Search

With relatively sufficient antenatal health service supplies in eastern rural China, the utilization still needs to be improved. The objective of this study was to identify factors that correlate with antenatal care (ANC) utilization from the demand-side in Jiangsu, China. In a cross-sectional survey, a sample of 896 rural women who had a childbearing history in the previous 5 years answered ANC questions and formed the final analysis. Questionnaire was designed based on Andersen's behavioral model. The outcome variables included receiving times and items of prescribed ANC utilization, and the explanatory variables were organized into 3 hierarchical levels: predisposing, enabling, and need factors. Univariate analysis and multivariate logistic regression analysis were conducted. In the results of multivariate logistic regression, factors significantly associated with ANC examination times included income, odds ratio (OR) (95% confidence interval [CI]) = 2.90 (1.92-4.39); the distance from the nearest hospital, OR (95% CI) = 0.67 (0.47-0.95); chronic disease, OR (95% CI) = 1.77 (1.15-2.72); and parity, OR (95% CI) = 0.66 (0.46-0.95), while factors significantly associated with ANC examination items included education, OR (95% CI) = 8.02 (1.08-59.67); income, OR (95% CI) = 3.90 (1.72-8.85); female medical staff in towns and villages, OR (95% CI) = 2.64 (1.39-5.02); and parity, OR (95% CI) = 0.41 (0.23-0.75). In reducing inadequate ANC utilization in rural area, efforts should be made not only to target the rural women with lower income, lower educational level, and multi-parity, but also to further improve the accessibility of the primary medical facilities and female staff at the grassroots level.

Both health resources and access to these resources increased after China's health care reform launched in 2009. However, it is not clear if the inequalities were reduced within rural China, which was one of the main targets in the reform. This study aims to examine the changes in inequalities in health resources and access following the reform. Data came from the routine report of rural counties in every other year from 2008 to 2014. Health professionals and hospital beds per 1000 population were used for measuring health resources, and the hospitalization rate was used for access. Descriptive analysis and the fixed effect model were used in this study. Health resources and access increased by about 50% between 2008 and 2014 in rural China. The counties in richer quintiles got more health resources and hospitalizations. As for health professionals, the absolute differences between the richer and the poorest quintile were significantly enlarging in 2014 when compared to 2008. Regarding the hospitalization rate, the differences between the richest and the poorest quintile showed no significant change after 2012. In sum, absolute inequalities of health resources were increased, while that of health utilization kept constant following China's health care reform. The reform needs to continually recruit qualified health workers and appropriately allocate health infrastructures to strengthen the capacity of the health care system in the impoverished areas.

The purpose of this study was to examine the dietary views and practices and to identify associated barriers to and facilitators of healthy eating of rural residents emerging from poverty in the context of rapid socio-economic development. A qualitative design with semi-structured interviews was utilized to collect detailed insights into the dietary behaviors of 22 rural residents from 10 villages in Fengshan town, Dafang county, Guizhou province, China. Thematic analysis was applied to interpret the interview data, guided by the socio-ecological model. Four themes were identified: traditional eating patterns, factors influencing food choice, limited knowledge of healthy diet, and lack of nutritional guidance. Barriers to healthy eating included traditional but unhealthy foods, limited nutritional knowledge, inadequate understanding of nutritional requirements, overwhelming nutritional information, and limited professional guidance. Facilitators encompassed healthy traditional eating patterns, household composition, home gardening, preference for traditional bean and soy products, improved food supply and availability owing to poverty alleviation efforts, and being open to receiving professional dietary guidance. As a preliminary investigation into the dietary views and practices of this population, the study highlights a significant gap in the nutritional knowledge and guidance available to rural residents in China, emphasizing the need for comprehensive strategies that address the complex socio-ecological factors influencing dietary behaviors. [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]

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]

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]

Copyright of Journal of Clinical Nursing in Practice is the property of Journal of Clinical Nursing in Practice (Editorial Board, Shanghai Jiao Tong University Press) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

According to the stratified poverty theory, poverty includes individual (people) and regional (place) poverty. Understanding the interaction mechanism between individual poverty and regional poverty is crucial to achieving the UN goal of poverty eradication by 2030. However, at present, the relevant empirical research is still limited by the availability of data. To fill this important gap, based on the multi-source data of poverty census, geo-environmental and socio-economic data of China's 1587 counties in 2013, we used exploratory spatial data analysis (ESDA) and spatial econometric models (spatial-lag and spatial-error model) to identify determinants of individual poverty and regional poverty in this county. Results show that the spatial distribution of the rural poor in China had strong spatial dependence (Global Moran's I = 0.574). There was a high degree of spatial overlap between individual poverty and regional poverty. The poverty-causing factors were complex and varied across regions and individuals. Disease of family members was the leading factor driving rural areas in Northeast, Central, and Southwest China. Northeast China was mainly affected by the illness and lack of labor skills of family members. The complex terrain conditions were the determinants driving rural poverty in most areas of China. Improved transportation can greatly reduce rural poverty. Geographical isolation or lack of geographical capital caused by complex terrain conditions, backward transportation, and regional closure promoted regional poverty. In turn, regional poverty-causing factors further restricted the improvement of rural residents' self-development ability and aggravated individual poverty. Our findings indicate that individual poverty and regional poverty have different poverty-causing mechanisms and poverty reduction priorities. Effective poverty reduction strategies require the coordinated promotion of individual and regional poverty reduction. The reduction of individual poverty should focus on enhancing the livelihood capital of the poor through differentiated policy intervention, while regional poverty alleviation should focus on creating a favorable development environment by increasing infrastructure investment and public service supply. [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]

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]

Correlations between socioeconomic factors and poverty in regression models do not reflect actual relationships, especially when data exhibit patterns of spatial heterogeneity. Spatial regression models can estimate the relationships between socioeconomic factors and poverty in defined geographical areas, explaining the imbalanced distribution of poverty, but the relationships between these factors and poverty are not always linear however, and conventional simple linear local regression models do not accurately capture these nonlinear relationships. To fill this gap, we used a local regression method, geographically weighted random forest regression (GW-RFR), that integrates a spatial weight matrix (SWM) and random forest (RF). The GW-RFR evaluates the spatial variations in the nonlinear relationships between variables. A county-level poverty data set of China was employed to estimate the performance of the GW-RFR against the random forest (RF). In this poverty application, the value of R 2 was 0.128 higher than that of the RF, the NRMSE value was 1.6% lower than the RF, and the MAE value was 0.295 lower than the RF. These results showed that the relationship between poverty factors and poverty varies with space at the county level in China, and the GW-RFR was suitable for dealing with nonlinear relationships in local regression analysis. [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: It is unknown whether and how poverty influences the long-term outcome of persons with severe mental illness (SMI). Aims: To explore the change of poverty status in persons with SMI from 1994 to 2015 and examine the impact of poverty status on patients' outcome in rural China. Method: Two mental health surveys using identical methods and International Classification of Disease (ICD-10) were conducted in 1994 and 2015 in the same six townships of Xinjin County, Chengdu, China. Results: The annual net income per person was 19.8% and 100.2% higher for the general population than for persons with SMI in 1994 and 2015 respectively. Compared with 1994 (48.2%), persons with SMI in 2015 had significantly higher rates of poor family economic status (

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]

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]

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]

Objective. The increased blood pressure level in children and adolescents is recognized as an essential predictor of adulthood cardiovascular disease. This study aimed to ascertain the prevalence and the urban-rural disparity of childhood hypertension in the southwest of China. Methods. Using stratified cluster sampling in urban and rural areas, a total of 13597 primary school children aged 6∼12 years living in the Southwest of China were included. The prevalence of hypertension was analyzed. The risk factors were collected by questionnaires, and the risk factors of childhood hypertension were analyzed by the logistic regression model. Results. The prevalence of hypertension was 13.75%, 9.02%, and 17.47% in total, urban, and rural children, respectively, and the urban-rural difference was 8.44% (95%CI: 7.32%, 9.56%). Children with obesity, maternal gestational hypertension, >10 months of breastfeeding, or low family income had a significantly increased prevalence of hypertension (29.4%, 20.00%, 16.31%, and 16.25%, respectively). Rural residence, intake of more pickle (in rural), maternal gestational hypertension (in urban), low birth weight (in rural), obesity, increased heart rate, and red blood cell counts were the risk factors of childhood hypertension. The adjusted R2 values were 13.61%, 23.25%, 10.88%, 11.12%, 12.23%, and 25.04% in the full models excluding and including serum indexes for total, urban, and rural children, respectively. Conclusions. The prevalence of childhood hypertension is significant in the Southwest of China and alarming in rural areas, which requires community intervention. Children living in rural areas combined with obesity, low social economic status, dietary imbalance, and abnormal lipid metabolism were associated with an increased risk of hypertension, and routine care programs should be conducted to prevent childhood hypertension. [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]

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]

Poverty is a major problem that has consistently impacted human development. The spatial characteristics of poverty are nonvolatile at the regional level and represent the primary factors underlying the spatial poverty trap. Previous research on spatial poverty has frequently attempted to theoretically demonstrate the relationship between the spatial distribution of socioeconomic factors and regional poverty by drawing poverty maps, whereas less attention has focused on geographic factors. The case of Miao–Dong Autonomous Prefecture of Qiandongnan in Guizhou Province, China, is examined herein. This paper proposes a theoretical framework for the mechanisms linking the geographical environment and regional poverty and then conducts a quantitative analysis of the spatial association and degree of influence of these mechanisms. A geographically weighted regression (GWR) is employed to analyse the explanatory ability of variables in local areas. The results show that the mean slope and road network density have the most statistically significant correlations with the town-level poverty headcount ratios in Qiandongnan. Specifically, mountainous regions with steeper slopes suffer from a higher poverty headcount ratio, and towns with higher road network densities have a lower poverty headcount ratio because of the convenience of transportation. Additionally, the GWR indicates the occurrence of spatial nonstationarity, which indicates that the nature and strength of the association between each geographic indicator and the poverty headcount ratio varies across the 201 towns, with a linear growth pattern observed from north to south. Moreover, the results of a correlation analysis demonstrate that land cover with different slope classifications is more related to the regional poverty headcount ratio than land cover without a slope classification. We expect that this paper will provide useful insights for incorporating geographical factors into the formulation of poverty reduction policies. [ABSTRACT FROM AUTHOR]

This study aimed to explore the relationship between poverty and children’s mental health in the social context of China. Data were consisted of 1314 children, which were collected with a multi-stage cluster random sampling method in Xiushui, a typical poverty city in China. Structural equation modeling was adopted to test the hypothesized model. Results showed that both social causation model and social selection model could explain the relationship between poverty and children’s mental health in Mainland China. The implications of these findings on theory and social work services were also discussed. [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]

Background: Healthcare financing should be equitable. Fairness in financial contribution and protection against financial risk is based on the notion that every household should pay a fair share. Health policy makers have long been concerned with protecting people from the possibility that ill health will lead to catastrophic financial payments and subsequent impoverishment. A number of studies on health care financing equity have been conducted in some provinces of China, but in Guangxi, we found such observation is not enough. What is the situation in Guagnxi? A research on rural areas of Guangxi can add knowledge in this field and help improve the equity and efficiency of health financing, particularly in low-income citizens in rural countries, is a major concern in China's medical sector reform. Methods: Socio-economic characteristics and healthcare payment data were obtained from two rounds of household surveys conducted in 2009 (4634 respondents) and 2013 (3951 respondents). The contributions of funding sources were determined and a progressivity analysis of government healthcare subsidies was performed. Household consumption expenditure and total healthcare payments were calculated and incidence and intensity of catastrophic health payments were measured. Summary indices (concentration index, Kakwani index and Gini coefficient) were obtained for the sources of healthcare financing: indirect taxes, out of pocket payments, and social insurance contributions. Results: The overall health-care financing system was regressive. In 2013, the Kakwani index was 0.0013, the vertical effect of all the three funding sources was 0.0001, and some values exceeded 100%, indicating that vertical inequity had a large influence on causing total health financing inequity. The headcount of catastrophic health payment declined sharply between 2009 and 2013, using total expenditure (from 7.3% to 1.2%) or non-food expenditure (from 26.1% to 7.5%) as the indicator of household capacity to pay. Conclusion: Our study demonstrates an inequitable distribution of government healthcare subsidies in China from 2009 to 2013, and the inequity was reduced, especially in rural areas. Future healthcare reforms in China should not only focus on expanding the coverage, but also on improving the equity of distribution of healthcare benefits. [ABSTRACT FROM AUTHOR]

Background: Spontaneous abortion (SA) is one of the prevalent negative reproductive outcomes among women around the world, which is a great challenge faced by maternal health promotion. The present study is aimed to explore the association between SA and socioeconomic status (SES) and provides reference for policy makers to improve strategies on maternal health promotion. Methods: A cross-sectional analysis was conducted with baseline data from a large-scale population-based cohort study of 0.5 million people from 10 geographically diverse areas of China recruited from 2004 to 2008. The study collected data from 84,531 women aged 35-45 years old in the baseline survey of China Kadoorie Biobank. Participants were interviewed using a standardized questionnaire, and information on demographic-socioeconomic as well as reproductive health status was collected. Odds ratios (OR) with 95% CI, estimated by a multistep logistic regression, were used to approximate the associations between SA occurrence and characteristics of SES. A stratification analysis was also applied to find out how SES influenced women's reproductive health outcomes differently between rural and urban areas. The model was adjusted for age at study date, tea consumption, alcohol consumption, cigarette smoking, and number of induced abortion. Results: The risk of SA in rural was 1.68 times greater than in urban (AOR = 1.68, 95%CI: 1.54-1.84). Women with high income had a decreased risk of SA when compared with that of women with low income (AOR = 0.90, 95%CI: 0.84-0.97). Compared with women in low educational attainment, women in higher educational attainment had a lower prevalence of SA (AOR = 0.90, 95%CI: 0.82-0.98). The risk of SA only reduced in factory worker (AOR = 0.59, 95%CI: 0.53-0.66) and professional worker (AOR = 0.75, 95%CI: 0.66-0.84) compared with agriculture and related workers. After stratifying by rural/urban, the association between income and SA in urban (AOR = 0.88, 95%CI: 0.78-0. 99) was stronger than that in rural (AOR = 0.92, 95%CI: 0.84-1.00). Association between education and SA was found in urban (AOR = 0.66, 95%CI: 0.55-0.78) but not in rural (AOR = 1.05, 95%CI: 0.34-1.17), and there was no difference on how occupation impacted SA among women between the two subgroups. Conclusions: Generally women with lower SES status had a higher risk of SA. Lower income and educational attainment were inversely associated with the risk of SA. Women with agricultural and related work had a significantly higher prevalence of SA. Interventions could be targeted more on women with low SES to increase both health profits as well as economic gains for health programs. [ABSTRACT FROM AUTHOR]

In recent times, China has significantly reduced hunger in its populace. The main objective of this paper was to analyze some of the contextual socioeconomic factors contributing to the reduction of hunger in China, using Qualitative Interpretative Meta-Synthesis ( QIMS). The results revealed that China has followed a broad-based and multispectral approach to reduce hunger. Factors, such as poverty alleviation; social safety nets for disadvantaged villagers; agricultural development and land reforms; regional development and equity in development activities; infrastructural development; and political-economic reform and sustainable growth were influential in reducing hunger in China. Poverty is attributed as one of the principal contributors and is interlinked with many other dimensions. The findings of this paper are a useful guide to the Chinese government, policy-makers, international organizations, and development practitioners. [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]

Objective To assess universal health coverage for adults aged 50 years or older with chronic illness in China, Ghana, India, Mexico, the Russian Federation and South Africa. Methods We obtained data on 16 631 participants aged 50 years or older who had at least one diagnosed chronic condition from the World Health Organization Study on Global Ageing and Adult Health. Access to basic chronic care and financial hardship were assessed and the influence of health insurance and rural or urban residence was determined by logistic regression analysis. Findings The weighted proportion of participants with access to basic chronic care ranged from 20.6% in Mexico to 47.6% in South Africa. Access rates were unequally distributed and disadvantaged poor people, except in South Africa where primary health care is free to all. Rural residence did not affect access. The proportion with catastrophic out-of-pocket expenditure for the last outpatient visit ranged from 14.5% in China to 54.8% in Ghana. Financial hardship was more common among the poor in most countries but affected all income groups. Health insurance generally increased access to care but gave insufficient protection against financial hardship. Conclusion No country provided access to basic chronic care for more than half of the participants with chronic illness. The poor were less likely to receive care and more likely to face financial hardship in most countries. However, inequity of access was not fully determined by the level of economic development or insurance coverage. Future health reforms should aim to improve service quality and increase democratic oversight of health care. [ABSTRACT FROM AUTHOR]

Background: This study examines how nicotine dependence is distributed across socioeconomic gradients in rural Yunnan province, which has the most ethnic minorities in one province in southwest China.Methods: A cross-sectional survey was conducted in four rural areas of Yunnan province among 17,158 consenting individuals aged ≥18 years in 2011. Information on demographic characteristics and smoking habits was obtained using a standard questionnaire. The Fagerstrom Test for Nicotine Dependence (FTND) was applied to assess nicotine dependence. Multilevel logistic regression was used to model the variation in prevalence of nicotine dependence.Results: In the study population, the overall prevalence of current smokers and nicotine dependence was 32.4 % and 31.6 %, respectively. Females were much less likely to have nicotine addiction than males: odds ratio (OR) of 0.01 (95 % CI: 0.008 - 0.012). Higher annual household income was associated with a greater risk of nicotine dependence (OR 1.09, 95 % CI: 1.01 - 1.17). Adults who grew tobacco were more likely to have nicotine addiction (OR 1.22, 95 % CI 1.07 - 1.41). Individual educational level was inversely associated with the probability of nicotine dependence (OR 0.63, 95 % CI 0.55 - 0.72), lower community educational level was also associated with an increased risk of nicotine dependence (OR 0.94, 95 % CI 0.92 - 0.98).Conclusions: Nicotine dependence showed significant variations across different indicators of both contextual and individual socioeconomic status in rural southwest China. Future interventions on tobacco cessation should give increased attention to men, tobacco farmers, less educated or poorer persons, and lower educational level communities. [ABSTRACT FROM AUTHOR]

• Older adults' unmet long-term care needs in china and taiwan were compared. • Care poverty concept/Andersen's behavior model were employed for the comparison. • The care poverty rate in IADL was lower in taiwan than in china. • Unmet needs were driven by different factors between two groups of older adults. • LTC services should meet the IADL care needs in both china and taiwan. Applying the concept of care poverty and Andersen's Behavior Model, this study compares the patterns of unmet long-term care needs and investigates the association between unmet needs and the depression and life satisfaction of older adults aged ≥ 65 in China and Taiwan that belong to the same East Asia welfare model. Data come from the 2015 China Health and Retirement Longitudinal Survey (N = 6,341) and the 2015 Taiwan Longitudinal Study on Ageing (N = 4,588). Older adults in China and Taiwan differ significantly in terms of demographic and socioeconomic characteristics. The care poverty rate in activities of daily living (ADL) in these two Asian societies was similar and the rate in instrumental activities of daily living (IADL) was lower in Taiwan than in China. Regression analyses showed that unmet care needs were associated with different predisposing and enabling factors between older Chinese (e.g., residential area and marital status) and Taiwanese (e.g., living arrangement and frequency of seeing children) adults, but the association between depressive symptoms and life satisfaction and unmet care needs were highly similar based on comparison of correlation coefficients. Chinese disadvantaged older adults facing a higher risk of unmet care needs were those who were single and lived in rural areas, while Taiwanese were those who lived alone and had no close relationship with children. Additionally, long-term care services should meet the IADL care needs but not be limited to only meeting ADL care needs in both China and Taiwan. [ABSTRACT FROM AUTHOR]

This article challenges the conventional view that regards material poverty and socioeconomic stagnation the major cause of protest in modern China, disputes the materialist, economically determinist interpretation of Chinese revolutions, and argues that economic prosperity often fuels political discontent in the process of China's pursue of modernization. It sketches three cycles of Chinese history that each starts from a crisis of the existing institutions triggering reforms, through the reforms that create prosperity, to the social conflicts stirred by economic achievements, as those demonstrated in the Cixi reform of the 1900s, the 'New Deal' of the nationalist Nanjing decade, and the recent rise of China as a global power. With the rediscovery of forgotten prosperity, it re-examines the connections between economic conditions, on one hand, and social discontents and political protests on the other. [ABSTRACT FROM AUTHOR]

In the 2011 Hong Kong population census, 26.4% of domestic households were in the poverty category, and one in every four children (26.4%) lived in low-income households. Children in low-income families face financial and material barriers, and these barriers leave them trapped in a cycle of disempowerment. The present study has invited 1622 children aged three to six and 152 teachers in ten kindergartens in the top five child-poverty-rated districts in Hong Kong to participate in the study (a) to validate the psychometric properties of the culturally and developmentally appropriate Preschool Play Behavior Scale (PPBS) with a Confirmatory Factor Analysis (CFA) model, (b) to assess social withdrawal in three subtypes — reticence, solitary-passive, solitary-active and social play among preschoolers in low-income families, (c) to investigate gender difference in social withdrawal and social play, (d) to investigate age difference in social withdrawal and social play, and (e) to inform early childhood intervention to children in low-income families. The PPBS has adopted 18 items assessing five factors: reticence, solitary-passive, solitary-active, rough play, and social play. The “back-translation” procedure – a commonly used procedure in the translation of cross-cultural research instruments – was adopted. Results indicated that the five-factor model of the PPBS statistically fits the results of the Hong Kong samples. Girls exhibited greater social competence (social play) less socially withdrawal behavior. Social play behavior increased with age, while social withdrawal decreased with age. Cultural contexts (emic consideration) on scale items were received attention in future research. Recommendations for cultural understandings on shyness, social withdrawal and social disinterest, and concurrent validation of the PIPPS (Hong Kong version) were made in the study. [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]

Enhancing mobility for the rural poor is believed to be a vital component of poverty reduction policy in many countries. However, the relationship between poverty and mobility in rural areas is still arguable. This paper aims to provide new evidence by exploring rural residents' mobility in China, using nationwide survey data with 15,388 respondents from rural areas. The results of the analysis show the mobility of the poverty group is notably lower than medium-income and wealthy groups in rural China. The low level of mobility among the poorest group in both rural townships and farm villages is mainly affected by fewer travel demands for living and jobs in higher-order centres, low car ownership, unemployment and regional remoteness. In particular, for poor farm villagers, their mobility is limited by the availability of cars and public transport services. Higher mobility is significantly related to an increase in income for wealthy people living in townships. But for the poor, higher mobility would not guarantee a higher income. Other socioeconomic factors for example low labour skills and a lack of education have stronger relationship with their poverty. Transport policies designed to alleviate poverty in rural areas should be integrated with other policies such as education and labour training to be more successful. The findings and conclusion in this paper enhance our existing knowledge of the relationships between rural poverty and mobility and add value to both transport and poverty-reduction policies. • The mobility of the poverty group is notably lower than wealthier groups. • The mobility of the rural poor is restricted by low car ownership, fewer travel demands, and unemployment. • Higher mobility would not guarantee a higher income for the rural poor. • Transport policies designed to alleviate poverty should be integrated with education and labour training. [ABSTRACT FROM AUTHOR]

• Poverty exposure affects children's cognitive abilities in rural China. • We used a nationally representative sample. • We constructed an IV based on the heteroskedasticity of the error term of the poverty status. • IV estimates suggested that poverty significantly led to low cognitive abilities of children. • Oaxaca-Blinder decomposition results showed that family investments were quite important. Family poverty may affect family investments, which affect children's cognitive development. Based on a unique and nationally representative sample from the National Children's Study of China (NCSC), this study aimed to explore the relationship between poverty and children's cognitive abilities and the roles of different investments to the cognitive gaps. We had the following three findings. First, the cognitive abilities of children in poor families were significantly and negatively affected by their families' poverty status. Second, poverty was significantly correlated with lower family education expenditures, lower expectations of parents for their children's education, and more permissive parenting styles. Finally, the results of the Oaxaca-Blinder decomposition method showed that family educational expenditures, educational expectations, and permissive parenting styles accounted for substantial portions of the gaps in cognitive abilities. [ABSTRACT FROM AUTHOR]

• The LBC have more insomnia and nightmares than controls. • Longer separation of LBC coincided with more insomnia and nightmares. • The LBC experienced more peer bullying than controls. • Psychological distress is a mediator between childhood adversities and sleep. This study investigated the impact of parental migration and other childhood adversities such as peer bullying and poverty on adolescent insomnia and nightmares in Sichuan Province, China, and identified the potential relationships with sleeping problems. In this cross-sectional study, the sleep behaviors of adolescents from migrant working parents known as "left-behind children" (LBC) were compared with adolescents from non-migrant working parents. The left-behind status, left-behind duration and primary caregivers were determined through face-to-face interviews, and insomnia and nightmares, psychological distress, peer bullying and family economic situations were assessed using a battery of self-administered questionnaires. Structural equation models were then used to examine the effects of parental migration and/or other psychosocial difficulties on the incidence of insomnia and nightmares. The LBCs were found to have worse sleep outcomes than the children of non-migrant parents: insomnia (26.3% vs. 19.0%) and nightmares (8.8% vs. 4.4%): with longer periods of separation resulting in higher sleep disturbance and nightmare frequencies. The LBC also experienced more bullying from their peers than the children of non-migrant parents, and it was found that psychological distress partly mediated the relationship between these adversities and insomnia and/or nightmares. The LBC are at a higher risk of developing sleep problems, being bullied and suffering from poverty. Therefore, correctly identifying these children would allow for early intervention to enhance their quality of life. These findings supported the implementation of comprehensive school programs to improve sleep quality that target vulnerable LBC sub-groups, and especially bullied or poverty-stricken adolescents or with psychological distress. [ABSTRACT FROM AUTHOR]

• Despite legislation and financial redistribution, unequal access to educational resources in China remains. • The government has failed to provide sufficient financial support to underdeveloped provinces. • In underdeveloped areas, financial capacity is lower, but educational need is higher. There is great inequality of educational resources between different provinces in China due to unbalanced economic development. Despite continued redistribution of financial resources by the central government in favor of poorer provinces, educational inequality remains. In this paper, we argue that focusing on educational resources is far from sufficient. Poorer provinces do not only suffer from a lower level of educational resources, but they also have more children to educate, i.e. a greater need for education. Combining and analyzing the data in the Sixth National Population Census of China and the official statistics on education spending and resources, we found that provincial-level variations in the child population and the child dependency ratio have made access to educational resources even more unequal given the unequal financial capacity at the provincial level. Poorer provinces face a higher child dependency ratio and have lower economic development, and these two factors jointly lead to limited educational resources. Apart from a much higher level of redistribution in favor of less developed provinces, encouraging more balanced distribution of teachers and more broadly promoting economic equality are essential to reduce inequality in educational resources in China. [ABSTRACT FROM AUTHOR]

Background: Beginning in 2010, China has endeavoured to expand health coverage and provide residents with fair access to primary health care with the intention of improving health equity. This study aims to measure changes in income-related health inequity in China between 2010 and 2014. Methods: Data were extracted from the nationally representative annual survey of the China Family Panel Studies in 2010 and 2014 with a first wave of 31,743 respondents and a second wave of 32,006 respondents over age 15. In both years, subjects were stratified into the following five categories of income: poorest 20%, lower 20%, medium 20%, higher 20% and richest 20%. The concentration curve and index was used to compare the distribution of health status in income quintiles, and a logistic model was used to examine the relationship between health and socioeconomic indicators with self-assessed health as the primary outcome of interest. Results: Income was significantly associated with self-assessed health in China. The concentration curve was above the line of equality in both years, while the self-assessed health line in 2014 was closer to the equality line. The concentration index (CIN) displayed the similar result of decreasing inequality, with the CIN in 2014 (− 0.157) closer to zero (the line of equality) than that of 2010 (− 0.167). In 2010, there was a decreasing trend of people reporting poor health from the poorest to the richest, while in 2014, there was no significant difference between the poorest and lower 20% or between the higher 20% and the medium 20%. The odds ratio of the prevalence of self-reporting poor health between the poorest and richest increased from 0.555 (95% CI: 0.484–0.636) in 2010 to 0.598 (95% CI: 0.513–0.696) in 2014. Conclusions: From 2010 to 2014, the self-assessed health gap between income groups in China decreased, and health equity improved. However, health differences remain. In order to achieve better health for all, China should further strengthen the role of primary care in reducing health inequity. [ABSTRACT FROM AUTHOR]

Following the dramatic socioeconomic transition since the 1980s in China, some people became unemployed and experienced a significant drop in income. The aim of this study was to assess the effects of low income on health-related quality of life (HRQOL) among the population in northeast China. A total of 5100 individuals in northeast China were randomly sampled and investigated using the 36-item Short-Form Health Survey (SF-36) from November 2005 to October 2006. According to the monthly per capita income level, the population was divided into different groups for analysis. Multiple linear regressions showed that low income, older age, disease, and unemployment were the important factors that could lead to worse HRQOL. Covariance analysis showed that there were significant differences in HRQOL scores among the subgroups of the low-income population. When the income level increased, HRQOL scores improved. This study could provide valuable information for planning integrated economic and public health policies to improve the health of people living in poverty. [ABSTRACT FROM PUBLISHER]