Interdisciplinary research on global health problems through the lenses of economics, nutrition and politics.
Research Spotlight
Tackling the Health of Women and Children in Global Conflict Settings
A new four-paper series in The Lancet exposes the far-reaching effects of modern warfare on women’s and children’s health. Stanford researchers, including SHP's Paul Wise and Eran Bendavid, have joined other academics and health-care experts in calling for an international commitment from humanitarian actors and donors to confront political and security challenges.
Many countries have taken digital epidemiology to the next level in responding to COVID-19. Focusing on core public health functions of case detection, contact tracing, and isolation and quarantine, the authors explore ethical concerns raised by digital technologies and new data sources in public health surveillance during epidemics.
Does Diversity Matter for Health? Experimental Evidence from Oakland
African-American men have the lowest life expectancy of any major demographic group in
the United States and live on average 4.5 fewer years than non-Hispanic white men. This paper finds that the mortality disparity is partly related to underutilized preventive
healthcare services.
Purpose Literature has shown that the intergenerational transmission of cognitive abilities is stronger for children raised in more advantaged environments. However, there has never been an empirical investigation of this pattern in China. This study examines differences in the intergenerational transmission of cognitive capabilities among mothers and young children in urban and rural subpopulations in China and investigates whether these differences are driven by differences in parental investment in the home environment.
Design/methodology/approach Data collected from randomly selected 6- to 36-month-old babies and their mothers in a Northwestern province in China was used. Child capabilities were assessed by the Bayley Scales of Infant and Toddler Development (3rd edition). Maternal intelligence quotient (IQ) scores were assessed with the Raven’s Progressive Matrices test. The non-parametric regression methods were used to construct the factor scores of child capabilities. The ordinary least squares (OLS) models were employed to investigate the relations between child cognition, maternal IQ and parental investment.
Findings In urban households, where most children are raised in a positive home environment, child cognitive scores are strongly correlated with maternal IQ. In rural households, where parental investments are lower and more variable, child cognitive scores are not significantly correlated with maternal IQ but are predicted by differences in parental investments in a cognitively stimulating home environment.
Originality/value This study provides a unique contribution by utilizing rural–urban disparities in China as a unique natural experiment to investigate differences in the transmission of cognitive capabilities across socioeconomic status (SES). It also provides the first empirical evidence of SES differences in the intergenerational transmission of cognitive capabilities in a developing country. This study reveals that intergenerational mother–child cognition associations are disrupted by poor parental investment in rural households but not in urban households.
Background Comorbidity in mental disorders is prevalent among adolescents, with evidence suggesting a general psychopathology factor (“p” factor) that reflects shared mechanisms across different disorders. However, the association between the “p” factor and protective factors remains understudied. The current study aimed to explore the “p” factor, and its associations with psycho-social functioning, in Chinese adolescents.
Methods 2052 students, aged 9–17, were recruited from primary and secondary schools in Shanghai, China. Multiple rating scales were used to assess psychological symptoms and psycho-social functioning. Confirmatory factor analysis was conducted to verify the fit of models involving different psychopathology domains such as externalizing, internalizing, and the “p” factor. Subsequently, structural equation models were used to explore associations between the extracted factors and psycho-social functioning, including emotion regulation, mindful attention awareness, self-esteem, self-efficacy, resilience, and perceived support.
Results The bi-factor model demonstrated a good fit, with a “p” factor accounting for 46 % of symptom variation, indicating that the psychological symptoms of Chinese adolescents could be explained by internalizing, externalizing, and the “p” factor. Psychologically, a higher “p” was positively correlated with emotion suppression and negatively correlated with mindful attention awareness, emotion reappraisal, self-esteem, and resilience. Socially, a higher “p” was associated with decreased perceived support.
Limitations Only common symptoms were included as this study was conducted at school. Furthermore, the cross-sectional design limited our ability to investigate causal relationships.
Conclusions A “p” factor exists among Chinese adolescents. Individuals with higher “p” factor levels were prone to experience lower levels of psycho-social functions.
Economic Development and Cultural Change,
June 7, 2024
EdTech, which includes computer assisted learning (CAL), online education, and remote instruction, was expanding rapidly even before the current full-scale substitution for in-person learning at all levels of education around the world because of COVID-19. Studies of CAL interventions often find positive effects, however, these “CAL programs” often include non-technology based inputs such as more time on learning and instructional support by facilitators in addition to technology-based components. 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 a novel multi-treatment field experiment with more than four thousand schoolchildren in rural China. For the full sample, we find null effects for both the total CAL program and the technology-based effects of CAL (which are measured relative to a traditional pencil-and-paper learning treatment) 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 and yet that tech programs can substitute atleast to a certain extent for traditional learning.
Background: Maternal empowerment - the capacity to make decisions within households - is linked to better child feeding and nutritional outcomes, but few studies have considered the mediating role of caregiver knowledge. Further, existing literature centres primarily on the husband-wife dyad while overlooking grandmothers as important childcare decision-makers.
Methods: We collected primary data through household surveys in 2019 and 2021 from 1190 households with infants zero to six months living in rural western China. We identified the primary and secondary caregivers for each infant and assessed their feeding knowledge and practices, as well as infant nutritional status. We constructed a maternal empowerment index using a seven-item decision-making questionnaire and examined the relationship between maternal empowerment in childcare and household decisions, caregivers' feeding knowledge, and infant feeding practices and nutritional outcomes.
Results: Mothers had significantly higher levels of feeding knowledge than secondary caregivers (most were grandmothers, 72.7%), with average knowledge scores of 5.4 vs. 4.1, respectively, out of 9. Mothers and secondary caregivers with higher levels of feeding knowledge had significantly higher exclusive breastfeeding rates by 13-15 percentage points (P < 0.01) and 11-13 percentage points (P < 0.01), respectively. The knowledge of secondary caregivers was even more strongly associated with not feeding formula (15 percentage points, P < 0.01). Mothers empowered to make childcare decisions were more likely to exclusively breastfeed (12-13 percentage points, P < 0.01), less likely to formula feed (9-10 percentage points, P < 0.05), and more likely to have children with higher Z-scores for length-for-age (0.32-0.33, P < 0.01) and weight-for-age (0.24-0.25, P < 0.05). Effects remained after controlling for maternal feeding knowledge.
Conclusions: While mothers' and grandmothers' feeding knowledge was both important for optimal infant feeding, grandmothers' knowledge was particularly critical for practicing exclusive breastfeeding. Given the disparity in feeding knowledge between the two caregivers, our study further shows that mothers empowered in childcare decision-making were more likely to exclusively breastfeed their infants. This implies that some mothers with adequate knowledge may not practice optimal feeding because of lower decision-making power. Overall, our study highlights the role of secondary caregivers (grandmothers) in infant care and suggests that future child nutritional interventions may benefit from involving secondary caregivers (grandmothers).
Background: To explore the associations between anxiety and depression symptoms and academic burnout among children and adolescents in China, and to examine the role of resilience and self-efficacy in addressing academic burnout.
Methods: A total of 2,070 students in grades 4–8 were recruited from two primary and three middle schools in Shanghai, completed the Elementary School Student Burnout Scale (ESSBS), the Multidimensional Anxiety Scale for Children-Chinese (MASC-C), the Center for Epidemiological Studies Depression Scale (CES-D), the Connor-Davidson Resilience Scale (CD-RISC), and the General Self-Efficacy Scale (GSES), with 95.04% effective response rate. Multivariable regression analyses examining the associations between anxiety / depression symptoms and academic burnout (as well as the associations between resilience / self-efficacy and academic burnout) were performed using STATA 16.0 and SmartPLS 3.0.
Results: Anxiety symptoms (β = 0.124, p < 0.01) and depression symptoms (β = 0.477, p < 0.01) were positively correlated with academic burnout. Resilience partially mediated the association between depression symptoms and academic burnout (β = 0.059, p < 0.01), with a mediation rate of 12.37%. Self-efficacy partially mediated the associations between anxiety symptoms and academic burnout (β = 0.022, p < 0.01) and between depression symptoms and academic burnout (β = 0.017, p < 0.01), with mediation rates of 17.74% and 3.56%, respectively. Resilience and self-efficacy together (β = 0.041, p < 0.01) formed a mediating chain between depression symptoms and academic burnout, with a mediation rate of 8.6%.
Conclusions: Anxiety and depression symptoms were positively associated with academic burnout. Resilience and self-efficacy were found to mediate the associations partially.
Background: Comorbidity in mental disorders is prevalent among adolescents, with evidence suggesting a general psychopathology factor (“p” factor) that reflects shared mechanisms across different disorders. However, the association between the “p” factor and protective factors remains understudied. The current study aimed to explore the “p” factor, and its associations with psycho-social functioning, in Chinese adolescents.
Methods: 2052 students, aged 9–17, were recruited from primary and secondary schools in Shanghai, China. Multiple rating scales were used to assess psychological symptoms and psycho-social functioning. Confirmatory factor analysis was conducted to verify the fit of models involving different psychopathology domains such as externalizing, internalizing, and the “p” factor. Subsequently, structural equation models were used to explore associations between the extracted factors and psycho-social functioning, including emotion regulation, mindful attention awareness, self-esteem, self-efficacy, resilience, and perceived support.
Results: The bi-factor model demonstrated a good fit, with a “p” factor accounting for 46 % of symptom variation, indicating that the psychological symptoms of Chinese adolescents could be explained by internalizing, externalizing, and the “p” factor. Psychologically, a higher “p” was positively correlated with emotion suppression and negatively correlated with mindful attention awareness, emotion reappraisal, self-esteem, and resilience. Socially, a higher “p” was associated with decreased perceived support.
Limitations: Only common symptoms were included as this study was conducted at school. Furthermore, the cross-sectional design limited our ability to investigate causal relationships.
Conclusions: A “p” factor exists among Chinese adolescents. Individuals with higher “p” factor levels were prone to experience lower levels of psycho-social functions.
According to Communist Party discourse, China’s ‘New Era’ began when Xi Jinping was anointed Party boss in 2012. The shape of this New Era became eminently clear in 2023 when Xi commenced his third five-year term as General Secretary of the Party, a fortification of one-man authoritarian rule unprecedented in post-Mao China. Under Xi, the Party has expanded its influence over government, the economy and society. The Party-State is now more Party than State. The year 2023 saw other ‘new eras’ for China as well. Despite initial optimism sparked by the end of COVID-19 restrictions in late 2022, the Chinese economy in 2023 was buffeted by continuing property sector woes, record unemployment, and an unfolding local government debt crisis. Globally, China adopted a series of new and ambitious diplomatic initiatives to woo the Global South and amplify its voice on the world stage. The China Story Yearbook 2023: China’s New Era provides informed perspectives on these and other important stories that will resonate for years to come.
