000353743200001

• Factors Underlying Different Myopia Prevalence between Middle- and Low-income Provinces in China OPHTHALMOLOGY Zhou, Z., Ma, X., Yi, H., Pang, X., Shi, Y., Chen, Q., Meltzer, M. E., Price-Sanchez, C., He, M., Rozelle, S., Morgan, I., Congdon, N. 2015; 122 (5): 1060-1062

  View details for Web of Science ID 000353337600036

  View details for PubMedID 25660492

• 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

• Poor vision among China's rural primary school students: Prevalence, correlates and consequences CHINA ECONOMIC REVIEW Yi, H., Zhang, L., Ma, X., Congdon, N., Shi, Y., Pang, X., Zeng, J., Wang, L., Boswell, M., Rozelle, S. 2015; 33: 247-262

  View details for DOI 10.1016/j.chieco.2015.01.004

  View details for Web of Science ID 000353315900017

• 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

• Giving kids a head start: The impact and mechanisms of early commitment of financial aid on poor students in rural China JOURNAL OF DEVELOPMENT ECONOMICS Yi, H., Song, Y., Liu, C., Huang, X., Zhang, L., Bai, Y., Ren, B., Shi, Y., Loyalka, P., Chu, J., Rozelle, S. 2015; 113: 1-15

  View details for DOI 10.1016/j.jdeveco.2014.11.002

  View details for Web of Science ID 000348885300001

• 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 Childcare and Eldercare on Off-farm Activities in Rural China CHINA & WORLD ECONOMY Qiao, F., Rozelle, S., Zhang, L., Yao, Y., Zhang, J. 2015; 23 (2): 100-120

  View details for DOI 10.1111/cwe.12109

  View details for Web of Science ID 000352097700006

• Gut Instincts: Knowledge, Attitudes, and Practices regarding Soil-Transmitted Helminths in Rural China PLOS NEGLECTED TROPICAL DISEASES Lu, L., Liu, C., Zhang, L., Medina, A., Smith, S., Rozelle, S. 2015; 9 (3)

  Abstract

  Soil-transmitted helminth (STH) infections affect more than two out of every five schoolchildren in the poorest regions of rural China, an alarmingly high prevalence rate given the low cost and wide availability of safe and effective deworming treatment. Understanding of local knowledge, attitudes, and practices regarding STH infection in rural China has until now, been sparse, although such information is critical for prevention and control initiatives.This study aims to elucidate the structural and sociocultural factors that underlie high STH infection rates as well as explain why deworming treatment is rarely sought for children. In-depth, qualitative interviews were conducted in six rural villages in Guizhou Province; participants included schoolchildren, children's parents and grandparents, and village doctors. Data analysis exposed three predominant reasons for high STH prevalence: (1) lack of awareness and skepticism about the high prevalence of STH infection, (2) local myths about STH infection and deworming treatment, and (3) poor quality of village health care.The findings from this study reveal reasons for why deworming treatment is not sought, and inform specific recommendations for a deworming intervention that can more effectively address underlying barriers to deworming in areas of persistently high STH infection rates. The main barrier to seeking STH treatment is not availability or cost of the drugs, but rather the lack of impetus to seek the drugs. A comprehensive nationwide deworming program in China should involve annual provision of free deworming treatment in village clinics or schools, distribution of culturally appropriate educational materials to inform children and families about STH infection, and improvement of the quality of health care delivered by village clinicians.

  View details for DOI 10.1371/journal.pntd.0003643

  View details for Web of Science ID 000352199400096

  View details for PubMedCentralID PMC4373855

• Gut instincts: knowledge, attitudes, and practices regarding soil-transmitted helminths in rural China. PLoS neglected tropical diseases Lu, L., Liu, C., Zhang, L., Medina, A., Smith, S., Rozelle, S. 2015; 9 (3)

  Abstract

  Soil-transmitted helminth (STH) infections affect more than two out of every five schoolchildren in the poorest regions of rural China, an alarmingly high prevalence rate given the low cost and wide availability of safe and effective deworming treatment. Understanding of local knowledge, attitudes, and practices regarding STH infection in rural China has until now, been sparse, although such information is critical for prevention and control initiatives.This study aims to elucidate the structural and sociocultural factors that underlie high STH infection rates as well as explain why deworming treatment is rarely sought for children. In-depth, qualitative interviews were conducted in six rural villages in Guizhou Province; participants included schoolchildren, children's parents and grandparents, and village doctors. Data analysis exposed three predominant reasons for high STH prevalence: (1) lack of awareness and skepticism about the high prevalence of STH infection, (2) local myths about STH infection and deworming treatment, and (3) poor quality of village health care.The findings from this study reveal reasons for why deworming treatment is not sought, and inform specific recommendations for a deworming intervention that can more effectively address underlying barriers to deworming in areas of persistently high STH infection rates. The main barrier to seeking STH treatment is not availability or cost of the drugs, but rather the lack of impetus to seek the drugs. A comprehensive nationwide deworming program in China should involve annual provision of free deworming treatment in village clinics or schools, distribution of culturally appropriate educational materials to inform children and families about STH infection, and improvement of the quality of health care delivered by village clinicians.

  View details for DOI 10.1371/journal.pntd.0003643

  View details for PubMedID 25807188

• THE PREVALENCE OF ANEMIA IN CENTRAL AND EASTERN CHINA: EVIDENCE FROM THE CHINA HEALTH AND NUTRITION SURVEY SOUTHEAST ASIAN JOURNAL OF TROPICAL MEDICINE AND PUBLIC HEALTH Li, L., Luo, R., Sylvia, S., Medina, A., Rozelle, S. 2015; 46 (2): 306-321

  Abstract

  Although China has experienced rapid economic growth over the past few decades, significant health and nutritional problems remain. Little work has been done to track basic diseases, such as iron-deficiency anemia, so the exact prevalence of these health problems is unknown. The goals of this study were to assess the prevalence of anemia in China and identify individual, household and community-based factors associated with anemia. We used data from the 2009 China Health and Nutrition Survey (CHNS), including the measurement of hemoglobin levels among 7,261 individuals from 170 communities and 7 provinces in central and eastern China. The overall prevalence of anemia was 13.4% using the WHO's blood hemoglobin thresholds (1968). This means in China's more developed central and eastern regions up to 180 million people may be anemic. Some vulnerable subgroups were disproportionately affected by anemia. Seniors (aged 60 years and above) were more likely to be anemic than younger age cohorts, and females had higher anemia prevalence among all age groups except among children aged 7 to 14 years. We found a negative correlation between household wealth and the presence of anemia, suggesting anemia prevalence may decline as China's economy grows. However, the prevalence of anemia was greater in migrant households, which should be experiencing an improved economic status.

  View details for Web of Science ID 000351554300016

• Unequal Access to College in China: How Far Have Poor, Rural Students Been Left Behind? CHINA QUARTERLY Li, H., Loyalka, P., Rozelle, S., Wu, B., Xie, J. 2015; 221: 185-207

  View details for DOI 10.1017/S0305741015000314

  View details for Web of Science ID 000351629400009

• Micronutrient deficiencies and developmental delays among infants: evidence from a cross-sectional survey in rural China. BMJ open Luo, R., Shi, Y., Zhou, H., Yue, A., Zhang, L., Sylvia, S., Medina, A., Rozelle, S. 2015; 5 (10): e008400

  Abstract

  Research increasingly indicates the importance of the nutritional programming that occurs in the first 2-3 years of life. Quality nutrition during this brief window has been shown to have large and significant effects on health and development throughout childhood and even into adulthood. Despite the widespread understanding of this critical window, and the long-term consequences of leaving nutritional deficiencies unaddressed, little is known about the status of infant nutrition in rural China, or about the relationship between infant nutrition and cognitive development in rural China.In April 2013 and October 2013, we conducted a survey of 1808 infants aged 6-12 months living in 351 villages across 174 townships in nationally designated poverty counties in rural areas of southern Shaanxi Province, China.Infants were administered a finger prick blood test for haemoglobin and assessed according to the Bayley Scales of Infant Development. They were also measured for length and weight. Caregivers were administered a survey of demographic characteristics and feeding practices.We found that 48.8% of sample infants were anaemic, 3.7% were stunted, 1.2% were underweight and 1.6% were wasted. Approximately 20.0% of the sample infants were significantly delayed in their cognitive development, while just over 32.3% of the sample infants were significantly delayed in their psychomotor development. After controlling for potential confounders, infants with lower haemoglobin counts were significantly more likely to be delayed in both their cognitive (p<0.01) and psychomotor development (p<0.01).The anaemia rates that we identify in this study classify anaemia as a 'severe' public health problem according to the WHO. In contrast, there is virtually no linear growth failure among this population. We find that low haemoglobin levels among our sample population are associated with significant cognitive and psychomotor delays that could eventually affect children's schooling performance and labour force outcomes.ISRCTN44149146.

  View details for DOI 10.1136/bmjopen-2015-008400

  View details for PubMedID 26438137

  View details for PubMedCentralID PMC4611485

• AN INVESTIGATION OF VISION PROBLEMS AND THE VISION CARE SYSTEM IN RURAL CHINA (vol 45, pg 1464, 2014) SOUTHEAST ASIAN JOURNAL OF TROPICAL MEDICINE AND PUBLIC HEALTH Bai, Y., Yi, H., Zhang, L., Shi, Y., Ma, X., Congdon, N., Zhou, Z., Boswell, M., Rozelle, S. 2015; 46 (1): 175

  View details for Web of Science ID 000349508400022

• The transformation of public services in rural China GEOGRAPHICAL TRANSFORMATION OF CHINA Zhang, L., Liu, C., Luo, R., Yi, H., Shi, Y., Rozelle, S., Dunford, M., Liu, W. 2015; 133: 164-205

  View details for Web of Science ID 000350364600008

• The Han-Minority Achievement Gap, Language, and Returns to Schools in Rural China. Economic development and cultural change Yang, Y., Wang, H., Zhang, L., Sylvia, S., Luo, R., Shi, Y., Wang, W., Rozelle, S. 2015; 63 (2): 319-359

  View details for PubMedID 25635143

  View details for PubMedCentralID PMC4307025

• Irrigation investment in China: trends, correlates and impacts CHINA AGRICULTURAL ECONOMIC REVIEW He, F., Shi, Y., Luo, R., Zhang, L., Johnson, N., Rozelle, S. 2015; 7 (3): 344-359

  View details for DOI 10.1108/CAER-09-2014-0084

  View details for Web of Science ID 000367081800002

• Non-use of health care service among empty-nest elderly in Shandong, China: a cross-sectional study. BMC health services research Zhou, C., Ji, C., Chu, J., Medina, A., Li, C., Jiang, S., Zheng, W., Liu, J., Rozelle, S. 2015; 15: 294-?

  Abstract

  Empty-nest elderly refers to those elderly with no children or whose children have already left home. Few studies have focused on healthcare service use among empty-nest seniors, and no studies have identified the prevalence and profiles of non-use of healthcare services among empty-nest elderly. The purpose of this study is to compare the prevalence of non-use of healthcare services between empty-nest and non-empty-nest elderly and identify risk factors for the non-use of healthcare services among empty-nest seniors.Four thousand four hundred sixty nine seniors (60 years and above) were draw from a cross-sectional study conducted in three urban districts and three rural counties of Shandong Province in China. Non-visiting within the past 2 weeks and non-hospitalization in previous year are used to measure non-use of healthcare services. Chi-square test is used to compare the prevalence of non-use between empty-nesters and non-empty-nesters. Multivariate logistic regression analysis is employed to identify the risk factors of non-use among empty-nest seniors.Of 4469 respondents, 2667(59.7 %) are empty-nesters. Overall, 35.5 % of the participants had non-visiting and 34.5 % had non-hospitalization. Non-visiting rate among empty-nest elderly (37.7 %) is significantly higher than that among non-empty-nest ones (32.7 %) (P = 0.008). Non-hospitalization rate among empty-nesters (36.1 %) is slightly higher than that among non-empty-nesters (31.6 %) (P = 0.166). Financial difficulty is the leading cause for both non-visiting and non-hospitalization of the participants, and it exerts a larger negative effect on access to healthcare for empty-nest elderly than non-empty-nest ones. Both non-visiting and non-hospitalization among empty-nest seniors are independently associated with low-income households, health insurance status and non-communicable chronic diseases. The non-visiting rate is also found to be higher among the empty-nesters with lower education and those from rural areas.Our findings indicate that empty-nest seniors have higher non-use rate of healthcare services than non-empty-nest ones. Financial difficulty is the leading cause of non-use of health services. Healthcare policies should be developed or modified to make them more pro-poor and also pro-empty-nested.

  View details for DOI 10.1186/s12913-015-0974-1

  View details for PubMedID 26219288

  View details for PubMedCentralID PMC4517420

• The Han-Minority Achievement Gap, Language, and Returns to Schools in Rural China ECONOMIC DEVELOPMENT AND CULTURAL CHANGE Yang, Y., Wang, H., Zhang, L., Sylvia, S., Luo, R., Shi, Y., Wang, W., Rozelle, S. 2015; 63 (2): 319-359

  View details for DOI 10.1086/679070

  View details for Web of Science ID 000346349600004

  View details for PubMedCentralID PMC4307025

• Text Messaging and its Impacts on the Health and Education of the Poor: Evidence from a Field Experiment in Rural China WORLD DEVELOPMENT Mo, D., Luo, R., Liu, C., Zhang, H., Zhang, L., Medina, A., Rozelle, S. 2014; 64: 766-780

  View details for DOI 10.1016/j.worlddev.2014.07.015

  View details for Web of Science ID 000342246100056

• Response to the Commentary "Reassessing Disparity in Access to Higher Education in Contemporary China" CHINA QUARTERLY Wang, X., Liu, C., Zhang, L., Shi, Y., Rozelle, S., Loyalka, P. 2014; 220: 1131-1135

  View details for DOI 10.1017/S0305741014001179

  View details for Web of Science ID 000346727400013

• Anemia and Feeding Practices among Infants in Rural Shaanxi Province in China NUTRIENTS Luo, R., Shi, Y., Zhou, H., Yue, A., Zhang, L., Sylvia, S., Medina, A., Rozelle, S. 2014; 6 (12): 5975-5991

  Abstract

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

  View details for DOI 10.3390/nu6125975

  View details for Web of Science ID 000346796100037

  View details for PubMedID 25533008

  View details for PubMedCentralID PMC4277010

• Learning but Not Acting in Rural China Women in the Ningxia Autonomous Region, Voting Rights Training, and Voting Behavior in Village Elections ASIAN SURVEY Pang, X., Zeng, J., Rozelle, S. 2014; 54 (6): 1009-1036

  View details for DOI 10.1525/AS.2014.54.6.1009

  View details for Web of Science ID 000347362800002

• AN INVESTIGATION OF VISION PROBLEMS AND THE VISION CARE SYSTEM IN RURAL CHINA SOUTHEAST ASIAN JOURNAL OF TROPICAL MEDICINE AND PUBLIC HEALTH Bai, Y., Yi, H., Zhang, L., Shi, Y., Ma, X., Congdon, N., Zhou, Z., Boswell, M., Rozelle, S. 2014; 45 (6): 1464-1473

  Abstract

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

  View details for Web of Science ID 000352328200024

• Effect of providing free glasses on children's educational outcomes in China: cluster randomized controlled trial BMJ-BRITISH MEDICAL JOURNAL Ma, X., Zhou, Z., Yi, H., Pang, X., Shi, Y., Chen, Q., Meltzer, M. E., le Cessie, S., He, M., Rozelle, S., Liu, Y., Congdon, N. 2014; 349

  Abstract

  To assess the effect of provision of free glasses on academic performance in rural Chinese children with myopia.Cluster randomized, investigator masked, controlled trial.252 primary schools in two prefectures in western China, 2012-13.3177 of 19,934 children in fourth and fifth grades (mean age 10.5 years) with visual acuity <6/12 in either eye without glasses correctable to >6/12 with glasses. 3052 (96.0%) completed the study.Children were randomized by school (84 schools per arm) to one of three interventions at the beginning of the school year: prescription for glasses only (control group), vouchers for free glasses at a local facility, or free glasses provided in class.Spectacle wear at endline examination and end of year score on a specially designed mathematics test, adjusted for baseline score and expressed in standard deviations.Among 3177 eligible children, 1036 (32.6%) were randomized to control, 988 (31.1%) to vouchers, and 1153 (36.3%) to free glasses in class. All eligible children would benefit from glasses, but only 15% wore them at baseline. At closeout glasses wear was 41% (observed) and 68% (self reported) in the free glasses group, and 26% (observed) and 37% (self reported) in the controls. Effect on test score was 0.11 SD (95% confidence interval 0.01 to 0.21) when the free glasses group was compared with the control group. The adjusted effect of providing free glasses (0.10, 0.002 to 0.19) was greater than parental education (0.03, -0.04 to 0.09) or family wealth (0.01, -0.06 to 0.08). This difference between groups was significant, but was smaller than the prespecified 0.20 SD difference that the study was powered to detect.The provision of free glasses to Chinese children with myopia improves children's performance on mathematics testing to a statistically significant degree, despite imperfect compliance, although the observed difference between groups was smaller than the study was originally designed to detect. Myopia is common and rarely corrected in this setting.Trial Registration Current Controlled Trials ISRCTN03252665.

  View details for DOI 10.1136/bmj.g5740

  View details for Web of Science ID 000342425700006

  View details for PubMedCentralID PMC4172821

• Integrating computer-assisted learning into a regular curriculum: evidence from a randomised experiment in rural schools in Shaanxi JOURNAL OF DEVELOPMENT EFFECTIVENESS Mo, D., Zhang, L., Luo, R., Qu, Q., Huang, W., Wang, J., Qiao, Y., Boswell, M., Rozelle, S. 2014; 6 (3): 300-323

  View details for DOI 10.1080/19439342.2014.911770

  View details for Web of Science ID 000341579100006

• The education of China's migrant children: The missing link in China's education system INTERNATIONAL JOURNAL OF EDUCATIONAL DEVELOPMENT Lai, F., Liu, C., Luo, R., Zhang, L., Ma, X., Bai, Y., Sharbono, B., Rozelle, S. 2014; 37: 68-77

  View details for DOI 10.1016/j.ijedudev.2013.11.006

  View details for Web of Science ID 000337882300009

• Road Expansion and Off-Farm Work in Rural China CHINA QUARTERLY Qiao, F., Rozelle, S., Huang, J., Zhang, L., Luo, R. 2014; 218: 428-451

  View details for DOI 10.1017/S0305741014000629

  View details for Web of Science ID 000343049700006

• Improving the Health and Education of Elementary Schoolchildren in Rural China: Iron Supplementation Versus Nutritional Training for Parents JOURNAL OF DEVELOPMENT STUDIES Wong, H. L., Shi, Y., Luo, R., Zhang, L., Rozelle, S. 2014; 50 (4): 502-519

  View details for DOI 10.1080/00220388.2013.866223

  View details for Web of Science ID 000333887300003

• GENDER INEQUALITY IN EDUCATION IN CHINA: A META-REGRESSION ANALYSIS CONTEMPORARY ECONOMIC POLICY Zeng, J., Pang, X., Zhang, L., Medina, A., Rozelle, S. 2014; 32 (2): 474-491

  View details for DOI 10.1111/coep.12006

  View details for Web of Science ID 000331606300014

• Factors underlying large differences in myopia prevalence among primary school children in adjoining provinces of western China Zhou, Z., Ma, X., Yi, H., Pang, X., Shi, Y., Meltzer, M., He, M., Rozelle, S., Morgan, I., Congdon, N. G. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2014

  View details for Web of Science ID 000433203503312

• Provision of spectacles improves academic performance of primary school children in a randomized trial in China Congdon, N. G., Ma, X., Zhou, Z., Yi, H., Pang, X., Shi, Y., Chen, Q., Meltzer, M., He, M., Rozelle, S. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2014

  View details for Web of Science ID 000433203503310

• Encouraging classroom peer interactions: Evidence from Chinese migrant schools JOURNAL OF PUBLIC ECONOMICS Li, T., Han, L., Zhang, L., Rozelle, S. 2014; 111: 29-45

  View details for DOI 10.1016/j.jpubeco.2013.12.014

  View details for Web of Science ID 000333882000003

• Do poor students benefit from China's Merger Program? Transfer path and educational performance ASIA PACIFIC JOURNAL OF EDUCATION Chen, X., Yi, H., Zhang, L., Mo, D., Chu, J., Rozelle, S. 2014; 34 (1): 15-35

  View details for DOI 10.1080/02188791.2013.790781

  View details for Web of Science ID 000329564700002

• Accuracy of Rural Refractionists in Western China INVESTIGATIVE OPHTHALMOLOGY & VISUAL SCIENCE Zhou, Z., Zeng, J., Ma, X., Pang, X., Yi, H., Chen, Q., Meltzer, M. E., He, M., Rozelle, S., Congdon, N. 2014; 55 (1): 154-161

  Abstract

  We assessed the prevalence and predictors of inaccurate refractive error among rural refractionists in western China.A subset of primary school children with visual acuity (VA) ≤6/12 in ≥1 eye, undergoing subjective refinement by local refractionists after cycloplegic autorefraction in an ongoing population-based study, received repeat refraction by university optometrists for quality control.Among 502 children (mean age 10.5 years, 53.2% girls), independent predictors of poor (inaccurate by ≥1.0 diopter [D]) refraction by 21 rural practitioners (66.7% with high school or lower education) included hyperopia (odds ratio [OR], 4.2; 95% confidence interval [CI], 2.4-7.3, P < 0.001), astigmatism (OR = 3.8; 95% CI, 2.5-5.6; P < 0.001) and VA uncorrectable to >6/12 by the rural refractionist (OR = 4.7; 95% CI, 3.1-7.3; P = < 0.001). Among 201 children whose vision was uncorrectable in ≥1 eye by the rural refractionists, vision could be improved to >6/12 by the university optometrist in 110 (54.7%). We estimate vision could be so improved in 9.1% of all children refracted by these rural refractionists. A reason for inaccuracy in this setting is the erroneous tendency of rural refractionists to adjust instrument values for accommodation, even under cycloplegia.Rural refractionists in western China have little formal training and frequently fail to optimize VA among children, even when autorefractors are used. Training is needed emphasizing better use of automated refraction, particularly in children with astigmatism and hyperopia.

  View details for DOI 10.1167/iovs.13-13250

  View details for Web of Science ID 000331877200017

  View details for PubMedID 24327616

• The Role of Cultivated Land Expansion on the Impacts to Global Agricultural Markets from Biofuels Yang, J., Huang, J., Msangi, S., Rozelle, S., Weersink, A., Danielle, T., Yan, J., Lee, D. J., Chou, S. K., Desideri, U., Li, H. ELSEVIER SCIENCE BV. 2014: 999-1011

  View details for DOI 10.1016/j.egypro.2014.11.1012

  View details for Web of Science ID 000375936100227

• Effect of providing free glasses on children's educational outcomes in China: cluster randomized controlled trial. BMJ (Clinical research ed.) Ma, X., Zhou, Z., Yi, H., Pang, X., Shi, Y., Chen, Q., Meltzer, M. E., le Cessie, S., He, M., Rozelle, S., Liu, Y., Congdon, N. 2014; 349: g5740-?

  Abstract

  To assess the effect of provision of free glasses on academic performance in rural Chinese children with myopia.Cluster randomized, investigator masked, controlled trial.252 primary schools in two prefectures in western China, 2012-13.3177 of 19,934 children in fourth and fifth grades (mean age 10.5 years) with visual acuity <6/12 in either eye without glasses correctable to >6/12 with glasses. 3052 (96.0%) completed the study.Children were randomized by school (84 schools per arm) to one of three interventions at the beginning of the school year: prescription for glasses only (control group), vouchers for free glasses at a local facility, or free glasses provided in class.Spectacle wear at endline examination and end of year score on a specially designed mathematics test, adjusted for baseline score and expressed in standard deviations.Among 3177 eligible children, 1036 (32.6%) were randomized to control, 988 (31.1%) to vouchers, and 1153 (36.3%) to free glasses in class. All eligible children would benefit from glasses, but only 15% wore them at baseline. At closeout glasses wear was 41% (observed) and 68% (self reported) in the free glasses group, and 26% (observed) and 37% (self reported) in the controls. Effect on test score was 0.11 SD (95% confidence interval 0.01 to 0.21) when the free glasses group was compared with the control group. The adjusted effect of providing free glasses (0.10, 0.002 to 0.19) was greater than parental education (0.03, -0.04 to 0.09) or family wealth (0.01, -0.06 to 0.08). This difference between groups was significant, but was smaller than the prespecified 0.20 SD difference that the study was powered to detect.The provision of free glasses to Chinese children with myopia improves children's performance on mathematics testing to a statistically significant degree, despite imperfect compliance, although the observed difference between groups was smaller than the study was originally designed to detect. Myopia is common and rarely corrected in this setting.Trial Registration Current Controlled Trials ISRCTN03252665.

  View details for DOI 10.1136/bmj.g5740

  View details for PubMedID 25249453

  View details for PubMedCentralID PMC4172821

• Marketing Raw Milk from Dairy Farmers before and after the 2008 Milk Scandal in China: Evidence from Greater Beijing AGRIBUSINESS Jia, X., Luan, H., Huang, J., Li, S., Rozelle, S. 2014; 30 (4): 410-423

  View details for DOI 10.1002/agr.21375

  View details for Web of Science ID 000344348300004

• Dormitory management and boarding students in China's rural primary schools CHINA AGRICULTURAL ECONOMIC REVIEW Yue, A., Shi, Y., Chang, F., Yang, C., Wang, H., Yi, H., Luo, R., Liu, C., Zhang, L., Chu, J. Y., Rozelle, S. 2014; 6 (3): 523-550

  View details for DOI 10.1108/CAER-05-2012-0048

  View details for Web of Science ID 000341664200010

• Do you get what you pay for with school-based health programs? Evidence from a child nutrition experiment in rural China ECONOMICS OF EDUCATION REVIEW Sylvia, S., Luo, R., Zhang, L., Shi, Y., Medina, A., Rozelle, S. 2013; 37: 1-12

  View details for DOI 10.1016/j.econedurev.2013.07.003

  View details for Web of Science ID 000329557800002

• Social learning and parameter uncertainty in irreversible investments: Evidence from greenhouse adoption in northern China CHINA ECONOMIC REVIEW Wang, H., Yu, F., Reardon, T., Huang, J., Rozelle, S. 2013; 27: 104-120

  View details for DOI 10.1016/j.chieco.2013.09.003

  View details for Web of Science ID 000327829500009

• Can information and counseling help students from poor rural areas go to high school? Evidence from China JOURNAL OF COMPARATIVE ECONOMICS Loyalka, P., Liu, C., Song, Y., Yi, H., Huang, X., Wei, J., Zhang, L., Shi, Y., Chu, J., Rozelle, S. 2013; 41 (4): 1012-1025

  View details for DOI 10.1016/j.jce.2013.06.004

  View details for Web of Science ID 000327571000004

• The human capital roots of the middle income trap: the case of China AGRICULTURAL ECONOMICS Zhang, L., Yi, H., Luo, R., Liu, C., Rozelle, S. 2013; 44: 151-162

  View details for DOI 10.1111/agec.12059

  View details for Web of Science ID 000327302100015

• Information, college decisions and financial aid: Evidence from a cluster-randomized controlled trial in China ECONOMICS OF EDUCATION REVIEW Loyalka, P., Song, Y., Wei, J., Zhong, W., Rozelle, S. 2013; 36: 26-40

  View details for DOI 10.1016/j.econedurev.2013.05.001

  View details for Web of Science ID 000325674200003

• LIQUIDITY CONSTRAINTS AND POSTHARVEST SELLING BEHAVIOR: EVIDENCE FROM CHINA'S MAIZE FARMERS DEVELOPING ECONOMIES Sun, D., Qiu, H., Bai, J., Liu, H., Lin, G., Rozelle, S. 2013; 51 (3): 260-277

  View details for DOI 10.1111/deve.12018

  View details for Web of Science ID 000323197000002

• The impact of teacher training on teacher and student outcomes: evidence from a randomised experiment in Beijing migrant schools JOURNAL OF DEVELOPMENT EFFECTIVENESS Zhang, L., Lai, F., Pang, X., Yi, H., Rozelle, S. 2013; 5 (3): 339-358

  View details for DOI 10.1080/19439342.2013.807862

  View details for Web of Science ID 000325515200004

• The impact of vouchers on preschool attendance and elementary school readiness: A randomized controlled trial in rural China ECONOMICS OF EDUCATION REVIEW Wong, H. L., Luo, R., Zhang, L., Rozelle, S. 2013; 35: 53-65

  View details for DOI 10.1016/j.econedurev.2013.03.004

  View details for Web of Science ID 000321089000005

• The subsidization of farming households in China's agriculture FOOD POLICY Huang, J., Wang, X., Rozelle, S. 2013; 41: 124-132

  View details for DOI 10.1016/j.foodpol.2013.04.011

  View details for Web of Science ID 000327281600014

• Will Demographic Change Slow China's Rise? JOURNAL OF ASIAN STUDIES Eggleston, K., Oi, J. C., Rozelle, S., Sun, A., Walder, A., Zhou, X. 2013; 72 (3): 505-518

  View details for DOI 10.1017/S0021911813000557

  View details for Web of Science ID 000324763900002

• Providing quality infrastructure in rural villages: The case of rural roads in China JOURNAL OF DEVELOPMENT ECONOMICS Wong, H. L., Luo, R., Zhang, L., Rozelle, S. 2013; 103: 262-274

  View details for DOI 10.1016/j.jdeveco.2013.03.002

  View details for Web of Science ID 000320686800021

• Impact of the Global Financial Crisis in Rural China: Gender, Off-farm Employment, and Wages FEMINIST ECONOMICS Zhi, H., Huang, Z., Huang, J., Rozelle, S. D., Mason, A. D. 2013; 19 (3): 238-266

  View details for DOI 10.1080/13545701.2013.809137

  View details for Web of Science ID 000323478900012

• Does financial aid help poor students succeed in college? CHINA ECONOMIC REVIEW Wang, X., Liu, C., Zhang, L., Yue, A., Shi, Y., Chu, J., Rozelle, S. 2013; 25: 27-43

  View details for DOI 10.1016/j.chieco.2013.01.003

  View details for Web of Science ID 000318960400003

• [Correlation between soil-transmitted nematode infections and children's growth]. Zhongguo xue xi chong bing fang zhi za zhi = Chinese journal of schistosomiasis control Wang, X., Wang, G., Zhang, L., Luo, R., Wang, J., Medina, A., Eggleston, K., Rozelle, S., Smith, S. 2013; 25 (3): 268–74

  Abstract

  OBJECTIVE: To understand the infection status of soil-transmitted nematodes in southwest China and the correlation between soil-transmitted nematode infections and children's growth.METHODS: The prevalence of soil-transmitted nematode infections was determined by Kato-Katz technique, and in part of the children, the examination of Enterobius vermicularis eggs was performed by using the cellophane swab method. The influencing factors were surveyed by using a standardized questionnaire. The relationship between soil-transmitted nematode infections and children's growth was analyzed by the ordinary least square (OLS) method.RESULTS: A total of 1 707 children were examined, with a soil-transmitted nematode infection rate of 22.2%. The results of OLS analysis showed that there existed the negative correlation between soil-transmitted nematode infections and the indexes of children's growth including BMI, the weight-for-age Z score and height-for-age Z score. Furthermore, other correlated variables included the age, gender, educational level of mother and raising livestock and poultry, etc.CONCLUSIONS: Children' s retardation is still a serious issue in the southwest poor areas of China and correlated with the infections of soil-transmitted nematodes. For improving children's growth, it is greatly significant to enhance the deworming and health education about parasitic diseases in mothers.

  View details for PubMedID 24024446

• College is a Rich, Han, Urban, Male Club: Research Notes from a Census Survey of Four Tier One Colleges in China CHINA QUARTERLY Wang, X., Liu, C., Zhang, L., Shi, Y., Rozelle, S. 2013: 456-470

  View details for DOI 10.1017/S0305741013000647

  View details for Web of Science ID 000320869300012

• Can One-to-One Computing Narrow the Digital Divide and the Educational Gap in China? The Case of Beijing Migrant Schools WORLD DEVELOPMENT Mo, D., Swinnen, J., Zhang, L., Yi, H., Qu, Q., Boswell, M., Rozelle, S. 2013; 46: 14-29

  View details for DOI 10.1016/j.worlddev.2012.12.019

  View details for Web of Science ID 000318392600002

• Computer assisted learning as extracurricular tutor? Evidence from a randomised experiment in rural boarding schools in Shaanxi JOURNAL OF DEVELOPMENT EFFECTIVENESS Lai, F., Zhang, L., Hu, X., Qu, Q., Shi, Y., Qiao, Y., Boswell, M., Rozelle, S. 2013; 5 (2): 208-231

  View details for DOI 10.1080/19439342.2013.780089

  View details for Web of Science ID 000318778100004

• Neglected Rural Public Health Issue: The Case of Intestinal Roundworms CHINA & WORLD ECONOMY Zhang, L., Cai, Y., Wang, X., Ma, X., Medina, A., Smith, D. S., Rozelle, S. 2013; 21 (3): 25-43

  View details for DOI 10.1111/j.1749-124X.2013.12020.x

  View details for Web of Science ID 000319212800003

• Guest Editors' Words CHINA & WORLD ECONOMY Zhang, L., Rozelle, S. 2013; 21 (3): 1-3

  View details for DOI 10.1111/j.1749-124X.2013.12018.x

  View details for Web of Science ID 000319212800001

• The Feminisation of Agriculture with Chinese Characteristics JOURNAL OF DEVELOPMENT STUDIES De Brauw, A., Huang, J., Zhang, L., Rozelle, S. 2013; 49 (5): 689-704

  View details for DOI 10.1080/00220388.2012.724168

  View details for Web of Science ID 000319552900007

• Roots of Tomorrow's Digital Divide: Documenting Computer Use and Internet Access in China's Elementary Schools Today CHINA & WORLD ECONOMY Yang, Y., Hu, X., Qu, Q., Lai, F., Shi, Y., Boswell, M., Rozelle, S. 2013; 21 (3): 61-79

  View details for DOI 10.1111/j.1749-124X.2013.12022.x

  View details for Web of Science ID 000319212800005

• Impact of a Senior High School Tuition Relief Program on Poor Junior High School Students in Rural China CHINA & WORLD ECONOMY Chen, X., Shi, Y., Mo, D., Chu, J., Loyalka, P., Rozelle, S. 2013; 21 (3): 80-97

  View details for DOI 10.1111/j.1749-124X.2013.12023.x

  View details for Web of Science ID 000319212800006

• Multiple Micronutrient Supplementation Reduces Anemia and Anxiety in Rural China's Elementary School Children JOURNAL OF NUTRITION Zhang, L., Kleiman-Weiner, M., Luo, R., Shi, Y., Martorell, R., Medina, A., Rozelle, S. 2013; 143 (5): 640-647

  Abstract

  Despite growing wealth and a strengthening government commitment to improve livelihoods and welfare, many students across rural China have inadequate access to micronutrient-rich diets. Poor diets can lead to nutritional problems, such as iron-deficiency anemia, that can adversely affect health, attention, learning, and mental health. The overall goal of this paper is to assess the impact of multiple micronutrient supplementation (MMS) on anemia and anxiety among students in poor areas of rural China. To achieve this goal, we conducted a randomized controlled trial in 54 randomly chosen elementary schools in 8 of the poorest counties in Shaanxi Province in Northwest China. Study participants were 2730 fourth-grade students, mostly aged 10-12 y. Schools were randomly assigned to 1 of 2 groups: a control group that received no intervention and an intervention group that received a daily MMS with 5 mg of iron (ferrous sulfate) for 5 mo. Our primary outcome measures were hemoglobin (Hb) concentrations (assessed by HemoCue 201+ technology), anemia prevalence (defined as Hb) concentrations ≤120 g/L), and anxiety (using a written mental health test). The results showed that 42.4% of students were anemic at baseline. The Hb concentration was 121.7 ± 10.7 g/L in the treatment group and 123.4 ± 11.4 g/L in the control group. MMS increased Hb concentrations by 1.7 g/L ± 0.15 and reduced anemia rates by 7.0 percentage points (P < 0.05). Anxiety was reduced by 0.30 SDs (P < 0.01). MMS reduced both anemia and anxiety. Our results should encourage further research on the linkages between nutrition and mental health in a development context.

  View details for DOI 10.3945/jn.112.171959

  View details for Web of Science ID 000318056700013

  View details for PubMedID 23514770

• Eggs versus chewable vitamins: Which intervention can increase nutrition and test scores in rural China? CHINA ECONOMIC REVIEW Kleiman-Weiner, M., Luo, R., Zhang, L., Shi, Y., Medina, A., Rozelle, S. 2013; 24: 165-176

  View details for DOI 10.1016/j.chieco.2012.12.005

  View details for Web of Science ID 000314625600012

• Does Women's Knowledge of Voting Rights Affect their Voting Behaviour in Village Elections? Evidence from a Randomized Controlled Trial in China CHINA QUARTERLY Pang, X., Zeng, J., Rozelle, S. 2013: 39-59

  View details for DOI 10.1017/S0305741012001531

  View details for Web of Science ID 000316641500003

• School Dropouts and Conditional Cash Transfers: Evidence from a Randomised Controlled Trial in Rural China's Junior High Schools JOURNAL OF DEVELOPMENT STUDIES Mo, D., Zhang, L., Yi, H., Luo, R., Rozelle, S., Brinton, C. 2013; 49 (2): 190-207

  View details for DOI 10.1080/00220388.2012.724166

  View details for Web of Science ID 000314452600002

• The impact of biofuel growth on agriculture: Why is the range of estimates so wide? FOOD POLICY Zhang, W., Yu, E. A., Rozelle, S., Yang, J., Msangi, S. 2013; 38: 227-239

  View details for DOI 10.1016/j.foodpol.2012.12.002

  View details for Web of Science ID 000315553700021

• Information, College Decisions and Financial Aid: Evidence from a Cluster-Randomized Controlled Trial in China Economics of Education Review Loyalka , P., Song, Y., Wei, J., Zhong, W., Rozelle, S. 2013; 36: 26-40
• Project design, village governance and infrastructure quality in rural China CHINA AGRICULTURAL ECONOMIC REVIEW Liu, C., Zhang, L., Huang, J., Luo, R., Yi, H., Shi, Y., Rozelle, S. 2013; 5 (2): 248-280

  View details for DOI 10.1108/17561371311331124

  View details for Web of Science ID 000330418800006

• Gender Inequality in Education in China: A Meta-Regression Analysis Contemporary Economic Policy, Zeng, J., Pang, X., Zhang, L., Medina, A., Rozelle, S. 2013
• Do You Get What You Pay For with School-Based Health Programs? Evidence from a Child Nutrition Experiment in Rural China Economics of Education Review Rozelle, S., et al 2013
• Computers and the academic performance of elementary school-aged girls in China's poor communities COMPUTERS & EDUCATION Yang, Y., Zhang, L., Zeng, J., Pang, X., Lai, F., Rozelle, S. 2013; 60 (1): 335-346

  View details for DOI 10.1016/j.compedu.2012.08.011

  View details for Web of Science ID 000312231900030

• The Effects of Well Management and the Nature of the Aquifer on Groundwater Resources AMERICAN JOURNAL OF AGRICULTURAL ECONOMICS Huang, Q., Wang, J., Rozelle, S., Polasky, S., Liu, Y. 2013; 95 (1): 94-116

  View details for DOI 10.1093/ajae/aas076

  View details for Web of Science ID 000312651700005

• Are elite university graduates aiding China's transition to an innovation-based economy? Results from a career choices survey among would-be innovators in China and the USA ASIA-PACIFIC JOURNAL OF ACCOUNTING & ECONOMICS Zhang, L., Pollak, E., Darwin, R., Boswell, M., Rozelle, S. 2013; 20 (1): 58-69

  View details for DOI 10.1080/16081625.2013.748436

  View details for Web of Science ID 000315203700005

• The nature and causes of the global water crisis: Syndromes from a meta-analysis of coupled human-water studies WATER RESOURCES RESEARCH Srinivasan, V., Lambin, E. F., Gorelick, S. M., Thompson, B. H., Rozelle, S. 2012; 48

  View details for DOI 10.1029/2011WR011087

  View details for Web of Science ID 000309608800001

• Global biofuel production and poverty in China APPLIED ENERGY Huang, J., Yang, J., Msangi, S., Rozelle, S., Weersink, A. 2012; 98: 246-255

  View details for DOI 10.1016/j.apenergy.2012.03.031

  View details for Web of Science ID 000306889200026

• Estimating production technology for policy analysis: trading off precision and heterogeneity JOURNAL OF PRODUCTIVITY ANALYSIS Huang, Q., Howitt, R., Rozelle, S. 2012; 38 (2): 219-233

  View details for DOI 10.1007/s11123-012-0272-4

  View details for Web of Science ID 000308251500009

• Soil-Transmitted Helminth Infections and Correlated Risk Factors in Preschool and School-Aged Children in Rural Southwest China PLOS ONE Wang, X., Zhang, L., Luo, R., Wang, G., Chen, Y., Medina, A., Eggleston, K., Rozelle, S., Smith, D. S. 2012; 7 (9)

  Abstract

  We conducted a survey of 1707 children in 141 impoverished rural areas of Guizhou and Sichuan Provinces in Southwest China. Kato-Katz smear testing of stool samples elucidated the prevalence of ascariasis, trichuriasis and hookworm infections in pre-school and school aged children. Demographic, hygiene, household and anthropometric data were collected to better understand risks for infection in this population. 21.2 percent of pre-school children and 22.9 percent of school aged children were infected with at least one of the three types of STH. In Guizhou, 33.9 percent of pre-school children were infected, as were 40.1 percent of school aged children. In Sichuan, these numbers were 9.7 percent and 6.6 percent, respectively. Number of siblings, maternal education, consumption of uncooked meat, consumption of unboiled water, and livestock ownership all correlated significantly with STH infection. Through decomposition analysis, we determined that these correlates made up 26.7 percent of the difference in STH infection between the two provinces. Multivariate analysis showed that STH infection is associated with significantly lower weight-for-age and height-for-age z-scores; moreover, older children infected with STHs lag further behind on the international growth scales than younger children.

  View details for DOI 10.1371/journal.pone.0045939

  View details for Web of Science ID 000309517500047

  View details for PubMedID 23029330

  View details for PubMedCentralID PMC3459941

• Shifting Fiscal Control to Limit Cadre Power in China's Townships and Villages CHINA QUARTERLY Oi, J. C., Babiarz, K. S., Zhang, L., Luo, R., Rozelle, S. 2012: 649-675

  View details for DOI 10.1017/S0305741012000823

  View details for Web of Science ID 000309680800003

• Where is the balance? Implications of adopting Special Products and Sensitive Products in Doha negotiations for world and China's agriculture CHINA ECONOMIC REVIEW Yang, J., Huang, J., Rozelle, S., Martin, W. 2012; 23 (3): 651-664

  View details for DOI 10.1016/j.chieco.2010.06.009

  View details for Web of Science ID 000308733900013

• Marketing China's milk: A case study of the sales activity of dairy farmers in greater Beijing CHINA ECONOMIC REVIEW Huang, J., Wu, Y., Yang, Z., Rozelle, S., Fabiosa, J., Dong, F. 2012; 23 (3): 675-689

  View details for DOI 10.1016/j.chieco.2010.09.006

  View details for Web of Science ID 000308733900015

• Does it pay to be a cadre? Estimating the returns to being a local official in rural China JOURNAL OF COMPARATIVE ECONOMICS Zhang, J., Giles, J., Rozelle, S. 2012; 40 (3): 337-356

  View details for DOI 10.1016/j.jce.2012.04.006

  View details for Web of Science ID 000307907900002

• Biofuels and the poor: Global impact pathways of biofuels on agricultural markets FOOD POLICY Huang, J., Yang, J., Msangi, S., Rozelle, S., Weersink, A. 2012; 37 (4): 439-451

  View details for DOI 10.1016/j.foodpol.2012.04.004

  View details for Web of Science ID 000307203000009

• China's Milk Scandal, government policy and production decisions of dairy farmers: The case of Greater Beijing FOOD POLICY Jia, X., Huang, J., Luan, H., Rozelle, S., Swinnen, J. 2012; 37 (4): 390-400

  View details for DOI 10.1016/j.foodpol.2012.03.008

  View details for Web of Science ID 000307203000005

• Effectiveness of provider incentives for anaemia reduction in rural China: a cluster randomised trial BRITISH MEDICAL JOURNAL Miller, G., Luo, R., Zhang, L., Sylvia, S., Shi, Y., Foo, P., Zhao, Q., Martorell, R., Medina, A., Rozelle, S. 2012; 345

  Abstract

  To test the impact of provider performance pay for anaemia reduction in rural China.A cluster randomised trial of information, subsidies, and incentives for school principals to reduce anaemia among their students. Enumerators and study participants were not informed of study arm assignment.72 randomly selected rural primary schools across northwest China.3553 fourth and fifth grade students aged 9-11 years. All fourth and fifth grade students in sample schools participated in the study.Sample schools were randomly assigned to a control group, with no intervention, or one of three treatment arms: (a) an information arm, in which principals received information about anaemia; (b) a subsidy arm, in which principals received information and unconditional subsidies; and (c) an incentive arm, in which principals received information, subsidies, and financial incentives for reducing anaemia among students. Twenty seven schools were assigned to the control arm (1816 students at baseline, 1623 at end point), 15 were assigned to the information arm (659 students at baseline, 596 at end point), 15 to the subsidy arm (726 students at baseline, 667 at end point), and 15 to the incentive arm (743 students at baseline, 667 at end point).Student haemoglobin concentrations.Mean student haemoglobin concentration rose by 1.5 g/L (95% CI -1.1 to 4.1) in information schools, 0.8 g/L (-1.8 to 3.3) in subsidy schools, and 2.4 g/L (0 to 4.9) in incentive schools compared with the control group. This increase in haemoglobin corresponded to a reduction in prevalence of anaemia (Hb <115 g/L) of 24% in incentive schools. Interactions with pre-existing incentives for principals to achieve good academic performance led to substantially larger gains in the information and incentive arms: when combined with incentives for good academic performance, associated effects on student haemoglobin concentration were 9.8 g/L (4.1 to 15.5) larger in information schools and 8.6 g/L (2.1 to 15.1) larger in incentive schools.Financial incentives for health improvement were modestly effective. Understanding interactions with other motives and pre-existing incentives is critical.ISRCTN76158086.

  View details for DOI 10.1136/bmj.e4809

  View details for Web of Science ID 000306997800001

  View details for PubMedID 22842354

  View details for PubMedCentralID PMC3406729

• Nutrition and Educational Performance in Rural China's Elementary Schools: Results of a Randomized Control Trial in Shaanxi Province ECONOMIC DEVELOPMENT AND CULTURAL CHANGE Luo, R., Shi, Y., Zhang, L., Liu, C., Rozelle, S., Sharbono, B., Yue, A., Zhao, Q., Martorell, R. 2012; 60 (4): 735-772

  View details for Web of Science ID 000305445700004

• Dropping out: Why are students leaving junior high in China's poor rural areas? INTERNATIONAL JOURNAL OF EDUCATIONAL DEVELOPMENT Yi, H., Zhang, L., Luo, R., Shi, Y., Mo, D., Chen, X., Brinton, C., Rozelle, S. 2012; 32 (4): 555-563

  View details for DOI 10.1016/j.ijedudev.2011.09.002

  View details for Web of Science ID 000304637200009

• Rental markets for cultivated land and agricultural investments in China AGRICULTURAL ECONOMICS Gao, L., Huang, J., Rozelle, S. 2012; 43 (4): 391-403

  View details for DOI 10.1111/j.1574-0862.2012.00591.x

  View details for Web of Science ID 000306065800004

• The Limits of Health and Nutrition Education: Evidence from Three Randomized-Controlled Trials in Rural China CESIFO ECONOMIC STUDIES Luo, R., Shi, Y., Zhang, L., Zhang, H., Miller, G., Medina, A., Rozelle, S. 2012; 58 (2): 385-404

  View details for DOI 10.1093/cesifo/ifs023

  View details for Web of Science ID 000304540500008

• [Investigation on prevalence of soil-transmitted nematode infections and influencing factors for children in southwest areas of China]. Zhongguo xue xi chong bing fang zhi za zhi = Chinese journal of schistosomiasis control Wang, X., Wang, G., Zhang, L., Luo, R., Tian, H., Tang, L., Wang, J., Medina, A., Wise, P., Rozelle, S. 2012; 24 (3): 268–93

  Abstract

  OBJECTIVE: To understand the infection status and main risk factors of soil-transmitted nematodes in southwest China so as to provide the evidence for making the control programs for soil-transmitted nematodiasis.METHODS: The prevalence of soil-transmitted nematode infections was determined by Kato-Katz technique and influencing factors were surveyed by using a standardized questionnaire, and in part of the children, the examination of Enterobius vermicularis eggs was performed by using the cellophane swab method. The relationship between soil-transmitted nematode infections and influencing factors was analyzed by the multiple probit estimated method.RESULTS: A total of 1 707 children were examined, with a soil-transmitted nematode infection rate of 22.2%, the crowd infection rates ofAscaris lumbricoides, hookworm, and Trichuris trichiura were 16.0%, 3.8% and 6.6% respectively and 495 children were examined on Enterobius vermicularis eggs, with the infection rate of 5.1%. The results of probit estimated analysis suggested that the effects of 4 factors on soil-transmitted nematode infections were significant (all P values were less than 0.05), namely the number of sib, educational level of mother, drinking unboiled water and raising livestock and poultry. Among the factors above, the educational level of mother could reduce the probability of infection (ME = -0.074), while the number of sib, drinking unboiled water and raising livestock and poultry could increase the probability of the infections (with ME of 0.028, -0.112 and 0.080, respectively).CONCLUSIONS: Soil-transmitted nematode infection rates are still in a high level for children in southwest poor areas of China, with Ascaris lumbricoides as a priority. The changes of children's bad health habits, raising livestock and poultry habits, and implementing the health education about parasitic diseases in mothers would be of great significance for the prevention and control of soil-transmitted nematodiasis.

  View details for PubMedID 23012947

• Liquid biofuels in China: Current status, government policies, and future opportunities and challenges RENEWABLE & SUSTAINABLE ENERGY REVIEWS Qiu, H., Sun, L., Huang, J., Rozelle, S. 2012; 16 (5): 3095-3104

  View details for DOI 10.1016/j.rser.2012.02.036

  View details for Web of Science ID 000305354200065

• Food Standards and Welfare: General Equilibrium Effects JOURNAL OF AGRICULTURAL ECONOMICS Xiang, T., Huang, J., Kancs, d., Rozelle, S., Swinnen, J. 2012; 63 (2): 223-244

  View details for DOI 10.1111/j.1477-9552.2012.00334.x

  View details for Web of Science ID 000304252800001

• Transfer paths and academic performance: The primary school merger program in china INTERNATIONAL JOURNAL OF EDUCATIONAL DEVELOPMENT Mo, D., Yi, H., Zhang, L., Shi, Y., Rozelle, S., Medina, A. 2012; 32 (3): 423-431

  View details for DOI 10.1016/j.ijedudev.2011.11.001

  View details for Web of Science ID 000301698300008

• China's New Cooperative Medical Scheme Improved Finances Of Township Health Centers But Not The Number Of Patients Served HEALTH AFFAIRS Babiarz, K. S., Miller, G., Yi, H., Zhang, L., Rozelle, S. 2012; 31 (5): 1065-1074

  Abstract

  China's New Cooperative Medical Scheme, launched in 2003, was designed to protect rural households from the financial risk posed by health care costs and to increase the use of health care services. This article reports on findings from a longitudinal study of how the program affected the use of health care services, out-of-pocket spending on medical care, and the operations and financial viability of China's township health centers, which constitute a middle tier of care in between village clinics and county hospitals. We found that between 2005 and 2008 the program provided some risk protection and increased the intensity of inpatient care at township health centers. Importantly, the program appears to have improved the centers' financial status. At the same time, the program did not increase the overall number of patients served or the likelihood that a sick person would seek care at a township center. These findings serve as a benchmark of the program's early impact. The results also suggest that the composition of health care use in China has changed, with people increasingly seeking outpatient care at village clinics and inpatient care at township health centers.

  View details for DOI 10.1377/hlthaff.2010.1311

  View details for Web of Science ID 000303873100023

  View details for PubMedID 22566448

• Checking into China's cow hotels: Have policies following the milk scandal changed the structure of the dairy sector? JOURNAL OF DAIRY SCIENCE Mo, D., Huang, J., Jia, X., Luan, H., Rozelle, S., Swinnen, J. 2012; 95 (5): 2282-2298

  Abstract

  China's milk scandal is well known for causing the nation's largest food safety crisis and for its effect on thousands of children. Less, however, is known about the effect on the other victim: China's small dairy farmers. Although small backyard producers were not the ones that added melamine to the milk supply, the incomes of dairy farmers fell sharply after the crisis. In response, one of the actions taken by the government was to encourage small dairy producers to check into production complexes that were supposed to supply services, new technologies, and provide for easy/bulk procurement of the milk produced by the cows of the farmers. Because both farmers and their cows were living (and working) away from home, in the rest of the paper we call these complexes cow hotels. In this paper we examine the dynamics of China's dairy production structure before and after the milk scandal. In particular, we seek to gain a better understanding about how China's policies have been successful in encouraging farmers to move from the backyard into cow hotels. We also seek to find if larger or smaller farmers respond differently to these policy measures. Using data from a sample of farmers from dairy-producing villages in Greater Beijing, our empirical analysis finds that 1 yr after the milk scandal, the dairy production structure changed substantially. Approximately one quarter (26%) of the sample checked into cow hotels after the milk scandal, increasing from 2% before the crisis. Our results also demonstrate that the increase in cow hotel production can largely be attributed to China's dairy policies. Finally, our results suggest that the effects of government policy differ across farm sizes; China's dairy policies are more likely to persuade larger farms to join cow hotels. Apparently, larger farms benefit more when they join cow hotels. Overall, these results suggest that during the first year after the crisis, the government policies were effective in moving some of the backyard farmers into cow hotels (although 60% farmers remained backyard producing).

  View details for DOI 10.3168/jds.2011-4720

  View details for Web of Science ID 000303074900005

  View details for PubMedID 22541457

• Persistent Poverty in Rural China: Where, Why, and How to Escape? WORLD DEVELOPMENT Glauben, T., Herzfeld, T., Rozelle, S., Wang, X. 2012; 40 (4): 784-795

  View details for DOI 10.1016/j.worlddev.2011.09.023

  View details for Web of Science ID 000301810100010

• Behind before they begin: The challenge of early childhood education in rural China AUSTRALASIAN JOURNAL OF EARLY CHILDHOOD Luo, R., Zhang, L., Liu, C., Zhao, Q., Shi, Y., Rozelle, S., Sharbono, B. 2012; 37 (1): 55-64

  View details for Web of Science ID 000303557900006

• Quality and Inclusion of Producers in Value Chains: A Theoretical Note REVIEW OF DEVELOPMENT ECONOMICS Vandemoortele, T., Rozelle, S., Swinnen, J., Xiang, T. 2012; 16 (1): 122-136

  View details for DOI 10.1111/j.1467-9361.2011.00649.x

  View details for Web of Science ID 000299098900009

• Parental training, anemia and the impact on the nutrition of female students in China's poor rural elementary schools CHINA AGRICULTURAL ECONOMIC REVIEW Shi, Y., Chang, F., Su, X., Luo, R., Zhang, L., Rozelle, S. 2012; 4 (2): 151-167

  View details for DOI 10.1108/17561371211224746

  View details for Web of Science ID 000311001600002

• Consumers' trust in government and their attitudes towards genetically modified food: empirical evidence from China JOURNAL OF CHINESE ECONOMIC AND BUSINESS STUDIES Qiu, H., Huang, J., Pray, C., Rozelle, S. 2012; 10 (1): 67-87

  View details for DOI 10.1080/14765284.2012.638471

  View details for Web of Science ID 000212279200004

• Children of China's Future YaleGlobal Online Eggleston, K., Oi , J. C., Rozelle, S., Sun, A., Zhou, X. 2012
• Impact of China’s New Cooperative Medical Scheme on Township Health Centers Health Affairs Rozelle, S., Babiarz , K. S., Miller, G., Yi, H., Zhang , L. 2012; 31 (5): 1065-1074
• A complementary measurement of changes in China's forestry area using remote sensing data JOURNAL OF FOOD AGRICULTURE & ENVIRONMENT Deng, X., Fang, Y., Uchida, E., Rozelle, S. 2012; 10 (3-4): 1355-1358

  View details for Web of Science ID 000312085300001

• Pesticide use and farmers' health in China's rice production CHINA AGRICULTURAL ECONOMIC REVIEW Qiao, F., Huang, J., Zhang, L., Rozelle, S. 2012; 4 (4): 468-484

  View details for DOI 10.1108/17561371211284821

  View details for Web of Science ID 000311660100006

• The effect of off-farm employment on the decisions of households to rent out and rent in cultivated land in China CHINA AGRICULTURAL ECONOMIC REVIEW Huang, J., Gao, L., Rozelle, S. 2012; 4 (1): 5-17

  View details for DOI 10.1108/17561371211196748

  View details for Web of Science ID 000300124100001

• The rise of migration and the fall of self employment in rural China's labor market CHINA ECONOMIC REVIEW Wang, X., Huang, J., Zhang, L., Rozelle, S. 2011; 22 (4): 573-584

  View details for DOI 10.1016/j.chieco.2011.07.005

  View details for Web of Science ID 000297664100012

• College education and the poor in China: documenting the hurdles to educational attainment and college matriculation ASIA PACIFIC EDUCATION REVIEW Wang, X., Liu, C., Zhang, L., Luo, R., Glauben, T., Shi, Y., Rozelle, S., Sharbono, B. 2011; 12 (4): 533-546

  View details for DOI 10.1007/s12564-011-9155-z

  View details for Web of Science ID 000296285400003

• Do roads lead to grassland degradation or restoration? A case study in Inner Mongolia, China ENVIRONMENT AND DEVELOPMENT ECONOMICS Deng, X., Huang, J., Huang, Q., Rozelle, S., Gibson, J. 2011; 16: 751-773

  View details for DOI 10.1017/S1355770X11000180

  View details for Web of Science ID 000299019900006

• Anaemia among Students of Rural China's Elementary Schools: Prevalence and Correlates in Ningxia and Qinghai's Poor Counties JOURNAL OF HEALTH POPULATION AND NUTRITION Luo, R., Zhang, L., Liu, C., Zhao, Q., Shi, Y., Miller, G., Yu, E., Sharbono, B., Medina, A., Rozelle, S., Martorell, R. 2011; 29 (5): 471-485

  Abstract

  Although the past few decades have seen rising incomes and increased government attention to rural development, many children in rural China still lack regular access to micronutrient-rich diets. Insufficient diets and poor knowledge of nutrition among the poor result in nutritional problems, including iron-deficiency anaemia, which adversely affect attention and learning of students in school. Little research has been conducted in China documenting the prevalence of nutritional problems among vulnerable populations, such as school-age children, in rural areas. The absence of programmes to combat anaemia among students might be interpreted as a sign that the Government does not recognize its severity. The goals of this paper were to measure the prevalence of anaemia among school-age children in poor regions of Qinghai and Ningxia, to identify individual-, household- and school-based factors that correlate with anaemia in this region, and to report on the correlation between the anaemic status and the physical, psychological and cognitive outcomes. The results of a cross-sectional survey are reported here. The survey involved over 4,000 fourth and fifth grade students from 76 randomly-selected elementary schools in 10 poor counties in rural Qinghai province and Ningxia Hui Autonomous Region, located in the northwest region of China. Data were collected using a structured questionnaire and standardized tests. Trained professional nurses administered haemoglobin (Hb) tests (using Hemocue finger prick kits) and measured heights and weights of children. The baseline data showed that the overall anaemia rate was 24.9%, using the World Health Organization's blood Hb cut-offs of 120 g/L for children aged 12 years and older and 115 g/L for children aged 11 years and under. Children who lived and ate at school had higher rates of anaemia, as did children whose parents worked in farms or were away from home. Children with parents who had lower levels of education were more likely to be anaemic. The anaemic status correlated with the adverse physical, cognitive and psychological outcomes among the students. Such findings are consistent with findings of other recent studies in poor, northwest areas of China and led to conclude that anaemia remains a serious health problem among children in parts of China.

  View details for Web of Science ID 000296910300007

  View details for PubMedID 22106753

  View details for PubMedCentralID PMC3225109

• INVERSE RELATIONSHIP BETWEEN PRODUCTIVITY AND FARM SIZE: THE CASE OF CHINA CONTEMPORARY ECONOMIC POLICY Chen, Z., Huffman, W. E., Rozelle, S. 2011; 29 (4): 580-592

  View details for DOI 10.1111/j.1465-7287.2010.00236.x

  View details for Web of Science ID 000295083600008

• Do Trees Grow with the Economy? A Spatial Analysis of the Determinants of Forest Cover Change in Sichuan, China ENVIRONMENTAL & RESOURCE ECONOMICS Zhao, H., Uchida, E., Deng, X., Rozelle, S. 2011; 50 (1): 61-82

  View details for DOI 10.1007/s10640-011-9462-1

  View details for Web of Science ID 000293969400004

• HIGH ANEMIA PREVALENCE IN WESTERN CHINA SOUTHEAST ASIAN JOURNAL OF TROPICAL MEDICINE AND PUBLIC HEALTH Luo, R., Wang, X., Zhang, L., Liu, C., Shi, Y., Miller, G., Rozelle, S., Yu, E., Martorell, R. 2011; 42 (5): 1204-1213

  Abstract

  We assessed the prevalence of anemia among schoolchildren in western China as determined by seven cross-sectional surveys involving 12,768 children aged 8-12 years. Subjects were selected randomly from 283 primary schools in 41 economically disadvantaged counties of Ningxia, Qinghai, Shaanxi and Sichuan Provinces. Data were collected through questionnaires and hemoglobin levels were measured. The anemia prevalence was 34% using the WHO hemoglobin cutoff of < 120 g/l. Boarding students and girls were more likely to be anemic. The prevalence of anemia in schoolchildren was high. Iron deficiency is a significant nutrition issue in China.

  View details for Web of Science ID 000295186800020

  View details for PubMedID 22299447

• Early commitment on financial aid and college decision making of poor students: Evidence from a randomized evaluation in rural China ECONOMICS OF EDUCATION REVIEW Liu, C., Zhang, L., Luo, R., Wang, X., Rozelle, S., Sharbono, B., Adams, J., Shi, Y., Yue, A., Li, H., Glauben, T. 2011; 30 (4): 627-640

  View details for DOI 10.1016/j.econedurev.2011.02.003

  View details for Web of Science ID 000292409100005

• Biofuel Development, Food Security and the Use of Marginal Land in China JOURNAL OF ENVIRONMENTAL QUALITY Qiu, H., Huang, J., Keyzer, M., van Veen, W., Rozelle, S., Fisher, G., Ermolieva, T. 2011; 40 (4): 1058-1067

  Abstract

  With concerns of energy shortages, China, like the United States, European Union, and other countries, is promoting the development of biofuels. However, China also faces high future demand for food and feed, and so its bioenergy program must try to strike a balance between food and fuel. The goals of this paper are to provide an overview of China's current bioethanol program, identify the potential for using marginal lands for feedstock production, and measure the likely impacts of China's bioethanol development on the nation's future food self-sufficiency. Our results indicate that the potential to use marginal land for bioethanol feedstock production is limited. Applying a modeling approach based on highly disaggregated data by region, our analysis shows that the target of 10 million t of bioethanol by 2020 seems to be a prudent target, causing no major disturbances in China's food security. But the expansion of bioethanol may increase environmental pressures due to the higher levels of fertilizer use. This study shows also that if China were able to cultivate 45% of its required bioethanol feedstock on new marginal land, it would further limit negative effects of the bioethanol program on the domestic and international economy, but at the expense of having to apply another 750 thousand t of fertilizer.

  View details for DOI 10.2134/jeq2011.0012

  View details for Web of Science ID 000292084100002

  View details for PubMedID 21712574

• MARKET DEVELOPMENT AND THE RISE AND FALL OF BACKYARD HOG PRODUCTION IN CHINA DEVELOPING ECONOMIES Qiao, F., Chen, J., Carter, C., Huang, J., Rozelle, S. 2011; 49 (2): 203-222

  View details for DOI 10.1111/j.1746-1049.2011.00129.x

  View details for Web of Science ID 000290870800004

• Which households are most distant from health centers in rural China ? Evidence from a GIS network analysis GEOJOURNAL Gibson, J., Deng, X., Boe-Gibson, G., Rozelle, S., Huang, J. 2011; 76 (3): 245-255

  View details for DOI 10.1007/s10708-010-9337-y

  View details for Web of Science ID 000210517500004

• The Impact of the Global Financial Crisis on Off-farm Employment and Earnings in Rural China WORLD DEVELOPMENT Huang, J., Zhi, H., Huang, Z., Rozelle, S., Giles, J. 2011; 39 (5): 797-807

  View details for DOI 10.1016/j.worlddev.2010.09.017

  View details for Web of Science ID 000290082800010

• The impact of the Doha trade proposals on farmers' incomes in China JOURNAL OF POLICY MODELING Yang, J., Huang, J., Li, N., Rozelle, S., Martin, W. 2011; 33 (3): 439-452

  View details for DOI 10.1016/j.jpolmod.2010.08.005

  View details for Web of Science ID 000290882200008

• Mapping poverty in rural China: how much does the environment matter? ENVIRONMENT AND DEVELOPMENT ECONOMICS Olivia, S., Gibson, J., Rozelle, S., Huang, J., Deng, X. 2011; 16: 129-153

  View details for DOI 10.1017/S1355770X10000513

  View details for Web of Science ID 000289876900001

• Efficiency of Land Allocation through Tenancy Markets: Evidence from China ECONOMIC DEVELOPMENT AND CULTURAL CHANGE Kimura, S., Otsuka, K., Sonobe, T., Rozelle, S. 2011; 59 (3): 485-510

  View details for DOI 10.1086/649639

  View details for Web of Science ID 000288652500001

• Conducting influential impact evaluations in China: the experience of the Rural Education Action Project JOURNAL OF DEVELOPMENT EFFECTIVENESS Boswell, M., Rozelle, S., Zhang, L., Liu, C., Luo, R., Shi, Y. 2011; 3 (3): 420-430

  View details for DOI 10.1080/19439342.2011.596940

  View details for Web of Science ID 000297213800006

• Alarmingly High Anemia Prevalence in Western China Southeast Asian Journal of Tropical Medicine and Public Health Rozelle , S., et al 2011; 42 (5)
• Private Migrant Schools or Rural/Urban Public Schools: Where Should China Educate Its Migrant Children? Economics of Education Review Rozelle, S. 2011
• How widespread are nonlinear crowding out effects? The response of private transfers to income in four developing countries APPLIED ECONOMICS Gibson, J., Olivia, S., Rozelle, S. 2011; 43 (27): 4053-4068

  View details for DOI 10.1080/00036841003800831

  View details for Web of Science ID 000295691100011

• The effects of price on household demand for food and calories in poor countries: are our databases giving reliable estimates? APPLIED ECONOMICS Gibson, J., Rozelle, S. 2011; 43 (27): 4021-4031

  View details for DOI 10.1080/00036841003781478

  View details for Web of Science ID 000295691100008

• What is keeping the poor out of college? Enrollment rates, educational barriers and college matriculation in China CHINA AGRICULTURAL ECONOMIC REVIEW Wang, X., Liu, C., Zhang, L., Luo, R., Glauben, T., Shi, Y., Rozelle, S., Sharbono, B. 2011; 3 (2): 131-149

  View details for DOI 10.1108/17561371111131281

  View details for Web of Science ID 000292071200002

• Community service, educational performance and social responsibility in Northwest China JOURNAL OF MORAL EDUCATION Luo, R., Shi, Y., Zhang, L., Liu, C., Li, H., Rozelle, S., Sharbono, B. 2011; 40 (2): 181-202

  View details for DOI 10.1080/03057240.2011.568100

  View details for Web of Science ID 000290633500003

• Pressure cookers or pressure valves: Do roads lead to deforestation in China? JOURNAL OF ENVIRONMENTAL ECONOMICS AND MANAGEMENT Deng, X., Huang, J., Uchida, E., Rozelle, S., Gibson, J. 2011; 61 (1): 79-94

  View details for DOI 10.1016/j.jeem.2010.04.005

  View details for Web of Science ID 000286544500006

• Subsidies and distortions in China's agriculture: evidence from producer-level data AUSTRALIAN JOURNAL OF AGRICULTURAL AND RESOURCE ECONOMICS Huang, J., Wang, X., Zhi, H., Huang, Z., Rozelle, S. 2011; 55 (1): 53-71

  View details for DOI 10.1111/j.1467-8489.2010.00527.x

  View details for Web of Science ID 000285873900004

• Empirical assessment of water management institutions in northern China AGRICULTURAL WATER MANAGEMENT Huang, Q., Wang, J., Easter, K. W., Rozelle, S. 2010; 98 (2): 361-369

  View details for DOI 10.1016/j.agwat.2010.09.004

  View details for Web of Science ID 000285452200015

• Policy support and emerging farmer professional cooperatives in rural China CHINA ECONOMIC REVIEW Deng, H., Huang, J., Xu, Z., Rozelle, S. 2010; 21 (4): 495-507

  View details for DOI 10.1016/j.chieco.2010.04.009

  View details for Web of Science ID 000283913900001

• Does taking one step back get you two steps forward? Grade retention and school performance in poor areas in rural China INTERNATIONAL JOURNAL OF EDUCATIONAL DEVELOPMENT Chen, X., Liu, C., Zhang, L., Shi, Y., Rozelle, S. 2010; 30 (6): 544-559

  View details for DOI 10.1016/j.ijedudev.2009.12.002

  View details for Web of Science ID 000281173300003

• China's agriculture: drivers of change and implications for China and the rest of world 27th Conference of the International-Association-of-Agricultural-Economists Huang, J., Yang, J., Rozelle, S. WILEY-BLACKWELL. 2010: 47–55

  View details for Web of Science ID 000285124700005

• The effect of primary school mergers on academic performance of students in rural China INTERNATIONAL JOURNAL OF EDUCATIONAL DEVELOPMENT Liu, C., Zhang, L., Luo, R., Rozelle, S., Loyalka, P. 2010; 30 (6): 570-585

  View details for DOI 10.1016/j.ijedudev.2010.05.003

  View details for Web of Science ID 000281173300005

• New evidence on the impact of China's New Rural Cooperative Medical Scheme and its implications for rural primary healthcare: multivariate difference-in-difference analysis BRITISH MEDICAL JOURNAL Babiarz, K. S., Miller, G., Yi, H., Zhang, L., Rozelle, S. 2010; 341

  Abstract

  To determine whether China's New Rural Cooperative Medical Scheme (NCMS), which aims to provide health insurance to 800 million rural citizens and to correct distortions in rural primary care, and the individual policy attributes have affected the operation and use of village health clinics.We performed a difference-in-difference analysis using multivariate linear regressions, controlling for clinic and individual attributes as well as village and year effects.100 villages within 25 rural counties across five Chinese provinces in 2004 and 2007. Participants 160 village primary care clinics and 8339 individuals.Clinic outcomes were log average weekly patient flow, log average monthly gross income, log total annual net income, and the proportion of monthly gross income from medicine sales. Individual outcomes were probability of seeking medical care, log annual "out of pocket" health expenditure, and two measures of exposure to financial risk (probability of incurring out of pocket health expenditure above the 90th percentile of spending among the uninsured and probability of financing medical care by borrowing or selling assets).For village clinics, we found that NCMS was associated with a 26% increase in weekly patient flow and a 29% increase in monthly gross income, but no change in annual net revenue or the proportion of monthly income from drug revenue. For individuals, participation in NCMS was associated with a 5% increase in village clinic use, but no change in overall medical care use. Also, out of pocket medical spending fell by 19% and the two measures of exposure to financial risk declined by 24-63%. These changes occurred across heterogeneous county programmes, even in those with minimal benefit packages.NCMS provides some financial risk protection for individuals in rural China and has partly corrected distortions in Chinese rural healthcare (reducing the oversupply of specialty services and prescription drugs). However, the scheme may have also shifted uncompensated new responsibilities to village clinics. Given renewed interest among Chinese policy makers in strengthening primary care, the effect of NCMS deserves greater attention.

  View details for DOI 10.1136/bmj.c5617

  View details for Web of Science ID 000283553200002

  View details for PubMedID 20966008

• Access to groundwater and agricultural production in China AGRICULTURAL WATER MANAGEMENT Zhang, L., Wang, J., Huang, J., Huang, Q., Rozelle, S. 2010; 97 (10): 1609-1616

  View details for DOI 10.1016/j.agwat.2010.05.015

  View details for Web of Science ID 000280627600022

• Natural refuge crops, buildup of resistance, and zero-refuge strategy for Bt cotton in China SCIENCE CHINA-LIFE SCIENCES Qiao Fangbin, F. B., Huang JiKun, J. K., Rozelle, S., Wilen, J. 2010; 53 (10): 1227-1238

  Abstract

  In the context of genetically modified crops expressing the Bacillus thuringiensis (Bt) toxin, a 'refuge' refers to a crop of the same or a related species that is planted nearby to enable growth and reproduction of the target pest without the selection pressure imposed by the Bt toxin. The goal of this study is to discuss the role of natural refuge crops in slowing down the buildup of resistance of cotton bollworm (CBW), and to evaluate China's no-refuge policy for Bt cotton. We describe in detail the different factors that China should consider in relation to the refuge policy. Drawing on a review of scientific data, economic analyses of other cases, and a simulation exercise using a bio-economic model, we show that in the case of Bt cotton in China, the no-refuge policy is defensible.

  View details for DOI 10.1007/s11427-010-4076-3

  View details for Web of Science ID 000283120000010

  View details for PubMedID 20953946

• Farmer Participation, Processing, and the Rise of Dairy Production in Greater Beijing, P. R. China CANADIAN JOURNAL OF AGRICULTURAL ECONOMICS-REVUE CANADIENNE D AGROECONOMIE Huang, J., Wu, Y., Yang, Z., Rozelle, S., Fabiosa, J., Dong, F. 2010; 58 (3): 321-342

  View details for DOI 10.1111/j.1744-7976.2010.01185.x

  View details for Web of Science ID 000280630000004

• Water Governance and Water Use Efficiency: The Five Principles of WUA Management and Performance in China1 JOURNAL OF THE AMERICAN WATER RESOURCES ASSOCIATION Wang, J., Huang, J., Zhang, L., Huang, Q., Rozelle, S. 2010; 46 (4): 665-685

  View details for DOI 10.1111/j.1752-1688.2010.00439.x

  View details for Web of Science ID 000280357300003

• A decade of Bt cotton in Chinese fields: Assessing the direct effects and indirect externalities of Bt cotton adoption in China SCIENCE CHINA-LIFE SCIENCES Huang JiKun, J. K., Mi JianWei, J. W., Lin Hai, H., Wang Zijun, Z. J., Chen RuiJian, R. J., Hu RuiFa, R. F., Rozelle, S., Pray, C. 2010; 53 (8): 981-991

  Abstract

  The objective of this study is to examine whether or not the gains from reduced spraying for bollworms are being sustained more than one decade after the initial adoption in 2007. Based on farm-level data collected by the authors in 1999-2007 in 16 villages from 4 provinces, this study shows that insecticides applied for controlling bollworms have declined. This analysis supports Chinese policy makers' decision to not require refuges of non-Bt cotton fields. It also suggests that past studies may have underestimated the benefits from adopting Bt technology.

  View details for DOI 10.1007/s11427-010-4036-y

  View details for Web of Science ID 000281670300009

• Productivity, efficiency and technical change: measuring the performance of China's transforming agriculture Conference on Trends and Forces in International Agricultural Productivity Growth Jin, S., Ma, H., Huang, J., Hu, R., Rozelle, S. SPRINGER. 2010: 191–207

  View details for DOI 10.1007/s11123-009-0145-7

  View details for Web of Science ID 000277720500003

• Agricultural Development, Nutrition, and the Policies Behind China's Success ASIAN JOURNAL OF AGRICULTURE AND DEVELOPMENT Huang, J., Rozelle, S. 2010; 7 (1): 93-126

  View details for Web of Science ID 000422284200005

• Irrigation water demand and implications for water pricing policy in rural China ENVIRONMENT AND DEVELOPMENT ECONOMICS Huang, Q., Rozelle, S., Howitt, R., Wang, J., Huang, J. 2010; 15: 293-319

  View details for DOI 10.1017/S1355770X10000070

  View details for Web of Science ID 000279212700003

• Economic Growth and the Expansion of Urban Land in China URBAN STUDIES Deng, X., Huang, J., Rozelle, S., Uchida, E. 2010; 47 (4): 813-843

  View details for DOI 10.1177/0042098009349770

  View details for Web of Science ID 000275724000006

• Why is China's Blue Revolution so "Blue"? The determinants of conservation tillage in China JOURNAL OF SOIL AND WATER CONSERVATION Wang, J., Huang, J., Zhang, L., Rozelle, S., Farnsworth, H. F. 2010; 65 (2): 113-129

  View details for DOI 10.2489/jswc.65.2.113

  View details for Web of Science ID 000276286500012

• Cost-Effectiveness of Payments for Ecosystem Services with Dual Goals of Environment and Poverty Alleviation ENVIRONMENTAL MANAGEMENT Gauvin, C., Uchida, E., Rozelle, S., Xu, J., Zhan, J. 2010; 45 (3): 488-501

  Abstract

  The goal of this article is to understand strategies by which both the environmental and poverty alleviation objectives of PES programs can be achieved cost effectively. To meet this goal, we first create a conceptual framework to understand the implications of alternative targeting when policy makers have both environmental and poverty alleviation goals. We then use the Grain for Green program in China, the largest PES program in the developing world, as a case study. We also use a data set from a survey that we designed and implemented to evaluate the program. Using the data set we first evaluate what factors determined selection of program areas for the Grain for Green program. We then demonstrate the heterogeneity of parcels and households and examine the correlations across households and their parcels in terms of their potential environmental benefits, opportunity costs of participating, and the asset levels of households as an indicator of poverty. Finally, we compare five alternative targeting criteria and simulate their performance in terms of cost effectiveness in meeting both the environmental and poverty alleviation goals when given a fixed budget. Based on our simulations, we find that there is a substantial gain in the cost effectiveness of the program by targeting parcels based on the "gold standard," i.e., targeting parcels with low opportunity cost and high environmental benefit managed by poorer households.

  View details for DOI 10.1007/s00267-009-9321-9

  View details for Web of Science ID 000275789700007

  View details for PubMedID 19536592

• Impacts of El Nino-Southern Oscillation events on China's rice production JOURNAL OF GEOGRAPHICAL SCIENCES Deng Xiangzheng, X. Z., Huang Jikun, J. K., Qiao Fangbin, F. B., Naylor, R. L., Falcon, W. P., Burke, M., Rozelle, S., Battisti, D. 2010; 20 (1): 3-16

  View details for DOI 10.1007/s11442-010-0003-6

  View details for Web of Science ID 000273792100001

• Village Elections, Public Goods Investments and Pork Barrel Politics, Chinese-style JOURNAL OF DEVELOPMENT STUDIES Luo, R., Zhang, L., Huang, J., Rozelle, S. 2010; 46 (4): 662-684

  View details for DOI 10.1080/00220380903318061

  View details for Web of Science ID 000277694700004

• Financial reform and transition in China: a study of the evolution of banks in rural China AGRICULTURAL FINANCE REVIEW Shen, M., Huang, J., Zhang, L., Rozelle, S. 2010; 70 (3): 305-+

  View details for DOI 10.1108/00021461011088468

  View details for Web of Science ID 000212408500001

• Growing Pains: Tensions and Opportunity in China's Transformation Oi, J. C., Rozelle, S., Zhou , X. Shorenstein APARC. 2010
• Anemia in Rural China's Elementary Schools: Prevalence and Correlates in Shaanxi Province's Poor Counties ECOLOGY OF FOOD AND NUTRITION Luo, R., Kleiman-Weiner, M., Rozelle, S., Zhang, L., Liu, C., Sharbono, B., Shi, Y., Yue, A., Martorell, R., Lee, M. 2010; 49 (5): 357-372

  Abstract

  Despite growing wealth in China, a significant share of children across rural China still have no access to iron-rich foods, vitamins, and other micronutrients. Such poor diets may result in high incidences of nutritional problems, including anemia. The objective of the study was to increase understanding of the extent of anemia, and identify structural correlates of anemia in poor Shaanxi province's primary schools. The article shows that the overall anemia rate is 21.5 percent when using a blood hemoglobin cutoff of 115 g/L (39 percent with a cutoff of 120 g/L). We find that those students that are boarding at school and eat lunch away from home are more likely to be anemic. Children with anemia are found to have lower height for age (HAZ) scores. If this part of Shaanxi province is representative of all poor counties in China, these findings mean millions of children in poor rural China may be anemic.

  View details for DOI 10.1080/03670244.2010.507437

  View details for Web of Science ID 000284103700002

  View details for PubMedID 21888576

• The challenges facing young workers during rural labor transition CHINA AGRICULTURAL ECONOMIC REVIEW Li, X., Liu, C., Luo, R., Zhang, L., Rozelle, S. 2010; 2 (2): 185-199

  View details for DOI 10.1108/17561371011044298

  View details for Web of Science ID 000281034500004

• A comparison of rural and urban healthcare consumption and health insurance CHINA AGRICULTURAL ECONOMIC REVIEW Wang, H. H., Huang, S., Zhang, L., Rozelle, S., Yan, Y. 2010; 2 (2): 212-227

  View details for DOI 10.1108/17561371011044315

  View details for Web of Science ID 000281034500006

• Bioethanol development in China and the potential impacts on its agricultural economy APPLIED ENERGY Qiu, H., Huang, J., Yang, J., Rozelle, S., Zhang, Y., Zhang, Y., Zhang, Y. 2010; 87 (1): 76-83

  View details for DOI 10.1016/j.apenergy.2009.07.015

  View details for Web of Science ID 000271037600008

• Biofuels and the Greater Mekong Subregion: Assessing the impact on prices, production and trade APPLIED ENERGY Yang, J., Huang, J., Qiu, H., Rozelle, S., Sombilla, M. A. 2009; 86: S37-S46

  View details for DOI 10.1016/j.apenergy.2009.04.031

  View details for Web of Science ID 000271170300005

• Producing and Procuring Horticultural Crops with Chinese Characteristics: The Case of Northern China WORLD DEVELOPMENT Wang, H., Dong, X., Rozelle, S., Huang, J., Reardon, T. 2009; 37 (11): 1791-1801

  View details for DOI 10.1016/j.worlddev.2008.08.030

  View details for Web of Science ID 000271925700007

• Changes in trade and domestic distortions affecting China's agriculture FOOD POLICY Huang, J., Liu, Y., Martin, W., Rozelle, S. 2009; 34 (5): 407-416

  View details for DOI 10.1016/j.foodpol.2009.04.001

  View details for Web of Science ID 000270349200002

• Economic Consequences of Urbanisation and Urbanisation Policy in China COMPARATIVE ECONOMIC STUDIES Brada, J., Fleisher, B., Rozelle, S., Swinnen, J. 2009; 51 (3): 281-283

  View details for DOI 10.1057/ces.2009.3

  View details for Web of Science ID 000210781100001

• Effect of Migration on Children's Educational Performance in Rural China COMPARATIVE ECONOMIC STUDIES Chen, X., Huang, Q., Rozelle, S., Shi, Y., Zhang, L. 2009; 51 (3): 323-343

  View details for DOI 10.1057/ces.2008.44

  View details for Web of Science ID 000210781100004

• The evolution of groundwater governance: productivity, equity and changes in the level of China's aquifers QUARTERLY JOURNAL OF ENGINEERING GEOLOGY AND HYDROGEOLOGY Wang, J., Huang, J., Huang, Q., Rozelle, S., Farnsworth, H. F. 2009; 42: 267-280

  View details for DOI 10.1144/1470-9236/09-005

  View details for Web of Science ID 000269089300001

• HEALTH INSURANCE AND CATASTROPHIC ILLNESS: A REPORT ON THE NEW COOPERATIVE MEDICAL SYSTEM IN RURAL CHINA HEALTH ECONOMICS Yi, H., Zhang, L., Singer, K., Rozelle, S., Atlas, S. 2009; 18: S119-S127

  Abstract

  The overall goal of the paper is to understand the progress of the design and implementation of China's New Cooperative Medical System (NCMS) program between 2004 (the second year of the program) and 2007. In the paper we seek to assess some of the strengths and weaknesses of the program using a panel of national-representative, household survey data that were collected in 2005 and early 2008. According to our data, we confirm the recent reports by the Ministry of Health that there have been substantial improvements to the NCMS program in terms of coverage and participation. We also show that rural individuals also perceive an improvement in service by 2007. While the progress of the NCMS program is clear, there are still weaknesses. Most importantly, the program clearly does not meet one of its key goals of providing insurance against catastrophic illnesses. On average, individuals that required inpatient treatment in 2007 were reimbursed for 15% of their expenditures. Although this is higher than in 2004, on average, as the severity of the illness (in terms of expenditures on health care) rose, the real reimbursement rate (reimbursement amount/total expenditure on medical care) fell. The real reimbursement rate for illnesses that required expenditures between 4000 and 10,000 yuan (over 10,000 yuan) was only 11% (8%). Our analysis shows that one of the limiting factors is constrained funding.

  View details for DOI 10.1002/hec.1510

  View details for Web of Science ID 000267744300010

  View details for PubMedID 19551747

• Why did the communist party reform in China, but not in the Soviet Union? The political economy of agricultural transition Chinese-Economists-Society-Europe Conference 2007 Rozelle, S., Swinnen, J. F. ELSEVIER SCIENCE INC. 2009: 275–87

  View details for DOI 10.1016/j.chieco.2008.10.014

  View details for Web of Science ID 000267184900015

• Reforming intellectual property rights and the Bt cotton seed industry in China: Who benefits from policy reform? RESEARCH POLICY Hu, R., Pray, C., Huang, J., Rozelle, S., Fan, C., Zhang, C. 2009; 38 (5): 793-801

  View details for DOI 10.1016/j.respol.2008.12.008

  View details for Web of Science ID 000266187100010

• Dynamically optimal strategies for managing the joint resistance of pests to Bt toxin and conventional pesticides in a developing country EUROPEAN REVIEW OF AGRICULTURAL ECONOMICS Qiao, F., Wilen, J., Huang, J., Rozelle, S. 2009; 36 (2): 253-279

  View details for DOI 10.1093/erae/jbp014

  View details for Web of Science ID 000268587700006

• Introduction to the symposium on agriculture in transition CHINA ECONOMIC REVIEW Fleisher, B. M., Brada, J., Rozelle, S., Swinnen, J. 2009; 20 (2): 263-264

  View details for DOI 10.1016/j.chieco.2008.11.001

  View details for Web of Science ID 000267184900013

• Farm technology and technical efficiency: Evidence from four regions in China CHINA ECONOMIC REVIEW Chen, Z., Huffman, W. E., Rozelle, S. 2009; 20 (2): 153-161

  View details for DOI 10.1016/j.chieco.2009.03.002

  View details for Web of Science ID 000267184900004

• The impact of climate change on China's agriculture AGRICULTURAL ECONOMICS Wang, J., Mendelsohn, R., Dinar, A., Huang, J., Rozelle, S., Zhang, L. 2009; 40 (3): 323-337

  View details for DOI 10.1111/j.1574-0862.2009.00379.x

  View details for Web of Science ID 000265184500005

• Moving off the farm and intensifying agricultural production in Shandong: a case study of rural labor market linkages in China AGRICULTURAL ECONOMICS Huang, J., Wu, Y., Rozelle, S. 2009; 40 (2): 203-218

  View details for DOI 10.1111/j.1574-0862.2009.00370.x

  View details for Web of Science ID 000263675500007

• Wine Markets in China: Assessing the Potential with Supermarket Survey Data JOURNAL OF WINE ECONOMICS Lee, H., Huang, J., Rozelle, S., Sumner, D. 2009; 4 (1): 94–113

  View details for DOI 10.1017/S1931436100000705

  View details for Web of Science ID 000218282600008

• Conservation Payments, Liquidity Constraints, and Off-Farm Labor: Impact of the Grain-for-Green Program on Rural Households in China AMERICAN JOURNAL OF AGRICULTURAL ECONOMICS Uchida, E., Rozelle, S., Xu, J. 2009; 91 (1): 70-86

  View details for DOI 10.1111/j.1467-8276.2008.01184.x

  View details for Web of Science ID 000262346000005

• Water management institutional reform: A representative look at northern China AGRICULTURAL WATER MANAGEMENT Huang, Q., Rozelle, S., Wang, J., Huang, J. 2009; 96 (2): 215-225

  View details for DOI 10.1016/j.agwat.2008.08.002

  View details for Web of Science ID 000262240200005

• Understanding the Water Crisis in Northern China: What the Government and Farmers are Doing INTERNATIONAL JOURNAL OF WATER RESOURCES DEVELOPMENT Wang, J., Huang, J., Rozelle, S., Huang, Q., Zhang, L. 2009; 25 (1): 141-158

  View details for DOI 10.1080/07900620802517566

  View details for Web of Science ID 000262630200010

• Regulation of local governments and enterprise formation in rural China JOURNAL OF CHINESE ECONOMIC AND BUSINESS STUDIES Zhang, J., Mohapatra, S., Boucher, S., Rozelle, S. 2009; 7 (3): 321-339

  View details for DOI 10.1080/14765280903073199

  View details for Web of Science ID 000212268200003

• Effect of Migration on Children's Educational Performance in Rural China Comparative Edonomic Studies Chen, X., Huang, Q., Rozelle, S., Sharbono , B. 2009; 51
• Bt Cotton in China: Are Secondary Insect Infestations Offsetting the Benefits in Farmer Fields? AGRICULTURAL SCIENCES IN CHINA Wang Zi-Jun, Z. J., Lin Hai, H., Huang Ji-kun, J. K., Hu Rui-fa, R. F., Rozelle, S., Pray, C. 2009; 8 (1): 83-90

  View details for Web of Science ID 000207992500012

• Development challenges, tuition barriers, and high school education in China ASIA PACIFIC JOURNAL OF EDUCATION Liu, C., Zhang, L., Luo, R., Rozelle, S., Sharbono, B., Shi, Y. 2009; 29 (4): 503-520

  View details for DOI 10.1080/02188790903312698

  View details for Web of Science ID 000274345500008

• Malnutrition in China's rural boarding schools: the case of primary schools in Shaanxi Province ASIA PACIFIC JOURNAL OF EDUCATION Luo, R., Shi, Y., Zhang, L., Liu, C., Rozelle, S., Sharbono, B. 2009; 29 (4): 481-501

  View details for DOI 10.1080/02188790903312680

  View details for Web of Science ID 000274345500007

• Governance Structures and Resource Policy Reform: Insights from Agricultural Transition ANNUAL REVIEW OF RESOURCE ECONOMICS Swinnen, J. F., Rozelle, S. 2009; 1: 33-54

  View details for DOI 10.1146/annurev.resource.050708.144122

  View details for Web of Science ID 000273629900004

• Contribution of Wheat Diversity to Total Factor Productivity in China JOURNAL OF AGRICULTURAL AND RESOURCE ECONOMICS Jin, S., Meng, E. C., Hu, R., Rozelle, S., Huang, J. 2008; 33 (3): 449-472

  View details for Web of Science ID 000262138900010

• Fighting global food price rises in the developing world: the response of China and its effect on domestic and world markets AGRICULTURAL ECONOMICS Yang, J., Qiu, H., Huang, J., Rozelle, S. 2008; 39 (3): 453-464

  View details for DOI 10.1111/j.1574-0862.2008.00351.x

  View details for Web of Science ID 000261686600008

• Small holder incomes, food safety and producing, and marketing China's fruit Annual Meeting of the Allied-Social-Science-Association Huang, J., Wu, Y., Zhi, H., Rozelle, S. WILEY-BLACKWELL. 2008: 469–79

  View details for DOI 10.1111/j.1467-9353.2008.00421.x

  View details for Web of Science ID 000258976900011

• Development and impacts of agricultural biotechnology in China Huang, J., Hu, R., Rozelle, S., Pray, C. ELSEVIER SCIENCE BV. 2008: S214-S215

  View details for DOI 10.1016/j.jbiotec.2008.07.454

  View details for Web of Science ID 000208979401007

• Incentive Complementarity in China's Rural Enterprises REVIEW OF INDUSTRIAL ORGANIZATION Mohapatra, S., Goodhue, R. E., Rozelle, S. 2008; 33 (1): 63-79

  View details for DOI 10.1007/s11151-008-9178-8

  View details for Web of Science ID 000260018600004

• Feminization of agriculture in China? Myths surrounding women's participation in farming CHINA QUARTERLY de Brauw, A., Li, Q., Liu, C., Rozelle, S., Zhang, L. 2008: 327-348

  View details for DOI 10.1017/S0305741008000404

  View details for Web of Science ID 000257370100004

• Dynamically optimal strategies for managing resistance to genetically modified crops JOURNAL OF ECONOMIC ENTOMOLOGY Qiao, F., Wilen, J., Rozelle, S. 2008; 101 (3): 915-926

  Abstract

  This paper develops a dynamic model of the evolution of pest a population and pest resistance to characterize the socially optimal refuge strategy for managing a pest's resistance to genetically modified crops. Previous theoretical economic analyses of this problem focus on steady states; we also address refuge policies along the optimal path to the final equilibrium. To elaborate on our theoretical analysis of the resistance problem, we develop a simulation model calibrated to cotton (Gossypium spp.) production in China. Our results show the importance of fitness cost as a determinant of the qualitative nature of optimal refuge policies.

  View details for Web of Science ID 000258337200035

  View details for PubMedID 18613595

• Migration and household investment in rural China CHINA ECONOMIC REVIEW De Brauw, A., Rozelle, S. 2008; 19 (2): 320-335

  View details for DOI 10.1016/j.chieco.2006.10.004

  View details for Web of Science ID 000256609700016

• Water management reform and the choice of contractual form in China ENVIRONMENT AND DEVELOPMENT ECONOMICS Huang, Q., Rozelle, S., Msangi, S., Wang, J., Huang, J. 2008; 13: 171-200

  View details for DOI 10.1017/S1355770X07004196

  View details for Web of Science ID 000255249900002

• Development of groundwater markets in China: A glimpse into progress to date WORLD DEVELOPMENT Zhang, L., Wang, J., Huang, J., Rozelle, S. 2008; 36 (4): 706-726

  View details for DOI 10.1016/j.worlddev.2007.04.012

  View details for Web of Science ID 000255121200010

• Reconciling the returns to education in off-farm wage employment in rural China REVIEW OF DEVELOPMENT ECONOMICS de Brauw, A., Rozelle, S. 2008; 12 (1): 57-71

  View details for DOI 10.1111/j.1467-9361.2007.00376.x

  View details for Web of Science ID 000252330600004

• Will the Biosafety Protocol hinder or protect the developing world: Learning from China's experience FOOD POLICY Huang, J., Zhang, D., Yang, J., Rozelle, S., Kalaitzandonakes, N. 2008; 33 (1): 1-12

  View details for DOI 10.1016/j.foodpol.2007.05.002

  View details for Web of Science ID 000253118800001

• Growth, population and industrialization, and urban land expansion of China JOURNAL OF URBAN ECONOMICS Deng, X., Huang, J., Rozelle, S., Uchida, E. 2008; 63 (1): 96-115

  View details for DOI 10.1016/j.jue.2006.12.006

  View details for Web of Science ID 000252977300005

• Economic growth, the nature of growth and poverty reduction in rural China CHINA ECONOMIC JOURNAL Huang, J., Zhang, Q., Rozelle, S. 2008; 1 (1): 107-122

  View details for DOI 10.1080/17538960701770547

  View details for Web of Science ID 000422586600006

• Understanding the water crisis in northern China How do farmers and the government respond? CHINAS DILEMMA: ECONOMIC GROWTH, THE ENVIRONMENT AND CLIMATE CHANGE Wang, J., Huang, J., Rozelle, S., Huang, Q., Zhang, L., Song, L., Woo, W. T. 2008: 276-296

  View details for Web of Science ID 000291424800013

• Agricultural development and policy before and after China's WTO accession AGRICULTURE AND FOOD SECURITY IN CHINA: WHAT EFFECT WTO ACCESSION AND REGIONAL TRADE ARRANGEMENTS Huang, J., Rozelle, S., Chen, C., Duncan, R. 2008: 27-54

  View details for Web of Science ID 000291426900003

• Genetically modified rice, yields, and pesticides: Assessing farm-level productivity effects in China ECONOMIC DEVELOPMENT AND CULTURAL CHANGE Huang, J., Hu, R., Rozelle, S., Pray, C. 2008; 56 (2): 241-263

  View details for Web of Science ID 000251458700001

• Consumption of dairy products in urban China: results from Beijing, Shangai and Guangzhou AUSTRALIAN JOURNAL OF AGRICULTURAL AND RESOURCE ECONOMICS Fuller, F., Beghin, J., Rozelle, S. 2007; 51 (4): 459-474

  View details for DOI 10.1111/j.1467-8489.2007.00379.x

  View details for Web of Science ID 000250518700006

• The ripple effect: Biofuels, food security, and the environment ENVIRONMENT Naylor, R. L., Liska, A. J., Burke, M. B., Falcon, W. P., Gaskell, J. C., Rozelle, S. D., Cassman, K. G. 2007; 49 (9): 30-43

  View details for Web of Science ID 000250943700005

• The dynamics of Chinese rural households' participation in labor markets 26th Meeting of the International-Association-of-Agricultural-Economists (IAAE) Brosig, S., Glauben, T., Herzfeld, T., Rozelle, S., Wang, X. WILEY-BLACKWELL. 2007: 167–78

  View details for Web of Science ID 000250967400006

• Elections, fiscal reform and public goods provision in rural China JOURNAL OF COMPARATIVE ECONOMICS Luo, R., Zhang, L., Huang, J., Rozelle, S. 2007; 35 (3): 583-611

  View details for DOI 10.1016/j.jce.2007.03.008

  View details for Web of Science ID 000249844200008

• Are the poor benefiting from China's land conservation program? Annual Meeting of the American-Agricultural-Economics-Association Uchida, E., Xu, J., Xu, Z., Rozelle, S. CAMBRIDGE UNIV PRESS. 2007: 593–620

  View details for DOI 10.1017/S1355770X07003713

  View details for Web of Science ID 000248677700006

• Summary of agriculture of Zigong district in China AGRICULTURAL ECONOMICS Ma, H., Rae, A. N., Huang, J., Rozelle, S. 2007; 37 (1): 29-42

  View details for Web of Science ID 000247903500003

• Irrigation management reforms in the Yellow River Basin: Implications for water saving and poverty IRRIGATION AND DRAINAGE Wang, J., Huang, J., Xu, Z., Rozelle, S., Hussain, I., Biltonen, E. 2007; 56 (2): 247-259

  View details for DOI 10.1002/ird.306

  View details for Web of Science ID 000246090300010

• Water saving technology and saving water in China AGRICULTURAL WATER MANAGEMENT Blanke, A., Rozelle, S., Lohmar, B., Wang, J., Huang, J. 2007; 87 (2): 139-150

  View details for DOI 10.1016/j.agwat.2006.06.025

  View details for Web of Science ID 000243736800003

• The Rise of Self-employment in China: Development or Distress World Development Mohaptra, S., Rozelle, S., Goodhue, R. 2007; 35 (1)
• Investing in rural China Tracking China's commitment to modernization PAYING FOR PROGRESS IN CHINA Zhang Linxiu, Luo Renfu, Liu Chengfang, Rozelle, S., Shue, Wong, C. 2007; 21: 117-144

  View details for Web of Science ID 000275764300007

• Integrating China's agricultural economy into the global market Measuring distortions in China's agricultural sector CHINA: LINKING MARKETS FOR GROWTH Huang, J., Liu, Y., Martin, W., Rozelle, S., Garnaut, R., Song, L. 2007: 118–32

  View details for Web of Science ID 000291684400007

• Agricultural trade liberalization and poverty in China Conference on Law, Finance and Economic Development Huang, J., Jun, Y., Xu, Z., Rozelle, S., Li, N. ELSEVIER SCIENCE INC. 2007: 244–65

  View details for DOI 10.1016/j.chieco.2007.02.003

  View details for Web of Science ID 000247867500003

• Incentive contracts and bank performance - Evidence from rural China ECONOMICS OF TRANSITION Li, H., Rozelle, S., Zhou, L. 2007; 15 (1): 109-124

  View details for Web of Science ID 000243533700005

• Agriculture and groundwater development in northern China: trends, institutional responses, and policy options WATER POLICY Wang, J., Huang, J., Rozelle, S., Huang, Q., Blanke, A. 2007; 9: 61-74

  View details for DOI 10.2166/wp.2007.045

  View details for Web of Science ID 000246697500005

• The rise of self-employment in rural China: Development or distress? WORLD DEVELOPMENT Mohapatra, S., Rozelle, S., Goodhue, R. 2007; 35 (1): 163-181

  View details for DOI 10.1016/j.worlddev.2006.09.007

  View details for Web of Science ID 000243627200009

• Enhancing productivity on suburban dairy darms in China Agricultural Economics Ma, H., Rae, A., Huang , J., Rozelle , S. 2007; 37 (1)
• Cultivated land conversion and potential agricultural productivity in China LAND USE POLICY Deng, X., Huang, J., Rozelle, S., Uchida, E. 2006; 23 (4): 372-384

  View details for DOI 10.1016/j.landusepol.2005.07.003

  View details for Web of Science ID 000239322300002

• Climbing the development ladder: Economic development and the evolution of occupations in rural China JOURNAL OF DEVELOPMENT STUDIES Mohapatra, S., Rozelle, S., Huang, J. 2006; 42 (6): 1023-1055

  View details for DOI 10.1080/00220380600774988

  View details for Web of Science ID 000239925000007

• Livestock in China: Commodity-specific total factor productivity decomposition using new panel data AMERICAN JOURNAL OF AGRICULTURAL ECONOMICS Rae, A. N., Ma, H., Huang, J., Rozelle, S. 2006; 88 (3): 680-695

  View details for Web of Science ID 000239208000012

• Self-employment with Chinese characteristics: The forgotten engine of rural China's growth CONTEMPORARY ECONOMIC POLICY Zhang, J., Zhang, L., Rozelle, S., Boucher, S. 2006; 24 (3): 446-458

  View details for DOI 10.1093/cep/byj034

  View details for Web of Science ID 000239016700009

• Got milk? The rapid rise of China's dairy sector and its future prospects FOOD POLICY Fuller, F., Huang, J., Ma, H., Rozelle, S. 2006; 31 (3): 201-215

  View details for DOI 10.1016/j.foodpol.2006.03.002

  View details for Web of Science ID 000238039900002

• Incentives to managers or participation of farmers in China's irrigation systems: which matters most for water savings, farmer income, and poverty? AGRICULTURAL ECONOMICS Wang, J. X., Xu, Z. G., Huang, J. K., Rozelle, S. 2006; 34 (3): 315-330

  View details for Web of Science ID 000236911700010

• Privatization of tubewells in North China: Determinants and impacts on irrigated area, productivity and the water table HYDROGEOLOGY JOURNAL Wang, J. X., Huang, J. K., Huang, Q. Q., Rozelle, S. 2006; 14 (3): 275-285

  View details for DOI 10.1007/s10040-005-0482-1

  View details for Web of Science ID 000236101400002

• Fostering or stripping rural China: Modernizing agriculture and rural to urban capital flows DEVELOPING ECONOMIES Huang, J., Rozelle, S., Wang, H. 2006; 44 (1): 1-26

  View details for DOI 10.1111/j.1746-1049.2006.00001.x

  View details for Web of Science ID 000238913600001

• Getting rich and eating out: Consumption of food away from home in urban China CANADIAN JOURNAL OF AGRICULTURAL ECONOMICS-REVUE CANADIENNE D AGROECONOMIE Ma, H. Y., Huang, J. K., Fuller, F., Rozelle, S. 2006; 54 (1): 101-119

  View details for Web of Science ID 000235360600006

• Irrigation, agricultural performance and poverty reduction in China FOOD POLICY Huang, Q. Q., Rozelle, S., Lohmar, B., Huang, J. K., Wang, J. X. 2006; 31 (1): 30-52

  View details for DOI 10.1016/j.foodpol.2005.06.004

  View details for Web of Science ID 000234762000003

• From Marx and Mao to the Market: The Economics and Politics of Agrarian Transition Rozelle, S., Swinnen , J. Oxford University Press. 2006
• Investing in Rural China Tracking China's Commitment to Modernization CHINESE ECONOMY Zhang, L., Luo, R., Liu, C., Rozelle, S. 2006; 39 (4): 57-84

  View details for DOI 10.2753/CES1097-1475390404

  View details for Web of Science ID 000213191000005

• Grain for green versus grain: Conflict between food security and conservation set-aside in China WORLD DEVELOPMENT Xu, Z. G., Xu, J. T., Deng, X. Z., Huang, J. K., Uchida, E., Rozelle, S. 2006; 34 (1): 130-148

  View details for DOI 10.1016/j.worlddev.2005.08.002

  View details for Web of Science ID 000234689000008

• The emergence of agricultural commodity markets in China Summer Conference of the Chinese-Economists-Society on Technoloyg, Human Capital and Economic Development Huang, J., Rozelle, S. ELSEVIER SCIENCE INC. 2006: 266–80

  View details for DOI 10.1016/j.chieco.2006.04.008

  View details for Web of Science ID 000240487900004

• Incentives in water management reform: assessing the effect on water use, production, and poverty in the Yellow River Basin ENVIRONMENT AND DEVELOPMENT ECONOMICS Wang, J. X., Xu, Z. G., Huang, J. K., Rozelle, S. 2005; 10: 769-799

  View details for DOI 10.1017/S1355770X05002524

  View details for Web of Science ID 000234243300003

• Labor market emergence and returns to education in rural China Annual Meeting of the Allied-Social-Sciences-Association Li, Q., de Brauw, A., Rozelle, S., Zhang, L. X. BLACKWELL PUBLISHING. 2005: 418–24

  View details for DOI 10.1111/j.1467-9353.2005.00238.x

  View details for Web of Science ID 000231231400015

• Economies of scale and scope and the economic efficiency of China's agricultural research system INTERNATIONAL ECONOMIC REVIEW Jin, S. Q., Rozelle, S., Alston, J., Huang, J. K. 2005; 46 (3): 1033-1057

  View details for Web of Science ID 000230603700013

• Evolution of tubewell ownership and production in the North China Plain AUSTRALIAN JOURNAL OF AGRICULTURAL AND RESOURCE ECONOMICS Wang, J. X., Huang, J. K., Rozelle, S. 2005; 49 (2): 177-195

  View details for Web of Science ID 000229634900004

• Irrigation, poverty and inequality in rural China AUSTRALIAN JOURNAL OF AGRICULTURAL AND RESOURCE ECONOMICS Huang, Q. Q., Dawe, D., Rozelle, S., Huang, J. K., Wang, J. X. 2005; 49 (2): 159-175

  View details for Web of Science ID 000229634900003

• Grain for green: Cost-effectiveness and sustainability of China's conservation set-aside program LAND ECONOMICS Uchida, E., Xu, J. T., Rozelle, S. 2005; 81 (2): 247-264

  View details for Web of Science ID 000229093400007

• Insect-resistant GM rice in farmers' fields: Assessing productivity and health effects in China SCIENCE Huang, J. K., Hu, R. F., Rozelle, S., Pray, C. 2005; 308 (5722): 688-690

  Abstract

  Although no country to date has released a major genetically modified (GM) food grain crop, China is on the threshold of commercializing GM rice. This paper studies two of the four GM varieties that are now in farm-level preproduction trials, the last step before commercialization. Farm surveys of randomly selected farm households that are cultivating the insect-resistant GM rice varieties, without the aid of experimental station technicians, demonstrate that when compared with households cultivating non-GM rice, small and poor farm households benefit from adopting GM rice by both higher crop yields and reduced use of pesticides, which also contribute to improved health.

  View details for DOI 10.1126/science.1108972

  View details for Web of Science ID 000228810900048

  View details for PubMedID 15860626

• Prices and unit values in poverty measurement and tax reform analysis WORLD BANK ECONOMIC REVIEW Gibson, J., Rozelle, S. 2005; 19 (1): 69-97

  View details for DOI 10.1093/wber/1hi002

  View details for Web of Science ID 000230207200004

• The engines of a viable agriculture: Advances in biotechnology, market accessibility and land rentals in rural China Conference on the First 40 Years of the Universities Service Centre for China Studies Rozelle, S., Huang, J., Otsuka, K. UNIV CHICAGO PRESS. 2005: 81–111

  View details for Web of Science ID 000227895200006

• Chinese animal product consumption in the 1990s AUSTRALIAN JOURNAL OF AGRICULTURAL AND RESOURCE ECONOMICS Ma, H. Y., Rae, A., Huang, J. K., Rozelle, S. 2004; 48 (4): 569-590

  View details for Web of Science ID 000225683900001

• Local government behavior and property right formation in rural China JOURNAL OF INSTITUTIONAL AND THEORETICAL ECONOMICS-ZEITSCHRIFT FUR DIE GESAMTE STAATSWISSENSCHAFT Brandt, L., Rozelle, S., Turner, M. A. 2004; 160 (4): 627-662

  View details for Web of Science ID 000226585500005

• Insider privatization with a tail: the screening contract and performance of privatized firms in rural China JOURNAL OF DEVELOPMENT ECONOMICS Li, H. B., Rozelle, S. 2004; 75 (1): 1-26

  View details for DOI 10.1016/j.jdeveco.2003.08.001

  View details for Web of Science ID 000229755400001

• The sequencing of reform policies in China's agricultural transition ECONOMICS OF TRANSITION de Brauw, A., Huang, J. K., Rozelle, S. 2004; 12 (3): 427-465

  View details for Web of Science ID 000223377400003

• Working until you drop: The elderly of rural China CHINA JOURNAL Pang, L. H., de Brauw, A., Rozelle, S. 2004; 52: 73-94

  View details for Web of Science ID 000223953300004

• Success and failure of reform: Insights from the transition of agriculture JOURNAL OF ECONOMIC LITERATURE Rozelle, S., Swinnen, J. F. 2004; 42 (2): 404-456

  View details for Web of Science ID 000222539700002

• Is it better to be a boy? A disaggregated outlay equivalent analysis of gender bias in Papua New Guinea JOURNAL OF DEVELOPMENT STUDIES Gibson, J., Rozelle, S. 2004; 40 (4): 115-136

  View details for DOI 10.1080/00220380410001673210

  View details for Web of Science ID 000221611100005

• China's rural labor market development and its gender implications International Rice Congress Zhang, L. X., de Brauw, A., Rozelle, S. ELSEVIER SCIENCE INC. 2004: 230–47

  View details for DOI 10.1016/j.chieco.2004.03.003

  View details for Web of Science ID 000222198200006

• Cultivated land conversion and bioproductivity in China Conference on Remote Sensing and Modeling of Ecosystems for Sustainability Huang, J. K., Deng, X. Z., Rozelle, S. SPIE-INT SOC OPTICAL ENGINEERING. 2004: 135–148

  View details for DOI 10.1117/12.563268

  View details for Web of Science ID 000225599600013

• Reassessing China's livestock statistics: An analysis of discrepancies and the creation of new data series ECONOMIC DEVELOPMENT AND CULTURAL CHANGE Ma, H. Y., Huang, J. K., Rozelle, S. 2004; 52 (2): 445-473

  View details for Web of Science ID 000220452700008

• Tracking distortions in agriculture: China and its accession to the World Trade Organization WORLD BANK ECONOMIC REVIEW Huang, J. K., Rozelle, S., Chang, M. 2004; 18 (1): 59-84

  View details for DOI 10.1093/wber/lhh033

  View details for Web of Science ID 000222116000004

• Privatizing rural China: Insider privatization, innovative contracts and the performance of township enterprises CHINA QUARTERLY Li, H. B., Rozelle, S. 2003: 981-1005

  View details for Web of Science ID 000188772800006

• Migration and incomes in source communities: A new economics of migration perspective from China ECONOMIC DEVELOPMENT AND CULTURAL CHANGE Taylor, J. E., Rozelle, S., de Brauw, A. 2003; 52 (1): 75-101

  View details for Web of Science ID 000189219900004

• Poverty and access to roads in Papua New Guinea ECONOMIC DEVELOPMENT AND CULTURAL CHANGE Gibson, J., Rozelle, S. 2003; 52 (1): 159-185

  View details for Web of Science ID 000189219900007

• Biotechnology as an alternative to chemical pesticides: a case study of Bt cotton in China AGRICULTURAL ECONOMICS Huang, J. K., Hu, R. F., Pray, C., Qiao, F. B., Rozelle, S. 2003; 29 (1): 55-67

  View details for DOI 10.1016/S0169-5150(03)00044-6

  View details for Web of Science ID 000184353000005

• Improving estimates of inequality and poverty from urban China's Household Income and Expenditure Survey REVIEW OF INCOME AND WEALTH Gibson, J., Huang, J. K., Rozelle, S. 2003: 53-68

  View details for Web of Science ID 000182246300004

• Producer benefits from input market and trade liberalization: The case of fertilizer in China Annual Meeting of the American-Agricultural-Economics-Association Qiao, F. B., Lohmar, B., Huang, J., Rozelle, S., Zhang, L. X. WILEY-BLACKWELL PUBLISHING, INC. 2003: 1223–27

  View details for Web of Science ID 000187491300021

• Forest exploitation and protection in reform China - Assessing the impacts of policy and economic growth Conference on Policy Reform and Forestry in China Rozelle, S., Huang, J., Benziger, V. RESOURCES FOR THE FUTURE INC. 2003: 109–133

  View details for Web of Science ID 000223145400006

• Continuity and change in China's rural periodic markets CHINA JOURNAL Rozelle, S., Huang, J. K., Benziger, V. 2003; 49: 89-115

  View details for Web of Science ID 000184926500004

• Hazards of expropriation: Tenure insecurity and investment in rural China AMERICAN ECONOMIC REVIEW Jacoby, H. G., Li, G., Rozelle, S. 2002; 92 (5): 1420-1447

  View details for Web of Science ID 000180306100008

• The creation and spread of technology and total factor productivity in China's agriculture AMERICAN JOURNAL OF AGRICULTURAL ECONOMICS Jin, S. Q., Huang, J. K., Hu, R. F., Rozelle, S. 2002; 84 (4): 916-930

  View details for Web of Science ID 000179570200003

• Transgenic varieties and productivity of smallholder cotton farmers in China AUSTRALIAN JOURNAL OF AGRICULTURAL AND RESOURCE ECONOMICS Huang, J. K., Hu, R. F., Rozelle, S., Qiao, F. B., Pray, C. E. 2002; 46 (3): 367-387

  View details for Web of Science ID 000177646100003

• Enhancing the crops to feed the poor NATURE Huang, J. K., Pray, C., Rozelle, S. 2002; 418 (6898): 678-684

  Abstract

  Solutions to the problem of how the developing world will meet its future food needs are broader than producing more food, although the successes of the 'Green Revolution' demonstrate the importance of technology in generating the growth in food output in the past. Despite these successes, the world still faces continuing vulnerability to food shortages. Given the necessary funding, it seems likely that conventional crop breeding, as well as emerging technologies based on molecular biology, genetic engineering and natural resource management, will continue to improve productivity in the coming decades.

  View details for DOI 10.1038/nature01015

  View details for Web of Science ID 000177305600054

  View details for PubMedID 12167874

• How elastic is calorie demand? Parametric, nonparametric and semiparametric results for urban Papua New Guinea JOURNAL OF DEVELOPMENT STUDIES Gibson, J., Rozelle, S. 2002; 38 (6): 23-46

  View details for Web of Science ID 000177788000002

• Five years of Bt cotton in China - the benefits continue PLANT JOURNAL Pray, C. E., Huang, J. K., Hu, R. F., Rozelle, S. 2002; 31 (4): 423-430

  Abstract

  Bt cotton is spreading very rapidly in China, in response to demand from farmers for technology that will reduce both the cost of pesticide applications and exposure to pesticides, and will free up time for other tasks. Based on surveys of hundreds of farmers in the Yellow River cotton-growing region in northern China in 1999, 2000 and 2001, over 4 million smallholders have been able to increase yield per hectare, and reduce pesticide costs, time spent spraying dangerous pesticides, and illnesses due to pesticide poisoning. The expansion of this cost-saving technology is increasing the supply of cotton and pushing down the price, but prices are still sufficiently high for adopters of Bt cotton to make substantial gains in net income.

  View details for Web of Science ID 000177863400003

  View details for PubMedID 12182701

• The evolution of China's rural labor markets during the reforms Conference on the Transformation of Chinas Rural Economy de Brauw, A., Huang, J. K., Rozelle, S., Zhang, L. X., Zhang, Y. G. ACADEMIC PRESS INC ELSEVIER SCIENCE. 2002: 329–53

  View details for Web of Science ID 000177478100007

• Market emergence and transition: Arbitrage, transaction costs, and autarky in China's grain markets AMERICAN JOURNAL OF AGRICULTURAL ECONOMICS Park, A., Jin, H. H., Rozelle, S., Huang, J. K. 2002; 84 (1): 67-82

  View details for Web of Science ID 000173727300006

• Plant biotechnology in China SCIENCE Huang, J. K., Rozelle, S., Pray, C., Wang, Q. F. 2002; 295 (5555): 674-677

  Abstract

  A survey of China's plant biotechnologists shows that China is developing the largest plant biotechnology capacity outside of North America. The list of genetically modified plant technologies in trials, including rice, wheat, potatoes, and peanuts, is impressive and differs from those being worked on in other countries. Poor farmers in China are cultivating more area of genetically modified plants than are small farmers in any other developing country. A survey of agricultural producers in China demonstrates that Bacillus thuringiensis cotton adoption increases production efficiency and improves farmer health.

  View details for Web of Science ID 000173560900044

  View details for PubMedID 11809972

• Employment, emerging labor markets, and the role of education in rural China International Conference on Has China Become a Market Economy Zhang, L. X., Huang, J. K., Rozelle, S. ELSEVIER SCIENCE INC. 2002: 313–28

  View details for Web of Science ID 000177464700012

• Land rights in rural China: Facts, fictions and issues CHINA JOURNAL Brandt, L., Huang, J. K., Li, G., Rozelle, S. 2002; 47: 67-97

  View details for Web of Science ID 000173714100004

• Emerging markets, evolving institutions, and the new opportunities for growth in China's rural economy CHINA ECONOMIC REVIEW Rozelle, S., Huang, J. K., Zhang, L. X. 2002; 13 (4): 345-353

  View details for Web of Science ID 000179797600005

• Off-farm jobs and on-farm work in periods of boom and bust in rural China JOURNAL OF COMPARATIVE ECONOMICS Zhang, L. X., Rozelle, S., Huang, J. K. 2001; 29 (3): 505-526

  View details for DOI 10.1006/jcec.2001.1728

  View details for Web of Science ID 000170753100006

• Why is income inequality so low in China compared to other countries? The effect of household survey methods ECONOMICS LETTERS Gibson, J., Huang, J. K., Rozelle, S. 2001; 71 (3): 329-333

  View details for Web of Science ID 000168590800005

• Transition, development and the supply of wheat in China AUSTRALIAN JOURNAL OF AGRICULTURAL AND RESOURCE ECONOMICS Rozelle, S., Huang, J. K. 2000; 44 (4): 543-571

  View details for Web of Science ID 000167810300002

• Responsiveness, flexibility, and market liberalization in China's agriculture Annual Meeting of the Agricultural-Economics-Association de Brauw, A., Huang, J. K., Rozelle, S. BLACKWELL PUBLISHING. 2000: 1133–39

  View details for Web of Science ID 000166378800008

• Saving or stripping rural industry: an analysis of privatization and efficiency in China AGRICULTURAL ECONOMICS Li, H. B., Rozelle, S. 2000; 23 (3): 241-252

  View details for Web of Science ID 000089175700005

• Elections and power: The locus of decision-making in Chinese villages CHINA QUARTERLY OI, J. C., Rozelle, S. 2000: 513-539

  View details for Web of Science ID 000088096400007

• Bureaucrat to entrepreneur: The changing role of the state in China's grain economy ECONOMIC DEVELOPMENT AND CULTURAL CHANGE Rozelle, S., Park, A., Huang, J. K., Jin, H. H. 2000; 48 (2): 227-252

  View details for Web of Science ID 000085197000001

• Aging, wellbeing, and social security in rural northern China POPULATION AND DEVELOPMENT REVIEW Benjamin, D., Brandt, L., Rozelle, S. 2000; 26: 89-116

  View details for Web of Science ID 000181519800005

• WTO and agriculture: radical reforms or the continuation of gradual transition CHINA ECONOMIC REVIEW Huang, J. K., Rozelle, S., Zhang, L. X. 2000; 11 (4): 397-401

  View details for Web of Science ID 000168684300006

• Leaders, managers, and the organization of township and village enterprises in China JOURNAL OF DEVELOPMENT ECONOMICS Chen, H. Y., Rozelle, S. 1999; 60 (2): 529-557

  View details for Web of Science ID 000083724400011

• China's food economy to the twenty-first century: Supply, demand, and trade ECONOMIC DEVELOPMENT AND CULTURAL CHANGE Huang, J. K., Rozelle, S., Rosegrant, M. W. 1999; 47 (4): 737-766

  View details for Web of Science ID 000081879600002

• Leaving China's farms: Survey results of new paths and remaining hurdles to rural migration CHINA QUARTERLY Rozelle, S., Guo, L., Shen, M. G., Hughart, A., Giles, J. 1999: 367-393

  View details for Web of Science ID 000081332700004

• Migration, remittances, and agricultural productivity in China 111th Annual Meeting of the American-Economic-Association Rozelle, S., Taylor, J. E., deBrauw, A. AMER ECONOMIC ASSOC. 1999: 287–91

  View details for Web of Science ID 000080438400052

• Wheat in China: Supply, demand and trade in the 21st century Symposium on The Economics of World Wheat Markets - Implications for North America ROZELLE, S. D., Huang, J. CABI PUBLISHING. 1999: 145–173

  View details for Web of Science ID 000087207800007

• Targeted poverty investments and economic growth in China WORLD DEVELOPMENT Rozelle, S., Park, A., Benziger, V., Ren, C. Q. 1998; 26 (12): 2137-2151

  View details for Web of Science ID 000077990100003

• Reforming state-market relations in rural China ECONOMICS OF TRANSITION Park, A., Rozelle, S. 1998; 6 (2): 461-480

  View details for Web of Science ID 000077353200010

• Tenure, land rights, and farmer investment incentives in China AGRICULTURAL ECONOMICS Li, G., Rozelle, S., Brandt, L. 1998; 19 (1-2): 63-71

  View details for Web of Science ID 000076125100008

• Pesticide productivity, host-plant resistance and productivity in China AGRICULTURAL ECONOMICS Widawsky, D., Rozelle, S., Jin, S. Q., Huang, J. K. 1998; 19 (1-2): 203-217

  View details for Web of Science ID 000076125100020

• The emergence of a future market: Mungbeans on the China Zhengzhou Commodity Exchange JOURNAL OF FUTURES MARKETS Williams, J., Peck, A., Park, A., Rozelle, S. 1998; 18 (4): 427-448

  View details for Web of Science ID 000073213500004

• Village leaders and land-rights formation in China 110th Annual Meeting of the American-Economic-Association Rozelle, S., Li, G. AMER ECONOMIC ASSOC. 1998: 433–38

  View details for Web of Science ID 000073658200081

• Market development and food demand in rural China CHINA ECONOMIC REVIEW Huang, J., Rozelle, S. 1998; 9 (1): 25-45

  View details for Web of Science ID 000076584400003

• China's forests under economic reform: Timber supplies, environmental protection, and rural resource access 71st Annual Conference of the Western-Economic-Association-International ALBERS, H. J., ROZELLE, S. D., Guo, L. WILEY-BLACKWELL PUBLISHING, INC. 1998: 22–33

  View details for Web of Science ID 000071348400004

• Wheat in China: Supply trends in the reform era Symposium on World Agricultural Trade, at the Conference on Economics Rozelle, S., Huang, J. K. WESTVIEW PRESS. 1998: 73–100

  View details for Web of Science ID 000078387800005

• Varietal diversity and yield variability in Chinese rice production Conference on Building a Basis for the Economic Analysis of Genetic Resources and Diversity in Crop Plants Widawsky, D., Rozelle, S. KLUWER ACADEMIC PUBLISHERS. 1998: 159–172

  View details for Web of Science ID 000084977700010

• Marketing reforms, market development and agricultural production in China AGRICULTURAL ECONOMICS Weersink, A., Rozelle, S. 1997; 17 (2-3): 95-114

  View details for Web of Science ID 000071273800001

• China's past, present, and future food economy: Can China continue to meet the challenges? FOOD POLICY Rozelle, S., Rosegrant, M. W. 1997; 22 (3): 191-200

  View details for Web of Science ID A1997XL67200001

• Poverty, population and environmental degradation in China FOOD POLICY Rozelle, S., Huang, J. K., Zhang, L. X. 1997; 22 (3): 229-251

  View details for Web of Science ID A1997XL67200004

  View details for PubMedID 12348536

• Liberalization and rural market integration in China ASSA Winter Meeting Rozelle, S., Park, A., Huang, J. K., Jin, H. H. WILEY-BLACKWELL PUBLISHING, INC. 1997: 635–42

  View details for Web of Science ID A1997YG25900034

• The impact of environmental degradation on grain production in China, 1975-1990 ECONOMIC GEOGRAPHY Rozelle, S., Veeck, G., Huang, J. K. 1997; 73 (1): 44-66

  View details for Web of Science ID A1997WH04000003

• Distributional consequences of reforming local public finance in China CHINA QUARTERLY Park, A., Rozelle, S., Wong, C., Ren, C. Q. 1996: 751-778

  View details for Web of Science ID A1996WG95000005

• Technological change: Rediscovering the engine of productivity growth in China's rural economy JOURNAL OF DEVELOPMENT ECONOMICS Huang, J. K., Rozelle, S. 1996; 49 (2): 337-369

  View details for Web of Science ID A1996UT90000004

• Stagnation without equity: Patterns of growth and inequality in China's rural economy CHINA JOURNAL Rozelle, S. 1996; 35: 63-92

  View details for Web of Science ID A1996TX26800003

• ENVIRONMENTAL-STRESS AND GRAIN YIELDS IN CHINA AMERICAN JOURNAL OF AGRICULTURAL ECONOMICS Huang, J. K., Rozelle, S. 1995; 77 (4): 853-864

  View details for Web of Science ID A1995TH07000003

• CONTROL IN A DYNAMIC VILLAGE ECONOMY - THE REFORMS AND UNBALANCED DEVELOPMENT IN CHINA RURAL ECONOMY JOURNAL OF DEVELOPMENT ECONOMICS Rozelle, S., Boisvert, R. N. 1995; 46 (2): 233-252

  View details for Web of Science ID A1995RF08700002

• RURAL INDUSTRIALIZATION AND INCREASING INEQUALITY - EMERGING PATTERNS IN CHINA REFORMING ECONOMY JOURNAL OF COMPARATIVE ECONOMICS Rozelle, S. 1994; 19 (3): 362-391

  View details for Web of Science ID A1994PZ09800002

• FERTILIZER DEMAND IN CHINA REFORMING ECONOMY CANADIAN JOURNAL OF AGRICULTURAL ECONOMICS-REVUE CANADIENNE D ECONOMIE RURALE Ye, Q. L., Rozelle, S. 1994; 42 (2): 191-207

  View details for Web of Science ID A1994PD74200005

• DECISION-MAKING IN CHINA RURAL ECONOMY - THE LINKAGES BETWEEN VILLAGE LEADERS AND FARM HOUSEHOLDS CHINA QUARTERLY Rozelle, S. 1994: 99-124

  View details for Web of Science ID A1994NV40400004

• QUANTIFYING CHINESE VILLAGE LEADERS MULTIPLE OBJECTIVES JOURNAL OF COMPARATIVE ECONOMICS Rozelle, S., Boisvert, R. N. 1994; 18 (1): 25-45

  View details for Web of Science ID A1994MZ00800002

• GRAIN POLICY IN CHINESE VILLAGES - YIELD RESPONSE TO PRICING, PROCUREMENT, AND LOAN POLICIES AMERICAN JOURNAL OF AGRICULTURAL ECONOMICS Rozelle, S., Boisvert, R. N. 1993; 75 (2): 339-349

  View details for Web of Science ID A1993LD51400009

• A RISK ANALYSIS OF THE ONTARIO WHITE BEAN SECTOR CANADIAN JOURNAL OF AGRICULTURAL ECONOMICS-REVUE CANADIENNE D ECONOMIE RURALE Weersink, A., VONMASSOW, M., Rozelle, S. 1991; 39 (2): 271-281

  View details for Web of Science ID A1991GJ93200006

• ALTERNATIVES TO CENTRAL WATER-TREATMENT JOURNAL AMERICAN WATER WORKS ASSOCIATION Burke, ROZELLE, CIROLIA, McGuire, GUERRERA, MCCLELLAND, Cook, FIE 1986; 78 (12): 12-?

  View details for Web of Science ID A1986F072300002