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We aimed to investigate health care needs, health service utilization, and their socio-economic and health-related determinants in people with spinal cord injury (SCI) living in Jiangsu and Sichuan Provinces of China. A total of 1355 participants with SCI living in the community were recruited using a multi-stage stratified random sample and surveyed by telephone or online. Outcomes evaluated included the presence of health care needs, mode of health service utilization, and specific provider types seen within 12 months preceding the survey. The prevalence of healthcare needs was 92%. Needs were higher in Sichuan (98%) as compared to Jiangsu (80%). Of those in need of health care, 38% reported not having utilized care, more in Sichuan (39%) than in Jiangsu (37%). In Jiangsu, inpatient care was more often used than in Sichuan (46% vs. 27%), while in Sichuan outpatient services were utilized more often (33% vs. 17%). On average, 1.6 provider types were seen, with Sichuan reporting fewer different provider types. Considerable differences in the prevalence of health care needs and service utilization patterns were found between provinces, mostly in favour of the economically more developed Jiangsu Province. People with low income, particularly those below the World Bank poverty line for middle-income countries, had increased health care needs but utilized health care less often. Moreover, environmental barriers contributed significantly to unmet health care needs. This implies the necessity to provide better accessible and more affordable rehabilitation services for people with spinal cord injury (SCI) in China such as community-based rehabilitation programming. Policies for alleviation of poverty in the case of SCI including insurance for catastrophic health expenditure should also be reviewed and adapted where applicable. [ABSTRACT FROM AUTHOR]

Growing evidence exists about the candidate factors of childhood cognitive performance, but mainly limited to single-exposure studies. We sought to systematically and simultaneously identify and validate a wide range of potential modifiable factors for childhood cognitive performance. We used data from five waves of data from the China Family Panel Studies (CFPS-2010, 2012, 2014, 2016 and 2018). Our analytical sample was restricted to those children aged 2–5 at baseline with valid exposure information. A total of 80 modifiable factors were identified. Childhood cognitive performance was assessed using vocabulary and mathematics test at wave 5. We used an environment-wide association study (EnWAS) to screen all exposure-outcome associations independently and used the least absolute shrinkage and selection operator (LASSO) variable selection algorithm to identify factors associated with cognitive performance. Multivariable linear model was then used to evaluate causal relationships between identified factors and cognitive performance. Of the 1305 participants included in the study (mean ± SD, 3.5 ± 1.1 years age at baseline, 45.1% girls). Eight factors were retained in the LASSO regression analysis. Six factors across community characteristics (percentage of poverty in the community; percentage of children in the community), household characteristics (family size), child health and behaviors (mobile internet access), parenting behaviors and cognitive enrichment (parental involvement in child' s education), and parental wellbeing (paternal happiness) domains were significantly associated with childhood cognition. Using a three-stage approach, this study validates several actionable targets for improving childhood cognitive performance. [ABSTRACT FROM AUTHOR]

A large literature has examined early-life insult and later-life health outcomes. However, whether early-life exposure might persist into the outcomes of future generations remains unclear. Using data from the China Family Panel Studies, this study examines the intergenerational effects of early-life health shocks during the great famine in China, distinguishes the intergenerational effects of in utero and early-life famine exposure, and estimates whether there is a sex-specific transgenerational response. Difference-in-difference results show that first-generation male in utero famine exposure (1959–1961) is associated with a series of health and economic disadvantages in the second generation, compared with the unexposed post-famine-born cohort (1964–1965) in China. The effect persists in the third generation but attenuates, and there is no same-sex transgenerational response. These findings may suggest a novel source of multigenerational persistence in health and economic poverty and may point to a need to consider evidence of transgenerational mechanisms. [ABSTRACT FROM AUTHOR]

Household income predicts early adolescents' cognitive development. However, the mechanism underlying this association and protective factors are unclear. This study assessed one-year longitudinal data to examine whether perceived discrimination mediated the association between household income and executive function and the moderating role of shift-and-persist. 344 early adolescents in rural China were included in the study (mean = 10.88 years, SD = 1.32 years, girls: 51.74%). The latent variable model revealed that household income predicted early adolescents' cognitive flexibility and working memory in the subsequent year through perceived discrimination. Shift-and-persist moderated the negative effects of perceived discrimination on cognitive flexibility: perceived discrimination impeded cognitive flexibility only among early adolescents with low shift-and-persist. The findings highlight perceived discrimination in the relation between household income and early adolescents' executive function and underscore the protective role of shift-and-persist. [ABSTRACT FROM AUTHOR]

Little is known about the differences in feelings of poverty and social assistance receipt among the different genders of heads of Chinese Dibao families. This article makes a preliminary analysis of the feelings of Chinese female heads of Dibao families about living in poverty and depending on social assistance and compares them with those of male heads. It finds that there are gender differences in the experiences between the female and male heads of Dibao families in China. The article argues that social assistance policies should be constructed or correspondingly adjusted in a targeted manner to become gender-sensitive. [ABSTRACT FROM AUTHOR]

This article contributes to the growing body of research on social assistance (SA) dynamics by analyzing patterns of SA receipt in China, a middle-income country with a large informal employment sector. Using national low-income household survey data and event history analysis, this study explored the mechanisms underlying exit from Dibao (formally known as Minimum Living Security) and changes in exit probability over time. We found that in the context of an informal economy, the 'explicit' change of individual characteristics and employment structure decisively affects receipt duration on the micro and macroeconomic levels, respectively. On the policy level, affected by the informal employment structure, employment services tend to be of low quality and fail to promote Dibao exit effectively. Although the specific Dibao payment strategy, which is used to address the difficulty in means tests, largely curbs the risks of declining working motivation, it considerably increases the possibility of prolonged Dibao use. With this systemic influence of informal employment, a unique pattern of SA receipt characterized by the combination of long-term use and a nondecreasing hazard rate has developed in China. [ABSTRACT FROM AUTHOR]

Poverty impedes children's executive function (EF). Therefore, it is necessary to mitigate the negative effect of poverty by developing efficient interventions to improve poor children's cognitive function. In three studies, we examined whether high‐level construals can improve EF among poor children in China. In Study 1, we observed a positive relationship between family socioeconomic status and children's EF, which was moderated by construal level (n = 206; Mage = 9.71; 45.6% girls). In Study 2a, we experimentally induced high‐ versus low‐level construals and found that poor children with high‐level construals exhibited better EF than those with low‐level construals (n = 65; Mage = 11.32; 47.7% girls). However, the same intervention did not affect the performance of affluent children in Study 2b (n = 63; Mage = 10.54; 54% girls). Moreover, we found that the interventional effects of high‐level construals improved the ability of children living in poverty to make healthy decisions and delayed gratification in Study 3 (n = 74; Mage = 11.10; 45.9% girls). These findings may have implications for using high‐level construals as an effective intervention to improve poor children's EF and cognitive capacity. [ABSTRACT FROM AUTHOR]

Although overeating increases risk for chronic illness and premature mortality, evolutionary life-history theorists posit that such behaviors arise as a potential outcome of using fast life-history strategies to function in environments that are harsh or unpredictable. To test this premise, we examined links between harsh, unpredictable living conditions (HULC), the adoption of fast life-history (LH) strategies, and overeating among early adolescents using a four-wave longitudinal design. Participants were 2547 Chinese adolescents (1202 girls, 1345 boys) who completed baseline questionnaires assessing experiences of HULC, preferences for use of fast LH strategies, and overeating. Measures were re-administered in follow-ups 7, 13, and 20 months later. Analyses indicated HULC predicted increased use of fast LH strategies within each gender. However, fast LH strategy adoption contributed to increases in overeating only among girls. Findings supported specific tenets of life-history theory and underscored gender as an important consideration in understanding links between living conditions, the adoption of fast LH strategies, and risk for overeating. Interventions focused on reducing poverty and increasing stable, nurturing family, and community environments may aid in reducing overeating and obesity for adolescents. [ABSTRACT FROM AUTHOR]

Background: Although stigma and caregiving burden are important in relation to mental health recovery, few studies have been conducted on affiliate stigma and caregiving burden among family caregivers of persons with schizophrenia (FCPWS) in rural China. Aims: This study aimed to examine the severity level of affiliate stigma and caregiving burden, and identify the correlates among FCPWS in rural China. Methods: A mental health survey was conducted (N = 253 FCPWS) in Xinjin county, Sichuan province, China. Affiliate Self-Stigma Scale and Zarit Burden Interview Short Form were used. The regression analysis was performed to explore the correlates of stigma and burden. Results: Most FCPWS reported experiencing high and severe level of affiliate stigma (78.66%) and caregiving burden (95.26%). Family caregivers who were middle aged, unemployed, with high caregiving burden and low quality of life (QoL), showed more severe affiliate stigma. Family caregivers who were female, older, with low income, high affiliate stigma and low QoL, experienced greater caregiving burden. Conclusions: The large majority of FCPWS in rural China experienced severe affiliate stigma, caregiving burden and poor QoL. It is crucial to develop culture-specific anti-stigma interventions to reduce caregivers' stigma and caregiving burden, and improve QoL. Specific risk factors of family caregivers' affiliate stigma and caregiving burden should be considered for development of health policy and community-based mental health services. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to examine the mediating effect of perceived social support in the relationship between loneliness and social isolation among Chinese older adults relocated for poverty relief. Methods: We surveyed 128 older migrants from four resettlement areas in Guizhou Province, southwest China. A general information questionnaire, the Lubben Social Network Scale‐6, the Perceived Social Support Rating Scale, and the Single Item Loneliness Scale were used in our study. We also used the SPSS macro PROCESS to test a mediation model and the Bootstrap method to assess its significance. Results: The prevalence of social isolation among older relocators was 85.9%; the mediation model showed that loneliness had a direct negative effect on social isolation (B = −1.25, p < 0.01), and that perceived social support fully mediated this effect (−1.18), with a total effect of −1.25 (p < 0.01) and a mediating proportion of 94.4%. Conclusions: Older relocators in poverty alleviation areas experienced high levels of social isolation. Perceived social support might buffer the negative impact of loneliness on social isolation. We suggest that interventions should be designed to enhance perceived social support and reduce social isolation among this vulnerable population. [ABSTRACT FROM AUTHOR]

The parental expectation in adolescents' education is an essential factor of adolescents' social and emotional development. However, little is known about how it is related to adolescents' mobile phone addiction, especially for adolescents from low-income families. To address this issue, this study investigated the relationship between parental expectation and mobile phone addiction, and its underlying mechanisms in adolescents from low-income families. We hypothesized that parental expectation would negatively predict mobile phone addiction, and self-esteem and social anxiety would play multiple mediation roles in this relationship. Results from a sample of 1,953 Chinese adolescents in low-income families revealed that (a) parental expectation was negatively associated with adolescents' mobile phone addiction, (b) both social anxiety and self-esteem played partial and parallel mediating roles between parental expectation and mobile phone addiction, and (c) social anxiety and self-esteem mediated the association between parental expectation and mobile phone addiction sequentially. This study would advance our understanding of how proper parenting styles and social networks helped to prevent children's mobile phone addiction. The limitations and implications of this study are discussed. [ABSTRACT FROM AUTHOR]

Based on the ecological systems theory, this study examined the multiple risk factors experienced by children from low-income families in China and their subsequent impact on children's psychological adaptation. A cumulative ecological risk questionnaire was constructed to examine the exploratory and descriptive risk factors most commonly exposed to children in families, schools and communities. The study sample consisted of 428 children from low-income families (N = 428; Mage = 12.35, SD = 2.51) from 20 ordinary primary and secondary schools across China. We conducted an exploratory latent class analysis using the responses from the cumulative ecological risk questionnaire. The results showed that a three-group solution fit the data best, with the following breakdown: "low-risk" = 41.1%, "family-risk" = 21.7%, and "school-risk" = 37.2%. The three groups showed significant differences in terms of psychological adaptation. The "low-risk" group exhibited fewer problem behaviors and higher prosocial behavior than the other groups. The "family-risk" group showed more significant adaptation difficulties, while the "school-risk" group showed lower levels of prosocial behavior. The results suggest that the ecological risks experienced by children from low-income families had significant group heterogeneity, which may further affect their psychological adaptation. Highlights: The ecological risks of children from low-income families were heterogeneous and may affect children's psychological adaptation. Latent class analysis favored a three-group solution: low-risk, family-risk, and school-risk groups. The three groups showed significant differences in terms of the children's psychological adaptation. [ABSTRACT FROM AUTHOR]

This study aimed to examine the perspective of person-in-environment by identifying whether social work students in China held a dominant orientation. The study was based on a sample of over 1,000 final-year social work students in Guangdong Province. It was revealed that although respondents prioritised the profession's individual-oriented goals, their practice preferences were indeterminate. Moreover, society-orientation was far from absent because social causes of poverty received most support. Paradoxically, micro practice was the preferred way of dealing with poverty. Ambiguity and discrepancy in the orientations of Chinese social work students not only reflected the evolving and pragmatic nature of social work in China, but also indicated the importance of understanding person-in-environment within an authoritarian context. IMPLICATIONS Chinese social work educators should provide integrative learning with both individual and society orientations. The international community of social work educators needs to be more culturally sensitive in their teaching regarding person-in-environment. [ABSTRACT FROM AUTHOR]

Background. Effective functional family was beneficial for older adults' health, which may affect the quality of life (QoL) in hypertension patients. This study aimed to clarify the association between family function, anxiety, and QoL for older adults with hypertension in low-income communities. Methods. A questionnaire survey was conducted on 363 older adults with hypertension in low-income communities in Wuhan from September 2019 to November 2019. The relationships among the variables were examined by Pearson's correlation analysis. Predictor effects were tested using hierarchical multiple regressions, controlling for demographic characteristics. The structural equation model (SEM) was used to test the mediation effects of anxiety on the pathway from family function to QoL. Results. Family function was negatively correlated with the self-rating anxiety scale (SAS) score and positively correlated with the mental component score (MCS), but had no influence on the physical component score (PCS). Both PCS and MCS were negatively correlated with SAS. Anxiety was the negative predictor of MCS and PCS. Family function was the positive predictor of MCS, but had no influence on PCS. The path model indicated that anxiety significantly mediated the link between family function and QoL (R2 = 32.8%), but only partially. Conclusion. A significant correlation between anxiety, family function, and QoL was found. Anxiety had a partial mediating effect on the relationship between family function and QoL. Further research should focus on increasing the level of family function and reducing the perceived anxiety of older adults with hypertension to improve their QoL level. [ABSTRACT FROM AUTHOR]

The primary goal of this study is to link both subjective and objective indicators of financial strain to two distinct dimensions of intimate partner violence (IPV) against women—the husband's violent behavior and gendered control—in postreform China. The data for this study were drawn from a community survey conducted in Chengdu, the capital of Sichuan province, in 2017 (N = 340). By utilizing the family stress model and quantitative methods, the following results emerged from a series of multivariate statistical analyses: (a) among married women, self-perceived financial strain is significantly and positively associated with the risk of experiencing the husband's perpetration of violent behavior and financial control; (b) low family income significantly elevates the likelihood of the husband's exertion of personal and financial control over the wife, albeit the effect is weaker for financial control; and (c) unemployment of the husband significantly increases the likelihood of the husband's exertion of financial controlling behavior against his wife. These results underscore the importance of gender and income inequalities in research on IPV against women in postreform China. These findings also cross-culturally substantiate the family stress model that has been utilized previously to examine the multifaceted associations between economic hardship and IPV in the U.S. Policy makers, academic researchers, and health practitioners are urged to recognize both subjective and objective financial strains as social and psychological determinants of IPV against women in postreform China. [ABSTRACT FROM AUTHOR]

Background: The determinants of access to immunizers are still poorly understood, leading to questions about which criteria were considered in this distribution. Given the above, the present study aimed to analyze the determinants of access to the SARS-CoV-2 vaccine by different countries. Methods: The study covered 189 countries using data from different public databases, and collected until February 19, 2021. We used eight explanatory variables: gross domestic product (GDP), extreme poverty, human development index (HDI), life expectancy, median age, coronavirus disease 2019 (COVID-19) cases, COVID-19 tests, and COVID-19 deaths. The endogenous variables were total vaccine doses, vaccine doses per thousand, and days of vaccination. The structural equation modeling (SEM) technique was applied to establish the causal relationship between the country's COVID-19 impact, socioeconomic variables, and vaccine access. To support SEM, we used confirmatory factor analysis, t-test, and Pearson's correlation. Results: We collected the sample on February 19, and to date, 80 countries (42.1%) had already received a batch of immunizers against COVID-19. The countries with first access to the vaccine (e.g., number of days elapsed since they took the first dose) were the United Kingdom (68), China (68), Russia (66), and Israel (62). The countries receiving the highest doses were the United States, China, India, and Israel. The countries with extreme poverty had lower access to vaccines and the richer countries gained priority access. Countries most affected by COVID (deaths and cases) also received immunizers earlier and in greater volumes. Unfortunately, similar to other vaccines, indicators, such as income, poverty, and human development, influence vaccines' access. Thus affecting the population of vulnerable and less protected countries. Therefore, global initiatives for the equitable distribution of COVID need to be discussed and encouraged. Conclusions: Determinants of vaccine distribution consider the impact of the disease in the country and are also affected by favorable socioeconomic indicators. The COVID-19 vaccines need to be accessible to all affected countries, regardless of their social hands. [ABSTRACT FROM AUTHOR]

Background Previous reports about health-related quality of life (HRQoL) of type 2 diabetes mellitus (T2DM) concentrated on general patients rather than patients in rural areas with poor infrastructure and limited resources. Thus, the aims of this study were to evaluate the HRQoL of diabetics in the countryside and explore its influencing factors. Methods A total of 23 053 participants aged from 18 to 79 years were drawn from the Henan Rural Cohort Study for this cross-sectional study. The HRQoL of participants were assessed by utility index and VAS-score of European Quality of Life Five Dimension Five Level Scale (EQ-5D-5L) instrument. Binary logistic regression, generalized linear and tobit regression models were used to estimate the potential influencing factors on HRQoL. Results This study (23 053 participants) included 2231 T2DM patients with a crude prevalence of 9.68%. The utility index and VAS-score in health group were 0.96 ± 0.10 and 78.85 ± 14.53, while in T2DM group were 0.93 ± 0.15 and 74.09 ± 16.09, respectively. In total, most diabetics reported problem about pain/discomfort dimension. Being old, poverty, low physical activity, and with comorbidities was negatively related to HRQoL of diabetics, while high educational level was positively related to HRQoL. Conclusion HRQoL of rural T2DM patients depended on several sociodemographic factors. More attention should be paid to diabetics with poor socioeconomic status in rural areas. Clinical trial registration The Henan Rural Cohort Study has been registered at Chinese Clinical Trial Register (Registration number: ChiCTR-OOC-15006699) http://www.chictr.org.cn/showproj.aspx?proj=11375. [ABSTRACT FROM AUTHOR]

Background: Improving health equity is a fundamental goal for establishing social health insurance. This article evaluated the benefits of the Integration of Social Medical Insurance (ISMI) policy for health services utilization in rural China. Methods: Using the China Health and Retirement Longitudinal study (2011‒2018), we estimated the changes in rates and equity in health services utilization by a generalized linear mixed model, concentration curves, concentration indices, and a horizontal inequity index before and after the introduction of the ISMI policy. Results: For the changes in rates, the generalized linear mixed model showed that the rate of inpatient health services utilization (IHSU) nearly doubled after the introduction of the ISMI policy (8.78 % vs. 16.58 %), while the rate of outpatient health services utilization (OHSU) decreased (20.25 % vs. 16.35 %) after the implementation of the policy. For the changes in inequity, the concentration index of OHSU decreased significantly from − 0.0636 (95 % CL: −0.0846, − 0.0430) before the policy to − 0.0457 (95 % CL: −0.0684, − 0.0229) after it. In addition, the horizontal inequity index decreased from − 0.0284 before the implementation of the policy to − 0.0171 after it, indicating that the inequity of OHSU was further reduced. The concentration index of IHSU increased significantly from − 0.0532 (95 % CL: −0.0868, − 0.0196) before the policy was implemented to − 0.1105 (95 % CL: −0.1333, − 0.0876) afterwards; the horizontal inequity index of IHSU increased from − 0.0066 before policy implementation to − 0.0595 afterwards, indicating that more low-income participants utilized inpatient services after the policy came into effect. Conclusions: The ISMI policy had a positive effect on improving the rate of IHSU but not on the rate of OHSU. This is in line with this policy's original intention of focusing on inpatient service rather than outpatients to achieve its principal goal of preventing catastrophic health expenditure. The ISMI policy had a positive effect on reducing the inequity in OHSU but a negative effect on the decrease in inequity in IHSU. Further research is needed to verify this change. This research on the effects of integration policy implementation may be useful to policy makers and has important policy implications for other developing countries facing similar challenges on the road to universal health coverage. [ABSTRACT FROM AUTHOR]

The socioeconomic disadvantage may adversely affect HIV treatment outcomes, particularly in resource-limited settings. Data from people living with HIV (PLWH) who were receiving antiretroviral therapy (ART) in Guangxi, China were analyzed to investigate the impact of socioeconomic status (SES) on the immunologic outcome (i.e., CD4 counts). Among 1198 participants, 55.0% were having CD4 counts ≤500 cells/mm3 and over two-third (68.5%) were considered to have a low level of SES. PLWH with high SES were more likely to have higher CD4 counts (adjusted Odds Ratio [aOR]: 1.44, 95%CI: 1.08–1.91) than PLWH with low SES, after adjusting for potential confounders. CD4 counts were also significantly associated with certain socio-demographic characteristics such as age, gender, and sexual orientation. In order to reduce SES-related disparity, a holistic approach may be needed to address the barriers to successful HIV treatment and care among PLWH with low SES. Poverty reduction and other structural interventions in addressing the socioeconomic disadvantages among PLWH should be key components of the national response to improving HIV treatment outcomes and ending the HIV epidemic in China and other low- and middle-income countries. [ABSTRACT FROM AUTHOR]

Purpose: The current study developed a strength-based flourishing intervention (SFI) and examined its efficacy on fostering the resilience of people with physical disabilities in poor areas, using a randomized (1:1) parallel-group controlled, and single-blind trial. Method: A total of 51 participants (M age = 42.16, standard deviation = 8.42; 43.14% males; 29 for the intervention group, whereas 22 for the control group) completed preintervention, postintervention, and 3-month follow-up tests. Results: The 2 × 3 mixed repeated measure analyses and post hoc analyses revealed a significant main group effect (F = 4.46, p =.04) and a short-term effect (i.e., 3 month; F = 6.35, p =.02) of the SFI. The results indicated that the SFI could significantly promote resilience in the intervention group. However, the effects of the intervention did not immediately appear. Discussion: The SFI could assist in providing research-based and cost-effective health services to promote flourishing and resilience in vulnerable populations. [ABSTRACT FROM AUTHOR]

We tracked the motor skill development of young children aged 3–6 years and investigated the influence of middle-income home environment on the development of motor skill. 268 children were selected from kindergartens in Beijing. The Test of Gross Motor Development (TGMD) tool was used to test the development of locomotor and object-control skills (LS and OS), and a survey of children's behaviour and home environment was conducted. During the follow-up, the LS and OS of children aged 3–6 years continued to grow, with an annual growth rate of 20% and 30%. Five LS indicators and two OS indicators were significantly higher in the 3–4-year group than in the 4–5 and 5–6-year groups (p < 0.01). The age-sex trend model showed that girls' locomotor skill developed at a significantly higher rate than that of boys (β = 6.3004 and 4.6782, p < 0.001). Three-year-old boys performed significantly better than girls on object-control motor skill (p < 0.05). Factors affecting the rate of children's motor skill development in middle-income families included the frequency of playing with friends (β = 0.133 , p = 0.032) and the frequency of bicycling, skateboarding, dancing, running, and jumping (β = 0.041 , p = 0.042). Family income, parents' education level, and family activity area did not significantly affect the growth rate of motor skills. For middle-income families, the improvement of material environment at home like more playing spaces and toys did not speed up the motor development, while more opportunities to play with friends and engage in a variety of sports activities could promote children's motor skill development. [ABSTRACT FROM AUTHOR]

Objectives: With a longitudinal design, we aimed to investigate the relationship between poverty and the risk of incident cognitive impairment in China. Methods: We used three waves of the Chinese Longitudinal Healthy Longevity Survey (2008–2014). Cognitive impairment was assessed using the Chinese version of the Mini Mental State Examination. Poverty was measured according to the latest national poverty line settled at an annual per-capita income of 2300 yuan (approximately equivalent to 1.25 dollar/day) in 2011 in China. A marginal structural model was utilized to explore the association between poverty and the risk of incident cognitive impairment. The subgroup analyses were also conducted in this study. Results: The cumulative incidence of cognitive impairment over 6 years was 30.69% (1936/6309). Poverty increased 34% risk of incident cognitive impairment in the elderly (odds ratio = 1.34, 95% confidence interval (CI): 1.15–1.56) after controlling behavioral factors and health status covariates. Participants who were male (OR = 1.38, 95% CI: 1.08–1.76), lived in urban areas (OR = 1.55, 95% CI: 1.22–1.98), and were married (OR = 1.72, 95% CI: 1.28–2.32) had higher poverty risks on incident cognitive impairment in subgroup analyses. Conclusions: Our results provide empirical support for the ongoing discussion about how economic hardship impacts of cognitive functioning, and highlight the negative health risks that economically disadvantaged individuals may experience. [ABSTRACT FROM AUTHOR]

Objectives: In this study, we explored the association between sleep quality, duration and prevalence of rheumatoid arthritis (RA) among low-income adults in rural areas of China. Methods: Face-to-face investigation were conducted in 2017, and completed questionnaires were obtained from 16,648 individuals. Sleep quality and duration were evaluated using the standard Pittsburgh Sleep Quality Index. RA was based on self-reported physician diagnosis. Logistic regression analysis and restricted cubic spline models were performed. Results: Sleep duration shorter than 7 hours was associated with increased odds of RA, with an odds ratio (OR) of 1.49 for 6–<7 hours and 1.70 for <6 hours. Poor sleep quality was associated with RA, with an OR of 1.68. The combination category of poor sleep quality and any group of sleep duration was associated with a significantly increased risk of developing RA. Combined groups of good sleep quality with short sleep duration (<7 hours) were also found to be related to prevalence of RA. There was a non-linear relationship between sleep quality, duration and the odds of RA. Conclusions: Poor sleep quality and short sleep duration may be trigger or risk factors for RA. [ABSTRACT FROM AUTHOR]

The aim of the study was to assess the effects of the maternal and child health (MCH) system strengthening through multilevel governmental collaboration in Nujiang Prefecture, China. A case study design was applied. Guided by the logical framework of the Nujiang MCH Comprehensive Intervention Project, national, provincial, and prefecture government sectors jointly implemented comprehensive health system strengthening (HSS) interventions in Nujiang Prefecture. In this case study, we conducted the end point surveys (November 2015 and January 2016) with 33 local MCH facilities. We also interviewed 35 MCH providers, government officials, leaders of MCH facilities, and project specialists. The thematic framework method was used to analyze the interview data, and descriptive analysis was performed to analyze the survey data. The three levels of governmental collaboration contributed to increased government investment in the local MCH system and ensured the successful implementation of the project. Participatory training methods and appropriate HSS interventions tailored to the local context were crucial to improve MCH providers' knowledge and skills, with the proportion of qualified MCH providers increasing from 70% in 2011 to 96% in 2015. Owing to this increase in knowledge and the increase in needed equipment, more MCH hospitals could provide inpatient obstetric services, and more town health clinics were capable of providing basic MCH services. The development of a reimbursement policy tailored to the local context promoted in-hospital delivery. At the conclusion of the project, percentages of antenatal care, in-hospital delivery, and newborn screening increased by 20.71%, 18.12%, and 278.62%, respectively. Growth monitoring coverage for children younger than three years remained stable at around 90%. However, the MCH system was negatively impacted by the workforce shortage. Those shortages were caused by a lack of positive recruitment and retention and incentive policies. Implementation of comprehensive HSS interventions through multilevel governmental collaboration improves the MCH system in remote and low-income areas. • Multilevel governmental collaboration improves the Maternal and Child Health (MCH) system in remote and low-income areas. • Participatory training methods contributes to the positive effects of health system strengthening interventions. • The MCH system is negatively impacted by the workforce shortages and inadequate incentives for health providers. [ABSTRACT FROM AUTHOR]

There is a large body of literature asserting that household asset holdings play a critical role in prospects of economic and social well-being. This study examines asset-poverty rates in China using the 2013 survey data from the Chinese Household Income Project (CHIP). The results indicate that asset-poverty rates in urban China were lower than those of developed countries, whereas rural and migrant households experienced more serious asset poverty than their counterparts in urban China. In addition, the asset-poverty rates were at least twice the income-poverty rates in China according to the different poverty lines used in the study. Several demographic characteristics were found associated with asset poverty. To assist the Chinese government in reaching its goal of eradicating absolute poverty by 2020 through targeted poverty alleviation, this study suggests including assets in the description and alleviation of poverty. [ABSTRACT FROM AUTHOR]

Poverty and poverty reduction in mainland China are the main concerns of development discourse and policy. Among poor individuals, children are the most vulnerable. This study aimed to investigate how multidimensional child poverty influenced children's academic achievement in poor rural areas in China. This study examined how this effect might be mediated by the stock of social relationships. Data were obtained from a questionnaire survey of 775 children (grades 4 to 9) living in the most underdeveloped rural areas in southwest China (Eryuan County). Results showed that multidimensional child poverty was negatively related to children's academic achievement. Social relationships played a significant role in mediating the effects of multidimensional child poverty on children's academic achievement. These findings provided valuable insights into the multidimensions of poverty and the underlying mechanisms from poverty to children's academic achievement. Implications in theory, social work practice, and social policy were discussed. Social work intervention and prevention were also developed in terms of fostering the growth of social relationships. • Poverty and poverty reduction in mainland China are currently the central concerns of development discourse and policy. • Multidimensional child poverty was negatively related to children's academic achievement. • Social relationships significantly mediated the effects of multidimensional child poverty on children's academic achievement. [ABSTRACT FROM AUTHOR]

Background: Health expenditure for tuberculosis (TB) care often pushes households into catastrophe and poverty. New Cooperative Medical Scheme (NCMS) aims to protect households from catastrophic health expenditure (CHE) and impoverishment in rural China. This article assesses the effect of NCMS on relieving CHE and impoverishment from TB care in rural China. Methods: Three hundred fourty-seven TB cases are included in the analysis. We analyze the incidence and intensity of CHE and poverty, and assess the protective effect of NCMS by comparing the CHE and impoverishment before and after reimbursement. Results: After out-of-pocket (OOP) payment for TB care, 16.1 % of non-poor fall below poverty line. The NCMS reduces the incidence of CHE and impoverishment by 11.5 % and 7.3 %. After reimbursement, 46.7 % of the households still experience CHE and 35.4 % are below the poverty line. The NCMS relieves the mean gap, mean positive gap, poverty gap and normalized positive gap by 44.5 %, 51.0 %, US$115.8 and 31.6 % respectively. Conclusions: The NCMS has partial effect on protecting households from CHE and impoverishment from TB care. The limited protection could be enhanced by redesigning benefit coverage to improve the "height" of the NCMS and representing fee-for-service with alternative payment mechanisms. [ABSTRACT FROM AUTHOR]

China made remarkable progress in rural poverty alleviation. A major policy instrument is the County Level Poverty Alleviation Program, which has vast policy support but is also criticized for targeting errors, misuse of funds, and making poverty both shameful and attractive. Whether this program, or the country’s economic growth in general, is the main force in poverty reduction is the question addressed in this article, analyzing data for the 592 poor counties. The response to the economic growth–policy alleviation conundrum is that a push for social wellbeing and empowerment is needed together with economic growth to achieve major poverty improvements. [ABSTRACT FROM AUTHOR]

With China’s gender imbalance and increasingly severe male marriage squeeze, patterns of intergenerational support in rural areas are likely to undergo significant change. Using data from a survey of four towns from X county in Anhui province carried out in 2008, this article analyzes the effects of sons’ marital status on intergenerational support. Random-effect regression analysis shows that son’s marital status has strong effects on financial support to and coresidence with parents. Compared with married sons, older unmarried sons (so-called forced bachelors) tend to provide less financial support to their parents and are more likely to live with their parents. Parents’ support of sons, as well as the parents’ own needs and sons’ capabilities all affect the support provided by sons. These results show that both theories of exchange and altruism are simultaneously relevant in the context of the marriage squeeze of contemporary rural China. [ABSTRACT FROM AUTHOR]

We examine the role of hopeful thinking in enhancing life satisfaction among a minority group facing pervasive group-based discrimination: country migrant workers' children in China. Positive psychology reasoning suggests that hopeful thinking can attenuate the negative impact of perceived discrimination on life satisfaction. This moderation model is compared to a mediation model, which predicts that reduced hopeful thinking explains the negative impact of perceived discrimination on life satisfaction. Study 1 showed that hopeful thinking did not moderate the relationship between discrimination and life satisfaction. Rather, the negative impact of discrimination on life satisfaction was mediated through diminished hopeful thinking. Study 2 manipulated perceived discrimination and replicated Study 1 findings. The results reveal that hopeful thinking can indeed have positive consequences, but that hopeful thinking is also constrained by perceiving discrimination. This suggests that there are limits to the extent to which hopeful thinking can be developed when facing group-based discrimination. [ABSTRACT FROM AUTHOR]

With visions of a better life through transnational marriage, women immigrants are often quickly disappointed when they are faced with social isolation as a result of heavy household responsibilities. The current study investigates 506 Chinese migrant mothers living in areas of concentrated poverty in Hong Kong. Using path analysis the study examines how several exogenous variables, such as marital contentment, household finances, and social support, predict perceived integration into the host society, and how hope for a better future might mediate the relationship between these variables and perceived integration. The results of the study have implications for social service practice in low-income neighborhoods. [ABSTRACT FROM PUBLISHER]

The effects of late-life subjective poverty on brain health are understudied. We aimed to investigate the association between duration of subjective poverty after age 64 and subsequent cognitive function and decline in China. Data were from 4118 adults aged ≥64 at baseline in the population-based China Longitudinal Healthy Longevity Survey (CLHLS), 2005–2018. The duration of subjective poverty was measured from self-rated economic status relative to neighbors in 2005, 2008, and 2011 (never; one time point; two or three time points). Cognitive function was assessed by the Chinese Mini-Mental State Exam (CMMSE; range: 0–30) in 2011, 2014, and 2018. We fitted attrition-weighted, multivariable mixed-effects Tobit regression models to examine the relationship between duration of subjective poverty from 2005 to 2011 and subsequent cognitive function and decline from 2011 to 2018. A total of 2675 (64.96%) participants never reported subjective poverty over the period 2005–2011, 930 (22.58%) participants reported subjective poverty at one time point, and 513 (12.46%) reported subjective poverty at two or three time points. Compared to those who never reported subjective poverty, participants experiencing subjective poverty at one time point (β = −0.95, 95% CI: −1.48 to −0.41) and two or three time points (β = −2.01; 95% CI: −2.73 to −1.29) had lower CMMSE scores in 2011, indicating a dose-response relationship. Individuals with a longer duration of subjective poverty had a slower rate of decline in CMMSE scores than those never in subjective poverty (β = 1.44; 95% CI: 0.20 to 2.68 for 2018 X Two or three time points). Subjective poverty in late life may have unique and cumulative contributions to cognitive aging among older adults in China. The lower level of initial cognitive function but slower rate of cognitive decline observed for those with greater subjective poverty is consistent with theories of cognitive reserve and empirical evidence from Western settings on other socioeconomic markers. • One of the first longitudinal studies of subjective poverty and cognitive aging. • This study focuses on the middle-old and oldest-old adults in China. • A longer subjective poverty duration was associated with worse cognitive function. • However, a longer subjective poverty duration may lead to slower cognitive decline. [ABSTRACT FROM AUTHOR]

• Employing resilience framework to examine the poverty effect under multisystems. • Constructing Multidimensional Poverty Index to measure household poverty. • Identifying promotive factors in mitigating poverty risk posed on child development. By employing the resilience framework, this study investigates how poverty would impact children's educational and behavioral performance in China. Considering the nested structure of the data, we employed multilevel structural equation modeling. The results suggest that, at the household level, personal agency and family resources completely mediate the effect of poverty on educational performance while partially mediating its effect on behavioral performance. At the community level, the two mediators partially mediate both educational and behavioral performance. Taking both mediators into account, poverty has a negative effect on cognitive ability at the community level, but positive impacts on behavioral performance at both the household and community levels. This study offers a new lens for social service practitioners who seek to promote poverty resilience among poor children. [ABSTRACT FROM AUTHOR]

• Poverty has a direct negative effect on adolescents' psychological well-being but not on their psychological distress. • Relational victimization, not overt victimization, mediates the association between poverty and adolescents' mental health. • Poverty and relational victimization negatively predict self-esteem, which in turn, jeopardizes adolescents' mental health. Poverty is negatively linked to adolescents' mental health. However, little is known about the underlying process that mediates this relationship. This study aims to examine the association among poverty, peer victimization, self-esteem, and mental health of adolescents. Data are collected through a multistage cluster random sampling in Hebei, China (N = 1280; mean age = 15.68; 47.4% male). Structural equation modeling is adopted to examine the hypothetical model using AMOS 24.0. Results reveal that the mechanisms linking poverty to adolescent mental health differ in terms of victimization types (overt or relational). Relational victimization and self-esteem partially mediate the relationship between poverty and psychological well-being and fully mediate the relationship between poverty and psychological distress after gender, age, hukou status, and family socioeconomic status are controlled. However, the mediating effect of overt victimization is not significant. The overall model accounts for 27% and 24.8% of the variance in psychological well-being and distress, respectively. This study contributes to an improved understanding of the mediating mechanisms underlying poverty and mental health. The implications of the present findings for social work interventions and social policies are also discussed. [ABSTRACT FROM AUTHOR]

Background: China poverty reduction policy (PRP) addresses two important elements: the targeted poverty reduction (TPA) project since 2015 in line with social assistance policy as national policy; and reducing inequality in health services utilization by making provision of medical financial assistance (MFA). Therefore, this study aims to assess the effects of the PRP in health services utilization (both inpatient and outpatient services) among the central and western rural poor of China. Methods: The study conducted household survey and applied propensity score matching (PSM) method to assess the effects of the PRP on health services utilization among the rural poor of Central and Western China. A sensitivity test was also performed on the PSM results to test their robustness. Results: Key findings showed 17.6% of respondents were the beneficial of PRP. The average treatment effects on the treated (ATT) of the PRP on the inpatient visits within one year was found significantly positive (P = 0.026). Conclusion: There has been relationship between PRP with medical financial assistance and reduction of inequality in health services utilization by the poorer, in particular to accessing the inpatient services from the county or township hospitals of China. Policy makers should pay attention for making provision of improving responsiveness of supply, when subsidizing on the demand side. [ABSTRACT FROM AUTHOR]