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Improving physical, mental and cognitive health is a strategic choice to help developing countries cross the middle-income trap. This paper used data from the 2019 China Rural Children Health and Nutrition Survey (n = 826), and used the Ordered Probit (Oprobit), Logit and ordinary least squares (OLS) analytical methods to systematically analyze the implications of parental migration on multidimensional health. The results indicate that parental migration significantly harms the physical and mental health of rural children, and that mobile phone addiction has a significant moderating effect. Moreover, parental migration has a greater impact on the physical health, mental health and cognitive ability of boys and rural children with low family income, while parents with higher nutrition knowledge and education can effectively improve the physical health and cognitive ability of their children. In conclusion, in order to improve the multidimensional health of rural children, the government should strengthen the policy of care and support for children whose parents migrate. Schools and families should pay attention to the supervision of rural children's mobile phone addiction. [ABSTRACT FROM AUTHOR]

There is now a growing interest in early-life influences on adult diseases in China. A number of birth cohorts have been established. This systematic review provided a better understanding of the development of mother–baby cohorts in China. Systematic review. We conducted a systematic review for research or profile papers in English/Chinese that reported data from mother–baby cohorts in mainland China, with ≥1y follow-up after birth. We identified 315 papers, corresponding to 31 cohorts from 19 provinces/megacities. All cohorts started in 1999–2017 (21 after 2010) and were set up with broad objectives or specific scientific focus. The baseline sample size varied, from <500 to >300,000 mothers. A majority of cohorts were initiated during pregnancy and followed children to <10y, only six to adolescence and none into adulthood. These cohorts mostly collected samples from mothers and babies, in addition to using interviews/questionnaires to collect information about pregnancy, birth and child health. Most cohorts were recruited from a single province/city. The large western region was understudied. Mother–baby cohorts have developed rapidly in China, but usually with a short follow-up duration. Extending the follow-up of children and developing cross-cohort collaboration will increase the diversity, size and coverage of the sample, allow studying early influences on life-course health and identify targets for early intervention in the Chinese population. [ABSTRACT FROM AUTHOR]

Purpose: China's rapid pace of urbanization has resulted in millions of rural residents migrating from rural areas to urban areas for better job opportunities. Due to economic pressures and the nature of China's demographic policies, many of these migrants have been forced to leave their children with relatives – typically paternal grandparents – at home in the countryside. Thus, while income for most migrant families has risen, a major unintended consequence of this labor movement has been the emergence of a potentially vulnerable sub-population of left-behind children (LBCs). The purpose of this paper is to examine the impacts of parental migration on both the academic performance and mental health of LBCs. Design/methodology/approach: Longitudinal data were drawn from three waves of a panel survey that followed the same students and their families – including their migration behavior (i.e. whether both parents, one parent, no parent migrated) – between 2015 and 2016. The survey covers more than 33,000 students in one province of central China. The authors apply a student fixed-effects model that controls for both observable and unobservable confounding variables to explicate the causal effects of parental migration on the academic and mental health outcomes for LBC. The authors also employ these methods to test whether these effects differ by the type of migration or by gender of the child. Findings: The authors found no overall impact of parental migration on either academic performance or mental health of LBCs, regardless of the type of migration behavior. The authors did find, however, that when the authors examined heterogeneous effects by gender (which was possible due to the large sample size), parental migration resulted in significantly higher anxiety levels for left-behind girls. The results suggest that parental migration affects left-behind boys and girls differently and that policymakers should take a more tailored approach to addressing the problems faced by LBCs. Originality/value: The main contributions of this paper come from the large and representative sample, as well as the causal effects analysis of being left-behind on both academic performance and mental health. First, the paper uses comprehensive panel data from a representative and populous province in China, and the sample size is the largest one among LBC-related papers to the authors' knowledge. Second, the paper separately examines the causal effects on the student outcomes of different migration strategies. Third, the paper analyzes the heterogeneous effects of different migration strategies on LBC gender. The authors believe that the paper makes a key contribution to the literature. [ABSTRACT FROM AUTHOR]

There is a growing literature documenting the link between parental migration and children's health. However, few studies have explained the underlying mechanism of this observed relationship. This paper examines the effect of parental migration on children's health through dietary diversity, using survey data collected in a less developed prefecture in South Central China in 2018. To overcome the potential endogeneity of parental migration, we instrument parental migration with the proportion of households with migrated labor force at the village level, and find that parental migration reduces children's dietary diversity at home. Moreover, we provide suggestive evidence that the reduction in dietary diversity may attribute to significant negative separation effects whereas minimal positive income effects in migrant-sending households. This study highlights the negative effects of labor migration on the next generation's nutrition. In those developing countries with a high prevalence of labor migration, policies that facilitate access to dietary diversity of those left-behind children are warranted. [ABSTRACT FROM AUTHOR]

Walking to school promotes the health of school‐aged children. The safety and comfort of the walking environment are lacking in China due to the prioritization of motorized traffic. This paper focuses on the choice of walking routes for school‐aged children commuting in old urban areas of China. A walking route choice model is constructed by combining a weighted Voronoi diagram and the closest facility analysis in ArcMap. The walking route choices of school‐aged children from home to school and the flows along routes are analysed. Based on the model results, targeted design suggestions for updating existing street spaces are proposed. [ABSTRACT FROM AUTHOR]

Background: Lack of physical activity is a growing problem in China, due to the fast economic development and changing living environment over the past two decades. The aim of this review is to summarize the factors related to physical activity in Chinese children and adolescents during this distinct period of development. Methods: A systematic search was finished on Jan 10th, 2017, and identified 2200 hits through PubMed and Web of Science. English-language published studies were included if they reported statistical associations between factors and physical activity. Adapted criteria from the Strengthening The Reporting of OBservational studies in Epidemiology (STROBE) statement and evaluation of the quality of prognosis studies in systematic reviews (QUIPS) were used to assess the risk of bias of the included studies. Related factors that were reported in at least three studies were summarized separately for children and adolescents using a semi-quantitative method. Results: Forty two papers (published 2002-2016) were included. Most designs were cross-sectional (79%), and most studies used questionnaires to assess physical activity. Sample size was above 1000 in 18 papers (43%). Thirty seven studies (88%) showed acceptable quality by methodological quality assessment. Most studies reported a low level of physical activity. Boys were consistently more active than girls, the parental physical activity was positively associated with children and adolescents' physical activity, children in suburban/rural regions showed less activity than in urban regions, and, specifically in adolescents, self-efficacy was positively associated with physical activity. Family socioeconomic status and parental education were not associated with physical activity in children and adolescents. Conclusions: The studies included in this review were large but mostly of low quality in terms of study design (cross-sectional) and methods (questionnaires). Parental physical activity and self-efficacy are promising targets for future physical activity promotion programmes. The low level of physical activity raises concern, especially in suburban/rural regions. Future research is required to enhance our understanding of other influences, such as the physical environment, especially in early childhood. [ABSTRACT FROM AUTHOR]

Food is the main way for people to be exposed to heavy metal cadmium (Cd), and Cd pollution will affect human health. In this paper, exposure and health risk assessment of dietary Cd intake were conducted in children aged 2, 3, 4, 5, 6–8, 9–11, 12–14 and 15–17 years in East China. The results showed that the total exposure of dietary Cd intake in children exceeded the standard limits. The total exposure of all age groups were 1.11 × 10–3, 1.15 × 10–3, 9.67 × 10–4, 8.75 × 10–4, 9.18 × 10–4, 7.75 × 10–4, 8.24 × 10–4, 7.11 × 10−4 mg kg−1 d−1, respectively, and the highest was the children aged 3 years. The hazard quotients of children aged 2 and 3 years were 1.11 and 1.15, respectively, at an unacceptable health risk level. The hazard quotients of dietary Cd intake in children of other ages were less than 1, at an acceptable health risk level. Staple foods were the most significant contributor to the dietary Cd intake in children, and the contribution ratio of non-carcinogenic risk of dietary Cd intake in all age groups were more than 35%, the proportion of non-carcinogenic risk in children aged 6–8 and 9–11 years were as high as 50%. This study provides scientific basis for the health of children in East China. [ABSTRACT FROM AUTHOR]

This paper examined the extent and risk factors of child subjective wellbeing and psychological health empirically using China Family Panel Studies data set. Child subjective wellbeing was measured in this paper using six indicators including the frequency in feelings of depression, nervousness, restlessness, hopelessness, helplessness, and meaninglessness. Risk factors of child subjective wellbeing have also been examined in particular to the domains of household multidimensional material deprivation, parenting practices, and children's personal health conditions. The results of this paper implied that providing adequate nutrition and ensuring children's access to basic water and sanitation facilities were important strategies for promoting children's psychological health and wellbeing. Also important factor for child wellbeing is parenting styles and practices, that is, how parents interact with children in daily lives and how they behave as parents. [ABSTRACT FROM AUTHOR]

This paper investigates the long-run effects of PM2.5 exposure in utero on the mental health of adolescents. Using nationally representative survey data from China, we instrument the PM2.5 exposure with wind speed to tackle the possible endogeneity problem. Our results show that mothers' PM2.5 exposure during their pregnancy negatively affects the mental health of their children aged between 10 and 15 years. A 1 µg/m3 increase in PM2.5 exposure in utero increases the probability of having a severe mental illness for adolescents by 0.6%. Our evidence supports the "fetal origins" hypothesis. We also find that fetal PM2.5 exposure leads adolescents to be more likely to be absent from school and quarrel with their parents, implying that fetal PM2.5 exposure may affect individuals' behavior when they grow up. [ABSTRACT FROM AUTHOR]

This paper uses data from the China Health and Retirement Survey to estimate the causal effect child out‐migration has on the health of parents in China. For rural parents, we show that after controlling for self‐selection, child out‐migration has a detrimental effect not only on subjective well‐being and mental health but also on cognitive function and physical health when measured using a series of clinical tests and health biomarkers. In contrast, for urban parents, only a few health effects are significant, and those that are tend to be positive. In terms of the mechanism through which migration affects parental health, we find that it is differences in the level of physical support that parents require that is central to explaining many of the health effects we observe. For those who require little physical support, the income effect helps to mitigate the negative effects associated with child out‐migration, while for more vulnerable groups of parents, the economic benefits of migration are currently no substitute for the loss of informal support networks when a child migrates. [ABSTRACT FROM AUTHOR]

Air pollution has been a deeply concerned issue posing an immediate and profound threat to human's lower respiratory health in China. The health of children under 5 years old, regarded as a key index of public health progress in a country, is closely related to the long-term human capital development. Hence, it is vital to investigate the potential association between air pollution and children's lower respiratory health outcomes and to explore related policy implications regarding the public health and the pollution regulation. As air pollutants diffuse across adjacent regions rather easily, considering the spatial spillover effect is meaningful in course of acquiring the aforementioned association. Based on the proposed province-level panel dataset of China during 2006–2017, this study constructs a dynamic spatial panel Durbin model to investigate the impact of air pollution on under-five children's lower respiratory infections. As a result, (1) both air pollution and children's respiratory health have obvious spatial spillover effects, and the latter has an outstanding characteristic of path dependence in time. (2) In the short term, air pollution presents significant negative impact on children's respiratory health, while in the long run, the impact decreases dramatically. (3) Regional comparison indicates that children in the western China are the most susceptible to air pollution followed by children in the central and eastern regions. (4) Other control variables have significant and varying impacts both in the short and long term. Particularly, this paper proves the existence of "siphon effect" in children healthcare system in China. From a broader and more comprehensive perspective, this study provides effective and constructive basis for policy making, in favor of improving children's health under air pollution and promoting sustainable development in China. [ABSTRACT FROM AUTHOR]

Early childhood education programs have been found to effectively promote children's social and cognitive development. However, the health impact of these programs is less understood. Using a quasi-experiment of the first universal child care reform in China from 2010, this paper aims to identify whether the preschool reform produces any short-term effects on health-related outcomes of preschoolers (3-6 years old). Specifically, this reform expands access to affordable preschools that provide full-day center-based education, with school meals and essential health services on campus. I exploit the variation in the number of newly established preschools across provinces and implement difference-in-differences and triple-difference strategies. Results confirm the effectiveness of this reform by showing a strong and positive impact on preschool attendance. This paper then documents the benefits to alleviating underweight among preschoolers. Estimates show a larger effect in rural areas, suggesting that the reform narrows rural-urban disparities in education access and undernutrition prevention. I also explore the impact on caregivers' health consciousness and find improved health-seeking behavior when children get sick. [ABSTRACT FROM AUTHOR]

As a significant children's recreational facility, children's pleasure ground not merely affects children's mental health, but is closely bound up with children's physical health and growth. 2-3 hours of outdoor activities every day is indispensable for children, especially for preschool children. Currently, China's pleasure grounds are too commercialized, and the recreational facilities are monotonous and boring, which severely restricts children's creativity and imagination. This paper aims to improve the design of children's playgrounds in China based on the signal processing system and help designers design more helpful playgrounds for children in terms of space layout, facility standards, safety hazards, education, and other aspects. [ABSTRACT FROM AUTHOR]

In this paper, we examine the effect of export expansion on the health of children under the age of 6 years in China. Using the CHNS survey, we exploit trade exposure variation among regions after China's entry into the WTO to construct a difference‐in‐differences and instrumental variable identification. We show that 1% increase in export expansion over GDP share exacerbates child' illness rates by 0.6%, and the effect is more pronounced for less educated parents. The increasing workloads and having less time to look after the child account for the increasing illness rates, especially for mothers. [ABSTRACT FROM AUTHOR]

The prevalence of stunting, wasting, overweight and their coexistence are various in different populations and they also have changed with social developing and environmental improving. In this paper, we aimed to analyze the prevalence of stunting, wasting, overweight and their coexistence in some developed regions of China. Data were collected in a population-based cross-sectional survey by a multi-stage cluster sampling method in nine cities located in the northern, central, and southern region of China in 2016. Children under seven years (n = 110,491) were measured. WHO growth standards were used to assess the growth status. Stunting, underweight, wasting, overweight and obesity were considered as the primary forms of malnutrition (includes undernutrition and overnutrition) for infant or young children at population-levels. The prevalence of stunting, underweight, wasting, and overweight or obesity were respectively 0.7%, 0.6%, 1.2%, and 7.6%. Most of these children (95.4%) suffered from one form of malnutrition, and only 0.2% of them concurrently stunted and wasted, 0.4% concurrently stunted and overweight, 1.7% concurrently stunted and underweight, 2.3% concurrently underweight and wasted. Among stunted children, 91.2% were appropriate body proportion, and only 2.3% were wasted, 6.5% were overweight or obesity. Among overweight or obese children, only 0.6% were stunted, whereas, 15.8% were high stature and 83.6% were the appropriate ranges of stature. Sex, age, urban/suburban, and region were associated with these primary forms of malnutrition in the multivariate logistic analysis. In conclusion, we found that the coexistence of stunting and overweight was not common at both population-level and individual-level. The situation for undernutrition had significantly improved, and overweight may be the leading public health issue for children under seven years in the nine cities of China. [ABSTRACT FROM AUTHOR]

This paper used data from 6 waves of the China Health and Nutrition Survey (CHNS) 1993-2009 to examine the effects of child gender, number of siblings, and sibling composition on children's health status, noting particularly any gender gaps, in the context of China's one-child policy. In the 1990s, the enforcement of the policy became less stringent, and ultrasound technologies, which enable prenatal gender selection, became more available. This led us to believe that the girls who were born were wanted by parents. In addition, growing income and industrialization should also narrow the gender gap in health status. Our results showed that on average, being a female decreased height-for-age approximately by 0.08 z-score as well as having an additional male sibling decreased height-for-age roughly by 0.17 z-score for a child under age 8. These results were particularly strong in the rural area but were non-existent in urban areas and among only-children. Our argument is that the gender gap was due to son preference and not sibling rivalry. Additionally, we found that having only one brother appeared to have a positive effect on girls' health status, compared to boys with another brother who tended to become rivals for household resources. [ABSTRACT FROM AUTHOR]

Background: Overweight/obesity is a serious public health problem that affects a large part of the world population across all age and racial/ethnic groups. However, there has not been a meta-analysis of the prevalence of childhood and adolescent overweight/obesity in China during the past 30 years. Methods: The China National Knowledge Infrastructure and Wanfang DATA, MEDLINE, EMBASE and Cumulative Index to Nursing and Allied Health Literature were searched for relevant studies published between January 1970 and June 2012. The prevalence of overweight/obesity over time was pooled using Stata/SE, version 9. Summary statistics (odds ratios, ORs) were used to compare sex-specific and urban-rural preponderance of overweight/obesity using Review Manager. Results: After screening 1326 papers, we included 35 papers (41 studies), most of medium quality. The prevalence of overweight/obesity increased from 1.8% (95% confidence interval [CI], 0.4%-3.1%) and 0.4% (95% CI, 20.1% to 20.8%) respectively in 1981-1985 to 13.1% (95% CI, 11.2%-15.0%) and 7.5% (95% CI, 6.6%-8.4%) respectively in 2006-2010. The average annual increase was 8.3% and 12.4% respectively. Boys were more likely to be overweight/obese than girls (OR, 1.36; 95% CI, 1.24-1.49 and OR, 1.68; 95% CI, 1.52-1.86 respectively). The prevalence of overweight/obesity was higher in urban areas than in rural areas (OR, 1.66; 95% CI, 1.54-1.79 and OR, 1.97; 95% CI, 1.68-2.30 respectively). For age-specific subgroup analyses, both overweight and obesity increased more rapidly in the toddler stage than in other developmental stages. Sensitivity analyses showed that sample-size differences, study quality, overweight/obesity criteria and geographical distribution affected overweight/obesity prevalence. Conclusions: Toddlers and urban boys were at particularly high risk; the prevalence in these groups increased more rapidly than in their counterparts. Public health prevention strategies are urgently needed to modify health behaviors of children and adolescents and control overweight/obesity in China. [ABSTRACT FROM AUTHOR]

This paper studies the causal effect of maternal and paternal unemployment on child health in China, analyzing panel data for the period 1997–2004, when the country underwent economic reforms leading to massive layoffs. Using a FE-IV strategy, we find that paternal unemployment reduces child health, while maternal unemployment has beneficial child health impacts. Analysis of channels shows that paternal and maternal unemployment have different effects on income, time use, and children's diets. Though many estimates are imprecise, a key finding is that paternal unemployment significantly reduces children's fat intake and dietary diversity. To the best of our knowledge, this is the first evidence on the causal effect of parental unemployment on the nutrient intake of children aged 0–17. In all, our estimates are consistent with the notion that traditional gender roles can explain why mothers' and fathers' unemployment affect child health differently. [ABSTRACT FROM AUTHOR]

Social pensions are important cash transfers to the elderly and their families. The pensions may not only affect the wellbeing of the direct recipients, but also have household and intergenerational spillover effects. Using the 2012 and 2014 waves of the China Family Panel Studies (CFPS) data, this paper examines the effect of the New Rural Pension Scheme (NRPS) and its mechanisms on child health in rural China. Our study shows a significant association between the NRPS and the health status of children up to 15 years of age. Moreover, the association of the NRPS with health is larger for children who are boys, 'left behind', six to 10 years of age, and in poor health. In addition, we investigate possible mechanisms of the effect, including health consciousness of the caregiver, household sanitation conditions, and high-protein food consumption, and find the increase of child nutrition intake is the main channel through which the NRPS affects child health. [ABSTRACT FROM AUTHOR]

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The development of economy promotes the improvement of living standards, but the environment has been severely damaged, and it greatly affects the survival and development of human beings. In addition, most Chinese families have only one or two children, who are treated as hottest babies, because of the one-child policy. This asks for higher medical service quality when the child is sick. Moreover, there is a serious lack of medical resources, clinical nurses with abundant experiences in particular. Therefore, in order to provide high-quality medical care and rehabilitation environment for children and protect children healthy growth, the study on the performance evaluating system of pediatric clinical nurse would be of great significance. The background and related theories are reviewed in this paper and the analytic hierarchy process (AHP) method has been employed to construct an index system for pediatric clinical performance appraisal from four aspects: professionalism, knowledge level, professional ability, work performance, which totally involve 16 level-Π indexes. An analysis summary was also made at last. The index system has important reference value to improve the level of pediatric care, pediatric clinical nurse management and performance appraisal. [ABSTRACT FROM AUTHOR]

Benzene has been measured in indoor environments for many decades and has been identified to cause variety of health effects. Children spend most of their time indoors such as daycare centre, preschool and school, they are more likely to be exposed to indoor air pollutants. This paper was aimed to review the exposure to benzene among children within indoor environments from worldwide studies from 2003 to 2018. Based on 24 papers evaluated, 54% were conducted in primary schools. The highest concentration of benzene was found in preschools in China at 148.0 µg/m3. The benzene levels were found higher in indoors than outdoors for most of the studies. Active sampling techniques were used in 42% of studies that enable the determination of acute health effects on children during short-period of exposure time. Differences in sampling techniques and durations make it hard to compare the outcomes of the studies with health-effect guidelines. This review indicated a diversity of sampling approaches and techniques, pointing to the importance of establishment of standard method for collecting and reporting data. [ABSTRACT FROM AUTHOR]

Abstract Child nutritional health has always been a research focus and an essential indicator reflecting children's health and living conditions in developing countries. This study investigates how household income and other individual and family factors influence child nutritional status. The Chinese Health and Nutrition Survey data are used to analyze changing patterns of child malnutrition status, and to compare the gap between genders, rural and urban areas etc., and the WHO new child growth standards are used in this paper as the reference for each specific age and gender. The findings in this paper include three aspects. First of all, the headcount ratio of undernourished children in both stunting and underweight has declined over years from 1991 to 2009 in China. Second, regional disparity in child nutritional status was significant, and the economic growth was a key driver to improve the nutritional conditions of the poor children. Furthermore, this paper also employs the stepwise logistic regression models to illustrate the influencing mechanisms of family income and other factors on child nutrition, and finds that household income affected child nutritional status significantly through the mechanisms of community, household, parental and individual factors. Highlights • This paper studies stunting and underweight rates of Chinese children and finds both malnutritional indicators have declined from 1991 to 2009. • This paper studies the regional and demographic differences in child nutrition and finds certain heterogeneity in malnutritional indicators. • This paper studies the relationship between family income and child nutrition and reveals significant and positive correlation between the two. • This paper finds significant impact mechanisms of individual, parental, family and community factors on child nutrition. [ABSTRACT FROM AUTHOR]

Background: Regulatory actions are increasingly used to tackle issues such as excessive alcohol or sugar intake, but such actions to reduce sedentary behaviour remain scarce. World Health Organization (WHO) guidelines on sedentary behaviour call for system-wide policies. The Chinese government introduced the world's first nation-wide multi-setting regulation on multiple types of sedentary behaviour in children and adolescents in July 2021. This regulation restricts when (and for how long) online gaming businesses can provide access to pupils; the amount of homework teachers can assign to pupils according to their year groups; and when tutoring businesses can provide lessons to pupils. We evaluated the effect of this regulation on sedentary behaviour safeguarding pupils. Methods: With a natural experiment evaluation design, we used representative surveillance data from 9- to 18-year-old pupils before and after the introduction of the regulation, for longitudinal (n = 7,054, matched individuals, primary analysis) and repeated cross-sectional (n = 99,947, exploratory analysis) analyses. We analysed pre-post differences for self-reported sedentary behaviour outcomes (total sedentary behaviour time, screen viewing time, electronic device use time, homework time, and out-of-campus learning time) using multilevel models, and explored differences by sex, education stage, residency, and baseline weight status. Results: Longitudinal analyses indicated that pupils had reduced their mean total daily sedentary behaviour time by 13.8% (95% confidence interval [CI]: -15.9 to -11.7%, approximately 46 min) and were 1.20 times as likely to meet international daily screen time recommendations (95% CI: 1.01 to 1.32) one month after the introduction of the regulation compared to the reference group (before its introduction). They were on average 2.79 times as likely to meet the regulatory requirement on homework time (95% CI: 2.47 to 3.14) than the reference group and reduced their daily total screen-viewing time by 6.4% (95% CI: -9.6 to -3.3%, approximately 10 min). The positive effects were more pronounced among high-risk groups (secondary school and urban pupils who generally spend more time in sedentary behaviour) than in low-risk groups (primary school and rural pupils who generally spend less time in sedentary behaviour). The exploratory analyses showed comparable findings. Conclusions: This regulatory intervention has been effective in reducing total and specific types of sedentary behaviour among Chinese children and adolescents, with the potential to reduce health inequalities. International researchers and policy makers may explore the feasibility and acceptability of implementing regulatory interventions on sedentary behaviour elsewhere. [ABSTRACT FROM AUTHOR]

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

The impact on child development of paternal involvement in childrearing has received growing attention recently. Based on data from the 2010, 2014 and 2018 waves of the China Family Panel Studies, this study applies the propensity score matching (PSM) method to investigate the causal effects of being primarily raised by one's father on children's cognitive skills and psychological well-being in different family types. In migrant families, primarily fathered children are not disadvantaged compared to those primarily mothered, and boys even have better word test scores. For children living with both parents, our results indicate no significant differences in most respects between the cognitive skills and mental health of children primarily cared for by fathers and by mothers, except that children perform slightly worse in word-test scores when their fathers are their primary caregivers. However, coresidence with grandparents substantially mitigates the negative effect of primary paternal involvement in childcare on children's language development. Our findings suggest that the role of father involvement in child development should be understood in more nuanced family contexts. [ABSTRACT FROM AUTHOR]

The quantity-quality trade-off is one important motivation for the family planning policies in many developing countries. In this paper, we examine the effect of number of siblings on children's health and education in China. We find evidence of quantity-quality trade-off in children's health but not in children's education. Our study has three contributions. First, we focus not only on children's education but also on children's health, which has received rather little attention in the literature. Secondly, we use a new source of exogenous variation in fertility - variations of the strictness of the One-Child policy across localities in China - to construct instrumental variable's (IV's). Finally, we empirically explore the underlying mechanism of the quantity-quality trade-off, and find supporting evidence for the resource dilution hypothesis. [ABSTRACT FROM AUTHOR]

This article examines how imbalanced sex ratios influence marriage decisions and household bargaining. Using data from the 1982 Chinese census, the traditional 'availability ratio' is modified to reflect the degree to which men tend to marry women from different cohorts. This ratio reflects the average tendency of men to prefer women who are close in age to women who are several years younger than them by weighting cohort sizes using the proportion of people in the population who marry someone born in a different cohort. Given that men generally marry younger women, this ratio varies independently of the size of one's own birth cohort. Yet, the ratio fluctuates considerably across individuals, as the sizes of birth cohorts in China vary across time and regions. This enables us to examine how variability in such ratios may influence marriage decisions and household bargaining. The findings suggest that women exercise greater bargaining power once married. Results indicate that as women become scarcer in the marriage market, they have healthier sons. Men also delay marriage, and consume less tobacco and alcohol. This paper also highlights how sensitive findings may be to using this modified weighted availability ratio rather than a traditional unweighted availability ratio. [ABSTRACT FROM AUTHOR]

Through the lens of psychoanalytic infant observation, the authors introduce some characteristics of Chinese urban families, most of which have grandparents to participate in the caretaking of infants. In some cases, infants may be separated from parents. These phenomena are understood in terms of cultural, political, social, economic and psychological dimensions. The observational frame is compared to the clinical frame and the patient's handling of the frame throws light to his/her internal world. In some cases, this internal world may be populated by absent objects. Related mental health difficulties are illustrated by two clinical vignettes of adult patients who experienced long‐term parental absence in childhood. [ABSTRACT FROM AUTHOR]

Children's respiratory health is vulnerable to air pollution. Based on data collected from June 2019 to June 2022 at a children's hospital in Zhengzhou, China, this study utilized Spearman correlation analysis and a generalized additive model (GAM) to examine the relationship between daily visits for common respiratory issues in children and air pollutant concentrations. Results show that the number of upper respiratory tract infection (URTI), pneumonia (PNMN), bronchitis (BCT), and bronchiolitis (BCLT) visits in children showed a positive correlation with PM2.5, PM10, NO2, SO2, and CO while exhibiting a negative correlation with temperature and relative humidity. The highest increases in PNMN visits in children were observed at lag 07 for NO2, SO2, and CO. A rise of 10 μg/m3 in NO2, 1 μg/m3 in SO2, and 0.1 mg/m3 in CO corresponded to an increase of 9.7%, 2.91%, and 5.16% in PNMN visits, respectively. The effects of air pollutants on the number of BCT and BCLT visits were more pronounced in boys compared to girls, whereas no significant differences were observed in the number of URTI and PNMN visits based on sex. Overall, air pollutants significantly affect the prevalence of respiratory diseases in children, and it is crucial to improve air quality to protect the children's respiratory health. [ABSTRACT FROM AUTHOR]

Despite increasing institutional and financial support, certain public health issues are still neglected by the Chinese Government. The present paper examines the soil-transmitted helminth (STH) infection and reinfection rates by conducting a survey on 1724 children in Guizhou Province, China. Our results indicate that 37.5 percent of children had been infected with one or more of the three types of tested STH. However, only 50.4 percent of children reported having taken deworming medicine during the 18-month period before the survey. Of those who reported being dewormed, 34.6 percent tested positive for STH infections. Poverty and number of siblings are significantly and positively correlated with infection and reinfection, and parental education is significantly and negatively correlated with infection and reinfection. Given the ineffectiveness of treatment in these areas to date, for anthelminthic campaigns to actually succeed, China must pay more attention to local-level incentives to improve children's health. [ABSTRACT FROM AUTHOR]

The Shanghai Refugee Children Nutritional Aid Committee, formed in 1937, sought to improve refugee children's nutritional health by making and distributing a scientifically tested soybean milk and soybean cakes. By 1942, the Committee had adopted a national platform and changed its moniker to the Chinese Nutritional Aid Council, with plans to open offices and nutrition clinics in Chongqing, Chengdu, Guiyang and Kunming. This paper argues that in linking biomedical understandings of nutrition with social change, this group of Western-trained physicians and young female social workers enacted a new kind of social activism, one which seized upon the food-as-fuel idea and staked the welfare of the nation upon the nutritional health of its citizenry. In contrast to earlier social relief projects promoted by the imperial state and the local philanthropic initiatives of gentry elites, the Chinese Nutritional Aid Committee articulated an image of professional and specialised expertise in the science of nutrition and care. Theirs was a project of modern refashioning in which science played a key and foundational role in crafting their understanding of both relief and the children they aimed to save. [ABSTRACT FROM AUTHOR]

Indoor air pollution (IAP) from cooking and heating stoves is a major cause of acute respiratory infections (ARI) and a serious health risk in developing countries. This paper examines improvements in respiratory health for children five and under in rural China resulting from stove and behavioural interventions to reduce IAP. The analysis uses data from a World Bank/Government of China project completed in 2006, whereby a large number of rural households from four provinces in China were subject to different combinations of stove improvement and behavioural interventions to reduce IAP levels and exposure. Difference-in-difference and matching models show that both stove and behavioural interventions were effective in reducing the incidence of ARI, although the latter are more cost effective. [ABSTRACT FROM AUTHOR]

AIM: This paper described a case study of a randomised controlled trial with the aim to illuminate how the intervention described takes into account the important methodological considerations for enhancing the efficacy of psychoeducational interventions for paediatric patients. BACKGROUND: Many nursing intervention studies commit a Type II error despite the fact that the intervention is effective. Lack of attention given to the threats of validity of an intervention study may lead to inaccurate inference about the efficacy of the intervention study, thereby precluding any definitive conclusions being drawn. DESIGN: A case study of a randomised controlled trial was described. METHOD: Two hundred and three Hong Kong Chinese children, admitted for elective surgery, were invited to participate in the study. By using a simple complete randomisation method, 97 children were assigned to the experimental group and received therapeutic play intervention and 106 children were assigned to the control group and received routine information preparation. RESULTS: Children received preoperative therapeutic play intervention experienced lower anxiety levels, fewer negative emotions and lower heart rates and mean arterial blood pressures. CONCLUSION: This case study illustrates that the more a measure is sensitive to differentiate between the experimental and control groups, the greater the likelihood of documenting intervention efficacy. Besides, the timing of measuring a dependent variable that matches with peak response to an intervention is crucial in evaluating the efficacy of an intervention. Additionally, outcome measures that are sensitive enough to differentiate between the experimental and control groups are extremely important to ensure greater accuracy in evaluating the efficacy of psychoeducational interventions. RELEVANCE TO CLINICAL PRACTICE: It is anticipated that designing an effective psychoeducational intervention research design can facilitate the development of holistic and quality care in preparing children for hospitalisation. [ABSTRACT FROM AUTHOR]

This paper reports an estimate of the dietary intake of lead by children and adults from the Jinhu area in South-eastern China. A duplicate diet approach was used to collect food samples in November and December 2007. The lead content was measured by furnace atomic absorption spectrometry. Median lead intakes for different groups were as follows: children: 1.65 µg(kgbw)-1 day-1; and adults: 1.10 µg(kgbw)-1 day-1. No exposure exceeded the provisional tolerable weekly intake (PTWI) of 25 µg(kgbw)-1 week-1 proposed by the World Health Organization (WHO). However, median and maximum exposure for the children group amounted to 60.8% and 97.2% of the PTWI, respectively, which were higher than those for adults, which were 40.5% and 86.4%, respectively. It was concluded that health risks due to dietary lead intake seem to be high in Jinhu. [ABSTRACT FROM AUTHOR]

Objective To assess the usefulness of serology as an indicator of Echinococcus transmission for developing preventive measures against echinococcosis in rural communities. Methods Cross-sectional survey in 2002 among 861 children aged 7 to 18 years in Xiji County, Ningxia, China. Before ultrasound abdominal examination, a questionnaire was used to identify socioeconomic, sanitary and hygiene risk factors for echinococcal infection; filter paper blood samples were collected from each child for specific antibody detection using EmP ( Echinococcus multilocularis) and EgB ( Echinococcus granulosus) antigens. Results Transmission of both E. multilocularis and E. granulosus occur in this area. Serological prevalence was far higher than disease prevalence in this age range. We found no gender-related differences of seroprevalence among the children, suggesting an equal chance of exposure to echinococcal egg-contaminated environments. The seroprevalence distribution was associated with changes in the ecology of wild hosts for E. multilocularis contamination, and with changes in socio-geographic features of the communities for E. granulosus contamination. Conclusions Serological data obtained for children in mass surveys of echinococcosis appear to be a comprehensive and useful tool to monitor changes of transmission dynamics in humans and provide ‘warning signals’ to decision makers for the instigation of specific control measures against the disease. [ABSTRACT FROM AUTHOR]

This paper examines the effect of parental, household and community character-istics on the health of children in China. We find that birth order, death of elder siblings, use of prenatal care and alcohol consumption by the mother when pregnant have statistically significant effects on the health of children. Although parental education does not have a significant direct effect on child health, it does affect mothers’ behavior during pregnancy and inflfluences the use of health inputs, indirectly impacting the health of children. The research findings have important implications for both family planning programs and broader social policies in China. [ABSTRACT FROM AUTHOR]

Breast milk is a potential source of infant and young children lead exposure, but national-level data on breast milk lead (BML) is unknown in China. To fill up this gap, we conducted a review by analyzing the articles enrolled through searching Wanfang MedOnline, CNKI, SinoMed, Pubmed, and Embase databases and relevant articles from 2000 through 2017. After screening and assessing process, 17 articles were included. The average concentrations of BML in these studies varied with regions (1.54-171.84 μg/L), and the BML level was dropping down in general. In conclusion, breast milk should still be encouraged to infant and young children in normal areas of China, and stopping breastfeeding should be considered prudently. Education for health workers and families on BML should be strengthened, and more surveys on BML should be conducted. [ABSTRACT FROM AUTHOR]

With the rapid development of urbanization, children's health has been becoming one of the most prominent problems in many countries, of which the lack of friendliness in urban is a main reason. This paper, takes Children's Participation Work Camp of Changsha 2050 and Fengquan Furui child-friendly community as an example, systematically summaries the research and design methods of Chinese Child-Friendly City (CFC), evaluates its generalizability, and puts forward that conducting a regular and continuous survey of Children's Drawing Camp and transforming public environment and establishing connections between community residents based on children focus are referencable ways for building CFC in China. [ABSTRACT FROM AUTHOR]

Background: Trilateral South‒South cooperation is envisioned as an equal and empowering partnership model but still faces certain challenges. This study addresses whether and how trilateral South‒South cooperation can transform traditional development assistance for health (DAH) and explores the opportunities and challenges of trilateral South‒South cooperation for transforming future DAH, in the theme of "the emerging development partner's DAH transformation facilitated by a multilateral organization". Methods: We evaluate a maternal, newborn, and child health (MNCH) project involving the Democratic Republic of Congo (DRC), the United Nations Children's Fund (UNICEF), and China (hereinafter referred to as the "DRC–UNICEF–China project"). We analyze data from project documents and seventeen semi-structured interviews using a pragmatic analytical framework based on the DAH program logic model and the OECD's trilateral cooperation framework. Results: Evidence from the DRC–UNICEF–China MNCH project suggests that trilateral South‒South cooperation facilitated by a multilateral organization can provide transformative opportunities for emerging development partners' DAH to generate and deliver context-based, demand-oriented solutions, harmonize rules and procedures, institutionalize mutual learning and knowledge sharing, and increase the visibility of emerging development partners as sources for South‒South development experience transfer. However, the project revealed some challenges, including the neglect of key stakeholders in the complex governance structure, the high transaction costs needed to ensure transparency, and the harm local absence of the emerging development partner poses to long-term DAH engagement. Conclusions: This study echoes some of the findings in trilateral SSC literature that claim power structures and philanthropic, normative justification for health equity are often juxtaposed in trilateral SSC partnerships. The opportunities offered by the DRC–UNICEF–China project align with China's cognitive learning process for strengthening international engagement and global image building. However, challenges may arise as a result of complex governance structures and the entrustment of facilitating partners, which can threaten the effectiveness of trilateral cooperation. We call for strengthening the beneficiary partner's ownership at all levels, engaging the emerging development partner to better understand the beneficiary partner's local context(s) and needs, and ensuring available resources to support programmatic activities and long-term partnerships for the health and well-being of the beneficiaries. [ABSTRACT FROM AUTHOR]

Background: The gender gap remains a major impediment in the path toward equality, and it is especially wide in low-income countries. Gender differences in health-seeking behaviors may be a factor. Family size and childbirth order are two critical factors affecting family resource allocation. This study examines gender differences in healthcare-seeking behaviors among children with visual impairment in rural China across different family structures (birth order and family size). Methods: We draw on a dataset containing 19,934 observations constructed by combining data from 252 different school-level surveys spanning two provinces. The surveys were all conducted in 2012 using uniform survey instruments and data collection protocols in randomly selected schools across western provinces in rural China. The sample children range in grades from 4 to 5. Our analysis compares rural girls with rural boys regarding vision health outcome and behavior (vision examination and correction). Results: The findings revealed that girls have worse vision than boys. Regarding vision health behaviors, girls have a lower overall vision examination rate than boys. There is no gender difference when the sample student is the only child or the youngest child in the family, but there is still a gender difference when the sample student is the oldest child in the family or the middle child in the birth order. When it comes to vision correction behavior, boys are more likely to own eyeglasses than girls are for groups of students with mild visual impairment, even when the sample student is the only child in the family. However, when the sample student has another brother or sister (the sample student is the youngest, the oldest child in the family, or the middle child in the birth order), the gender difference disappears. Conclusions: Gender differences in vision health outcomes are correlated with gender differences in vision health-seeking behaviors among rural children. Depending on the birth order and family size, gender disparities in visual health practices vary. In the future, consideration should be given to providing medical subsidies to reduce the cost of vision health behaviors and to provide information interventions to change gender inequality in households and promote equality in children's vision health behaviors. Trial registration: The trial was approved by the Stanford University Institutional Review Board (Protocol No. ISRCTN03252665). Permission was received from local Boards of Education in each region and the principals of all schools. The principles of the Declaration of Helsinki were followed throughout. Written informed consent was obtained from at least one parent for all child participants. [ABSTRACT FROM AUTHOR]

Objectives: Assess the validity of the Chinese version of the Dominic Interactive (DI), a 91-item, video-based diagnostic screening instrument for children that assesses four internalized disorders (phobias, separation anxiety disorder, generalized anxiety disorder, and major depressive disorder) and three externalized disorders (attention-deficit/hyperactivity disorder, conduct disorder, oppositional defiant disorder). Methods: (1) Compare DI-generated "probable" or "possible" diagnoses to diagnoses based on the Development and Well-Being Assessment (DAWBA) instrument in 113 psychiatric outpatients and 20 community controls. (2) Administer DI to 1,479 children from elementary schools in Tianjin. Results: In the validation sample, DI with DAWBA concordance was much greater for internalized disorders (mean Kappa = 0.56) than for externalized disorders (mean kappa = 0.11). The positive predictive value of DI diagnoses ranged from 0.96 (generalized anxiety disorder) to 25% (oppositional defiant disorder) and negative from 0.81 to 0.96. Using "probable" cuts provides better results. In the survey, prevalence of probable DI disorders ranged from 1.0% (conduct disorder) to 13.1% (phobias). Internal consistency of all DI items was excellent (Cronbach alpha = 0.93) and that of the seven subscales ranged from 0.64 (phobias) to 0.87 (major depressive disorder). In multilevel SEM analyses, SRMR (Standardized root mean square residual) or each of the seven diagnoses was below 0.08 and each coefficient of determination was below 0.60. Conclusion: The Chinese DI is a convenient method of screening common mental disorders in Chinese children mainly for internalized disorders, which are the most prevalent diagnoses in that population. However its high negative predictive values for externalized could be used for screening. [ABSTRACT FROM AUTHOR]

Parents' perception of parental involvement or that of children has been found to be associated with the mental health of children. Rather than scrutinizing whether parents' perception or children's perception matters more, this study investigated whether and how parent–child perception differences (parents' perceptions minus their children's perceptions) in home‐based parental involvement were related to anxiety, depression, and stress in children. We surveyed 2219 adolescents (approximately 12–14 years old) and their parents in nine middle schools in eastern China. Findings indicate that parent–child perception differences in parental daily involvement (e.g., Depression: β =.065, p <.01) and parent–child communication (e.g., Depression: β =.107, p <.001) were detrimental to the mental health of children, and that perceived peer support and perceived teacher emotional support might mitigate the adverse effects. [ABSTRACT FROM AUTHOR]

Few studies were conducted for associations of home environment with childhood health by on-site inspection in China. During 2013–2014, we conducted a case-control study with home inspection among 454 children (186 asthma children and 268 non-asthma children) in Shanghai, China. In this paper, we detailedly described the inspected methods and analyzed the preliminarily collected data. Except in winter, most residences meet the national standard for indoor temperature and relative humidity. Most living rooms had ≤1000 ppm CO 2 , whereas over half of the child's bedrooms had slightly >1000 ppm CO 2 during night. Most residences had notably lower than 2500 cfu/m 3 airborne culturable fungi and ≤100 μg/m 3 formaldehyde. More than 70% of the child's bedrooms had ≤75 μg/m 3 PM 2.5 and ≤150 μg/m 3 PM 10 . Indoor and outdoor concentrations of particulate matters had strong linear correlations ( r =0.891–0.922; p -value <0.001). Most differences between cases and controls were not significant with respect to CO 2 , culturable fungi, formaldehyde, and particulate matters. Before and after adjusted for potential confounders, indoor averaged concentration of CO 2 and particulate matters generally had negative associations with childhood history of doctor-diagnosed asthma in spring, summer, and autumn. Only in winter, indoor CO 2 concentration was significantly associated with the increased odds of childhood asthma. Our results indicated that air quality among most residences in Shanghai could meet the national standard for indoor air quality in warm seasons; but household air quality and ventilation status in winter should be greatly improved. We suspected that those “unexpected” negative associations could exist due to changes in lifestyle behaviors regarding indoor air quality after the child being diagnosed asthma by a doctor. [ABSTRACT FROM AUTHOR]

The purpose of the current study was to research the factors influencing thyroid volume (TVOL) in 6–12-year-old children and update the reference values. A cross-sectional study was carried out in iodine-sufficient areas of four provinces in China. Urine, edible salt and drinking water samples were collected from children. Children's height, weight and TVOL were measured. Ridge regression was used to screen variables for solving the multicollinearity problem. Quantile regression was used to analyse the relationship between the quantiles of TVOL and other variables. In total, 5653 children aged 6–12 years were enrolled in this study, including 2838 boys and 2815 girls. There was no significant difference in TVOL between boys and girls (P > 0·05). Spearman correlation analysis showed that total TVOL was positively correlated with age, height, weight, body surface area (BSA) and BMI, and the correlation coefficients were 0·616, 0·663, 0·669, 0·685 and 0·479, respectively. Among them, the correlation between TVOL and BSA was the strongest. According to the ridge regression results, age and BSA influenced TVOL, and the ridge regression coefficients were 0·13 and 0·94, respectively. Quantile regression further showed that age and BSA had significant influences on the whole TVOL distribution (P < 0·001). Therefore, the TVOL of children aged 6–12 years in China was mainly influenced by age and BSA, and reference values for TVOL of different genders based on age and BSA were established. [ABSTRACT FROM AUTHOR]

Background: Parental migration is an important factor affecting left-behind children's health. However, few studies have addressed the effect of parental migration on children's vision health in China. To fill the gap, this study aimed to assess the impact of parental migration on left-behind children's vision health and to explore the possible mechanisms of the effect. Methods: Data were obtained from the baseline survey of the China Education Panel Survey (CEPS), which included over 10,000 junior high school students. This study used myopia, the most common vision problem among junior high school students, and tried to analyze whether myopia was corrected with eyeglasses as indicator variables of vision health. The impact of parental migration on vision health was assessed using an instrumental variables approach. Results: The results show that parental migration reduced the likelihood of myopia in left-behind children and decreased the possibility of myopic left-behind children being corrected. This result passed a series of robustness tests. The mechanism analysis indicated that compared to non-left-behind children, left-behind children spent more time on outdoor activities and less time on after-school classes, reducing their risk of being myopic. Further, because left-behind children live apart from their parents, their myopia problem is more difficult for parents to notice, and left-behind children are less likely to inform their parents of their myopia than non-left-behind children actively. This helps to explain why left-behind children have a lower correction rate with eyeglasses. Conclusions: Our findings suggest that parental migration, while not increasing the prevalence of myopia in left-behind children, has led to inequity in myopic left-behind children's correction. Given the severe consequences of uncorrected myopia, action is required to enhance the correction rate of myopic left-behind children. [ABSTRACT FROM AUTHOR]

With rapid urbanization and industrialization, a large number of rural residents have migrated to urban areas for work, increasing the proportion of migration in rural villages. Previous studies have typically examined the direct effect of parental migration, while we provide the first evidence for the spillover effects of village migration on the health outcomes of non-left-behind children. The results from an instrumental variable analysis show a sizable adverse effect of exposure to village migration on the health outcomes of non-left-behind children. We examine the role of unhealthy peers, poor parental health behaviours, poor village healthcare infrastructure, and unbalanced human capital structure at the village level. [ABSTRACT FROM AUTHOR]