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Background: Air pollution affects residents' health to varying extents according to differences in socioeconomic status. However, there has been a lack of research on whether air pollution contributes to unfair health costs. Methods: In this research, data from the China Labour Force Dynamics Survey are matched with data on PM2.5 average concentration and precipitation, and the influence of air pollution on the health expenditures of residents is analysed with econometric methods involving a two-part model, instrument variables and moderating effects. Results: The findings reveal that air pollution significantly impacts Chinese residents' health costs and leads to low-income people face health inequality. Specifcally, the empirical evidence shows that air pollution has no significant influence on the probability of residents' health costs (β = 0.021, p = 0.770) but that it increases the amount of residents' total outpatient costs (β = 0.379, p < 0.006), reimbursed outpatient cost (β = 0.453, p < 0.044) and out-of-pocket outpatient cost (β = 0.362, p < 0.048). The heterogeneity analysis of income indicates that low-income people face inequality due to health cost inflation caused by air pollution, their total and out-of-pocket outpatient cost significantly increase with PM2.5 (β = 0.417, p = 0.013; β = 0.491, p = 0.020). Further analysis reveals that social basic medical insurance does not have a remarkable positive moderating effect on the influence of air pollution on individual health inflation (β = 0.021, p = 0.292), but supplementary medical insurance for employees could reduce the effect of air pollution on low-income residents' reimbursed and out-of-pocket outpatient cost (β=-1.331, p = 0.096; β=-2.211, p = 0.014). Conclusion: The study concludes that air pollution increases the amount of Chinese residents' outpatient cost and has no significant effect on the incidence of outpatient cost. However, air pollution has more significant impact on the low-income residents than the high-income residents, which indicates that air pollution leads to the inequity of medical cost. Additionally, the supplementary medical insurance reduces the inequity of medical cost caused by air pollution for the low-income employees. [ABSTRACT FROM AUTHOR]

Background: Based on CSS 2019 data, this article analyzes the impact of Basic Medical Insurance for Urban and Rural Residents (BMIUR) on perceived social equity of residents. Method: Using the CSS data of 2019, this article analyzes the influence of BMIUR on the perception of social equity of residents, on the basis of 2SLS model and mediating effect model. Results: We find that BMIUR has a significantly positive impact on the perception of social equity. That is to say, BMIUR can improve residents' evaluation of social equity and further promote the level of social equity, which makes residents more happiness. The conclusion remains valid after using robustness test and propensity score matching to conduct counterfactual reasoning. The discussion of mechanism indicates that the influence of BMIUR is mediated by enhancing social capital, improving satisfaction of income distribution and reducing self-paid medical expenses. This study also finds that the influence of BMIUR is more obvious in the low-income, low-skilled and mid-west groups. Conclusion: The reform of the medical security system should be regarded as a foothold for improving people's well-being and promoting social equity; Expanding people's social capital through multiple channels and improving income distribution mechanisms; Strengthen vocational skills training, especially to provide more public services and social security for low-income groups, low-skilled groups, and groups in the western region of China, in order to improve the welfare and policy effectiveness of China's social security reform. [ABSTRACT FROM AUTHOR]

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]

Objectives: This study aimed to understand the early development and nurturing care environment of children aged 0–6 years in rural China and to evaluate the sex‐ and age‐specific associations of nurturing care environment with child developmental outcomes. Methods: A cross‐sectional survey involving 2078 children aged 0–6 years was conducted using a stratified cluster sampling strategy. We used face‐to‐face interviews to collect information on child, family and nurturing care. The Ages & Stages Questionnaires‐Chinese version and ASQ: Social‐Emotional were applied to assess children's neuro‐ and social–emotional development, respectively. Lower neurodevelopmental scores indicate an increased risk for neurodevelopmental delay, and higher social–emotional scores are indicative to a risk of social–emotional problems. The multiple linear regression model examined the associations of nurturing care environments with childhood development. Results: Among the investigated children, the average age was (42.9 ± 19.8) months and 55.8% were boys; 67.9% of the children had absent fathers because of labour migration and 54.0% had limited access to books and toys. Overall, boys had a lower total neurodevelopmental score than girls; similar gender patterns were also found in the domains of communication, fine motor, problem‐solving and person‐social. Concurrent absent fathers and limited access to books and toys were significantly associated with reduced neurodevelopmental scores [β − 11.44, 95% CI (−18.20, −4.68)] and increased social–emotional developmental scores [β 5.88, 95%CI (1.35, 10.41)] after controlling for confounding factors. Sex‐specific analysis only echoed the results in boys. Additionally, having an absent father and limited access to books and toys was associated with lower neurodevelopmental scores [β − 14.58, 95%CI (−25.41, −3.75)] in children under 3 years of age and higher social–emotional developmental scores among children aged 3–6 years [β 10.66, 95%CI (5.09, 16.24)]. Conclusions: Children, especially boys, with absent fathers due to labour migration have poorer neuro‐ and social–emotional development. Limited access to books and toys and father absence are linked to the children's developmental delay, especially for those under 3 years of age. Our findings suggest that intervention programs in resource‐constrained rural areas are desirable; more importantly, such programs should begin before 3 years of age to achieve a benefit–cost outcome. [ABSTRACT FROM AUTHOR]

Background and Objectives This study aims to examine why rural-to-urban migrant workers in China remain in the workforce after age 60. Research Design and Methods Semistructured interviews were conducted and transcribed. Interview transcriptions were coded and analyzed by inductive content analysis. Results Rural-to-urban migrant workers in China continue to work even after they reach age 60 for reasons related to personal and family finances, as well as cognitive motivational, sociocultural, and working condition factors. Discussion and Implications Findings from this study deepen our understanding of the specific reasons why older rural-to-urban migrant workers in China continue working after age 60. While these findings emphasize the need for improved welfare programs and enhanced health care for older migrant workers, they also underscore the importance of providing a healthy and safe work environment for older workers. [ABSTRACT FROM AUTHOR]

Temporary workers' health problems in China have raised concerns recently. This study aimed to assess the relationship between temporary employment and three health outcomes with gradient severity and explore mediating mechanisms. Data was obtained from a national cross-sectional survey (China General Social Survey 2018). Compared with regular workers, temporary workers reported more frequent mood disorders (β = 0.197) and disturbance of daily activities (β = 0.132), however, there was no significant difference in serious health risks (inpatient treatment) between temporary and regular workers. Income poverty, subjective social status, and family relative socioeconomic status were significant mediators. The results suggest that temporary workers have higher general health risks, and economic deprivation is the main mechanism. Therefore, Chinese policymakers should provide more inclusive preventive health services beyond the existing health care system focused on critical illness to reduce the general health risks of grassroots workers. [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]

Living arrangements and health behaviors are considered to be associated with mental health, but their relationship has been less investigated by national survey data in China. The purpose of this study is to explore the relationship of living arrangements and health behaviors with anxiety among Chinese older people and to compare the results between urban and rural areas. The study was based on the Chinese Longitudinal Healthy Longevity Survey conducted in 2018, and a total of 12 726 old-aged respondents were included. Ordinal logistic regression was used to analyze the associations between living arrangements, health behaviors and anxiety. This study found that people living in nursing institutions are likely to be more anxious than their dwelling counterparts. Although we found no significant relationships of health behaviors such as smoking, drinking alcohol and exercise with anxiety, older adults with greater dietary diversity were less likely to experience anxiety. Furthermore, different trends between living arrangements and anxiety, smoking and anxiety were also found among urban versus rural respondents. The findings of this study help to better understand anxiety among Chinese older people and shed light on health policy on older people protection and services. [ABSTRACT FROM AUTHOR]

Objective: Kunjing children are children in need. This study aimed to evaluate the effectiveness of a pilot trial to promote the self-recognition, self-efficacy, and confidence of kunjing children without sufficient parental care (KCw/oSPC) in Mainland China. Method This intervention was a randomized controlled trial (RCT), 57 KCw/oSPC were recruited and allocated to treatment (n = 24) and waiting group (n = 33) randomly. Participants in treatment group received group-based services, while waiting group didn't receive any services in this trial period. We assessed participants' self-recognition, self-efficacy, and confidence in both groups during the pre- and post-treatment periods. Results: Group comparison results suggested that the group-based intervention was effective to promote the self-recognition, self-efficacy, and confidence of KCw/oSPC, with a large effect size as Cohen's d values suggested. Conclusion: This intervention was essential for KCw/oSPC in practice. Suggestions were provided to inform social work practice, involving integrating services, usage of group-based intervention module, and services settings. [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]

Background: Poverty vulnerability has been defined as the likelihood of a family falling into poverty in the upcoming months. Inequality is a major cause of poverty vulnerability in developing countries. There is evidence that establishing effective government subsidies and public service mechanisms significantly reduces health poverty vulnerability. One of the ways to study poverty vulnerability is by using empirical data such as income elasticity of demand to perform the analysis. Income elasticity refers to the extent to which changes in consumers' income affect changes in demand for commodities or public goods. In this work, we assess health poverty vulnerability in rural and urban China. We provide two levels of evidence on the marginal effects of the design and implementation of government subsidies and public mechanisms in reducing health poverty vulnerability, before and after incorporating the income elasticity of demand for health. Methods: Multidimensional physical and mental health poverty indexes, according to the Oxford Poverty & Human Development Initiative and the Andersen model, were implemented to measure health poverty vulnerability by using the 2018 China Family Panel Survey database (CFPS) as the data source for empirical analysis. The income elasticity of demand for health care was used as the key mediating variable of impact. Our assessment was conducted by a two-level multidimensional logistic regression using STATA16 software. Results: The first level regression indicates that the marginal utility of public mechanism (PM) in reducing urban and rural vulnerability as expected poverty on physical and mental health (VEP-PH&MH) was insignificant. On the other hand, government subsidies (GS) policies had a positive suppression effect on VEP-PH&MH to a relatively low degree. The second level regression found that given the diversity of health needs across individual households, i.e., the income elasticity of demand (HE) for health care products, PM and GS policies have a significant effect in reducing VEP-PH&MH in rural and urban areas. Our analysis has verified the significant positive impact of enacting accurate GS and PM policies on effectively reducing VEP-PH&MH in rural as well as urban areas. Conclusions: This study shows that implementing government subsidies and public mechanisms has a positive marginal effect on reducing VEP-PH&MH. Meanwhile, there are individual variations in health demands, urban-rural disparities, and regional disparities in the effects of GS and PM on inhibiting VEP-PH&MH. Therefore, special consideration needs to be given to the differences in the degree of health needs of individual residents among urban and rural areas and regions with varying economic development. Furthermore, considerations of this approach in the current worldwide scenario are analyzed. [ABSTRACT FROM AUTHOR]

A significant number of students in rural China drop out of junior high school. However, current analysis of the similarities and differences among these students are inadequate. Thus, we sought to explore the typology of students who dropped out of junior high school in the rural Hainan Province of China. We used latent class analysis to identify five types of students who chose to drop out. The categories included unexpected, unsupportive, maladjusted, financial difficulties, and peer-negative. Employing this typological classification as a guide, we explore the implications of our findings for future efforts in the field of research and in the prevention of junior high school withdrawal. Highlights: We explored the typology of students who dropped out of junior high school in the rural Hainan Province of China. We classified the dropout types as unexpected, unsupportive, maladjusted, financial difficulties, and peer-negative. Assessing and understanding a students' decision to drop out can facilitate future intervention efforts. [ABSTRACT FROM AUTHOR]

Summary: With the increase in urbanization in China, people's neighborhood has an important influence on their well-being. This study aims to explore the impact of neighborhood mutual support on well-being from the perspective of social work. A total of 13,486 samples from the 2016 China Labor-force Dynamics Survey were utilized. The data were analyzed by the ordered logit model and propensity score matching while controlling for individual, family, and socioeconomic features. Findings: (1) The more the neighborhood mutual support, the higher individuals' degree of well-being; this conclusion is robust. 2) Neighborhood mutual support has a larger improvement effect on the well-being of groups with low social status. (3) Neighborhood mutual support improves well-being through two mechanisms: it can grow an individual's support network, helping them obtain more material support, and it enhances individuals' integration into society, improving their well-being through increased feelings of community security. (4) The influence of neighborhood mutual support is weakened when a community has formal social support (full-time social workers) because individuals can resolve their problems through formal social support, reducing their reliance on neighbors. Applications: Based on the perspective of community development, understanding the influence of neighborhood mutual support on well-being is important. Social workers should adopt different intervention approaches according to characteristics of different groups to improve residents' level of neighborhood mutual support. Moreover, to promote community development, the government should consider arranging social work for less-developed communities. [ABSTRACT FROM AUTHOR]

Background: The HIV/AIDS epidemic is a concerning problem in many parts of the world, especially in rural and poor areas. Due to health service inequality and public stigma towards the disease, it is difficult to conduct face-to-face interventions. The widespread use of mobile phones and social media applications thus provide a feasible and acceptable approach for HIV prevention and education delivery in this population. The study aims to develop a generalizable, effective, acceptable, and convenient mobile-based information intervention model to improve HIV-related knowledge, attitudes, practices, and health outcomes in poverty-stricken areas in China and measure the impact of incentive policies on the work of village doctors in Liangshan, China.Methods: A randomized controlled trial design is used to evaluate the effectiveness of an 18-month mobile-based HIV prevention intervention, collaborating with local village doctors and consisting of group-based knowledge dissemination and individualized communication on WeChat and the Chinese Version of TikTok in Liangshan, China. Each village is defined as a cluster managed by a village doctor with 20 adults possessing mobile phones randomly selected from different families as participants, totaling 200 villages. Clusters are randomized (1:1:1) to the Control without mobile-based knowledge dissemination, Intervention A with standardized compensation to the village doctors, or Intervention B with performance-based compensation to the village doctors. The intervention groups will receive biweekly messages containing HIV-related educational modules. Data will be collected at baseline and 6-, 12-, and 18-month periods for outcome measurements. The primary outcomes of the study are HIV-related knowledge improvement and the effectiveness of village doctor targeted incentive policies. The secondary outcomes include secondary knowledge transmission, behavioral changes, health outcomes, social factors, and study design's acceptability and reproducibility. These outcomes will be explored via various qualitative and quantitative means.Discussion: The findings will provide insights into the effectiveness, generalizability, and challenges of the mobile-based HIV prevention intervention for the population living in rural communities with low education levels and will guide the development of similar models in other low-income and culturally isolated regions.Trial Registration: ClinicalTrial.gov: NCT05015062 ; Registered on June 6, 2022. [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]

Although extreme poverty has been eradicated in China, older adults in empty-nest households may risk falling into or returning to poverty in the future. Previous studies on poverty alleviation had focused on the measurement of ex-post poverty at a particular time. Few studies have assessed households' vulnerability to poverty from a forward-looking perspective. This study aims to identify the vulnerability to poverty and its determinants among rural empty-nest households with older adults. A total of 1951 rural empty-nest households with older adults followed for 1 year were included in the analysis. The three-stage Feasible Generalized Least Square method was used to estimate the vulnerability to poverty in 2019 and 2020. A regression model was used to explore the effect of different factors on vulnerability to poverty, and Shapley values were used to decompose each factor's contribution and the attributable percentage. With the increase of the poverty threshold, the success rate of predicting poverty status in 2020 based on poverty vulnerability in 2019 increased from 33.00% to 63.71%. Regardless of the poverty threshold, the vulnerability to poverty incidence decreased from 2019 to 2020. For example, under the Shandong province poverty line, the estimated proportion of rural empty-nest households with older adults vulnerable to poverty had decreased from 15.63% in 2019 to 11.17% in 2020. The Shapley decomposition results suggested that the number of the household labour force, the interviewees' education and age and household size were the four most influential factors that contributed significantly to the poverty vulnerability. This study reveals that a portion of rural empty-nest households with older adults are still vulnerable to poverty. The formulation of future anti-poverty policies should prioritize these groups and adopt targeted poverty prevention and poverty alleviation measures based on the driving factors of poverty vulnerability among rural empty-nest households with older adults. [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]

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]

Background: Organized breast and cervical cancer screening programme could only provide services at no cost for a fraction of socioeconomic-deprived women in China and other low-resource countries, however, little evidence exists for whether such a programme effectively affect the participation and inequalities at the population level.Methods: We used individual-level data from a nationally cross-sectional survey in 2014-2015 for breast and cervical cancer screening participation. Data for intervention and comparison grouping were from 2009 to 2014 national breast and cervical cancer screening programme, and counties covered by the programme were divided into intervention group. We assessed the impact of the intervention on the participation rates and the magnitude of inequalities with two approaches: multivariable multilevel logistic regressions adjusting for individual- and region-level covariates; and a difference analysis combined with propensity score matching that estimated the average intervention effect.Results: Of 69,875 included women aged 35-64 years, 21,620 were classified into the intervention group and 43,669 into the comparison group for breast cancer screening; and 31,794 into the intervention group, and 33,682 into the comparison group for cervical cancer screening. Participation rate was higher in intervention group than comparison group for breast cancer screening (25.3, 95% confidential interval [CI], 22.8-27.7%, vs 19.1, 17.4-20.7%), and cervical cancer screening (25.7, 23.8-27.7%, vs 21.5, 19.6-23.5%), respectively. Intervention significantly increased the likelihood of participation for both breast cancer and cervical cancer screening in overall women, rural women and urban women, whereas the effect was significantly higher in rural women than urban women. The average intervention effect on the participation rate was an increase of 7.5% (6.7-8.2%) for breast cancer screening, and 6.8% (6.1-7.5%) for cervical cancer screening, respectively. The inequalities were significantly decreased by 37-41% (P < 0.001) between rural and urban, however, were slightly decreased or even increased in terms of age, education status, and household income.Conclusions: Organized breast and cervical cancer screening programme targeting for a fraction of women could increase the participation rates at population level, however, it could not significantly affect socioeconomic-introduced inequalities. Further studies are need to conduct time-series analyses and strengthen the causal correlation. [ABSTRACT FROM AUTHOR]

Using data from the 2014 wave of the China Family Panel Studies (CFPS), a nationally representative survey, we examined the direct and indirect effects of family economic hardship on children's outcomes using the family stress model (FSM). Multitrait-multimethod data were from a sample of 777 two-parent families. Data from both parents and one of their school-age children (M = 11.36) were used to test the proposed conceptual model using structural equation modeling conducted in Mplus 8. The results indicate partial support for the FSM in the Chinese context and show variations in the pathways for rural and urban families. The mediating role of economic pressure and parental distress in the association between family economic hardship and child emotional distress was supported. The findings have implications for the development of intervention programs and for future studies on the association between family economic hardship and child emotional distress and child self-concept in the Chinese context. The study findings suggest that clinical and policy endeavors should be directed at alleviating the effects of economic pressure and targeting efforts toward reducing parental emotional distress. These attempts could be valuable in advancing child outcomes in the face of family economic hardship. (PsycInfo Database Record (c) 2020 APA, all rights reserved). [ABSTRACT FROM AUTHOR]

Background: Providing equal treatment for those who have the same need for healthcare, regardless of their socioeconomic and cultural background, has become a shared goal among policymakers who strive to improve healthcare. This study aims to identify the socioeconomic status (SES) inequities in inpatient service utilization based on need among migrants by using a nationally representative study in China.Methods: The data used in this study was derived from the 2014 National Internal Migrant Population Dynamic Monitoring Survey collected by the National Health Commission of China. The sampling frame for this study was taken using the stratified multistage random sampling method. All provincial urban belt and key cities were stratified, and 119 strata were finally determined. We used logistic regression method and Blinder-Oaxaca decomposition and calculated the concentration index to measure inequities of SES in inpatient service utilization based on need. Sample weights provided in the survey were applied in all the analysis and all standard errors in this study were clustered at the strata level.Results: Of the total internal migrants, 18.75% unmet the inpatient service need. Results showed that inpatient service utilization concentrated among high-SES migrants (Concentration Index: 0.036, p < 0.001) and the decomposition results suggested that about 44.16% of the total SES gap in inpatient service utilization could be attributed to the gradient effect. After adjusting for other confounding variables, those had high school degree and university degree were more likely to meet the inpatient services need, and the OR values were 1.48 (95% CI 1.07, 2.03, p = 0.017) and 2.04 (95% CI 1.45, 2.88, p = 0.001), respectively. The OR values for Quartile 3 and Quartile 4 income groups was 1.28 (95% CI 1.01, 1.62, p = 0.044) and 1.37 (95% CI 1.02, 1.83, p = 0.035), respectively.Conclusion: This study observed an inequity in inpatient service utilization where the utilization concentrates among high SES migrants. It is important for policy makers to be aware of them and more intervention should be conducted. [ABSTRACT FROM AUTHOR]

Background: Traditional bamboo weaving has been practiced for centuries in Sansui, a county dominated by the Miao people, in Guizhou province of Southwest China. Sansui bamboo weaving represents an intangible cultural heritage as defined by UNESCO, but, like many other traditional handicrafts in China, it has suffered a downfall in this period of rapid development. Sansui bamboo weaving is now experiencing a renaissance due to the joint efforts of the local government, bamboo weaving companies, and individual bamboo weavers. However, what bamboo species have supported the traditional bamboo weaving in Sansui keeps unknown up to now. The traditional knowledge and technology associated with bamboo weaving have not been reported. In addition, the resumption of the local bamboo industry may provide some valuable experiences for other downfallen traditional handicrafts or local communities. Thus, an ethnobotanical study on Sansui bamboo weaving has been carried out. Methods: This study mainly used ethnobotanical methods, including key informant interviews and participatory observations. Different stakeholders were selected by applying the snowball method as our key informants including 6 officials, 37 bamboo weavers, and 17 bamboo and bamboo weaving product merchants. We also went into the local weavers' houses to visit the whole weaving process. The bamboo and dye plant species for bamboo weaving were identified by taxonomists and referring to online databases available. Results: Based on field investigations, 17 bamboo species used for weaving were recorded. Different bamboo species were woven for different purposes based on their own characters. Phyllostachys heteroclada is the most popular species locally. Bamboo strips are usually dyed by using Platycarya strobilacea and Rubia cordifolia to be made for different images. In recent years, the size, functions, and materials of local bamboo weaving crafts as well as their market mode have been changed to adapt to new development trends and to cater to the market. In addition, the cooperation among bamboo weavers, bamboo companies, and household workshops has provided great support to the local bamboo industry and to reboot the economy of the local community. Some suggestions for the sustainable economic development of Sansui bamboo weaving and other Chinese traditional handicrafts are proposed. Conclusion: In the present study, the bamboo weaving-associated traditional knowledge was collected by means of ethnobotanical methods. The recent renaissance of the bamboo weaving business in Sansui can be attributed both to government support and the innovations of the bamboo weaving industry itself. The developing mode ("Internet + intangible cultural heritage + poverty alleviation"), which combined the internet, poverty alleviation, and intangible cultural heritage, is valid and worth being promoted. [ABSTRACT FROM AUTHOR]

Background: We examined the physiological, household, and spatial agglomeration characteristics of the health poverty population in China. We identified weak links that affect the implementation of the medical insurance and further improve its effectiveness for health poverty alleviation.Methods: A national representative sample from the China Health and Retirement Longitudinal Study (CHARLS) was analyzed. The WHO recommended method was adopted to calculate catastrophic health expenditure (CHE) and impoverishment by medical expenses (IME). We created a binary indicator for IME as the outcome variable and applied the treatment-effect model to analyze the determinants of IME.Results: The incidence of IME was 7.2% of the overall population, compared to 20.3% of the sample households trapped in CHE. The incidence of IME enrolled in insurance schemes was 7.4% higher than that of uninsured families (4.8%). Economic level, living area, family size, age of household head, having hospitalized members, and participating in insurance were statistically significant for the occurrence of IME.Conclusions: The original poverty-promoting policies has not reached the maximum point of convergence with China's current demand for health. The overlapped health vulnerabilities exacerbated the risk of poverty among the elderly and households with high health needs and utilization. In addition, the medical insurance schemes have proven to be insufficient for protection against economic burden of poor households. So, special health needs, age, and household capacity to pay should be comprehensively considered while strengthening the connection between the disease insurance scheme with supplementary insurance. [ABSTRACT FROM AUTHOR]

This study analyzed child income poverty in China from 2005 to 2015 using data obtained from the Chinese General Social Survey. Building on the Foster–Greer–Thorbecke (FGT) methodology, this study estimated the headcount, poverty gap and poverty severity indexes of all children and the poverty gap of poor children. Subgroup decomposition, growth-redistribution decomposition of poverty changes and pro-poor growth measurements were conducted. The results show that the overall poverty level among children was high despite a decreasing trend, and poor children's relative economic status worsened, especially in rural areas; there were large disparities among different groups of children by urban/rural status, ethnicity and hukou. Rural children contributed more to the overall poverty level and poverty changes than urban children. The growth among children is not relatively pro-poor but only absolutely pro-poor, increasing the inequality and finally offsetting the effect of growth on reducing poverty to some extent. • Measuring and performing sub-group and growth-redistribution decomposition of child income poverty throughout China. • There are still a large number of children living in poverty in China despite a decreasing trend. • Growth among children in China is absolutely pro-poor but not relatively pro-poor. [ABSTRACT FROM AUTHOR]

Background: Data on the association between socioeconomic status and post-stroke functional outcome in developing countries is lacking. We aimed to evaluate the association in stroke survivors in deprived rural Southern China.Methods: We conducted door-to-door interviews and collected data using a structured questionnaire in stroke survivors from five fourth-class rural areas of Guangdong Province through a non-government initiated registry from August 2014 to March 2015. Descriptive statistics were used to provide information on the demographic, socioeconomic and clinical characteristics of the selected population. Univariate and multivariate logistic regression were used to examine the relationship of socioeconomic status indexed by self-reported average family income and functional impairment defined as a modified Rankin Scale of 3 to 5.Results: Among the 425 stroke survivors, 52.7% lived below the poverty line set by the local government. About 50% of patients suffered from functional impairment and required assistance in their daily life. Compared with their wealthier counterpart, stroke survivors with lower income were more likely to have functional impairment (OR 2.85, 95% CI 1.93-4.23). The effect size increased and remained significant after adjusting for possible confounding factors (OR 3.17, 95% CI 2.04-4.91).Conclusions: Poorer patients tend to have poorer post-stroke functional outcome. Primary and secondary strategies targeting underprivileged populations in less-developed areas are thus urgently needed in China. [ABSTRACT FROM AUTHOR]

Aim This study aims to investigate the medical expenditure of people with Type 2 diabetes mellitus in Chongqing, China; to explore factors that contribute to the expenditure; and to examine the financial burden placed on households, particularly poor households. Methods A cross sectional survey was conducted with a sample of people diagnosed with Type 2 diabetes mellitus in 2014. Of the 664 people eligible, 76% were interviewed. Descriptive statistics and log-linear regression were used to examine respondents' age, sex and level education, location of residence, income and type of health insurance associated with out-of-pocket expenditure on accessing diabetes mellitus care. Results In a year, average out-of-pocket expenditure on the purchase of drugs from pharmacies and having outpatient care were US $333 and US $310, respectively. The average out-of-pocket expenditure on accessing inpatient care was 3.7 times ( US $1159) that of accessing outpatient care. After adjusting for age and sex, out-of-pocket expenditure on diabetes care was significantly higher for people covered by the Urban Employee Basic Medical Insurance programme and those enrolled in the identified priority diseases reimbursement programme, which provided higher reimbursement rates for outpatient and (or) inpatient care. Out-of-pocket expenditures on the purchase of drugs from pharmacies, having outpatient and inpatient care, respectively, were 9.8%, 16.2% and 62.6% of annual household income in low-income group. Conclusion Even with health insurance coverage, poor people with Type 2 diabetes mellitus suffered from significant financial hardship. This has significant implications for models of care and healthcare financing in China with the growing burden of diabetes. [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]

Introduction: In high-income countries, secondhand smoke (SHS) exposure is higher among disadvantaged groups. We examine socioeconomic inequalities in SHS exposure at home and at workplace in 15 low- and middle-income countries (LMICs).Methods: Secondary analyses of cross-sectional data from 15 LMICs participating in Global Adult Tobacco Survey (participants ≥ 15 years; 2008-2011) were used. Country-specific analyses using regression-based methods were used to estimate the magnitude of socioeconomic inequalities in SHS exposure: (1) Relative Index of Inequality and (2) Slope Index of Inequality.Results: SHS exposure at home ranged from 17.4% in Mexico to 73.1% in Vietnam; exposure at workplace ranged from 16.9% in Uruguay to 65.8% in Bangladesh. In India, Bangladesh, Thailand, Malaysia, Philippines, Vietnam, Uruguay, Poland, Turkey, Ukraine, and Egypt, SHS exposure at home reduced with increasing wealth (Relative Index of Inequality range: 1.13 [95% confidence interval [CI] 1.04-1.22] in Turkey to 3.31 [95% CI 2.91-3.77] in Thailand; Slope Index of Inequality range: 0.06 [95% CI 0.02-0.11] in Turkey to 0.43 [95% CI 0.38-0.48] in Philippines). In these 11 countries, and in China, SHS exposure at home reduced with increasing education. In India, Bangladesh, Thailand, and Philippines, SHS exposure at workplace reduced with increasing wealth. In India, Bangladesh, Thailand, Philippines, Vietnam, Poland, Russian Federation, Turkey, Ukraine, and Egypt, SHS exposure at workplace reduced with increasing education.Conclusion: SHS exposure at homes is higher among the socioeconomically disadvantaged in the majority of LMICs studied; at workplaces, exposure is higher among the less educated. Pro-equity tobacco control interventions alongside targeted efforts in these groups are recommended to reduce inequalities in SHS exposure.Implications: SHS exposure is higher among the socioeconomically disadvantaged groups in high-income countries. Comprehensive smoke-free policies are pro-equity for certain health outcomes that are strongly influenced by SHS exposure. Using nationally representative Global Adult Tobacco Survey (2008-2011) data from 15 LMICs, we studied socioeconomic inequalities in SHS exposure at homes and at workplaces. The study showed that in most LMICs, SHS exposure at homes is higher among the poor and the less educated. At workplaces, SHS exposure is higher among the less educated groups. Accelerating implementation of pro-equity tobacco control interventions and strengthening of efforts targeted at the socioeconomically disadvantaged groups are needed to reduce inequalities in SHS exposure in LMICs. [ABSTRACT FROM AUTHOR]

Aims To estimate the prevalence, awareness, treatment and control of diabetes in rural areas in Shandong Province, China. Methods The Luxemburg- WHO-Shandong Project on Rural Health Personnel Training and Chronic Disease Control, a cross-sectional study, examined 16 375 rural residents aged 25 years and over using multistage cluster sampling in April 2007. An overnight fasting blood specimen was collected to measure plasma glucose and a 2-h 75-g oral glucose tolerance test was conducted among people with a fasting blood glucose of ≥ 6.1 mmol/l. Information on the history of diabetes and hypoglycaemic medication was obtained using a standard questionnaire. Diabetes and prediabetes were defined according to the 1999 World Health Organization diagnostic criteria. Results Overall, the prevalence rates for diabetes, prediabetes and previously diagnosed diabetes in the rural population were estimated to be 3.5%, 6.0% and 1.2%, respectively. Among those with diabetes, only 34.8% were aware of their condition, 30.6% were currently undergoing medication treatment, and 11.5% achieved glycaemic control. Conclusions These results indicate that diabetes has become a public health problem in poor rural areas of China and the rates of awareness, treatment and control of diabetes were relatively low. There is an urgent need for strategies aimed at the prevention and treatment of diabetes in the rural population in Shandong Province, China. [ABSTRACT FROM AUTHOR]

It has been shown that food insecurity is associated with poor diet quality and unfavourable health outcomes. However, little is known about the potential effects of food insecurity on the overall malnutrition status among children. In this study, we investigated the prevalence of food insecurity among 1583 elementary school students, aged 6–14 years, living in Chinese rural areas and examined its association with four malnutrition signs, including rickets sequelae, anaemia, stunting and wasting. Information on food security was collected via questionnaires. Rickets sequelae were assessed by an experienced paediatrician during the interview. Anaemia was determined by the WHO Hb thresholds adjusted by the local altitude. Weight and height were measured during the interview. Stunting and wasting were then evaluated according to WHO child growth standards (2007). We examined the association between food insecurity and the number of malnutrition signs (total number=4), and the likelihood of having severe malnutrition (presence of 3+ signs), after adjusting for potential confounders, such as age, social-economic status and dietary intakes. During the previous 12 months, the overall prevalence of food insecurity was 6·1 % in the entire studied population and 16·3 % in participants with severe malnutrition. Participants with food insecurity had a slightly higher number of malnutrition signs (1·14 v. 0·96; P=0·043) relative to those who were food secure, after adjusting for potential confounders. Food insecurity was also associated with increased likelihood of having severe malnutrition (adjusted OR 3·08; 95 % CI 1·47, 6·46; P=0·003). In conclusion, food insecurity is significantly associated with malnutrition among Chinese children in this community. [ABSTRACT FROM PUBLISHER]

Because of the illegality and stigma associated with female sex workers (FSWs) in China, data were limited regarding their psychological stressors examined through the lens of occupational health. Analyzing qualitative data from 16 gatekeepers and 38 FSWs, we explored these stressors in the context of commercial sex in China. We found that FSWs faced a continuum of stressors that resulted from poverty, limited employment, lack of social protection, violence perpetrated by clients, and limited social support from peers and stable partners. We call for empowerment and a structural approach to address the needs of FSWs to improve their psychological well-being. [ABSTRACT FROM PUBLISHER]

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]

Prevalence of multimorbidity (i.e., ≥2 chronic conditions), chronic diseases, and obesity is increasing in low- and middle-income countries (LMICs), posing a potential threat to the health of older adults living in these areas. This study hence investigates the unexplored association between obesity and multimorbidity among older adults from LMICs. Cross-sectional, community-based data from the WHO Study on global Ageing and adult health (SAGE) were analysed. The sample consisted of 20,198 individuals aged ≥60 years [Mean age (SD) = 69.3 (13.1) years; 54.1% female] from China, India, Ghana, Mexico, Russia, South Africa. Twelve chronic conditions were assessed. Multivariable logistic regression was conducted to assess the association between BMI ≥ 30 kg/m2, high waist circumference (WC, cut-points > 102 cm for males and > 88 cm for females) and multimorbidity. After adjusting for potential confounders, overall, BMI ≥ 30 kg/m2 was associated with 1.43 (95%CI = 1.21-1.69) times higher odds for multimorbidity, while this estimate for high WC was 1.50 (95%CI = 1.21-1.86). Significant associations emerged between obesity measures and five out of twelve chronic conditions. Results from this study underline the need to reduce obesity among older adults in areas where its prevalence is increasing, as it is associated with increased odds for multimorbidity. Future longitudinal research in this setting is required to assess the impact of obesity reduction on multimorbidity incidence. [ABSTRACT FROM AUTHOR]