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This study explores the nexus between livelihood goals (LGs) and livelihood strategy (LS) selection preferences. We construct a measurement of three livelihood goals (survival, security, and self-respect goals) by combining qualitative and quantitative analysis and classify livelihood strategies into three groups (agricultural, non-agricultural, and diversification) based on household income sources. The multinomial logit model with fixed effects empirically estimates the relationship between livelihood goal indices and livelihood strategy selection with panel data (2010–2018) from the China Family Panel Studies surveys (CFPS). The results show that households with survival goals are more likely to choose the agricultural and diversification strategies and less likely to select the non-agricultural strategy. Households with security and self-respect goals are more likely to choose the non-agricultural strategy and are less likely to select the agricultural strategy. Families with a higher self-respect goal level are more flexible in livelihood strategy selection. The livelihood strategy selection preference is consistent in different regions of rural China when households pursue survival and security maximization. From the low-level survival goal to the high-level self-respect goal, consistent with a gradual transition from a low-income agricultural strategy to the high-income non-agricultural strategy; the diversification strategy is the transformed livelihood strategy in this process. [ABSTRACT FROM AUTHOR]

AbstractThis study examines the political motivations behind changes in labor migration rates in Chinese villages. Using data from the China village survey, we estimate the impact of the tenure gap between the village committee director and party branch secretary on village labor migration rates. We find that within the dual power structure of villages, a longer political tenure for the secretary relative to the director significantly suppresses village labor migration rates, while a shorter tenure significantly promotes them. IV estimation supports the causal interpretation found by OLS estimation. This mechanism of causality is associated with vested interests stemming from ambiguous ownership, having a director or secretary with a longer political tenure tends to bias these interests towards villagers or township authorities. Other accompanying effects of the tenure gap should not be ignored, including the amplification effect of the non-laboring population, the feedback effect of labor, and the shrinkage effect of outsiders. This causal relationship is heterogeneous, the dual role analysis shows that the structure and stance of village leaders will affect the strength of the causal relationship, and the regional heterogeneity analysis shows that economic factors that drive village labor migration may be more important than political factors. [ABSTRACT FROM AUTHOR]

Introduction: In 2016, the Chinese government officially scaled up family doctor contracted services (FDCS) scheme to guide patients' health seeking behavior from tertiary hospitals to primary health facilities. Methods: This study evaluated the overall gate-keeping effects of this scheme on healthcare utilization of rural residents by using a difference-in-differences (DiD) design. The analysis was based on Shandong Rural Elderly Health Cohort 2019 and 2020. Participants who contracted FDCS in second round and were not contracted with a family doctor in the first round were regarded as treatment group. In total, 310 respondents who have used medical care were incorporated for final study. Results: Participants who contracted FDCS (treatment group) experienced a significant decline in the mean level of first-contact health-care facilities, decreasing from 2.204 to 1.981. In contrast, participants who did not contract FDCS (control group), showed an increasing trend in the mean level of first-contact health-care facilities, rising from 2.128 to 2.445. Our results showed that contracting FDCS is associated with approximately 0.54 extra lower mean level of first-contact health-care facilities (P = 0.03, 95% CI: -1.03 to 0.05), which suggests an approximately 24.5% reduction in the mean first-contact health-care facility level for participants compared with contracted FDCS than those who did not. Conclusions: The study suggested primary healthcare quality should be strengthened and restrictive first point of contact policy should be enacted to establish ordered healthcare seeking behavior among rural residents. [ABSTRACT FROM AUTHOR]

The last decades have witnessed the flourishing of consultative democracy (xieshang minzhu, a concept similar to deliberative democracy) in China, with ambitions for implementing consultative politics and governance. In the West, mainstream deliberative democracy studies largely overlook the fact that deliberation is an elusive and polysemic notion, which develops into various practices in different social and cultural contexts. Therefore, a non-Western-centred approach needs to be adopted to further investigate deliberative experimentation in rural China. Based on the four months of fieldwork conducted in several villages in rural China, this paper argues that China's rural villages have inherited a strong Confucianism-based idea of deliberation and consultation. With case studies from the sociological–political perspective, this paper also aims to shed some new light on the compatibilities between modern democratic governance approaches and the informal, hierarchical and highly moralised forms of public order in the rural Chinese acquaintance society. Incorporating these empirical observations could bridge the gap between Western and Chinese perspectives on the theory and practice of deliberative democracy. [ABSTRACT FROM AUTHOR]

Based on 2022 data from the China Rural Revitalization Survey, we examined the impact of Agro-product Geographical Indications (AGIs) on the subjective well-being of rural residents. The results show that AGIs significantly enhance the subjective well-being of rural residents. This conclusion holds even when employing the exposure frequency of a village in Chinese newspapers regarding agriculture as an instrumental variable for whether this village has an AGI. The propensity score matching test indicates that the subjective well-being of rural residents in villages with AGIs is on average 0.402 higher compared to villages without AGIs, which corresponds to 5.08% of the latter’s average. The underlying mechanism for this impact is that AGIs contribute to elevating household income levels and improving the ecological environment and basic public services within villages. Furthermore, the effects of AGIs are more pronounced among those engaged in agricultural employment and in villages with high governance capacities. These findings imply that governments might enhance the subjective well-being of rural residents by protecting and promoting local agricultural products. [ABSTRACT FROM AUTHOR]

This study deployed photo-elicitation interviews (PEIs) to explore children's emotional experiences of the boarding school and their subjective views in a town-centred boarding school in central China. Through triangulating the visual and oral data generated from PEIs, this study found that child boarders were generally apathetic towards the boarding school. This study further elaborated on children's apathy by analysing their subjective views on the school's physical environment, disciplinary power, adult authority, and peer interaction. Accordingly, I argue that boarding school in rural China has formed a space where children's emotional activities are heavily neglected or suppressed. However, children can tactically retreat from the domination of the boarding school over their emotions, reshaping the school's spatiality from within. These findings highlighted the importance of mutual impacts between children's emotions and the construction of boarding school space. It is also recommended to adopt new research techniques, such as PEIs, to incorporate children's voices into future assessments of boarding schools in rural China. [ABSTRACT FROM AUTHOR]

In China's rural land system, the collective owns the land, and farmers, as members of the collective, can acquire land contractual management rights through land contracting. With the second round of land contracts nearing expiration, the central government has announced that the term should be extended for 30 years. This paper introduces the theory of psychological ownership to explore the implementation paths of the 30-year extension policy. The study finds that (1) farmers generally exhibit strong psychological ownership towards the contracted land. (2) The Household Contract Responsibility System satisfies the three routes for the formation of psychological ownership—control, intimate knowledge, and self-investment. As the duration of farmers' possession of contracted land extends, their psychological ownership gradually forms and strengthens. (3) Farmers' psychological ownership has both positive and negative effects. The 30-year extension policy must adhere to the path dependence formed by the evolution of the land contract system, comply with the institutional constraints imposed by rural land collective ownership, and simultaneously meet the practical demands posed by urban–rural integration and agricultural development. Drawing on the complex effects of farmers' psychological ownership and considering the historical, institutional, and practical contexts of policy implementation, this study proposes the dual necessity of facilitating and restraining farmers' psychological ownership when extending for another 30 years and offers corresponding policy suggestions. Facilitation requires empowering farmers with more stable land possession and stronger land rights. Restraint requires preventing the permanent locking of rural land allocation patterns to achieve fair and efficient land allocation. [ABSTRACT FROM AUTHOR]

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]

Introduction: Understanding the relationship between parenting style and the non-cognitive development of high school students is crucial, particularly in rural China. Non-cognitive abilities, including traits such as emotional regulation, resilience, and interpersonal skills, play a significant role in students' overall development and future success. This study aims to investigate how different parenting styles impact non-cognitive abilities among high school students in rural China. Methods: This study surveyed 6,549 high school students and their primary caregivers in rural China. The students had an average age of 17.61 years, with 48% being male, and 62% of Han ethnicity. Primary caregivers self-reported their parenting styles, while the students' non-cognitive abilities were assessed using the Big Five Inventory-Short (BFI-S). The relationship between parenting style and non-cognitive development was analyzed using two distinct methods: two dimensions (authoritative and authoritarian) and four categories of parenting styles. Results: The study revealed that an authoritative parenting style had a positive impact on the non-cognitive abilities of students. Conversely, a negative association was observed between the authoritarian parenting style and the students' non-cognitive development. This association was more pronounced in the non-cognitive developmental scores of girls compared to boys. Additionally, parents from wealthier families or those with higher levels of education were more likely to adopt an authoritative parenting style rather than an authoritarian one. Discussion: The results of this study highlight the significant influence of parenting styles on the non-cognitive development of high school students in rural China. Authoritative parenting, characterized by warmth and structure, appears to foster better non-cognitive outcomes, while authoritarian parenting, marked by strictness and less warmth, is associated with poorer non-cognitive development. The gender differences observed suggest that girls may be more sensitive to variations in parenting style. Furthermore, the socioeconomic and educational background of parents plays a crucial role in determining the parenting style adopted. These findings underscore the importance of developing and implementing parenting training interventions in rural China, aimed at promoting authoritative parenting practices to enhance the noncognitive development of students. [ABSTRACT FROM AUTHOR]

Enhancing collective action among rural households is crucial for promoting rural revitalization and improving livelihoods in underdeveloped areas. Taking Shanxi Province, China, as a case study, this paper employed a household survey method to collect 312 questionnaires from rural households. Using the mean value analysis of the measured items in the questionnaire. The participation status of farmers in less developed areas in collective actions, such as farmers' professional cooperatives, village cadre elections, and cooperative construction of small farmland water conservancy, was examined in four aspects: willingness to participate, frequency of participation, time of participation, and sense of the value of participation. From the perspectives of livelihood risks, livelihood assets, livelihood patterns, and livelihood income, it analyzed the livelihood conditions of rural households in underdeveloped regions. Building upon the empowerment of collective action in rural livelihoods, the study further applied a multiple linear regression model to assess the impact of collective action on livelihoods. The findings indicated (1) a strong willingness and perceived value among rural households to participate in collective action, albeit with a low frequency and limited time commitment; (2) relatively low livelihood levels, characterized by limited livelihood assets, predominant subsistence farming, small-scale non-specialized enterprises, and low livelihood income, yet with notable resilience against livelihood risks; (3) that collective action significantly enhances rural household livelihoods positively. Based on these findings, policy recommendations are proposed, emphasizing the enhancement of collective organization, provision of incentive mechanisms, and improvement of farmers' skills and qualities to foster greater participation in collective action. [ABSTRACT FROM AUTHOR]

The application of digital technology service like rural e-commerce service centers (RESCs) has captured considerable attention in China, but existing literature has not yet provided solid empirical evidence regarding its potential to foster rural income gains. Utilizing large-scale survey data from the Third National Agricultural Census (TNAC) of China, this study attempts to investigate the impact and underlying mechanisms of RESCs on income gains across 49,135 villages. The results indicate that RESCs significantly increase village income gains in rural China, which confirm the theory of "space of flows." In addition, heterogeneity analysis reveals that this income increasing effect is significantly higher in eastern China, as well as in rural villages with migrant populations and college-graduate cadres. The conclusion remains robust even after conducting several robustness checks and instrumental variable estimation. Furthermore, mechanism analysis unveils that RESCs improve village income gains by promoting characteristic agricultural development, encouraging entrepreneurship, and enhancing government funding support. The findings shed light on policy implications for the design and implementation of rural digital technology policies in developing countries. [ABSTRACT FROM AUTHOR]

Much of the existing debate on social reproduction focuses on capitalist social relations or is framed around the distinction between the Global North and Global South. Using China, whose unique post‐1949 developmental trajectory embraces both elements of socialism and capitalism, this article aims to breakdown the dichotomy between capitalism and other economic systems and instead draw attention to the ways in which households, the state and market are interdependent. Drawing upon an ethnography conducted in two rural villages and three‐generational life history data, this article explores how the organization of reproductive work evolved in rural families against the backdrop of wider political and economic transformations since 1949. Through an examination of the inter‐linkages between productive and reproductive activities across three generations, it reveals that unpaid reproductive work, performed unambiguously by women, has been central to China's economic modernization in both the Mao and Post‐Mao eras. The organization of this reproductive work among women inside the households of each generation since 1949 is influenced by a combination of factors including the patrilocal and patrilineal kinship system, the social welfare context and the economic processes of a particular era. While confirming existing scholarship on migration and agrarian change, by revealing the household as a site of gendered and intergenerational negotiation, this article disputes a linear generational power shift in agrarian transformations. [ABSTRACT FROM AUTHOR]

In early 2020, the spread of COVID-19 resulted in the wide use of online classes in China. Drawing on Foucault’s disciplinary power and De Certeau’s strategy-tactic dialectic, this paper explores the online learning practice of students in a rural junior middle school at Yu Town in Central China during the pandemic, through interviewing the students, teachers, and parents. The findings show that the teachers and the students engaged in a power game in online education and employed a series of strategies and tactics to realize the control and resistance through the creative use of media technologies. The study reveals the paradox that the rural students’ agency and resistance, enabled by the media technologies, may result in negative consequences for their learning and further broaden the gap between rural and urban students, thus reproducing the system that they are dissatisfied with. [ABSTRACT FROM AUTHOR]

This study investigates the interdependence of dietary knowledge and preference and potential rural-urban differences among middle-aged and older Chinese couples. Couple-level data from the 2015 China Health and Nutrition Survey were included (N = 2933). Structural Equation Model examined the actor and partner effects of dietary knowledge on dietary preferences. Findings indicated that greater dietary knowledge was associated with one's healthier diet preferences among both rural and urban residents (P <.01). In rural areas, ones' dietary knowledge was associated with their partners' dietary preferences (P <.01). However, in urban areas, husbands' dietary knowledge was not associated with their wives' dietary preferences (P =.58), whereas wives' dietary knowledge was associated with their husbands' dietary preferences (P <.05). The rural-urban difference indicates the greater decision-making power of men in rural households. A couple-based approach is suggested for dietary interventions and guidelines promoting healthy eating in China, particularly in rural regions. [ABSTRACT FROM AUTHOR]

Ru Yan,1,2 Songqing Jin,3 Chen Ji,1 Cindy Feng,2 Huan Wang,2 Jiayang Lyu,1,2 Scott Rozelle2,4 1China Academy for Rural Development, School of Public Affairs, Zhejiang University, Hangzhou, Zhejiang, People’s Republic of China; 2Stanford Center on China’s Economy and Institutions (SCCEI), Freeman Spogli Institute for International Studies, Stanford University, Palo Alto, California, USA; 3Department of Agricultural, Food and Resource Economics, Michigan State University, East Lansing, Michigan, USA; 4Tsingshan Institute for Advanced Business Studies, Zhejiang University, Hangzhou, Zhejiang, People’s Republic of ChinaCorrespondence: Songqing Jin, Department of Agric, Food and Resource Economics, Michigan State University, East Lansing, MI, 48823, USA, Email jins@msu.eduPurpose: 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.Keywords: adolescent health, academic performance, rural China, developing countries

Abstract Introduction In 2016, the Chinese government officially scaled up family doctor contracted services (FDCS) scheme to guide patients’ health seeking behavior from tertiary hospitals to primary health facilities. Methods This study evaluated the overall gate-keeping effects of this scheme on healthcare utilization of rural residents by using a difference-in-differences (DiD) design. The analysis was based on Shandong Rural Elderly Health Cohort 2019 and 2020. Participants who contracted FDCS in second round and were not contracted with a family doctor in the first round were regarded as treatment group. In total, 310 respondents who have used medical care were incorporated for final study. Results Participants who contracted FDCS (treatment group) experienced a significant decline in the mean level of first-contact health-care facilities, decreasing from 2.204 to 1.981. In contrast, participants who did not contract FDCS (control group), showed an increasing trend in the mean level of first-contact health-care facilities, rising from 2.128 to 2.445. Our results showed that contracting FDCS is associated with approximately 0.54 extra lower mean level of first-contact health-care facilities (P = 0.03, 95% CI: -1.03 to 0.05), which suggests an approximately 24.5% reduction in the mean first-contact health-care facility level for participants compared with contracted FDCS than those who did not. Conclusions The study suggested primary healthcare quality should be strengthened and restrictive first point of contact policy should be enacted to establish ordered healthcare seeking behavior among rural residents.

This paper examines the prevalence, correlates, and developmental consequences of divorce among junior high school students in rural China. Specifically, we investigate the connections between parental divorce and student mental health and academic performance, while also examining whether a student's living arrangement after divorce influences these outcomes. Data were collected from 17,955 students across 122 rural junior high schools in China on their mental health, characteristics, and academic performance. Mental health was measured using the self-reported Strengths and Difficulties Questionnaire. About 8.35 % of the students had divorced parents, with increased risk observed for students who were only children, had migrant mothers, or had higher educated mothers (ORs = 4.35, 29.94, and 1.78, respectively; Bonferroni - adjusted p < 0.05). Students with divorced parents exhibited a higher likelihood of internalizing (0.032), externalizing (0.052) abnormality (Bonferroni - adjusted p < 0.001) and scored 0.203 SD lower on the math test (Bonferroni - adjusted p < 0.001). Living arrangements post-divorce, either with a mother or a father, equally negatively impacted student mental health and academic performance, with a mitigating effect observed when grandparental childcare was provided. Our study faced limitations in assessing the influence of grandparental childcare on coping with parental divorce due to challenges in gauging the extent of such support for students residing with a parent after divorce. This study did not empirically find differences by ethnicity; further in-depth case study is needed to better illuminate the findings. Parental divorce among young students in rural China is associated with adverse developmental outcomes. These findings underscore the importance of implementing targeted programs in rural China to mitigate these risks and provide support for young students with divorced parents. • 8.45 % of 17,955 rural Chinese junior high students have divorced parents. • Only child status, high maternal education, and maternal migration are correlated with divorce. • Students with divorced parents had higher SDQ abnormality risk and lower math test scores. • Living with either parent post-divorce impacts SDQ and math scores; grandparental childcare helps. [ABSTRACT FROM AUTHOR]

Background: Preadolescents, who are in a transitional phase of development, may experience higher exposure to heterosexual interactions while facing higher risks regarding misinformation in sexual knowledge and unsafe engagement in sexual activities. There is a deficiency in the availability of qualified educators and age-appropriate teaching materials for sexuality education in China. Methods: We implemented an animation-based comprehensive sexuality education package among preadolescents aged 9 to 12 years from eight schools in Anhui, China. The first round of intervention included 1,835 participants, lasting 2 months from September to November 2020. A total of 374 participants, accounting for 52% of the intervention group, received a second round of intervention in September 2021. Participants completed immediate follow-up assessment and 1-year follow-up assessment to assess changes in their sexual knowledge, attitudes, and other outcomes. Propensity score matching and difference-in-difference analysis were performed to determine the short- and long-term impacts. Results: Significant improvements were observed for both sexual knowledge and sexual attitudes in the immediate follow-up. There was no significant effect on pornography-seeking behavior or awareness of experiencing sexual abuse. After 1 year, the effect was sustained for sexual knowledge, but slightly declined for sexual attitudes. The second intervention significantly improved sexual knowledge; however, no significant change in sexual attitudes, pornography-seeking behavior, or awareness of experiencing sexual abuse was observed. Conclusions: Our comprehensive sexuality education package was effective in improving sexual knowledge both immediately and 1 year after the intervention. Repeated intervention can be an effective strategy for promoting preadolescent health development regarding comprehensive sexuality education. [ABSTRACT FROM AUTHOR]

Abstract Understanding farmers’ future residential preferences and the factors affecting these choices is crucial for tackling the issues related to hollow village management and rural planning. Despite limited research on the role of the family life cycle, this study explores how the family life cycle, characteristics of the household head, livelihood strategies, and resource availability shape farmers’ future residential preferences. Data were collected from 777 households in China’s main grain-producing area. The findings reveal that 52.90% of households prefer to stay in their current rural residences. Other favored options are elderly care facilities (13.90%), living with children in the village (12.36%), and ancestral homes (11.68%). The family life cycle significantly affects these preferences (p

Abstract Background Metabolic syndrome (MetS) includes a group of metabolic irregularities, including insulin resistance (IR), atherogenic dyslipidemia, central obesity, and hypertension. Consistent evidence supports IR and ongoing low-grade inflammation as the main contributors to MetS pathogenesis. However, the association between the triglyceride-glucose (TyG) index and mortality in people with MetS remains uncertain. The objective of this study was to examine the correlation between the baseline TyG index and all-cause and cardiovascular (CV) mortality in rural Northeast Chinese individuals with MetS. Methods For the Northeast China Rural Cardiovascular Health Study, 3918 participants (mean age, 55 ± 10; 62.4% women) with MetS at baseline were enrolled in 2012–2013 and followed up from 2015 to 2017. The TyG index was calculated using the equation TyG index = ln [fasting TG (mg/dL) × fasting glucose (mg/dL)/2] and subdivided into tertiles [Q1(

Abstract Objectives In middle-income countries, poor physician-patient communication remains a recognized barrier to enhancing healthcare quality and patient satisfaction. This study investigates the influence of provider-patient communication skills on healthcare quality and patient satisfaction in the rural primary healthcare setting in China. Methods Data were collected from 504 interactions across 348 rural primary healthcare facilities spanning 21 counties in three provinces. Using the Standardized Patient method, this study measured physician-patient communication behaviors, healthcare quality, and patient satisfaction. Communication skills were assessed using the SEGUE questionnaire framework. Multivariate linear regression models and multivariate logistic regression models, accounting for fixed effects, were employed to evaluate the impact of physicians’ communication skills on healthcare quality and patient satisfaction. Results The findings indicated generally low provider-patient communication skills, with an average total score of 12.2 ± 2.8 (out of 24). Multivariate regression models, which accounted for physicians’ knowledge and other factors, demonstrated positive associations between physicians’ communication skills and healthcare quality, as well as patient satisfaction (P

Abstract 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 Background Healthcare providers play important roles in supporting breastfeeding. Although there has been insufficient actual breastfeeding support from healthcare providers in China, little research has been conducted to understand Chinese healthcare providers’ perceived barriers to providing breastfeeding support, especially in rural China. This study aims to identify these perceived barriers to providing breastfeeding support in Northwestern rural China. Methods This study was conducted during the period from March 2018 to December 2018. Forty-one healthcare providers were recruited through purposive sampling in two rural counties in Northwest China that are in close proximity to each other and share similar demographic features. Participants included obstetrician-gynecologists, midwives, nurses, “village doctors”, and township and village maternal and child health workers. Qualitative data were collected through one-on-one in-depth semi-structured interviews and focus group discussions. Transcripts were thematically analyzed. Results Analysis of interview data resulted in four themes that the participants perceived as barriers to supporting breastfeeding: (1) lack of medical resources, within which inadequate staffing, and lack of financial incentives were discussed, (2) lack of clear and specific responsibility assignment, within which no one takes the lead, and mutual buck-passing were discussed, (3) healthcare providers’ lack of relevant expertise, within which lack of knowledge and skills, and low prestige of village healthcare providers were discussed, (4) difficulties in accessing mothers, within which medical equipment shortages reduce services utilization, mothers’ housing situation, mothers’ mobility, and cultural barriers were discussed. Conclusions The study identified HCPs perceived barriers to providing breastfeeding support. Unique to China’s Tri-Level Healthcare System, challenges like staffing and financial incentives are hard to swiftly tackle. Recommendations include mHealth enhancement and clarified responsibilities with incentives and tailored training. Further research is crucial to evaluate these strategies in rural Northwestern China and comparable underdeveloped areas nationwide.

Understanding farmers' future residential preferences and the factors affecting these choices is crucial for tackling the issues related to hollow village management and rural planning. Despite limited research on the role of the family life cycle, this study explores how the family life cycle, characteristics of the household head, livelihood strategies, and resource availability shape farmers' future residential preferences. Data were collected from 777 households in China's main grain-producing area. The findings reveal that 52.90% of households prefer to stay in their current rural residences. Other favored options are elderly care facilities (13.90%), living with children in the village (12.36%), and ancestral homes (11.68%). The family life cycle significantly affects these preferences (p < 0.01), with changes in family structure and age leading to different living choices. Specifically, households in the initial (71.29%), burden (70.32%), and stable stages (40.14%) prefer their current rural residences, while those in the maintenance and empty-nest stages opt for living with their children's residences (22.22% and 16.96%, respectively) or in elderly care facilities (30.00% and 33.93%). Meanwhile, age, health, income, livelihood strategies, and land ownership also markedly influence the choice of residence. Recommendations include educational programs for elderly rural residents, improving older individuals' adaptability to rural changes, creating more rural employment opportunities, and enhancing medical and infrastructural services for the sustainable rural development. [ABSTRACT FROM AUTHOR]

This article investigates the practice of exemplarity in rural China through Secretary Xu's oral narratives to provincial leaders and local villagers in a northern model village. It applies a performative narrative analysis to reveal how Xu constructs his persona, utilizing narrative structures, chronotopes, and the interplay of events to forge exemplary images suited to each audience. In presentations to leaders, Xu highlights rural development achievements, while to villagers, he emphasizes common prosperity and community service. This strategic narrative manipulation not only showcases Xu's skill in aligning with both state and local values but also fosters cultural intimacy and community cohesion despite narrative discrepancies. The case study expands the discourse on narrative techniques and representational strategies within rural revitalization and social governance, offering a nuanced perspective on the intersection of narrative, identity, and governance. [ABSTRACT FROM AUTHOR]

Aging brings challenges for masculinity construction affecting older men in the countryside. The investigation of what and how rural older men negotiate their gendered identities in contemporary fast-changing societies contributes to the knowledge of aging masculinities. Taking a life-course perspective, this study explores how a group of rural Chinese older men negotiate masculinities and make sense of their aging lives. Twelve older men in a village located in southwest China participated in this study. We conducted individual semi-structured interviews with the participants and collected their life stories which were audio-recorded, transcribed, and coded following a thematic analysis approach. Analysis of the data suggests that rural Chinese older men created a having/being masculine plot while describing their transitions of family roles from providers to becoming helpers across their life courses. They struggled to maintain a sense of control when facing loss and vulnerability in later life and gendered norms in rural China contributed to their masculinity images. We discussed how the findings of this study, particularly intergenerational relations and narrative temporality in the construction of masculinities in later adulthood, contribute to both the research and practices regarding aging masculinities in rural areas. [ABSTRACT FROM AUTHOR]

Background: Metabolic syndrome (MetS) includes a group of metabolic irregularities, including insulin resistance (IR), atherogenic dyslipidemia, central obesity, and hypertension. Consistent evidence supports IR and ongoing low-grade inflammation as the main contributors to MetS pathogenesis. However, the association between the triglyceride-glucose (TyG) index and mortality in people with MetS remains uncertain. The objective of this study was to examine the correlation between the baseline TyG index and all-cause and cardiovascular (CV) mortality in rural Northeast Chinese individuals with MetS. Methods: For the Northeast China Rural Cardiovascular Health Study, 3918 participants (mean age, 55 ± 10; 62.4% women) with MetS at baseline were enrolled in 2012–2013 and followed up from 2015 to 2017. The TyG index was calculated using the equation TyG index = ln [fasting TG (mg/dL) × fasting glucose (mg/dL)/2] and subdivided into tertiles [Q1(< 8.92); Q2 (8.92–9.36); Q3 (≥ 9.36)]. Multivariate Cox proportional hazards models were developed to examine the correlations between mortality and the baseline TyG index. Results: During a median of 4.66 years of follow-up, 196 (5.0%) all-cause deaths and 108 (2.8%) CV disease-related deaths occurred. The incidence of all-cause mortality was significantly different among TyG index tertiles of the overall population (P = 0.045). Kaplan–Meier analysis demonstrated a significantly increased risk of all-cause mortality in rural Chinese patients with a higher TyG index (log-rank P < 0.05). After adjusting for possible confounders, Cox proportional hazard analysis revealed that the TyG index could effectively predict all-cause mortality (HR for the third vs. first tertile of TyG was 1.441 [95% confidence interval, 1.009–2.059]), but not CV mortality, in rural Chinese patients with MetS. Conclusions: The TyG index is an effective predictor of all-cause mortality in rural Chinese patients with MetS. This indicates that the TyG index may be useful for identifying rural Chinese individuals with MetS at a high risk of death. [ABSTRACT FROM AUTHOR]

The expansion of the tourism industry has generated a plethora of informal job opportunities. However, existing literature has not thoroughly explored the extensive involvement of local residents in rural areas in informal tourism employment. This study focuses on the Fujian Tulou villages in China and employs the fieldwork method to investigate the phenomenon of informal tourism employment among local residents in scenic-oriented rural communities. The findings indicate that the dearth of employment prospects in rural areas, coupled with China’s distinctive rural land ownership system and the support from the rural social network, are the primary drivers motivating locals to participate in informal tourism employment. Locals employ tactics such as camouflage, tacit collusion, lurking, and covert actions to engage in informal tourism employment while navigating the regulations imposed by scenic area management. In efforts to standardize management within scenic areas, both local governments and tourism management companies are implementing measures such as offering formal employment opportunities and profit-sharing arrangements to incentivize the regularization of local employment in the tourism sector. [ABSTRACT FROM AUTHOR]

Objectives: In middle-income countries, poor physician-patient communication remains a recognized barrier to enhancing healthcare quality and patient satisfaction. This study investigates the influence of provider-patient communication skills on healthcare quality and patient satisfaction in the rural primary healthcare setting in China. Methods: Data were collected from 504 interactions across 348 rural primary healthcare facilities spanning 21 counties in three provinces. Using the Standardized Patient method, this study measured physician-patient communication behaviors, healthcare quality, and patient satisfaction. Communication skills were assessed using the SEGUE questionnaire framework. Multivariate linear regression models and multivariate logistic regression models, accounting for fixed effects, were employed to evaluate the impact of physicians' communication skills on healthcare quality and patient satisfaction. Results: The findings indicated generally low provider-patient communication skills, with an average total score of 12.2 ± 2.8 (out of 24). Multivariate regression models, which accounted for physicians' knowledge and other factors, demonstrated positive associations between physicians' communication skills and healthcare quality, as well as patient satisfaction (P < 0.05). Heterogeneity analysis revealed stronger correlations among primary physicians with lower levels of clinical knowledge or more frequent training. Conclusion: This study emphasizes the importance of prioritizing provider-patient communication skills to enhance healthcare quality and patient satisfaction in rural Chinese primary care settings. It recommends that the Chinese government prioritize the enhancement of provider-patient communication skills to improve healthcare quality and patient satisfaction. [ABSTRACT FROM AUTHOR]

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

Background: Healthcare providers play important roles in supporting breastfeeding. Although there has been insufficient actual breastfeeding support from healthcare providers in China, little research has been conducted to understand Chinese healthcare providers' perceived barriers to providing breastfeeding support, especially in rural China. This study aims to identify these perceived barriers to providing breastfeeding support in Northwestern rural China. Methods: This study was conducted during the period from March 2018 to December 2018. Forty-one healthcare providers were recruited through purposive sampling in two rural counties in Northwest China that are in close proximity to each other and share similar demographic features. Participants included obstetrician-gynecologists, midwives, nurses, "village doctors", and township and village maternal and child health workers. Qualitative data were collected through one-on-one in-depth semi-structured interviews and focus group discussions. Transcripts were thematically analyzed. Results: Analysis of interview data resulted in four themes that the participants perceived as barriers to supporting breastfeeding: (1) lack of medical resources, within which inadequate staffing, and lack of financial incentives were discussed, (2) lack of clear and specific responsibility assignment, within which no one takes the lead, and mutual buck-passing were discussed, (3) healthcare providers' lack of relevant expertise, within which lack of knowledge and skills, and low prestige of village healthcare providers were discussed, (4) difficulties in accessing mothers, within which medical equipment shortages reduce services utilization, mothers' housing situation, mothers' mobility, and cultural barriers were discussed. Conclusions: The study identified HCPs perceived barriers to providing breastfeeding support. Unique to China's Tri-Level Healthcare System, challenges like staffing and financial incentives are hard to swiftly tackle. Recommendations include mHealth enhancement and clarified responsibilities with incentives and tailored training. Further research is crucial to evaluate these strategies in rural Northwestern China and comparable underdeveloped areas nationwide. [ABSTRACT FROM AUTHOR]

This study examines the gender-differentiated effects of improved land property rights on labor reallocation in China, using quasi-exogenous variation in the timing of the implementation of the Rural Land Contracting Law, which allows farmers to lease out their land. We find that while men and women tend to shift labor from the agricultural into non-agricultural sector following the land reform, women lag behind men. Our findings reveal a noticeable gender gap in the growth of off-farm labor participation (+16.69 % among men; + 1.95 % among women) and hours worked in off-farm sectors. The gender-differentiated effects on off-farm employment are likely caused by disadvantaged labor market conditions for women. These findings underscore the importance of improved land property rights in fostering rural structural transformation. Moreover, our results suggest that implementing land reforms without accompanying changes to address the root causes of gendered differences in off-farm employment could limit their full potential. This study has significant policy implications for the rural transformation of developing countries. [ABSTRACT FROM AUTHOR]

In order to improve local governance, the central government has, among other strategies, begun to introduce institutions for deliberation in rural China. This article analyses the implementation and consequences of this framework in two villages in rural Gansu Province. It shows that the current promotion of these institutions is a top‐down political effort and not a system with genuine local roots. Our findings also suggest that without strict legal requirements for deliberative institutions, village cadres do not follow the enactment of officially warranted procedures, which often may lead to rather formalistic implementation. Opportunities for deliberation seem to be offered only to those members of the community who are the most likely to be able to contribute social or financial capital to the local administration's agenda. This suggests that at least in this local setting, the rationale of introducing deliberation institutions clearly was to improve existing policy implementation and not to provide meaningful new avenues for participation. While this variant of deliberative institutions further raises the status of the rural elite, it appears to frustrate ordinary villagers and reduce their interest in these instruments. [ABSTRACT FROM AUTHOR]

The main objective of this study was to examine the integration of indigenous knowledge (IK) into the rapidly developing field of rural social work in China. The study demonstrated the incorporation of indigenous elements such as folkways, power structures, values, norms, traditions, and crafts into the practice through collaboration with the local community. The research employed purposive sampling, which included 4 agency directors, 1 head of a social work organization, 6 social workers, 21 social work students, 16 children and teenagers, 13 villagers, 1 folk writer, 5 local families, 3 teacher lecturers, and 6 government officers. Results showed that the integration process involves the identification, extraction, application, and evaluation of IK are closely linked to the indigenous environment, service recipients, and social workers. Nevertheless, further research is required to operationalize and evaluate the effectiveness of this integration. Findings would be important guidelines for policymakers, education and development experts, and service providers. The conclusions drawn from this study offer valuable insights into the effective integration of Indigenous Knowledge (IK) into social work practice. These insights hold significance for policymakers, education and development experts, as well as service providers not only in China but also in a broader international context. [ABSTRACT FROM AUTHOR]

This article is a critical ethnographic study that examines rural Chinese girls' literacy practices in sanctioned and unsanctioned spaces, and their negotiations with the articulated and delivered literacy program. In particular, this study focuses on a group of 1st-grade girls, who I call the "Spy Girls," engaged in the celebration of Christmas, and their interactions with unauthorized literacy practices or "forbidden literacy" that challenge the institutional and structural discourse in relation to gender and school policies. Using a feminist lens, I argue that although local governments have deemed celebrating Christmas to be a compromise of tradition and unpatriotic, the girls' practices exemplified the ways they negotiate gender roles and construct literate identities through appropriating acceptable forms of literacy expression to communicate under the radar. [ABSTRACT FROM AUTHOR]

Agricultural cropping structure is related to the quality of the agricultural supply system and is a key element of the structural reform of the agricultural supply side. Based on China's provincial panel data from 2000 to 2021, this paper empirically examines the impact and mechanism of rural population aging on the planting structure of food and cash crops by using a two-way fixed-effects model, which fills the gap in the research on the impact mechanism of the rural population aging on agricultural planting structure. The conclusions of the study show that: as the aging of the rural population deepens, the proportion of food crops planted will further increase, while the proportion of cash crops planted will decrease; agricultural mechanization will promote the further increase of the proportion of food crops planted while the proportion of cash crops planted will decrease in the deepening of the aging of rural population; the aging of the rural population has a more significant impact on the structure of agricultural planting in the eastern region and does not have a significant impact on the central and western provinces. The aging of the rural population has a significant impact on the agricultural planting structure in the eastern region, but not in the central and western provinces. This paper argues that we should fully respect the willingness of agricultural management subjects to choose planting varieties, increase the research, development, and promotion of agricultural machinery, continuously improve the level of farmers' human capital, and further enhance the degree of organization, scale, and specialization of agricultural production. [ABSTRACT FROM AUTHOR]

Although fertilizer can help alleviate hunger, it can also lead to disease. Using data from the National Fixed-Point Survey spanning from 1998 to 2017, we aimed to determine the impact of fertilizer use on healthcare costs. Our findings indicate that a ten percent increase in fertilizer use is responsible for a 0.63 percentage point rise in medical service fees, which translates to a staggering $678 million in medical expenses. Through an analysis of the various channels of pathogenic exposure, we discovered that food crops and drinking water are the primary sources of contamination. This implies that different rural environments, including fertilizer types, villages, terrain, and water sources, can exacerbate the negative effects of fertilizer use. Our research underscores the need for policymakers to consider compensating farmers who suffer from fertilizer pollution and incur health-related losses.

BackgroundAchieving universal health insurance coverage has become a fundamental policy for improving the accessibility and equity of healthcare services. China's Urban-Rural Resident Basic Medical Insurance (URRBMI) is a crucial component of the social security system, aimed at promoting social equity and enhancing public welfare. However, the effectiveness of this policy in improving rural residents' social fairness perceptions (SFP) remains to be tested.ObjectiveTo examine the impact of the urban-rural resident basic medical insurance (URRBMI) on rural residents' social fairness perception (SFP) in China.Methods and samplesThe study utilizes city-level and national micro-survey (CGSS) datasets, applying a time-varying difference-in-difference (DID) approach to analyze the equity effects of URRBMI. Excluding urban samples, the final dataset consists of 20,800 rural respondents from 2010, 2011, 2013, and 2015, covering 89 cities.ResultsKey findings reveal that URRBMI has a significant negative effect on SFP. The impact varies depending on the integration model and intensifies over time. Additionally, the negative effect shows heterogeneity based on income, age, health, and region.ConclusionThis study highlights the complexities and impacts of integrating China's urban and rural healthcare systems. It provides a detailed understanding of the role of URRBMI in rural China, emphasizing the need for targeted approaches to improve rural residents' perceptions of social fairness. The research offers specific policy recommendations, such as establishing differentiated contribution standards, implementing welfare policies favoring rural residents, and adopting varied reimbursement rates for different diseases.

This study uses China Family Panel Studies (CFPS) data from 2010 to 2018 to empirically investigate the interplay between digital technology access, labor market behavior, and income inequality in rural China. The following salient conclusions are derived. Digital technology access has a substantial negative influence on individual income inequality in rural China, with a more pronounced inhibitory effect on inequality among low-income groups, males, middle and higher professional classes, and younger cohorts. Mechanism analysis suggests that digital technology access significantly impacts a range of rural labor practices, including increasing the frequency of digital technology use among rural inhabitants, decreasing credit costs, enhancing entrepreneurial activities, and boosting rural labor mobility. Based on these findings, this study proposes accelerating digital infrastructure development in rural regions, improving digital and financial literacy among rural residents, and refining inclusive digital financial services to facilitate more stable and sustainable progress to promote common prosperity.

The global mental health crisis presents a significant challenge to sustainable development, and this crisis is more pronounced in China's rural areas versus urban areas. Alcohol consumption has increased in rural areas with China's economic growth, but the number of studies on the relationship between farmers' alcohol consumption and their mental health is limited. Based on data from the China Labor Force Dynamics Survey (CLDS), this study uses the endogenous switching regression model (ESR) to analyze the influence of alcohol consumption on farmers' mental health. On this basis, the study further conducts a counterfactual analysis to estimate the average treatment effect of alcohol consumption on farmers' mental health. The results show that: (1) There is a significant positive relationship between alcohol consumption and farmers' mental health. Specifically, the mental health index of drinking farmers increases by 19.7 % compared to non-drinking farmers. (2) Heterogeneity analysis shows that alcohol consumption is more beneficial for improving the mental health of male farmers, elderly farmers, and employed farmers. Furthermore, drinking alcohol almost every day, consuming Baijiu, and each drinking consumption ranging from 0 to 100 mL per occasion are more conducive to improving farmers' mental health. These findings have implications for relieving depressive symptomology and improving farmers' mental health in developing countries. The results of this study also provide guidance for addressing the global mental health crisis.

The study objective is to analyze the water expenditure of 4315 rural households in the Karst region of China. The empirical results have been analyzed by using the extended linear expenditure system model. The study has been based on water expenditure, which provides a feasible differential water pricing strategy in the karst region of China. The result shows that (1) the coefficient for water expenditure has been examined as low. The coefficient of water expenditure in the Karst region ranges from 0.534 to 1.025%, the average value is 0.723%, and the modified coefficient ranges from 0.814 to 1.508%, with an average value of 1.070%. (2) The marginal consumption propensity of rural residents in the Karst region is 0.2%, and the marginal consumption propensity in each province ranges from 0.1 to 1%. (3) The per capita basic water demand has 3 m3. In this scenario, the study recommended that basic water prices range from CNY 2.091 to CNY 3.468 per cubic meter. If the water consumption exceeds basic demand (3 m3 per month), then the bearing water price shall not be lower than CNY 2.091 to CNY 3.468 per cubic meter and not higher than CNY 7.122 per cubic meter. HIGHLIGHTS Analyzed the water expenditure of 4,315 rural households in the Karst region of China.; The basic water prices range from CNY 2.091 to CNY 3.468 per cubic meter.; The water price reform in rural China should be subsidies and flexible.; Increasing financial subsidies for low-income households and charging discount fees to households with idle water equipment.; Water pricing mechanism should be flexible for everyone.;

Abstract Background International experience shows that the suitability of a high-performance healthcare system for its given purposes is reflected in its ability to provide a continuum of services that match the changing health status of the given population. Although many low- and middle-income countries have sought to bring movement away from hospital-centered and towards patient-centered healthcare, such efforts have often had poor results, and one of the major reasons for this is the inability to accurately identify which inpatients need continuing care and what kind of continuing of care is needed. Objectives To measure and assess the continuing care needs of discharged patients and its influencing factors in rural China. Methods Data were obtained from the hospital database of Medical Center M in County Z from May to July 2022. County Z is a county of 1 million people in central China. The database includes basic patient information, disease-related information, and information on readiness for hospital discharge. Factors related to the need for continuing care were included in the analysis. The Readiness for Hospital Discharge Scale was used to assess the need for continuing care. The statistical data are expressed in terms of both frequency and composition ratio. Finally, linear regression was used to analyze the factors influencing the need for continuing care. Results The analysis included a total of 3,791 patients, 123 of whom (3.25%) had continuing nursing needs. The need of continuing nursing was related to patients’ age group, mode of admission, occupation and major diagnostic categories (P

Abstract Background Poor development of young children is a common issue in developing countries and it is well established that iron deficiency anemia is one of the risk factors. Research has shown that iron deficiency is a common micronutrient deficiency among children in rural China and can result in anemia. A previous paper using data from the same trial as those used in the current study, but conducted when sample children were younger, found that after 6 months of providing caregivers of children 6–11 months of age free access to iron-rich micronutrient powder (MNP) increased the hemoglobin concentrations (Hb) of their children. However, no effects were found 12 and 18 months after the intervention. The current study followed up the children four years after the start of the original intervention (when the children were 4–5 years old) and aims to assess the medium-term impacts of the MNP program on the nutritional status of the sample pre-school-aged children, including their levels of Hb, the prevalence of anemia, and the dietary diversity of the diets of the children. Methods At baseline, this study sampled 1,802 children aged 6–11 months in rural Western China. The intervention lasted 18 months. In this medium-term follow-up study that successfully followed 81% (n = 1,464) of children (aged 49–65 months) from the original study population 4 years after the start of the intervention, we used both intention-to-treat (ITT) effect and average treatment on the treated effect (ATT) analyses to assess the medium-term impacts of the MNP distribution program on the nutritional status of sample children. Results The ITT analysis shows that the MNP intervention decreased the prevalence of anemia of young children in the medium run by 8% (4 percentage points, p

The Rural Minimum Living Standard Guarantee (Rural Dibao) is an important unconditional cash transfer program to alleviate poverty in rural China. Despite the importance of children's nutrition in breaking poverty cycles, little is known about the impact of Rural Dibao on child nutrition outcomes. Using China Family Panel Studies (CFPS), this paper examines the effects of Rural Dibao on child nutrition outcomes and investigates potential pathways and heterogeneous effects. We exploit propensity score matching and difference-in-differences techniques to evaluate the effects of the Rural Dibao program on child nutrition outcomes. Our results suggest that Rural Dibao significantly impacts the nutrition outcomes of children up to 15 years of age. Specifically, our results suggest that Rural Dibao improves child height-to-age z-scores by 1.05 standard deviations and lowers the probability of stunting by 11.9 percentage points. Additional analyses suggest that increased protein intake is the main pathway through which Rural Dibao participation contributes to better nutrition outcomes. We also find that the effect of the program is more pronounced among girls, children who are non-left-behind or live with highly educated mothers, and those from low-income families and poor areas. Our findings suggest that Rural Dibao participation helps improve child nutrition outcomes through improving diet quality.

Over the past few decades, the Internet has rapidly diffused across China. The spread of the Internet has had a profound economic and social impact on Chinese rural areas. Existing research shows that Internet access significantly impacts agricultural production and improves smallholder farmers’ income. Beyond these, the Internet can affect other dimensions of social welfare. However, research about the impact of Internet access on dietary quality in rural China remains scarce. This study utilizes multi-period panel data from Fixed Observation Point in rural China from 2009 to 2015 to estimate the impact of Internet access on dietary quality and food consumption of rural households and conducts a causal analysis. Regression models with time and household fixed effects allow robust estimation while reducing potential issues of unobserved heterogeneity. The estimates show that Internet access has significantly increased rural household dietary quality (measured by the Chinese Diet Balance Index). Further research finds that Internet access has increased the consumption of animal products, such as aquatic and dairy products. We also examine the underlying mechanisms. Internet access improves dietary quality and food consumption mainly through increasing household income and food expenditure. These results encourage the promotion of Internet access as a valuable tool for nutritional improvements, especially in rural areas.

The incidence of tuberculosis (TB) has declined more slowly in rural than urban areas in China, and data on the patterns of transmission and the high-risk populations in rural areas remains scarce. We conducted a population-based study of culture-positive pulmonary TB patients diagnosed in rural Linzhou City, Henan Province from July 2018 to February 2023. Genomic clusters were defined based on whole-genome sequencing and risk factors for clustering were identified by logistic regression. Transmission events were inferred with phybreak and transmission links were sought through epidemiological investigation of clustered patients. Logistic regression was used to explore the relationship between genomic differences of patient isolates and geographical distances of patient residences. Spatial hotspots were defined using kernel density estimation. Of 455 culture-positive patients, 430 were included in the final analysis. Overall, 192 (44.7%,192/430) patients were grouped into 49 clusters. Clusters containing ≥5 patients accounted for 18.4% (9/49) of the clusters and clustering was highest in student patients. No super-spreaders were detected. Confirmed epidemiologic links were identified for only 18.2% of clustered patients. The clustering risk decreased rapidly with increasing distances between patient residences, but 77.6% of clustered patient pairs lived ≥5.0 km apart. Both the Central Subdistrict and Rencun Township were identified as hotspots for TB transmission. Recent transmission appears to be an important driver of the TB burden in Linzhou. The formulation of effective strategies to reduce TB incidence in rural areas will require further studies to identify high-risk populations and venues where local inhabitants congregate and transmit the infection.

Social capital provides a valuable theoretical framework for boosting disaster preparedness. However, the multidimensional and intricate nature of social capital poses challenges in its measurement. Achieving a balance between comprehensive and effective measurement of social capital indicators necessitates additional exploration, especially within the specific context of disasters. The current study utilizes the boosted regression tree (BRT) approach to identify key social capital indicators that influence disaster preparedness in rural disaster-prone areas of China. BRT is highly regarded for its ability to capture complex nonlinear relationships and interactions among variables, providing accurate predictions and facilitating interpretability for practical applications. Results reveal that geographic close social ties, social status, collective resources, non-farm employment assistance, gift exchange, interpersonal trust, and sense of belonging significantly impact disaster preparedness. The findings could offer valuable guidance to policymakers in designing targeted intervention strategies aimed at enhancing disaster resilience within these communities. [ABSTRACT FROM AUTHOR]

Background: International experience shows that the suitability of a high-performance healthcare system for its given purposes is reflected in its ability to provide a continuum of services that match the changing health status of the given population. Although many low- and middle-income countries have sought to bring movement away from hospital-centered and towards patient-centered healthcare, such efforts have often had poor results, and one of the major reasons for this is the inability to accurately identify which inpatients need continuing care and what kind of continuing of care is needed. Objectives: To measure and assess the continuing care needs of discharged patients and its influencing factors in rural China. Methods: Data were obtained from the hospital database of Medical Center M in County Z from May to July 2022. County Z is a county of 1 million people in central China. The database includes basic patient information, disease-related information, and information on readiness for hospital discharge. Factors related to the need for continuing care were included in the analysis. The Readiness for Hospital Discharge Scale was used to assess the need for continuing care. The statistical data are expressed in terms of both frequency and composition ratio. Finally, linear regression was used to analyze the factors influencing the need for continuing care. Results: The analysis included a total of 3,791 patients, 123 of whom (3.25%) had continuing nursing needs. The need of continuing nursing was related to patients' age group, mode of admission, occupation and major diagnostic categories (P < 0.05). Conclusions: Developing continuing care is an important initiative for bridging the fragmentation of health services, and an appropriate supply system for continuing care, interconnected with inpatient services, should be established in rural areas in China as soon as possible. And provide more appropriate care for patients in need. [ABSTRACT FROM AUTHOR]