Global Health

Background
Despite the benefits of exclusive breastfeeding, the proportion of exclusively breastfed children remains low in rural China. Self-efficacy is one of the most crucial modifiable factors predicting breastfeeding behavior. However, existing instruments in China do not specifically measure self-efficacy for exclusive breastfeeding but rather measure self-efficacy for any breastfeeding. Furthermore, they have been validated only in high-income Chinese settings. We sought to adapt and validate an instrument to measure exclusive breastfeeding self-efficacy within rural Chinese contexts.

Methods
We introduced relevant items to Dennis’ Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF), which can assess maternal self-efficacy for exclusive breastfeeding. It was then implemented in a multistage random cluster sampling design and cross-sectional survey with home-visit interviews among women 0–6 months postpartum (n = 654) in the rural areas of four counties in Sichuan, China. We performed item-total and adjusted item-total correlations, as well as exploratory factor analysis to remove redundant items and determine the latent factor structure. We further applied confirmatory factor analysis to test the dimensionality of the scale. We then assessed the reliability of the scale and conducted tests of predictive and divergent validity. Known group comparisons were made by primiparous status and breastfeeding support level. We compared the validated Exclusive Breastfeeding Self-Efficacy Scale with the BSES-SF in terms of reliability and validity to explore the added value of scale modification.

Results
Our modification of the BSES-SF to target exclusive breastfeeding produced 19 items. This was further reduced to 15 items based on adjusted item-total correlations and exploratory factor analysis, forming the Exclusive Breastfeeding Self-Efficacy Scale. This scale had three dimensions: “Breast milk supply and quality,” “Breastfeeding skills,” and “Exclusive breastfeeding” subscales. The Exclusive Breastfeeding Self-Efficacy Scale demonstrated strong internal consistency and overall reliability with a Cronbach’s alpha coefficient of 0.91. Predictive and divergent validity and known group comparison assessments supported its validity. Robust psychometric evaluations demonstrated enhanced validity and reliability compared to the original BSES-SF.

Conclusions
Our Exclusive Breastfeeding Self-Efficacy Scale is valid and reliable for measuring exclusive breastfeeding self-efficacy within rural Chinese contexts and is ready for adaptation and validation for clinical and programmatic use elsewhere, particularly within LMICs.

Against the backdrop of China’s post-1978 economic transformation, recent challenges such as COVID-19 have prompted speculations about rising popular pessimism regarding current inequalities and opportunities to get ahead. This study compares findings from three new nationally representative surveys conducted in 2023 with three earlier surveys from 2004, 2009, and 2014. Results reveal a significant attitudinal shift, with 2023 respondents expressing markedly more critical views about the fairness of current inequality patterns. Respondents in the 2023 surveys increasingly attribute poverty versus wealth to structural factors like unequal opportunities rather than to variations in individual merit. Respondents also reported lower expectations for future income growth compared with the earlier surveys. While not indicating imminent threats to political stability, such trends suggest that China’s leaders will likely face increasing skepticism and even critical popular responses as they try to mobilize their citizens to confront the serious challenges that China faces in coming years.

The Democratization of Information versus the Democratization of Ideas and Economic Capital

A country’s national income broadly depends on the quantity and quality of workers and capital. But how well these factors are managed within and between firms may be a key determinant of a country’s productivity and its GDP. Although social scientists have long studied the role of management practices in shaping business performance, their primary tool has been individual case studies. While useful for theory-building, such qualitative work is hard to scale and quantify. We present a large, scalable dataset measuring structured management practices at the business level across multiple countries. We measure practices related to performance monitoring, target-setting, and human resources. We document a set of key stylized facts, which we label “the international empirics of management”. In all countries, firms with more structured practices tend to also have superior economic performance: they are larger in scale, are more profitable, have higher labor productivity and are more likely to export. This consistency was not obvious ex-ante, and being able to quantify these relationships is valuable. We also document significant variation in practices across and within countries, which is important in explaining differences in the wealth of nations. The positive relationship between firm size and structured management practices is stronger in countries with more open and free markets, suggesting that stronger competition may allow firms with more structured management practices to grow larger, thereby potentially raising aggregate national income.

This paper examines the correlation between cognitive ability and firm creation. Drawing on administrative college admissions data and firm registration records in China, we investigate who had created firms by their mid-30s. We find a clear pattern of entrepreneurial reluctance: Given the same backgrounds, individuals with higher college entrance exam scores are less likely to create firms. Through an exploration of firm performance, alternative career trajectories, and variations across regions, we propose an explanation: The ability represented by exam scores is useful across occupations, yet higher-scoring individuals are attracted to waged jobs, particularly those of the state sector.

Existing Law and Extended Reality: An Edited Volume of the 2023 Symposium Proceedings, compiles and expands upon the ideas presented during the symposium. Edited by Brittan Heller, the collection includes contributions from symposium speakers and scholars who delve deeper into the regulatory gaps, ethical concerns, and societal impacts of XR and AI.

The Military Logic of Beijing's Growing Partnerships

In rural China, there exists a gender gap in academic achievement where girls outperform boys, suggesting similar differences in early language development. Moreover, recent research has revealed that children in peri-urban communities have worse language outcomes than children in rural communities. This study examines the impact of gender on early language development in low-SES, peri-urban Chinese communities. Data from 81 children (56.79% boys) aged 18-24 months (Mage = 21.16) living in peri-urban China were collected using two caregiver-reported tests for child language development and ability, and language environment analysis technology for measuring the home language environment. Results show that in peri-urban communities, girls were generally exposed to more adult-child conversations and showed higher counts of vocalizations than did boys; girls scored higher on language development measures than did boys. The implications of these findings on the gender gap and child development are discussed.

Using a longitudinal data set developed from surveys of 1,285 children (and their families), as well as 683 preschools teachers in 382 preschools in rural western China, we examined the association between preschool quality and the development (cognitive and social-emotional skills) of preschool children. The findings showed that 55 % of the sample children were cognitively delayed, and 49 % of the children were social-emotionally delayed at age 3. The rates of delay decreased to less than 40 % when the children were at preschool age. Although other factors were associated with the decline in development delays, according to the findings, preschool attendance respectively led to an improvement of 0.47 SD (p = 0.001) in child cognitive development (i.e., the fall in delays). More specifically, the global quality and the structural quality of preschools improved child cognitive development by 0.11 SD (p = 0.001) and 0.09 SD (p = 0.004), respectively. The findings of the subgroup analyses suggested that children from disadvantaged backgrounds benefited more from being able to attend quality preschools. Preschool quality also helped to improve developmental outcomes (cognitive abilities and social-emotional skills): for children that were developmentally delayed before age 3, but not for those children that were not delayed when they were 3 years old; for children with lower educated parents, but not for those with more highly educated parents; for children that were from relatively poor families, but not for those that were from relatively rich families; and for children that were attending preschools in rural areas, but not for those who were attending a preschool in an urban area.

New research shows China is remarkably effective in promoting its authoritarian governance to a global audience. The United States must up its game.

America’s New Trade Policy in the Asia-Pacific and Beyond

Security, Development, and Local Membership in China