[version 2; peer review: 2 approved, 3 approved with reservations]

Background
Mental health problems among young children have become a common public health issue worldwide. As the family plays a crucial role in creating a favorable environment for children’s mental health, the parenting style of caregivers is a key factor related to children’s mental health issues. This study aims to examine the associations between parenting styles of primary caregivers and the mental health of their primary school child in rural China and identifies the factors that may influence the adoption of different parenting styles.

Methods
Data were collected from 1,298 primary school children (aged 9–11) and their primary caregivers in northwestern China. The primary caregivers completed the Parenting Styles and Dimensions Questionnaire, the Strengths and Difficulties Questionnaire, and a socio-demographic questionnaire. The cognitive development of children was measured using the Wechsler Preschool and Primary Scale of Intelligence-Fourth Edition, and the non-cognitive development of children was evaluated using the Ages and Stages Questionnaire: Social-Emotional. We performed descriptive statistics, linear regression analysis, and multivariable regression analysis.

Results
Our data showed that 17% of the sampled children exhibited total difficulty problems. The results indicated that authoritative parenting style was negatively associated with child mental health problems. In contrast, authoritarian parenting style was positively associated with child mental health problems. Analysis of combined parenting styles revealed that the combinations that included relatively more intensive authoritative parenting styles was associated with reduced incidence of child mental health problems. In contrast, the combinations that were found to have relatively more authoritarian parenting styles were associated with higher rates of mental health issues among children. Demographic characteristics, such as child gender, child developmental outcomes, child attending preschools, identity of primary caregiver, and family economic status, that were associated with the adoption of different parenting styles.

Conclusions
The study indicates that an authoritative parenting style is positively associated child mental health outcomes. Likewise, when authoritative strategies are more prominent within combined parenting styles, the likelihood that a child will experience mental health problems decreases. In contrast, the more dominant authoritarian behaviors are, the greater the risk of child mental health problems. Therefore, primary caregivers should be encouraged to adopt more positive parenting styles, which can help promote better outcomes of child mental health.

Jing Tian ^1,2, Lei Wang ^1,✉, Steven Sun Zhao ³, Sicong Li ⁴, Zekai Fu ⁵, Scott Rozelle ⁶

This paper exploits the universe of credit- and debit-card transactions in China during 2013–2015 and provides the first nationwide analysis of the health care cost of PM2.5 for a developing country. We leverage spatial spillovers of PM2.5 from long-range transport to generate exogenous variation in local pollution, and we employ a flexible distributed lag model to capture semiparametrically the dynamic response of pollution exposure. We find significant impacts of PM2.5 on health care spending in both the short and medium terms. A 10 g/m decrease in PM2.5 would reduce annual health care spending by over $9.2 billion, about 1.5% of China’s annual health care expenditure.

Drawing on quantitative and qualitative data collected in 2024 and 2025 in a relatively well-off rural area of China, this study examines the mental health of primary caregivers of young children and its correlates. The quantitative data show high prevalence of cognitive (40%), language (42%), and motor (20%) developmental delays among the children. Caregiver mental health problems may be one possible contributing factor given that approximately 17% of caregivers exhibit at least one mental health issue (i.e. stress, anxiety, or depression). The qualitative analysis identifies several risk factors of caregiver mental health problems: limited awareness of mental health concepts; heavy burden of caregiving; insufficient public services; and a lack of awareness of caregiver mental health’s impact on child development.

This study examines how center-based parenting interventions aimed at improving early child development in rural China affect the mental health of caregivers. Data from an analytic sample of 615 caregiver–child dyads (children aged 6 to 24 months, 48.5% girls; data collection: 2015–2017) in a 2-year cluster randomized controlled trial conducted in 100 villages showed that the intervention had no significant effect on caregiver depressive (β = − .047, SE = .079), anxiety (β = .040, SE = .076), or stress (β = .032, SE = .081) symptoms. Subgroup analyses found no significant difference in effects on mental health by prespecified characteristics after adjustment for multiple comparisons, except that the caregivers of children without social–emotional delay at baseline exhibited lower depression scores after the intervention (β = − .205, SE = .097, p = .043). The findings suggest that the center-based parenting intervention focused solely on strengthening parenting skills may be insufficient to improve caregiver mental health over 2 years.

In rural China, there is an urgent need for investment and innovative approaches for addressing adolescent mental health issues. This embedded mixed-methods study examines the effectiveness of a social-emotional learning (SEL) program in rural primary schools across China and the factors affecting compliance among teachers delivering the program. Pre- and post-intervention surveys assessed its effect on 2027 students in 49 schools, and 38 teachers were interviewed during the intervention. Results show that SEL courses improved student mental health. Some teachers reported increased workload and lack of support, while others noted the importance of mental health education and positive student outcomes. Performance incentives and the positive perceptions of SEL among teachers were crucial for effective delivery, though workload and lack of support often limited commitment. Overall, enhancing rural students' well-being through SEL programs requires raising awareness for SEL among teachers and building institutional support.

Objectives
Considering the importance of caregiver mental health for early childhood development, this study investigates risk and protective factors of mental health of mothers and grandmothers caring for infants and toddlers in rural China.

Methods
Using survey data from 777 primary caregivers of children aged 5 to 25 months, we apply regression analysis and structural equation modeling to examine associations between social support, mental health literacy, parenting-related hardships, and mental health among mothers and grandmothers.

Results
The study finds that 33% of the caregivers report symptoms of mental health problems, with grandmothers experiencing more severe symptoms. Poor caregiver mental health is associated with lower child language (p < 0.05) and social-emotional development (p < 0.001). Social support and mental health literacy are associated with better mental health, but this association was not statistically significant among either the mothers or the grandmothers alone.

Conclusions
Enhancing caregiver mental health is crucial for children’s development. Social support and mental health literacy are predictors of mental health. Future research should examine the effect of improving social support and mental health literacy on the mental health of caregivers for young children.

Introduction: Longitudinal trends in breastfeeding (BF) are often overlooked in favor of binary or time-to-cessation measures. Characterizing these trends can inform promotion of sustained BF practices. We identified distinct BF profiles among participants of a maternal and child health program.

Methods: The Healthy Future program consisted of community health workers delivering a BF curriculum to mothers through monthly home visits. The program was evaluated in rural Sichuan, China with a cluster-randomized controlled trial (assigned to program versus not). We clustered 6-month postpartum trends (n = 949) of maternal-reported infant feeding using dynamic time warping. For each month, participants were categorized as either exclusive breastfeeding (EBF), mixed feeding (MF, feeding breastmilk plus other foods or liquids), or not breastfeeding (NBF). After identifying clusters, we regressed BF profiles on intervention assignment using adjusted multinomial logistic regression.

Results: Cluster analysis revealed seven profiles: always EBF, always MF, never breastfed, EBF until the 5th month, MF until the 5th month, mostly EBF, and NBF from the 3rd month. The intervention was associated with improved odds of always EBF (ROR = 2.61, 95% CI 1.25, 5.42), MF until the 5th month (ROR = 2.52, 95% CI 1.18, 5.39), and NBF from the 3rd month (ROR = 2.82, 95% CI 1.16, 6.87) compared to being never breastfed. Mothers in the never breastfed cluster had the lowest age, education, BF knowledge and attitudes, and decision-making power.

Discussion: Cluster analyses found the intervention significantly improved EBF, particularly in mothers characterized by higher baseline educational attainment and BF knowledge. Targeted efforts are needed to help mothers initiate EBF from birth and continue EBF through month 6.