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This study utilizes semi-structured interviews to explore the status quo of teacher training of rural and urban public primary school teachers in Henan Province China. Our findings showed that both rural and urban teachers had very limited training opportunities available to them. Most of the participants did not find the current training opportunities useful in improving their teaching practices. Both rural and urban teachers desired training in pedagogy, educational psychology, and curriculum. Rural teachers particularly expressed the need for training in ICT and classroom management skills. Observing education experts' demonstration classes is the most preferred training format. Policy implications are discussed.

In response to the COVID-19 epidemic, many education systems have relied on distance learning and educational technologies to an unprecedented degree. However, rigorous empirical research on the impacts on learning under these conditions is still scarce. We present the first large-scale, quantitative evidence detailing how school closures affected education in China. The data set includes households and teachers of 4,360 rural and urban primary school students. We find that although the majority of students engaged in distance education, many households encountered difficulties including barriers to learning (such as access to appropriate digital devices and study spaces), curricular delays, and costs to parents equivalent to between 3.5 and 6 months of income. We also find significant disparities across rural and urban households.

Research in developed countries has found that paternal involvement has positive and significant effects on early childhood development (ECD). Less is known, however, about the state of paternal involvement and its influence on ECD in rural China. Using data collected in Southern China that included 1,460 children aged 6-42 months and their fathers (as well as their primary caregivers), this study examines the association between paternal involvement and ECD. Although the results demonstrate that the average level of paternal involvement is low in rural China, paternal involvement is related to a significant increase in three domains of ECD (cognition, language, and social-emotional skills). Older children benefit significantly more than do younger children from paternal involvement in all domains of ECD. The results also show that, if the mother is the primary caregiver, the mother's higher educational level and the family's higher socioeconomic status are positively associated with paternal involvement.

This study examined the association between visual impairment, visual impairment corrected by wearing eyeglasses, academic performance, and mental health among junior high school students in rural China. Visual acuity assessments were conducted on 19,425 junior high school students by trained medical and research professionals to determine the presence of visual impairment. All sample students were surveyed with a questionnaire that asked about individual and family characteristics, eyeglasses ownership, and educational aspirations and included a standardized math test. Students then completed an official Chinese simplified version of the Strengths and Difficulties Questionnaire (SDQ) to assess their mental health multidimensionally. Among our sample, 37.2% of them suffered from visual impairment, but only 43.4% of the visually impaired students wore proper eyeglasses. Approximately 9.3% of students were categorized as high risk for mental health problems based on their SDQ score. A significant positive association existed between impaired vision and poorer mental health, and eyeglasses usage was associated with better mental health among visually impaired students. For students with better academic performance, eyeglasses usage associated with better mental health. Eyeglasses usage shows a positive association with higher education aspiration both for students with better and worse academic performance. The significant positive relationship between eyeglasses usage and mental health may guide future interventions and policies designed to improve student mental health by supplying them with eyeglasses. [ABSTRACT FROM AUTHOR]

Purpose: Depression is a growing public health concern around the world. For adolescents, depression not only impedes healthy development, but is negatively associated with academic performance. The purpose of this paper is to examine the prevalence of adolescent depressive symptoms in a sample of rural primary and junior high school students. Additionally, we examine various factors to identify subgroups within the sample that may be more vulnerable to depression. Finally, we explore the extent to which depression correlates with academic performance and conduct a series of heterogeneity analyses. Patients and Methods: We utilize cross-sectional data derived from 30 schools in underdeveloped regions of rural China encompassing primary and junior high school students (n = 1,609). Results: We find a high prevalence of depression, with 23% and 9% of students experiencing general depression (depression score ≥ 14) and severe depression (depression score ≥ 21), respectively. Female gender, elevated stress and anxiety levels, boarding at school, exposure to bullying, and having depressed caregiver(s) are positively correlated with depressive symptoms, while high social support exhibits a negative association. Importantly, our analyses consistently show a significantly negative link between depression and academic performance, which is measured using standardized math tests. For instance, transitioning from a non-depressed state to a state of general depression (depression score ≥ 14) is linked to a decline of 0.348– 0.406 standard deviations in math scores (p < 0.01). Heterogeneity analyses reveal that this adverse relationship is more pronounced for male students, boarding students, those with lower social support, individuals with more educated mothers, and those with lower family assets. Conclusion: Our findings underscore the high prevalence of depression in rural schools and the detrimental impact on academic performance. We advocate for the implementation of policies aimed at reducing student depression, particularly within vulnerable populations and subgroups. [ABSTRACT FROM AUTHOR]

Background: Childhood malnutrition is commonplace among poor rural communities in China. In 2012, China launched its first nationwide school-feeding program (SFP) to address this problem. This study examines the prevalence of malnutrition before and after the SFP and identifies possible reasons for the trends observed. Methods: Ordinary least squares regression and propensity score matching were used to analyze data from 2 cross-sectional surveys of 100 rural primary schools in northwestern China. Participants were fourth-and fifth-grade students. Outcome measures include anemia rates, hemoglobin levels, body mass index, and height for age Z scores. Results: Three years after implementation of the SFP, malnutrition rates among sample students had not fallen. The SFP had no statistically significant effect on either anemia rates or BMI, but was linked to an increase in the proportion of students with below normal height for age Z scores. Meals provided to students fell far short of national recommendations that the SPF should provide 40% of the recommended daily allowance of micronutrients. Conclusions: Despite significant budgetary outlays between 2012 and 2015, China's SFP has not reduced the prevalence of malnutrition among sample students. To make the SFP more effective, funding and human resources both need to be increased.

This study aims to investigate the developmental status of rural Chinese children, the extent of interactive parenting they receive, and the relation between the two. A sample of 448 six to eighteen-month-old children and their caregivers were randomly selected from two rural counties in Hebei and Yunnan provinces. According the third edition of the Bayley Scales of Infant and Toddler Development, 48.7% of sample children exhibited cognitive delays, 40.6% language delays, and 35% social-emotional delays. According to responses from caregivers, parenting in rural China is largely passive, lacking in interactive practices like storytelling, singing, and playing. Children-with-siblings, left-behind children, and children with less-educated mothers were even less likely to receive interactive practices. Children of caregivers who did engage in best parenting practices showed better cognitive, language, and social-emotional development; however, the public health system provides no platform for learning about optimal parenting.

It is commonly believed that reading challenges should be addressed early to reduce the likelihood that developmental delays will impact students over the long term. However, students in developing countries often have limited access to reading resources. In this study, the authors used a randomized controlled trial of 11,083 fourth- and fifth-grade students in 120 primary schools in rural China to examine the causal effect of an in-class library program on student reading outcomes and academic achievement in schools with poor reading resources over an eight-month period. An in-class library was installed in each of the selected classes in the 40 treatment schools. The authors found that the program significantly improved student affinity toward reading and student reading habits, and in these regards, it narrowed the gap between male and female students, between low- and high-performing students, and between left-behind children and children living with parents. However, the authors found no overall effect of the program on reading and academic achievement and a negative effect on student confidence in reading. There was also no effect on student, teacher, and primary caregiver perceptions toward the effect of independent reading on academic achievement, nor any effect on whether teachers and primary caregivers provided reading instructions to students. The authors propose three possible explanations for these findings: a lack of reading instruction from teachers and caregivers, a lack of reading materials specifically tailored to local needs and interests, and the relatively short duration of the intervention.

Background: The association between sleep patterns and young students' mental health, which is crucial for their development, remains understudied in rural China. Therefore, the relationship between sleep patterns and mental health among primary and junior high school students in rural China was examined. Method: A total of 1592 primary and junior high school students from rural areas of Gansu Province were surveyed, and the Depression Anxiety and Stress Scale (DASS) was utilized to assess mental health, alongside self-reported data on their daily sleep patterns. Results: Significant sleep inadequacies were identified: 28% of students received less than 8 h of sleep on weekdays, and 19% went to bed later than recommended. On weekends, 38% of students had delayed bedtimes, though only 7.2% received less than 8 h of sleep. Notably, a "U-shaped" relationship was uncovered between sleep duration and mental health for students on weekends, with optimal mental health correlated with receiving 10–11 h of sleep, while both shorter and longer sleep durations on weekends worsened outcomes. This pattern is absent on weekdays. Additionally, adequate sleep and an earlier bedtime was linked to a 6–8% decrease in mental health risks. Conclusions: These findings provide valuable insights for policymakers seeking to enhance student mental well-being in rural settings, emphasizing the importance of implementing measures that promote balanced sleep habits among young students. [ABSTRACT FROM AUTHOR]

EdTech, which includes computer-assisted learning (CAL), online education, and remote instruction, was expanding rapidly even before the COVID-19 pandemic. Studies of CAL interventions often find positive effects; however, these "CAL programs" often include non-technology-based inputs such as more time spent on learning and additional instructional support by facilitators. In this paper, we discuss the possible channels by which CAL programs affect academic outcomes among schoolchildren. We isolate the technology-based effects of CAL from the total program effects by designing and performing a novel multitreatment field experiment in rural China. For the full sample, we find null effects for both the total CAL program and the technology-based effects of CAL on math test scores. For boys, however, we find a positive and statistically significant effect of the CAL program but do not find evidence of a positive effect for the technology-based effect of CAL. When focusing on grades, we find evidence of positive CAL program effects but find null effects when we isolate the technology-based effects of CAL. Our empirical results suggest that the "Tech" in EdTech may have relatively small additional effects on academic outcomes, yet tech programs can substitute at least to a certain extent for traditional learning. [ABSTRACT FROM AUTHOR]

Research suggests that elements of the family environment may have significant associations with cognitive and language development outcomes. Less is known, however, about the family environment in peri-urban China, where rates of cognitive and language delay in children aged 0-3 years are as high as 51% and 54%, respectively. Using data collected from 81 peri-urban households with toddlers aged 18-24 months in Southwestern China, this study examines the associations between stimulating parenting practices, the home language environment, and parental self-efficacy, with cognitive and language development. The results indicate that stimulating parenting practices was significantly associated with cognitive development, the home language environment was significantly associated with language development, and parental self-efficacy was significantly associated with cognitive development. The implications of such findings reveal several mechanisms for supporting healthy cognitive and language development among toddlers from peri-urban China. [ABSTRACT FROM AUTHOR]

Improved survival of preterm low birthweight (LBW) infants due to advances in neonatal care has brought issues such as postnatal development trajectories to the foreground. This study pools evidence from three cluster‐randomized experiments evaluating community‐based psychosocial stimulation programs conducted from 2014 to 2017 that included 3571 rural Chinese children aged 6–24 months (51.1% male, 96.2% Han Chinese). The risk of severe cognitive delay was found to be 26.5 percentage points higher for preterm LBW children than for their peers at age 2.5, with a prevalence rate of 48.3%. Results show that psychosocial stimulation interventions can improve child cognitive development at scale, with beneficial impacts on child cognition disproportionately larger for preterm LBW children, helping them to catch up developmentally. [ABSTRACT FROM AUTHOR]

The goal of this paper is to describe and analyze the relationship between ability tracking and student social trust, in the context of low-income students in developing countries. Drawing on the results from a longitudinal study among 1,436 low-income students across 132 schools in rural China, we found a significant lack of interpersonal trust and confidence in public institutions among poor rural young adults. We also found that slow-tracked students have a significantly lower level of social trust, comprised of interpersonal trust and confidence in public institutions, relative to their fast-tracked peers. This disparity might further widen the gap between relatively privileged students who stay in school and less privileged students who drop out of school. These results suggest that making high school accessible to more students may improve social trust among rural low-income young adults.

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]

Despite rapid economic growth in China since 1978, rural-urban inequality has widened. High levels of socioeconomic inequality can have profound implications for child development and lifelong educational equity. Using a dataset containing early childhood development (ECD) outcomes of 0- to 3-year-olds (N = 9,053) from study sites in Eastern, Central, and Western China, the study finds that the risks of cognitive, language, and motor delay are, respectively, 43.2, 18.3, and 20.7 percentage points higher in rural study sites than in urban Shanghai (ps <.01). Impact evaluation of cluster-randomized experiments shows that parental training (focusing on child psychosocial stimulation and caregiver-child interaction) can improve parenting beliefs and practices (or investments) and ECD outcomes of disadvantaged rural children (p<.01). Such programs can play an important role in advancing progress toward more social equality and economic equity, the stated goals of China's "Common Prosperity" policy. [ABSTRACT FROM AUTHOR]

This study investigated the association between household characteristics, perceived family support (PFS), and the developmental outcomes (resilience, academic performance, and prosociality) among at-risk students. Our large sample included 1564 primary and secondary school students from poor rural China (M = 11.55 years old). Having a caregiver whose resilience score was in the top 50% of the sample was associated with a 0.48-point increase (or 0.31 d effect size), while having a migrant mother was correlated with a 0.26-point decrease (or 0.17 d effect size). PFS was a significant (p < 0.0001) mediator between household characteristics and developmental outcomes. Our study highlights the link between caregiver resilience and PFS, and the healthy functioning of disadvantaged students in a developing context. [ABSTRACT FROM AUTHOR]

One of the Millennium Development Goals is to ensure universal access to primary education by 2015. However, primary school dropout remains a challenge in many developing countries. While official statistics in China report aggregated primary school dropout of only 0.2%, almost no independent, survey-based studies have sought to verify these dropout rates in rural areas. The primary objective of our study is to document the dropout rate in primary schools in rural China and compare the dropout rate of ethnic minorities and Han students. Using a first-hand dataset of 14,761 primary students in northwest China, we demonstrate that the annual dropout rate in poor rural areas is 2.5%, suggesting a cumulative dropout of 8.2%. Importantly, Hui and Salar minority students drop out at rates that are significantly higher than the official rates. Most noteworthy, 23% of Hui girls and 22% of Salar girls are dropping out by the end of grade 6. Our findings call for more attention to China's primary school dropout issue--especially in minority areas. Policymakers should begin to examine new ways to increase the chances for minority students to succeed in the educational system.

The home language environment is a critical point of investment in early language skills. However, few studies have quantitatively measured the home language environment of low-socioeconomic-status households in non-western settings. This mixed methods study describes the home language environment and early child language skills among households in a low-socioeconomic-status, peri-urban district of Chengdu, China, and identifies factors influencing parental investment in the home language environment. Audio recordings were collected from 81 peri-urban households with children ages 18–24 months and analysed using the Language Environment Analysis (LENATM) system. The Mandarin version of the MacArthur-Bates Communicative Development Inventory was administered to each child's primary caregiver. The quantitative results revealed large variation in home language environments and child language skills among the sample, with relatively low average scores when compared to other Chinese samples. Qualitative interviews with a subset of 31 caregivers revealed that many caregivers face constraints on their knowledge of interactive parenting, compounded, in some households, by time constraints due to work or household responsibilities. The findings indicate a need for increased sources of credible parenting information for peri-urban caregivers of young children to promote investment in the home language environment. [ABSTRACT FROM AUTHOR]

Besides increasing knowledge, there is another potential mechanism at work when information is delivered to a treatment group: increasing the salience of existing knowledge. We use data from a randomized controlled trial of a health information campaign to explore the relative importance of this additional mechanism in a real-world environment. The health information campaign addressed the benefits of wearing eyeglasses and provided information meant to address the common misconceptions that contribute to low adoption rates of eyeglasses. In total, our study sample included 931 students with poor vision (mostly myopia), their parents, and their homeroom teachers in 84 primary schools in rural China. We find that the health information campaign was able to successfully increase student ownership and wearing of eyeglasses, relative to a control group. We demonstrate that the campaign had a larger impact when levels of preexisting information among certain subgroups of participants—namely, parents of students—were higher while we simultaneously provided new information to others. This suggests that the interaction between directed attention (i.e., salience) and baseline knowledge is important. We do not, however, find similar increases among teachers or the students themselves and additionally find no impacts on academic outcomes. [ABSTRACT FROM AUTHOR]

Aiming to provide better education facilities and improve the educational attainment of poor rural students, China's government has been merging remote rural primary schools into centralized village, town, or county schools since the late 1990s. To accompany the policy, boarding facilities have been constructed that allow (mandate) primary school-aged children to live at school rather than at home. More generally, there also have been efforts to improve rural schools, especially those in counties and towns. Unfortunately, little empirical work has been available to evaluate the impact of the new merger and investment programmes on the educational performance of students. Drawing on a unique dataset that records both the path by which students navigate their primary school years (i.e., which different types of schools did students attend) as well as math test scores in three poverty-stricken counties, we use descriptive statistics and multivariate analysis (both Ordinary Least Squares (OLS) and covariate matching) to analyse the relationship between different transfer paths and student educational performance. This allows us to examine the costs and benefits of the school merger and investment programmes. The results of the analysis show that students who attend county schools perform systematically better than those who attend village or town schools. However, completing primary school in town schools seems to have no effect on students' academic performance. Surprisingly, starting primary education in a teaching point does not hurt rural students; on the contrary, it increases their test scores in some cases. Finally, in terms of the boarding effect, the neutral estimate in OLS and the negative estimate in covariate matching results confirm that boarding at school does not help the students; in some cases it may even reduce their academic performance.

Experts agree that computers and computing play an important role in education. Since the 1980s there has been a debate about gender as it relates to computers and education. However, results regarding gender differences concerning computer use in education are not consistent. In particular there is little work done in China on this issue. Therefore, the overall goal of this paper is to demonstrate whether girls and boys can gain equally from computer-based education in China's elementary schools. To do so we analyze results from three randomized field experiments of a Computer Assisted Learning (CAL) program and One Laptop Per Child (OLPC) program. The field experiments are carried out in three kinds of schools: Shannxi rural public schools; Qinghai minority public schools; and Beijing migrant schools. Although CAL and OLPC have been considered cost effective means to improve learning outcomes, it is not known whether the programs impact girls differently than boys. Our analysis shows that, in fact, there were no differences between female and male students in either the improvement in standardized math test scores or Chinese test scores with either the CAL or OLPC programs. Our study suggests that among disadvantaged students in China's rural areas and migrant communities, there is reason to believe that computer based learning can benefit both girls and boys equally. This finding has possible implications for China's ongoing efforts to integrate computers and computing technologies into the nation's underserved schools. (Contains 7 tables.)

Despite requirements of and support for universal education up to grade 9, there are concerning reports that poor rural areas in China suffer from high and maybe even rising dropout rates. Although aggregated statistics from the Ministry of Education show almost universal compliance with the 9-year compulsory education law, there have been few independent, survey-based studies regarding dropout rates in China. Between 2009 and 2010 we surveyed over 7800 grade 7, 8, and 9 students from 46 randomly selected junior high schools in four counties in two provinces in North and Northwest China to measure the dropout rate. We also used the survey data to examine factors correlated with dropping out, such as the opportunity cost of going to school, household poverty, and poor academic performance. According to the study's findings, drop out rates between grade 7 and grade 8 reached 5.7% and dropout rates between grade 8 and grade 9 reached 9.0%. In sum, among the total number of students attending junior high school during the first month of the first term of grade 7, 14.2% had left school by the first month of grade 9. Dropout rates were even higher for students that were older, from poorer families (and families in which the parents were not healthy), or were performing more poorly academically. We conclude that although the government's policy of reducing tuition and fees for junior high students may be necessary, it is not sufficient to solve the dropout problem. (Contains 5 tables.)

In the late 1990s and early 2000s, China's Ministry of Education embarked on an ambitious program of primary school mergers by shutting down small village schools and opening up larger centralized schools in towns and county seats. The goal of the program was to improve the teacher and building resources in an attempt to raise the human capital of students in poor rural areas, although it was recognized that students would lose the opportunity to learn in the settings of their own familiar villages. Because of the increased distances to the new centralized schools, the merger program also entailed building boarding facilities and encouraging or mandating that students live at school during the week away from their family. Given the magnitude of the program and the obvious mix of benefits and costs that such a program entails there has been surprisingly little effort to evaluate the impact of creating a new system that transfers students from school to school during their primary school period of education and, in some cases, making student live in boarding facilities at school. In this paper, our overall goal is to examine the impact of the Rural Primary School Merger Program on academic performance of students using a dataset from a survey that we designed to reflect transfer paths and boarding statuses of students. We use OLS and Propensity Score Matching approaches and demonstrate that there is a large ''resource effect'' (that is, an effect that appears to be associated with the better facilities and higher quality of teachers in the town and county schools) that appears to be associated with the transfers of students from less centralized schools (such as village schools) to more centralized schools. Boarding, however, is shown to have negative impacts on academic performance. However, students who transfer to county school benefit from the transfer no matter where they start and whether they board or not. (Contains 2 figures and 8 tables.)

The main goal of this paper is to analyse factors (accessibility, attendance rates and quality of preschools) that may be affecting the educational readiness of China's rural children before they enter the formal school system. Using data from a survey of 82 preschools and 492 households in six counties in three provinces of China, this paper documents the nature of early childhood education (ECE) services and the educational readiness of children aged four to five years in rural China. We present evidence that ECE services are seriously deficient. We show that China's rural children score much lower on standardised tests of educational readiness than their urban counterparts and that more than one half of the rural children in our sample are "not ready" to continue on to the next level of formal education, possibly owing to the poor quality of early childhood education and low participation rates in early childhood education. (Contains 5 tables and 2 figures.)

Although universities have expanded in size, it is unclear whether the poor have benefited. If there are high returns to college education, then increasing access of the poor to college has important welfare implications. The objective of this paper is to document the rates of enrollment into college of the poor and to identify the hurdles to doing so. Relying on several sets of data, including a survey of college students from universities in three poor provinces in China, we have found that the college matriculation rate of the poor is substantially lower than students from non-poor families; the same is true for rural women and minorities. Clearly, there are barriers that are keeping the rural poor out. The paper also demonstrates that the real hurdles are not during the years of secondary schooling or at the time of admissions to college. The real impediments keeping the rural poor from pursuing a college education arise long before high school--as early as preschool and elementary school years--and are present throughout the entire schooling system.

Many educational systems have struggled with the question about how best to give out financial aid. In particular, if students do not know the amount of financial aid that they can receive before they make a decision about where to go to college and what major to study, it may distort their decision. This study utilizes an experiment (implemented by the authors as a Randomized Control Trial) to analyze whether or not an alternative way of providing financial aid--by providing an early commitment on financial aid during the student's senior year of high school instead of after entering college--affects the college decision making of poor students in rural China. We find that if early commitments are made early enough; and they are large enough, students will make less distorting college decisions. (Contains 5 tables and 3 figures.)

The main goal of this paper is to analyse the effect of high school scholarships tied to community service on the development of secondary school students in Northwest China. Using data from three rounds of surveys of thousands of students in 298 classes in 75 high schools in Shaanxi province, the paper documents the implementation of the Compassionate Heart Scholars Program and evaluates the effect of the programme on the educational performance, self-esteem, self-efficacy and social responsibility of the participants. We present evidence that part of the protocol of the programme (which includes the nomination and election of programme participants) improves the academic performance and self-esteem of those involved in the programme. The community service part of the programme is shown to raise the self-efficacy and the sense of social responsibility of the programme participants. One striking result is that the test scores of the community service participants do not appear to be adversely affected, even though they spend considerable time doing community service. The findings of this study, therefore, suggest that adding extra-curricular community service to school curricula may be a win-win-win strategy, for the students, for schools and for the local communities served. (Contains 1 figure, 4 tables and 8 notes.)

We examine the impact of primary school mergers on academic performance of students using a dataset that we collected using a survey designed specifically to examine changes in the academic performance of students before and after their schools were merged. We use difference-in-differences and propensity score matching approaches and demonstrate that overall the primary school merger has not harmed the academic performance of students, as some have claimed. We do find, however, that the timing of mergers matter; when students are older (e.g., the fourth grade) their grades rise after merging. The grades of younger students, however, fall. (Contains 9 tables and 4 figures.)

Despite the rise in grade retention in poor areas in rural China recently, little work has been done to understand the impact of grade retention on the educational performance of students in these areas in rural China. This paper seeks to redress this shortcoming and examines the effect of grade retention on educational performance on 1649 students in 36 elementary schools in Shaanxi province. With a dataset that was collected from a survey designed specifically to capture school performance of students before and after they were retained, we use differences-in-differences, propensity score matching and differences-in-differences matching approaches to analyze the effect of grade retention on school performance. Although the descriptive analysis shows that grade retention helps to improve the scores of the students that were retained, somewhat surprisingly, the results from the multivariate analysis consistently show that there is no significant positive effect of grade retention on school performance of the students. In fact, in some cases (e.g., for the students who repeat grade 2), grade retention is shown to hurt school performance. (Contains 13 tables.)

The main goal of this paper is to document the nature of boarding schools and empirically analyse the difference in nutrition intake and malnutrition status between boarding and non-boarding students in western rural China. By using two data sets on boarding schools and boarding students in Shaanxi Province, a representative province in western rural China, this paper finds that dormitory and student canteen facilities in boarding schools are under-equipped and services are of poor quality, far below that needed for student development. Poor services in boarding schools and inadequate nutrition intake may be an important cause of low student height-for-age Z-scores (HAZ), as students eating at school have a much lower HAZ on average than that of non-boarding students. Furthermore, girls and students with more siblings have relatively lower HAZ, while the higher the number of parents a student has and the more educated they are exerts a positive influence on child nutritional status. Finally, our analysis implies that the effective way to decrease the inequality of health, malnutrition and human capital between urban and rural areas in the long run is to improve the facilities and services of boarding schools in rural China. (Contains 8 tables, 4 figures and 7 notes.)

China has made remarkable progress along the path of economic transformation over the past three decades. To continue its rapid growth in an economy with increasingly higher wages, China's key challenge is whether it can become competitive enough in quasi-skilled and skilled sectors so that more technologically advanced industries and service sector firms eventually take the place of exiting low-wage factories. This study seeks to increase our understanding of high school education in China at a time when the nation is facing challenges in its development path. Using secondary statistics, we have found that educational access at the high school level is quite low, especially in poorer areas of rural China. We argue that the low level of access to high school education in China may be a problem resulting from high tuition and fees. We include empirical evidence about the tuition barrier argument by using a survey of 41 developing and developed countries and a representative survey of 1177 students from one of China's poorest provinces. We demonstrate that not only is financing high school a burden for the families of poor students, but there is also little financial aid available. The quality of education of students from poor rural areas prior to entering high school is also a problem. We conclude with a recommendation that in poor rural areas of China high school should be made free, as it is in most of the rest of the world, and efforts should be made to improve rural education in general. (Contains 3 tables, 3 figures and 9 notes.)

Background: Mothers' perception of infant hunger cues is a critical content of responsive feeding, which is central to the promotion of early childhood development. However, only a few studies have examined responsive feeding in China, especially lacking the studies on perceptions of infant hunger cues. Consider the cultural differences, the aim of this study was to describe the perceptions of infant hunger cues of Chinese mothers for infants aged 3 months, and explore the relationship between maternal perceptions of infant hunger cues and different feeding methods. Methods: A cross-sectional study was conducted with a sample of 326 mothers of healthy 3-month-old infants, including 188 exclusive breastfeeding (EBF) mothers and 138 formula feeding (FF) mothers. It was implemented in four provincial and municipal maternal and child health hospitals. The mothers' perceptions of infant hunger cues were surveyed by self-reporting questionnaires. Chi-square tests and logistic analysis were applied to analyze the differences in maternal perceptions of infant hunger cues, including the number of hunger cues and the specific cues, between EBF group and FF group by controlling sociodemographic variables and the daily nursing indicators. Results: We found that a higher proportion of EBF mothers could perceive multiple hunger cues (≥ 2) than FF mothers (66.5% vs.55.1%). For specific cues, the EBF mothers had higher perceptions of infant's "hand sucking" (67.6% vs. 53.6%) and "moving head frantically from side to side" (34.6% vs. 23.9%), all p < 0.05. Regression analysis revealed that EBF might support mothers to perceive infant hunger cues than FF mothers, with the number of infant hunger cues (OR = 1.70, 95% CI: 1.01–2.85), "hand sucking" (OR = 1.72, 95% CI: 1.04–2.87), "moving head frantically from side to side" (OR = 2.07, 95% CI: 1.19–3.62). The number of infant hunger cues perceived by mothers was also associated with their educational level and family structure. Conclusion: EBF mothers of 3-month-old infants may be more likely to perceive infant hunger cues than FF mothers in China. It is necessary to increase the health education about infant hunger and satiety cues to caregivers in China, especially among mothers with lower education levels, mothers living in nuclear families, and FF mothers. [ABSTRACT FROM AUTHOR]

Objective: To examine Hb level and anaemia status among infants under 6 months of age in rural China. Design: A cross-sectional survey collected data among infants under 6 months and their primary caregivers in Sichuan, China. Anaemia was defined using both the WHO and China Pediatrics Association thresholds. Multivariable linear regression was used to identify relevant factors among two age groups (<4 months; 4–5 months). Setting: Eighty townships were selected in Sichuan, China from November to December 2019. Participants: Nine hundred and forty-two infants under 6 months, while Hb level was tested for 577 infants. Results: The overall mean (±sd) Hb level was 106·03 (± 12·04) g/l. About 62·6 % (95 % CI 58·5, 66·6) of sample infants were anaemic using the WHO threshold, and 20·5 % (95 % CI 17·3, 24·1) were anaemic using the China Pediatrics Association thresholds. Anaemia rates rose with increasing age in months. Multivariable linear regressions revealed that lower Hb levels were significantly associated with lower birth weight (<4 months: β = 4·14, 95 % CI 0·19, 8·08; 4–5 months: β = 6·60, 95 % CI 2·94, 10·27) and delivery by caesarean section (<4 months: β = −4·64, 95 % CI −7·79, −1·49; 4–5 months: β = −4·58, 95 % CI −7·45, −1·71). Conclusion: A large share of infants under 6 months in rural western China are anaemic. Infants with low birth weight and caesarean delivered should be prioritised for anaemia testing. Future studies should move the point of focus forward to at least 4 months of age and examine the link between caesarean section and anaemia to promote health and development in infancy. [ABSTRACT FROM AUTHOR]

Purpose: We examine how adolescent free time allocation—namely, screen time and outdoor time—is associated with mental health and academic performance in rural China. Methods: This paper used a large random sample of rural junior high school students in Ningxia (n = 20,375; age=13.22), with data collected from self-reported demographic questionnaires (to assess free time allocation), the Strengths and Difficulties Questionnaire (to assess mental health), and a standardized math test (to measure academic performance). We utilized a multivariate OLS regression model to examine associations between free time allocation and adolescent outcomes, controlling for individual and family characteristics. Results: Our sample's screen time and outdoor time both averaged around 1 hour. About 10% of the sample adolescents reported behavioral difficulties, while a similar percentage (11%) reported abnormal prosocial behaviors. Adolescents with higher levels of screen time (> 2 hours) were 3 percentage points more likely to have higher levels of behavioral difficulties (p< 0.001), indicating that excessive screen time was associated with worse mental health. Meanwhile, outdoor time was associated with better mental health, and positive correlations were observed at all levels of outdoor time (compared to no outdoor time, decreasing the likelihood of higher levels of behavioral difficulties by between 3 and 4 percentage points and of lower prosocial scores by between 6 and 8 percentage points; all p's< 0.001). For academic performance, average daily screen times of up to 1 hour and 1– 2 hours were both positively associated with standardized math scores (0.08 SD, p< 0.001; 0.07 SD, p< 0.01, respectively), whereas there were no significant associations between outdoor time and academic performance. Conclusion: Using a large sample size, this study was the first to examine the association between adolescent free time allocation with mental health and academic performance, providing initial insights into how rural Chinese adolescents can optimize their free time. [ABSTRACT FROM AUTHOR]

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Background: A rich language environment is an important element of a nurturing home environment. Despite their proven importance, vocabulary and conversation have been shown to vary widely across households—even within the same socio-economic class. One significant gap in the existing literature is its nearly exclusive geographic focus on Western and developed settings, with little attention given to poorer communities in lower/middle income countries. The purpose of this study was to empirically illustrate the characteristics of the home language environment in the low SES, non-Western cultural setting of rural China. Methods: Using Language Environment Analysis (LENA) automated language-analysis system, this study measured the home language environment of 38 children aged 20-27 months in Northwest rural China. Our primary measures of the home language environment were Adult Word Count (AWC), Conversational Turn Count (CTC) and Child Vocalization Count (CVC). Multivariate linear regression models were used to examine the association between home language environment and family/child characteristics, and language skills (Measured by MacArthur-Bates Communicative Developmental Inventory score). Results: In this paper, by comparison, we found that the home language environment of our rural sample fell far behind that of urban households. We also identify significant, positive correlations between language skills and both AWC and CTC. Our analysis finds no significant correlations between home language environment and family/child characteristics. Conclusion: In this paper, we present the first ever findings using the LENA system to measure the home language environment of young children from poor rural communities in China. We found that the home language environment of lower-SES household was significantly worse than high-SES households, and demonstrated the importance of the home language environment to language skills, pointing to a need for more high-quality studies of the home language environment in rural China to better understand possible mechanisms behind low levels of parent-child language engagement and ways to improve the home language environment. [ABSTRACT FROM AUTHOR]

Academic achievement in middle schools in rural China remains poor for many students. This study examines whether programmes and interventions can improve academic achievement by reviewing rigorous experimental evaluations of nine programmes (11 interventions) on 47,480 rural middle school students in China. The results find none of the interventions improved academic achievement. Moreover, we find no evidence for heterogeneous treatment effects by student gender, age or previous academic achievement. These results may be due in part to the academically-demanding nature of the middle school curriculum, which is applied universally to students with varying levels of cognitive ability. [ABSTRACT FROM AUTHOR]

Background: The WHO recommends daily use of micronutrient powder for infants and toddlers at risk of micronutrient deficiencies in low-and-middle-income countries. China has established a micronutrient powder distribution program in many rural townships and villages, yet adherence to micronutrient powder remains suboptimal; a little is known about the behavioral inputs that may influence adherence. This study examines direct and indirect behavioral inputs in micronutrient powder adherence among caregivers in rural western China following the Integrated Behavioral Model (IBM) framework.Methods: Cross-sectional data were collected from April to May 2019 among 958 caregivers of children aged 6 to 24 months in six counties. Data were collected on micronutrient powder adherence behavior, direct behavioral inputs (knowledge and skills, intention, salience, environmental constraints, and habits), and indirect behavioral inputs (attitudes, perceived social norms, and personal agency). Structural equation modeling (SEM) adjusted for sociodemographic covariates was used to evaluate the IBM framework.Results: Mean micronutrient powder adherence in the previous seven days was 53.02%, and only 22.86% of caregivers consistently fed micronutrient powder from the start of micronutrient powder distribution at six months of age. The SEM model revealed small- to medium-sized effects of salience (β = 0.440, P < 0.001), intention (β = 0.374, P < 0.001), knowledge and skills (β = 0.214, P < 0.001), personal agency (st. effect = 0.172, P < 0.001), environmental constraints (β=-0.142, P < 0.001), and caregiver generation (β = 0.119, P < 0.05) on micronutrient powder adherence. Overall, 54.7% of the variance in micronutrient powder adherence was explained by the IBM framework. Salience had the largest impact on micronutrient powder adherence (Cohen's f 2 = 0.227). Compared to parent caregivers, grandparents had a higher degree of micronutrient powder adherence on average (P < 0.001), and behavioral inputs were consistent among both parent and grandparent caregivers.Conclusion: There is a need to improve micronutrient powder adherence among rural caregivers. The IBM framework showed a high degree of explanatory power in predicting micronutrient powder adherence behavior. The findings suggest that increased reminders from doctors regarding micronutrient powder and coaching to improve personal agency in micronutrient powder feeding may increase adherence. [ABSTRACT FROM AUTHOR]

Behavioral strengths and difficulties among children and adolescents may be significantly associated with their academic performance; however, the evidence on this issue for rural youth in developing contexts is limited. This study explored the prevalence and correlates of mental health from three specific dimensions—internalizing problems, externalizing problems, and prosocial behavior—measured by the Strengths and Difficulties Questionnaire (SDQ), and the association of these dimensions with academic performance in math among a sample of 1500 students in rural China. Our findings indicated that students in rural China had worse behavioral difficulties and poorer prosocial skills when compared to most past studies conducted inside and outside of China. In addition, total difficulties and prosocial scores on the SDQ were significantly associated with student math test scores, as students whose externalizing, internalizing, and prosocial scores were in the abnormal range scored lower in math by 0.35 SD, 0.23 SD, and 0.33 SD, respectively. The results add to the growing body of empirical evidence related to the links between social environment, mental health, and academic performance in developing countries, highlighting the importance of students' mental health for their academic performance, and of understanding risk factors in the social environment among rural youth in developing countries. [ABSTRACT FROM AUTHOR]

Background: The importance of breastfeeding in low- and middle- income countries is well recognized, yet the importance of postnatal mental health on breastfeeding practices and beliefs in these settings has been understudied. This study investigates the associations between maternal mental health problems, breastfeeding beliefs and breastfeeding practices in rural China. Methods: Cross-sectional data were collected in November and December 2019 from 742 mothers of infants under 6 months old in rural Sichuan Province, China. Maternal mental health (depression, anxiety, and stress symptoms) was assessed using the Depression, Anxiety, and Stress Scale (short form). Breastfeeding beliefs were assessed using the Iowa Infant Feeding Attitude Scale and Breastfeeding Self-Efficacy Scale (short form). Breastfeeding practices were assessed through a 24-h dietary recall questionnaire. Ordinary least squares regression, multiple logistic regression and heterogeneous effects analyses were used to identify associations between symptoms of mental health problems and breastfeeding outcomes. Results: The average age of sample infants was 2.7 months. Among mothers, 13% showed symptoms of depression, 16% anxiety, and 9% stress. The prevalence of exclusive breastfeeding in the previous 24 h was 38.0%. Depression symptoms were significantly associated with breastfeeding attitude (훽= − 1.11, 95% CI: − 2.07, − 0.14) and breastfeeding self-efficacy (훽= − 3.19, 95% CI: − 4.93, − 1.45). Anxiety and stress symptoms were significantly associated with breastfeeding self-efficacy (훽= − 1.81, 95% CI: − 3.43, − 0.18 and 훽 = − 2.88, 95% CI: − 4.98, − 0.78, respectively). There were no significant associations between symptoms of mental health problems and exclusive breastfeeding. The heterogeneous effects analyses revealed that less educated mothers with symptoms of stress had lower odds of exclusive breastfeeding than educated mothers without symptoms of stress (OR: 0.53, 95% CI: 0.25,1.10). Mothers of younger infants had higher odds of exclusive breastfeeding than the mother of older infants, regardless of depression, anxiety, or stress symptoms. Conclusion: Symptoms of maternal mental health problems are significantly associated with breastfeeding attitude and self-efficacy; however, these symptoms are not associated with breastfeeding practices. Maternal educational level and infant age may play a role in mothers' breastfeeding practices. To improve breastfeeding practices, interventions should employ a multi-dimensional approach that focuses on improving maternal mental well-being and considers demographic characteristics. [ABSTRACT FROM AUTHOR]

Background: High adherence and proper usage of micronutrient powder (MNP) influence child nutritional outcomes, yet few studies explore the role of delivery patterns. This study explores the association between MNP delivery patterns and MNP feeding behaviors among Han and minority caregivers in rural Western China.Methods: In August 2019, a total of 1021 caregiver-child pairs were selected through a four-stage cluster sampling process. A cross-sectional survey collected information on caregiver demographics, MNP delivery patterns (channel and frequency), and MNP feeding behaviors (proper usage and adherence). Using logistic regression, we examined which delivery channels and delivery frequencies were associated with proper usage and high adherence.Results: The results indicated that minority caregivers had lower levels of proper MNP usage than did Han caregivers (89.2%), with Tibetan caregivers' reporting the lowest rates of adherence (32.6%). Logistic regression revealed that that township-based channel was significantly correlated with proper usage among Tibetan and Yi caregivers (Odds Ratio, OR = 2.0, p < 0.01; and OR = 3.5, p < 0.001). Overall, the township-based and home-visit channels were significantly correlated with high adherence (OR = 1.7 and OR = 2.3, respectively; p < 0.001); delivery frequency was significantly correlated with high adherence (2 months: OR = 2.2, p < 0.001 and ≤ 1 month: OR = 3.5, p < 0.001) but not correlated with proper usage among the whole sample and individual ethnic groups.Conclusions: In conclusion, the study finds evidence of a correlation between MNP delivery channel and both proper usage and high adherence as well as a correlation between MNP delivery frequency and high adherence. [ABSTRACT FROM AUTHOR]

Background: Improving primary care providers' competence is key to detecting and managing hypertension, but evidence to guide this work has been limited, particularly for rural areas. This study aimed to use standardized clinical vignettes to assess the competence of providers and the ability of the primary healthcare system to detect and manage hypertension in rural China.Methods: A multi-stage random sampling method was administered to select target health facilities, providers, and households. The clinical vignette script was developed to evaluate provider competence in managing first-visit patients with symptoms of hypertension. Logistic regression was used to explore the factors correlated with provider competence. Provider referral and management rates were combined with patients' facility sorting behaviors to assess the ability of the rural healthcare system to manage hypertension in three policy scenarios.Results: A total of 306 providers and 153 facilities were enrolled in our study. In the 306 clinical vignette interactions, 25.9% of providers followed the national guidelines for hypertension consultation. The correct diagnosis was achieved by only 10.1% of providers, and 30.4% of providers were able to prescribe the correct treatment. Multi-variable regression results showed that younger providers (OR = 0.85, 95%CI: 0.73, 0.98) and those who work in township health centers (OR = 4.47, 95%: 1.07, 18.67) were more likely to provide a correct diagnosis. In a free-selection scenario, 29.8% of patients with hypertension were managed correctly throughout the rural system. When all patients first visit village clinics, system-level correct management is reduced to 20.5% but increases to 45.0% when all patients first visit township health centers.Conclusions: Rural primary care providers do not have enough competence to detect and treat hypertension cases in China to an acceptable degree. Policy constraints may limit the competence of the rural healthcare system. Research to improve detection and treatment competence in hypertension and optimize health policy is needed. [ABSTRACT FROM AUTHOR]

Background: Breastfeeding self-efficacy is known to positively influence breastfeeding behaviors. While previous research has studied the determinants of breastfeeding self-efficacy in general, these determinants are unstudied among postpartum women in rural China. This study aims to describe the breastfeeding self-efficacy of postpartum women in rural China and identify determinants of breastfeeding self-efficacy using the Dennis breastfeeding self-efficacy framework. Methods: Using a multi-stage random cluster sampling design, cross-sectional survey data were collected from 787 women within the 0–6 months postpartum period in 80 rural townships. Surveys collected data on breastfeeding self-efficacy, characteristics related to the Dennis breastfeeding self-efficacy framework, and demographic characteristics. Multiple linear regression analysis was used to identify determinants of breastfeeding self-efficacy. Results: Participants reported a moderate level of breastfeeding self-efficacy, with an item mean score of 3.50. Self-efficacy was lowest for exclusive breastfeeding. Breastfeeding attitudes (β = 0.088, P< 0.001), breastfeeding family support (β = 0.168, P< 0.001), and social support from significant others (β = 0.219, P< 0.001) were positively associated with breastfeeding self-efficacy. Breastfeeding problems, including trouble with latching (β = -0.170, P< 0.001), not producing enough milk (β = -0.148, P< 0.001), and milk taking too long to secrete (β = -0.173, P< 0.001) were negatively associated with breastfeeding self-efficacy. Conclusion: The findings indicate that positive attitudes, breastfeeding family support and social support contribute to greater breastfeeding self-efficacy in rural China, whereas difficulties with breastfeeding are associated with reduced self-efficacy. Researchers and practitioners should investigate effective strategies to improve social support and family support for breastfeeding, promote positive attitudes towards breastfeeding, and provide women with actionable solutions to breastfeeding problems. [ABSTRACT FROM AUTHOR]