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INTRODUCTION This study examined the prevalence of tobacco exposure and drinking and ascertained the relationships between tobacco exposure, alcohol drinking, concurrent smoking and drinking, and hypertension in rural southwestern China. METHODS Data were collected from a cross-sectional health interview and examination survey, which included 7572 adults aged ≥35 years, in rural China. Participant demographic characteristics, smoking habits, exposure to secondhand smoke (SHS), and alcohol drinking habits were obtained using a standard questionnaire. Blood pressure (BP), height, weight, and waist circumference were measured for each participant. RESULTS The overall prevalence of smoking, SHS exposure, drinking, concurrent smoking and drinking, concurrent exposure to SHS and drinking, and hypertension was 37.7%, 27.4%, 16.2%, 12.6%, 1.6%, and 41.3%, respectively. Males had a significantly higher prevalence of smoking (74.1% vs 2.2%, p<0.01), drinking (31.1% vs 1.7%, p<0.01), and concurrent smoking and drinking than females (25.3% vs 0.3%, p<0.01). However, females had a higher prevalence of SHS exposure than males (30.2% vs 20.6%, p<0.01). Ethnic minorities had a higher prevalence of SHS exposure, drinking, and concurrent smoking and drinking, than Han participants (p<0.01). Participants with a higher education level had a higher prevalence of smoking, drinking, and concurrent smoking and drinking than their counterparts (p<0.01). In contrast, participants with a lower education level had a higher prevalence of SHS exposure than their counterparts (p<0.01). Multivariate logistic regression analysis found that smokers (AOR=1.31; 95% CI: 1.13-1.51), individuals exposed to SHS (AOR=1.24; 95% CI: 1.11-1.43), drinkers (AOR=1.31; 95%: CI: 1.15-1.50), and concurrent smokers and drinkers (AOR=1.45; 95% CI: 1.25-1.67) all had a higher probability of having hypertension (p<0.01). Additionally, concurrent smoking and drinking had the strongest association with the prevalence of hypertension (AOR=1.45; 95% CI: 1.25-1.67; p<0.01). CONCLUSIONS Socioeconomic factors play an important role in influencing the prevalence of smoking, exposure to SHS, and drinking in rural southwest China. Interventions to prevent and reduce hypertension should, in particular, focus on smokers, individuals exposed to SHS, drinkers, and, in particular, concurrent smokers and drinkers. [ABSTRACT FROM AUTHOR]

Background: Most existing research on rural–urban health inequalities focuses on disparities in service access and health outcomes based on region. This paper examines rural–urban disparities in maternal healthcare utilization and delivery modes based on household registration (hukou) status to understand the role of state institutions in producing healthcare disparities in China. Methods: Utilizing administrative data from the Public Maternal Health Insurance scheme, we analyzed 54,733 live births in City A (2015–2019) and 25,849 live births in City B (2018–2019) in Guangdong Province in China. We constructed regression models using hukou status (rural versus urban) as the explanatory variable. Results: While there is no statistically significant difference in rural and urban mothers' probability of obtaining the minimum recommended number of prenatal care checkups in City A (OR = 0.990 [0.950, 1.032]), mothers with rural hukou status have a lower probability of obtaining the minimum recommended number of visits in City B than their counterparts with urban hukou (OR = 0.781 [0.740, 0.825]). The probability of delivering in tertiary hospital is lower among mothers with rural hukou than among those with urban hukou in both cities (City A: OR = 0.734 [0.701, 0.769]; City B: OR = 0.336 [0.319, 0.354]). Mothers with rural hukou are more likely to have a Cesarean section than those with urban hukou in both cities (City A: OR = 1.065 [1.027, 1.104]; City B: OR = 1.127 [1.069, 1.189]). Compared with mothers with urban hukou, mothers with rural hukou incurred 4 % (95 % CI [-0.046, -0.033]) and 9.4 % (95 % CI [-0.120, -0.068]) less in total medical costs for those who delivered via Cesarean section and 7.8 % (95 % CI [-0.085, -0.071]) and 19.9 % (95 % CI [-0.221, -0.177]) less for those who delivered via natural delivery in City A and City B, respectively. Conclusions: Rural hukou status is associated with younger age, no difference or lower probability of having a minimum number of prenatal checkups, higher likelihood of delivering in nontertiary hospitals, increased Cesarean delivery rates, and lower medical cost for delivery in these two Chinese cities. Evaluating how hukou status influences maternal healthcare in Chinese cities is important for devising targeted public policies to promote more equitable maternal health services. [ABSTRACT FROM AUTHOR]

Objectives: This paper studies the institutional inequality that exists in the prevalence of diabetes and hypertension, as well as their diagnosis and medication management, between urban and rural residency status (hukou) holders in China. Methods: Exploiting the Chinese Health and Nutrition Survey, we primarily demonstrate that while a lower proportion of rural residency holders suffer from diabetes and hypertension, a larger proportion have never been diagnosed with these conditions and do not take medicine to control them. We explore the determinants of these disparities by the non-linear decomposition method. Results: Decomposition results illustrate that a large part of disparities in the prevalence of diabetes and hypertension can be explained by the differences in demographic structure and occupational socio-economic status. Regarding the ruralurban disparity in the under diagnosis and under-medication rates, the differences in demographic structure, household affluence, occupational socio-economic status and consumption patterns make the greatest contributions. Conclusions: This evidence suggests that improving the institutional economic inequality and enhancing the occupational mobility of rural residency holders are of paramount importance to mitigate any inequality in health and healthcare utilisation. [ABSTRACT FROM AUTHOR]

Background: China issued strict nationwide guidelines to combat the COVID-19 outbreak in January 2020 and gradually loosened the restrictions on movement in early March. Little is known about how these disease control measures affected the 600 million people who live in rural China. The goal of this paper is to document the quarantine measures implemented in rural China outside the epicenter of Hubei Province and to assess the socioeconomic effect of the measures on rural communities over time. Methods: We conducted three rounds of interviews with informants from 726 villages in seven provinces, accounting for over 25% of China's overall rural population. The survey collected data on rural quarantine implementation; COVID-19 infections and deaths in the survey villages; and effects of the quarantine on employment, income, education, health care, and government policies to address any negative impacts. The empirical findings of the work established that strict quarantine measures were implemented in rural villages throughout China in February. Results: There was little spread of COVID-19 in rural communities: an infection rate of 0.001% and zero deaths reported in our sample. However, there were negative social and economic outcomes, including high rates of unemployment, falling household income, rising prices, and disrupted student learning. Health care was generally accessible, but many delayed their non-COVID-19 health care due to the quarantine measures. Only 20% of villagers received any form of local government aid, and only 11% of villages received financial subsidies. There were no reports of national government aid programs that targeted rural villagers in the sample areas. Conclusions: By examining the economic and social effects of the COVID-19 restrictions in rural communities, this study will help to guide other middle- and low-income countries in their containment and restorative processes. Without consideration for economically vulnerable populations, economic hardships and poverty will likely continue to have a negative impact on the most susceptible communities. [ABSTRACT FROM AUTHOR]

Objective: This research aimed to identify the fundamental and geographic characteristics of the primary healthcare personnel mobility in Nanning from 2000 to 2021 and clarify the determinants that affect their transition to non-primary healthcare institutions. Methods: Through utilizing the Primary Healthcare Personnel Database (PHPD) for 2000–2021, the study conducts descriptive statistical analysis on demographic, economic, and professional aspects of healthcare personnel mobility across healthcare reform phases. Geographic Information Systems (QGIS) were used to map mobility patterns, and R software was employed to calculate spatial autocorrelation (Moran's I). Logistic regression identified factors that influenced the transition to non-primary institutions. Results: Primary healthcare personnel mobility is divided into four phases: initial (2000–2008), turning point (2009–2011), rapid development (2012–2020), and decline (2021). The rapid development stage saw increased mobility with no spatial clustering in inflow and outflow. From 2016 to 2020, primary healthcare worker mobility reached its peak, in which the most significant movement occurred between township health centers and other institutions. Aside from their transition to primary medical institutions, the primary movement of grassroots health personnel predominantly directs towards secondary general hospitals, tertiary general hospitals, and secondary specialized hospitals. Since 2012, the number and mobility distance of primary healthcare workers have become noticeably larger and remained at a higher level from 2016 to 2020. The main migration of primary healthcare personnel occurred in their districts (counties). Key transition factors include gender, education, ethnicity, professional category, general practice registration, and administrative division. Conclusions: This study provides evidence of the features of primary healthcare personnel mobility in the less developed western regions of China, in which Nanning was taken as a case study. It uncovers the factors that impact the flow of primary healthcare personnel to non-primary healthcare institutions. These findings are helpful to policy refinement and support the retention of primary healthcare workers. [ABSTRACT FROM AUTHOR]

The gender gap in labor force participation (LFP) in China has grown over the last 30 years, despite substantial advances in women's education and economic development. Previous research has identified gender discrimination and work-family conflicts as two key explanations for the gap, both of which have risen since the start of China's economic reform in 1978. Using multiple waves of the national census and household panel data from China, this research shows that one overlooked mechanism widening the LFP gender gap lies in the institutional constraints that require women to retire earlier than men. This research also demonstrates how the impact of women's early retirement on the LFP gender gap has been exacerbated by two societal-level changes: (1) population aging, which increased the share of women who reached the retirement age; and (2) economic development, which increased the number of women entering nonfarming occupations and, hence, the gender-based retirement system. These findings suggest that without significant revisions to China's retirement system, the LFP gender gap will continue to expand as the population ages and economic development proceeds. [ABSTRACT FROM AUTHOR]

The purpose of this study was to examine the associations of social support factors with leisure-time physical activity (LTPA) of older people in Fuwen village. A cross-sectional study included 523 randomly selected elderly people (60+ years) whose LTPA levels were determined using the shortened version of the International Physical Activity Questionnaire (IPAQ-S). A modified version of the Physical Activity Social Support Scale (PASSS) was operated to gather perceived scores of the social support factors. A multivariate linear regression was performed to locate associations of perceived scores of social supports with leisure-time walking (LTW) and moderate and vigorous physical activity (MVPA). The results indicated that social support from family was positively and significantly related to LTW and MVPA in both models. The community factor was positively and significantly correlated with MVPA in both models. The sport club factor was related to LTW and MVPA to some extent. The results suggest that social support from family is the most important motivator for older people's LTW and MVPA in the village of Fuwen. Social support from the community is the motivator for older people's MVPA. The sport club factor has some effects on older people's LTW and MVPA as well. More future studies are needed to extend the database of the relationship between social support and rural older people's physical activity. [ABSTRACT FROM AUTHOR]

Ex post moral hazard, the additional healthcare utilization induced by health insurance, can be decomposed into an efficient portion generated by the income effect and an inefficient portion caused by the substitution effect, which has been discussed theoretically, but few studies have provided evidence of the efficient moral hazard. In 2016, the Chinese government launched the consolidation of urban and rural resident health insurance at the national level. After the consolidation, insurance benefits for nearly 800 million rural residents got improved. This paper uses a nationally-representative sample of 30,972 individuals from the China Health and Retirement Longitudinal Study (2011–2018) and adopts a 2-step empirical approach with the difference-in-differences method and the fuzzy regression discontinuity design to estimate the efficient moral hazard in the consolidation among rural residents. We find that the price shock contained in the consolidation increases inpatient care utilization, and the corresponding price elasticity is between −0.68 and −0.62. Further analysis shows that the efficient moral hazard resulting in welfare gains accounts for 43.33%–66.36% of the additional healthcare utilization. These findings highlight the necessity of evaluating the efficient moral hazard when analyzing the cost-benefit of health insurance reform. • We provide rare evidence of the efficient moral hazard effect in health insurance. • We focus on low-income groups from developing countries. • We use a 2-step empirical approach to estimate the efficient moral hazard effect. • The efficient moral hazard generated by income effect accounts for 43.33%–66.36%. [ABSTRACT FROM AUTHOR]

Background: Youth with disabilities have the same right to sexual and reproductive health (SRH) as their peers without disabilities. However, their needs and rights are often ignored. Little is known about the knowledge, needs and access barriers related to SRH information among youth with different types of disabilities in China. Methods: A cross-sectional survey was carried out among 473 unmarried youth aged 15–24 with visual, hearing, physical disabilities in both urban and rural areas in China. Results: Out of a maximum possible score of 100, respondent's median score ranged from 30 to 50 for knowledge related to sexual physiology, STIs/HIV/AIDS and contraception. For these three categories of knowledge, respondents with hearing and physical disabilities or from rural areas scored lower than their counterparts with visual disabilities or from urban areas. The multivariate analyses showed that the residential area and education level were strong correlates of knowledge among respondents with visual and hearing disabilities. Other significant correlates were age for respondents with visual impairment and physical impairment, and single child status in the family and father's education level for respondents with hearing impairment. Sources of and barriers and preferences in accessing SRH information differed by type of disabilities, residential areas and gender. In general, school teachers were the primary and most preferred sources of SRH knowledge, followed by the Internet, peers/friends and parents. Unaware of where to get accurate information and feeling embarrassed to seek information were the two most frequently mentioned barriers in accessing SRH information. Conclusion: Respondents had poor knowledge of SRH and limited access to SRH information, especially those from rural areas. Efforts should be made to promote school and family-based sexuality education tailored for youth with different types of disabilities. Plain language summary: Youth with disabilities have the same sexual and reproductive health (SRH) needs as their peers without disabilities and the equal right to attain the highest standard of SRH. However, their SRH needs and rights are often overlooked or neglected. Studies on SRH among unmarried youth with disabilities are very limited in China. This study used data collected from 473 unmarried youths with different types of disabilities from both urban and rural areas in China, to understand their SRH knowledge and its associated factors, as well as barriers and preferences in accessing sexuality-related information. This study demonstrated that unmarried youth with disabilities lacked knowledge of SRH, especially those with hearing or physical disabilities and those from rural areas. In general, residential area and education level were significant correlates of knowledge among respondents. Sources of and barriers and preferences in accessing SRH information varied across types of disabilities, residential areas and gender. In general, school teachers were the primary and most preferred sources of knowledge, followed by the Internet, peers and parents. Unaware of the available sources of accurate information and feeling embarrassed to seek information were the most frequently mentioned barriers in accessing SRH information. The findings of the study highlight the need to reduce the barriers to sexuality education for unmarried youth with different types of disabilities. Efforts should be made to promote school and family-based sexuality education tailored for youth with different types of disabilities and empower them to seek information proactively. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to explore the lived experiences of a rural dwelling person living with dementia and his children. Using a phenomenological case study methodology, it aims to explore the health-related and personal dilemmas faced by multiple family members who provide care to a person living with dementia in a rural area in Henan, China. The study also investigates the barriers to quality dementia care in this kind of setting in order to inform the relevant stakeholders. Method: A phenomenological case study was designed for this study. The case that formed the focus of the research included a person living with dementia and multiple family members. Semi-structured in-depth interviews were undertaken with the five family members of the person living with dementia. Smith's interpretative phenomenological analysis was used for data analysis. Findings: Three major themes were identified: (1) Dementia as a normal ageing process or a bad disease; (2) Commitment to and challenges of family caring and (3) Life in rural areas. Conclusion: With the development of China's economy and its social-cultural changes, traditional home-based care provision in rural areas of China is being challenged for people with dementia who have multiple children. It suggests that there needs to be an exploration into providing more appropriate care for people with dementia living in rural settings. It also suggests that more support is required to increase dementia awareness and to improve the quality of life of people with dementia and their families in rural China. [ABSTRACT FROM AUTHOR]

Despite the growing literature on loneliness, little attention has been paid to the impact of broader changes in social structure and environment on individuals' experience of loneliness. Drawing on data from the 2018 Urbanization and Quality of Life Survey (N = 3,229) conducted in 40 localities undergoing rural–urban transition in China, this study investigates how measures of urbanisation (including population density, duration of urban status, neighbourhood transition and housing type) are associated with residents' loneliness. We revised measures of the six‐item De Jong Gierveld Loneliness Scale, differentiated between emotional and social loneliness, estimated multi‐level mixed‐effects regressions and controlled for a number of individual‐level covariates. The results show that emotional loneliness and social loneliness have different patterns of association with multi‐level covariates: urbanisation at county, township and neighbourhood levels is significantly associated with emotional loneliness, whereas residence in temporary housing is a clear risk factor for social loneliness. The analyses further demonstrate that the revised measures of loneliness address concerns about the original scale, offer a clearer sense of the degrees of loneliness and are strongly associated with multi‐level covariates and psychological distress. In addition to showing how urbanisation leads to greater individual loneliness, our research also illustrates how to model locational parameters in analyses of individual well‐being. [ABSTRACT FROM AUTHOR]

Informal payment for medical services is a common phenomenon in China. Patients make informal payments, in cash or in kind, to physicians in addition to official charges billed for medical services. This paper assesses the associations between patients' perceptions of the physician as an agent for the patient's interests (physician agency problem) and informal payment behavior. Using data of 24,000 and 6700 rural households respectively from the Health Development of Rural China Program database (collected in 2008) and Ningxia data source (collected in 2015), we find that patients' concern about physician agency problems is significantly associated with informal payments. The data shows that patients are more likely to make informal payments when they show low trust towards their physicians. For example, in the surgical cases, among patients who strongly distrusted the physicians, 17.9% (95% confidence interval [CI]:]: 13.5, 22.3) initiated informal payments, compared to 8.0% (95% CI: 5.1, 10.9) who expressed "strong trust" in their physicians. Poor communication was also significantly associated with an increase in the informal payment rate. For example, in the non-surgical setting, among the patients who rated the physicians' explaining skills as "poor," 5.9% (95% CI: 5.0, 6.9) of them made informal payments, significantly higher than the patients who rated "excellent" (of whom 1.8% made informal payments 95% CI, 0.9, 2.7). In this study, we provide an explanation for this finding: patients may initiate informal payments to physicians in order to mitigate the physician agency problem. It suggests that to mitigate informal payments, improving alignment between doctors' incentives and patients' interests would be essential. • Informal payments were directly related to patients' concerns about physicians' behavior. • Patients were more likely to make informal payments when they showed low trust towards their physicians. • Poor communication between patients and physicians was related to informal payment rate. • Informal payment might be viewed as an effort by the patients to align the physicians. [ABSTRACT FROM AUTHOR]

Purpose: To identify the profile of a pediatric low-vision population and investigate the differences between low-vision services in urban and rural areas. Methods: A retrospective study was conducted of the records of 286 consecutive children presenting at the Low Vision Clinic of the Eye and ENT Hospital of Fudan University from January 2009 to December 2018. The data retrieved included age, sex, education, family history, rural vs. urban residence, cause of visual impairment, and low-vision aids dispensed. Results: Of the 286 children (65.0% boys and 35.0% girls), over half (178, 62.2%) were from urban areas. The age range of the patients was 3–15 years (mean 9.54 ± 4.11). The four major causes of visual impairment were congenital cataract (70, 24.5%), optic atrophy (37, 12.9%), congenital glaucoma (34, 11.9%), and macular dystrophy (31, 10.8%). Low-vision aids were prescribed for 203 children (71.0%), with binocular telescopes (69, 25.0%) and stand magnifiers (66, 23.9%) being the most common. The urban children enjoyed higher rates of low-vision services than the rural children, with more low-vision aids (192, 94.6%) prescribed for the former. Conclusions: Congenital and hereditary diseases constituted the major causes of low vision in the study population. In contrast to their urban counterparts, the rural children experienced inadequate low-vision rehabilitation. Our findings suggest that policymakers need to better address gender inequalities and urban–rural disparities in low-vision services and that the coverage of low-vision services, especially in rural areas, should be enhanced in China. [ABSTRACT FROM AUTHOR]

Using a sample of Chinese adults over the age of 50 from wave 1 of the WHO Study on Global Ageing and Adult Health (n = 13,367), we investigated the relationship between living arrangements and subjective well-being (SWB) in regard to life satisfaction, happiness, and control. We also looked at the moderating role of resources, proxied by income and hukou status. Multivariate regression results indicate that living only with a spouse was significantly associated with better SWB. Multigenerational living arrangements may not always promote SWB, particularly when resources are constrained. Yet, results also underscore the importance of daughters and daughters-in-law in promoting SWB among older adults. Older adults in rural areas had better SWB, including greater life satisfaction if living with grandchildren only, compared to their urban peers living with a spouse only. Findings suggest that context matters in the association between living arrangements and older adults' SWB. [ABSTRACT FROM AUTHOR]

Chronic disease multimorbidity has become a major challenge for health systems. While a lot of research has evaluated the direct economic burden of multimorbidity on health care utilization and cost, little attention has been given to the impacts on work productivity and functional limitations, as indirect indicators of disease burden. This study aims to examine the prevalence of multimorbidity among Chinese adults and its impact on functional disability and work productivity. It also investigates urban-rural differences in these relationships. This study utilized the data from the China Health and Retirement Longitudinal Study (CHARLS) in 2015, including 11,176 participants aged 45 years and older. Multivariable logistic regression models were used to estimate the effect of multimorbidity on functional disability (i.e. ADL: activities of daily life; IADL: instrumental activities of daily life), and work productivity loss due to health problems. Negative binomial regression models were used to assess the association of multimorbidity with sickness absences from agricultural work and employed non-agricultural work. 68.8% of total participants in CHARLS had multimorbidity in China in 2015. Rural residents with multimorbidity reported higher proportions of physical functions and days of sick leave than urban residents. Multimorbidity was positively associated with ADL limitation (odds ratio 1.924, 95% CI 1.656–2.236), IADL limitation (1.522, 1.326–1.748), limited work due to health problems (1.868, 1.601–2.178) and days of sick leave (for agricultural work, incidence rate ratio 1.676, 95% CI 1.390–2.020; for employed non-agricultural work, 2.418, 1.245–4.696). For the rural group, the impact of multimorbidity on functional limitations and work productivity loss (except for early retirement), was less than the urban group. Multimorbidity poses significant challenges for functional health and work productivity These have significant negative economic consequences for individuals, the Chinese health system and the society. [ABSTRACT FROM AUTHOR]

Over 90% of suicides in the West could be diagnosed with mental disorders, while only 50–70% of Chinese suicides had mental disorders. Using data from a case–control study on suicide attempt, we aimed to compare characteristics and risk factors between suicide attempters with and without mental disorders. Demographic and social psychological characteristics were compared between attempters with and without mental disorders. 19.1% of the suicide attempters were diagnosed with mental disorders. Suicide attempters with mental disorders endured more strain than those without. Strain was an independent risk factor for suicide attempt among people without mental disorders. Psychological strain might be an important reason for both mental disorders and following suicide attempt. More efforts on suicide prevention should be spent on people without mental disorders. The impact of social psychological factors, such as religion, negative life events, and psychological strains should be considered. [ABSTRACT FROM AUTHOR]

Elderly individuals' trust in general practitioners (GPs) is conducive to enhancing their health outcomes and promote healthy ageing. However, this trust has been declining in recent decades. Social capital is associated with patients' trust in healthcare providers in several countries, which make it a potential path for improving the trust of the elderly people in GPs in China, but it is not yet validated. The objective of this study was to explore how social capital influences elderly individuals' trust in GPs in China. The data were collected through a survey conducted with 2,754 people aged 60 and over in China, 2018. Multilevel regression models were employed to analyse the impact of social capital on the trust of the elderly people in GP in China. The results revealed that individual social capital (ISC) and community social capital (CSC) had significant positive correlations with the trust of the elderly people in GPs in China. In addition, CSC has more impact than ISC on the trust of the elderly people in GP. Additionally, older people, women and patients whose highest level of education was junior high school and who had participated in the New Cooperative Medical Scheme tended to have higher trust in GPs. In conclusion, more social capital, especially CSC, contributed more trust of the elderly people in GPs in China. [ABSTRACT FROM AUTHOR]

Economic growth has brought improvements in many areas of child health, but its effects on anaemia among school‐aged children remain unknown. However, this is important because iron deficiency anaemia is common and is the main cause of disability‐adjusted life years for school‐aged children. In this study, we included 429,222 Chinese children aged 7–17 years from five consecutive national cross‐sectional surveys during 1995–2014. Using altitude‐adjusted haemoglobin concentration measured from capillary blood samples, we defined anaemia status according to World Health Organization's recommendation. We used logistic regressions weighted by provincial population to examine the association between provincial gross domestic product (GDP) per capita and anaemia, adjusting for sex, age, urban–rural location, regional socio‐economic status (SES), fixed effect of province, and clustering of schools. We used generalised additive mixed models to evaluate a potentially non‐linear relationship. For each 100% growth in GDP per capita, there was a 40% (odds ratio [OR] = 0.60; 95% confidence interval [CI; 0.56, 0.65]) reduction in anaemia. However, the association was weaker for girls and in cities with a lower SES. The association was weaker across 2005–2014 (OR = 0.75, 95% CI [0.62, 0.90]) compared with 1995–2005 (OR = 0.52; 95% CI [0.44, 0.61]), reflecting a weaker association when GDP per capita reaches around $2,000. The results were similar for moderate‐to‐severe anaemia. We concluded that economic growth has been associated with reductions in anaemia among school‐aged children in China but with fewer benefits for girls and those in poorer settings. Further economic development in China is unlikely to bring similar reductions in anaemia, suggesting that additional population level and targeted interventions will be needed. [ABSTRACT FROM AUTHOR]

This study aimed to compare the mental disorders, psychological factors, and suicidal intent between high- and low-impulsivity Chinese rural young suicides. Rural young women and men aged 15 to 34 years who died by suicide and various risk factors were examined. The data were obtained using psychological autopsy method with instruments as Dysfunctional Impulsivity Scale, the Structured Clinical Interview for DSM-III-R, Beck Hopeless Scale, Social Support Index, Coping Response Inventory, Hamilton Depression Rating Scale, and Beck Suicide Intent Scale. Compared with low-impulsivity suicides, the high-impulsivity suicides were younger, had less mental disorders, owned less social support, scored lower on approach coping and higher on avoidance coping, and scored a lower score on the Suicide Intent Scale. Characteristics of high-impulsivity suicides differed significantly from low-impulsivity suicides in rural China. It was important to develop different prevention and intervention strategies to reduce the suicide rate in China. [ABSTRACT FROM AUTHOR]

The purpose of this study was to analyse the association between social determinants and the presence of essential hypertension in type 2 diabetes mellitus patients in one rural county (Jintan) of China. A health survey of Jintan residents was conducted in 2013, applying a cluster sampling method. Three hundred and fifty-seven type 2 diabetes mellitus patients were selected as research subjects. Among the patients selected, essential hypertension prevalence was 45.4% (n = 162). After univariate analyses and logistic regression analyses, an association was observed between the presence of essential hypertension in type 2 diabetes mellitus patients and marital status, described as 'others (unmarried, divorce, widower, etc.)', and participating in active physical activity. Both of these two significant variables were positively associated with the higher prevalence of essential hypertension in type 2 diabetes mellitus patients. In conclusion, the patients suffering from type 2 diabetes mellitus combined with essential hypertension often reported an association with more negative social determinants (with the exception of participation in physical activity). Further strengthening the comprehensive multi-disease management to control and reduce the prevalence of essential hypertension in type 2 diabetes mellitus patients is required. [ABSTRACT FROM AUTHOR]

Objectives: To assess the association between rural and urban residential mobility and cognitive function among middle-aged and older adults in China. Method: We used data from the World Health Organization Study on global AGEing and adult health that included adults age 50+ from China (N = 12,410). We used multivariate linear regressions to examine how residential mobility and age at migration were associated with cognitive function. Results: Urban and urban-to-urban residents had the highest level of cognitive function, whereas rural and rural-to-rural residents had the poorest cognitive function. Persons who migrated to/within rural areas before age 20 had poorer cognitive function than those who migrated during later adulthood. Socioeconomic factors played a major role in accounting for the disparities in cognition; however, the association remained significant after inclusion of all covariates. Discussion: Residential mobility and age at migration have significant implications for cognitive function among middle-aged and older adults in China. [ABSTRACT FROM AUTHOR]

Using a sample of 553 married and divorced women in a large city in southern China, this study tested the effects of demographic characteristics, risk behaviors, patriarchal ideology, and personal mentality and skills on women’s experience of physical violence, psychological violence, controlling behavior, and sexual abuse. Divorced women were more likely than married women to experience all types of IPV. Risk behaviors were consistently related to IPV incidents, whereas the impact of patriarchal ideology and personal mentality and skills was equivocal. Limitations of the study and implications for future research and policy are discussed. [ABSTRACT FROM AUTHOR]

The aim of our study was to systematically review studies which had compared self-concept in left-behind children with the general population of children in China. Relevant studies about self-concept of left-behind children in China published from 2004 to 2014 were sought by searching online databases including Chinese Biological Medicine Database ( CBM), Chinese National Knowledge Infrastructure ( CNKI), Wanfang Database, Vip Database, Pub Med Database, Google Scholar and Web of Science. The methodological quality of the articles was assessed by using Newcastle- Ottawa Scale ( NOS). Poled effect size and associated 95% confidence interval ( CI) were calculated using the random effects model. Cochrane's Q was used to test for heterogeneity and I2 index was used to determine the degree of heterogeneity. Nineteen studies involving 7758 left-behind children met the inclusion criteria and 15 studies were included in a meta-analysis. The results indicated that left-behind group had a lower score of self-concept and more psychological problems than the control group. The factors associated with self-concept in left-behind children were gender, age, grade and the relationships with parents, guardians and teachers. Left-behind children had lower self-concept and more mental health problems compared with the general population of children. The development of self-concept may be an important channel for promoting mental health of left-behind children. [ABSTRACT FROM AUTHOR]

This study examines how intergenerational exchanges affect elders' choice of preferred care-givers in the case of sickness among adult children in rural China. The sample derived from a four-wave longitudinal study in Anhui Province, China, based on which we constructed three time intervals (i.e. 2001–2003, 2003–2006 and 2006–2009) and stacked them. Our working sample included 10,181 observations from these three stacked intervals, representing 4,927 children with 1,170 elder parents. We used fixed-effects logistic regression to predict elders' favouritism among their children. Results show that those children who received more help with grandchild care from parents, who provided instrumental support to parents and whose spouses provided instrumental support to parents were more likely to be named the preferred care-givers. On average, parents favoured sons. For mothers, this favouritism was completely explained by proximity and intergenerational exchanges, and even reversed under certain circumstances. For fathers, this favouritism of sons was partially explained by proximity and intergenerational exchanges. Migrant children were less likely to be preferred care-givers. This effect was moderated by elder parents' help with caring for grandchildren. Particularly, mothers favoured daughters over sons if the above moderation effect was considered. We discuss these findings in the context of social changes including increased importance of daughters in elder parents' support networks and the large-scale rural to urban migration. [ABSTRACT FROM PUBLISHER]

Objective: This study is a systematic analysis of regional and local (urban-rural) rates of over-weight among elderly people in China. The primary goal is to update the different trends in over-nutrition by gender and location among elderly Chinese. Study design and Methods: Data used for this study were obtained from the comprehensive longitudinal data collected in the most recent waves of the China Health and Nutrition Survey in 2000 and 2006. Comparative data on four provinces, two located in the poorer west (Guangxi, Guizhou) and the other two located in the richer east (Jiangsu, Shandong) were selected from the nine provinces of China participating in the survey. The study population included elderly adults aged 60 years or older interviewed during either of the two survey waves. A total of 1996 individuals (998 in 2000 and 998 in 2006) aged 60 years or older made up the sample for the analysis. We compared changes in body mass index (BMI) with changes in the prevalence of over-nutrition across the 6 years. Results: The mean BMI values observed ranged from 20.8 kg/m 2 to 23.2 kg/m 2. The prevalence of over-weight ranged from 10.5% to 39.0% in both surveys. There were increases in the prevalence of overweight that were greater than the reduction in the prevalence of underweight among Chinese elderly people. Elderly people in the eastern regions and in urban areas were significantly more likely to be overweight compared with those in western regions and rural areas. Conclusion: This study found that the rates of overweight in elderly Chinese increased overall between 2000 and 2006. China must act quickly to curb continued increases in overweight and the associated economic costs, with particular focus on target groups. [ABSTRACT FROM AUTHOR]

Background: Epidemiologic features of unintentional injuries among children in rural China are unknown. Methods: Using a stratified sampling method, we conducted a retrospective study of injury reports over a year-long period. Structured oral questionnaires were administered to parents of 2551 children ages 0 to 14. Results: The annual incidence of unintentional injuries was 15.6%, with boys (16.7%) having a slightly higher rate than girls (14.5%; p greater than .05). The four leading causes of injury for both genders were falls (5.1% annual incidence), burns (2.9%), animal-related injuries (1.7%), and traffic injuries (1.6%). Conclusions: Unintentional injuries have substantial negative effects on children and their families. In rural PuCheng, China, the incidence of unintentional injury among children is extremely high compared to other regions of the world. The types of injuries incurred are somewhat different from those reported in other geographic areas. Injury prevention programs targeting the issues specific to this region, and similar rural regions of China, are needed. [ABSTRACT FROM AUTHOR]

A random sample consisting of 88 sexually active people living with HIV (PLWH) and their HIV negative spouses in rural China were interviewed. Data of 68 couples (77.2 %) who gave identical responses to whether they had been using condoms consistently in the last 12 months ( n = 136) were analyzed. The results showed that 27.9 % of the discordant couples used condom inconsistently in the last year. Condom non-availability was the most commonly given main reason for not using condoms. Free condoms should be made available to these low-income couples. Suicidal ideation of the PLWH and the spouse's perception on 'whether someone could contract HIV via unprotected sexual intercourse with a HIV positive person' were significantly associated with inconsistent condom use in the last year. Education program should change the cognition about the risk for HIV transmission via unprotected sex. Integrated psychological services to reduce suicidal ideation are greatly warranted. [ABSTRACT FROM AUTHOR]

Objectives. Relying on the concept of sociological ambivalence, this study investigated the sources of intergenerational ambivalence in rural China, a traditional society that undergoes dramatic demographic, economic, and social changes. Methods. Data were derived from a survey of 1,162 older adults and their 4,396 children in rural Anhui province. Two-level mixed-effects model was carried out to predict ambivalent feelings reported by the older parents toward their adult children. Results. The findings yielded both similar and distinctive predictors of intergenerational ambivalence among the Chinese elderly population compared with their Western counterparts. The Chinese elderly population reported greater ambivalence toward sons than toward daughters. Adult children’s higher socioeconomic status, represented by a more prestigious job and an urban household registry status (hukou), was associated with reduced ambivalence among parents. Parents’ monetary support to children and assistance with childcare, which is common in rural China due to the massive out-migration, were also associated with higher levels of ambivalent feelings. Discussion. We interpreted the findings in the larger social context of strong son preference, large-scale rural-to-urban migration, and rigid rural–urban division in China due to the household registration system. Our findings demonstrate that individual feelings of ambivalence are culturally structured and are determined within complex social environment. [ABSTRACT FROM PUBLISHER]

Aims and objectives. To explore the impact of delivery mode on women's postpartum quality of life in rural China and probe factors influencing postnatal quality of life. Background. Childbirth significantly affects puerpera's physical, psychological and social domains of quality of life. Under the circumstance of increasing high caesarean section rate in rural China, the impact of delivery mode on postnatal quality of life remains unclear. Design. Cross-sectional study design. Methods. Women residing in rural areas and in their 0-12 months after childbirth from 30 rural townships participated in a household survey. A structured questionnaire was used to evaluate women's socio-demographic characteristics, previous pregnant experiences, foetal characteristics and use of maternal health services. The scale for rural postnatal quality of life was adopted to assess postnatal quality of life from six dimensions: physical complaints and pain, sleep and energy, sex satisfaction, interpersonal communication, self-evaluated living stress and perceived life satisfaction. Results. The overall caeserean section rate was 70·0% (962/1375), and most of them (59·7%) were selected by maternal request. None of six dimensions and total score of quality of life displayed significant difference between women with normal delivery and cesaerean section. It was found that postnatal home visit related to good postnatal quality of life and lower husband education level, male gender of infant were associated with poor quality of life. Conclusions. Delivery mode did not affect postpartum quality of life in rural China. Socio-cultural determinants may contribute more in influencing postnatal quality of life. Relevance to clinical practice. Null findings in impact of delivery mode on postpartum quality of life may cause more difficulties in maternal decision-making for vaginal delivery in rural China. The importance of postnatal home visit could justify available and quality postnatal care in improving postpartum quality of life. Further research needs to explore the effective prevention programmes, especially attention for parenting boys. [ABSTRACT FROM AUTHOR]

To determine the level of antiretroviral treatment adherence and explore the correlated factors of perceived burden of taking antiretroviral medications among people living with HIV (PLH) in a rural area of China. Data were collected from 66 PLH who were currently receiving antiretroviral treatment. Face-to-face interviews were conducted during August to October, 2009. Approximately 18.2% of participants failed to adhere to antiretroviral treatment in the previous 30 days. A majority of PLH reported that taking antiretroviral medications posed a burden to them. Those who perceived a higher level of burden were more likely to be women, to have lower annual income, and to report a high level of depressive symptoms, poor physical health, and strained family interactions. Findings suggest that future programs in promoting adherence to antiretroviral treatment should address issues related to psychosocial well-being and PLH's interactions with their family members. [ABSTRACT FROM AUTHOR]

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