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The Association Between Screen Time and Outdoor Time on Adolescent Mental Health and Academic Performance: Evidence from Rural China

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Purpose: We examine how adolescent free time allocation—namely, screen time and outdoor time—is associated with mental health and academic performance in rural China.

Methods: This paper used a large random sample of rural junior high school students in Ningxia (n = 20,375; age=13.22), with data collected from self-reported demographic questionnaires (to assess free time allocation), the Strengths and Difficulties Questionnaire (to assess mental health), and a standardized math test (to measure academic performance). We utilized a multivariate OLS regression model to examine associations between free time allocation and adolescent outcomes, controlling for individual and family characteristics.

Results: Our sample’s screen time and outdoor time both averaged around 1 hour. About 10% of the sample adolescents reported behavioral difficulties, while a similar percentage (11%) reported abnormal prosocial behaviors. Adolescents with higher levels of screen time (> 2 hours) were 3 percentage points more likely to have higher levels of behavioral difficulties (p< 0.001), indicating that excessive screen time was associated with worse mental health. Meanwhile, outdoor time was associated with better mental health, and positive correlations were observed at all levels of outdoor time (compared to no outdoor time, decreasing the likelihood of higher levels of behavioral difficulties by between 3 and 4 percentage points and of lower prosocial scores by between 6 and 8 percentage points; all p’s< 0.001). For academic performance, average daily screen times of up to 1 hour and 1– 2 hours were both positively associated with standardized math scores (0.08 SD, p< 0.001; 0.07 SD, p< 0.01, respectively), whereas there were no significant associations between outdoor time and academic performance.

Conclusion: Using a large sample size, this study was the first to examine the association between adolescent free time allocation with mental health and academic performance, providing initial insights into how rural Chinese adolescents can optimize their free time.

Journal Publisher
Risk Management and Healthcare Policy
Authors
Huan Wang
Scott Rozelle

Global Health Economics, China, & the Science of Health Care Delivery in the Digital Age

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Global Health Economics, China, & the Science of Health Care Delivery in the Digital Age


Advances in artificial intelligence, use of "big data", digital platforms enabling mass collaboration, automation, the "internet-of-things" and other so-called "4th Industrial Revolution" (4IR) technologies are enabling a radical shift in how healthcare is delivered. Few places are attempting to integrate these technologies into healthcare as rapidly as China. This talk will discuss China's comparative advantage in the adoption of these technologies and lay out a research agenda for the economics of digital health. While these technologies bring potential to produce massive improvements in access to high-quality care and lower costs, this result is far from certain. Beyond mere technical uncertainty, 4IR technologies are likely to produce profound changes in healthcare markets by altering the nature of incentives in the health system and relationships between patients, providers, payers. Evidence on these issues is needed to inform policy and regulation aiming to maximize social value and mitigate unintended consequences. Specific applications will be drawn from online research in China and other middle-income countries.

About the Speaker

Sean Sylvia headshot.

Sean Sylvia is an Assistant Professor of health economics at UNC. His primary research interest is in the delivery of healthcare in China and other middle-income countries. Working with multidisciplinary teams of collaborators, he conducts large-scale population-based surveys and randomized trials to develop and test new approaches to provide healthcare to the poor and marginalized. His recent work focuses on the use of information technology to expand access to quality healthcare. 


For more information, please visit his personal website.

This event will be held in-person at Stanford University, masks are not required but strongly encouraged.

Questions? Contact sccei-communications@stanford.edu

 

Philippines Room, C330, Encina Hall, Stanford University

Sean Sylvia
Seminars

Protecting Reproductive Health Information after Fall of Roe v. Wade

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Beth Duff-Brown
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The Supreme Court ruling eliminating the constitutional right to an abortion could also result in women’s personal reproductive health data being used against them, warns Stanford Health Policy’s Michelle Mello.

The Dobbs v. Jackson Women’s Health Organization ruling could, for example, lead to a woman’s health data in clinician emails, electronic medical records, and online period-tracking platforms being used to incriminate her or her health-care providers, Mello said.

“Ultimately, broader information privacy laws are needed to fully protect patients and clinicians and facilities providing abortion services,” writes Mello, a professor of health policy and law in this JAMA Health Forum article with colleague Kayte Spector-Bagdady, a bioethicist from the University of Michigan. “As states splinter on abortion rights after the Dobbs Supreme Court decision, the stakes for providing robust federal protection for reproductive health information have never been higher.”

Eight states banned abortions on the same day the Dobbs ruling came down, and 13 states that had “trigger bans” that, if Roe v. Wade were struck down, would automatically prohibit abortion within 30 days. Other states are considering reactivating pre-Roe abortion bans and legislators in some states intend to introduce new legislation to curb or ban the medical procedure.”

Three Potential Scenarios

The authors note these new abortion restrictions may clash with privacy protections for health information, laying out three scenarios that could impact millions of women. And, they note, “despite popular misconceptions about the breadth of the Privacy Rule of the Health Information Portability and Accountability Act (HIPAA) and other information privacy laws, current federal law provides little protection against these scenarios.”

The first scenario is that a patient’s private health information may be sought in connection with a law-enforcement proceeding or civil lawsuit for obtaining an illegal abortion. HIPAA privacy regulations and Fourth Amendment rights against unreasonable searches and seizures won’t help physicians and hospitals resist such investigative demands, the authors write. And though physician-patient communications are ordinarily considered privileged information, the scope of that privilege varies greatly from state to state. “In many cases medical record information has been successfully used to substantiate a criminal charge,” the authors write.

Ultimately, broader information privacy laws are needed to fully protect patients and clinicians and facilities providing abortion services.
Michelle Mello
Professor of Health Policy, Law

The second privacy concern is the potential use of health-care facility records to incriminate an institution or its clinicians for providing abortion services. Relevant records could include electronic health records, employee emails or paging information and mandatory reports to state agencies. Clinicians may not realize that if they are using an institutional email address or server, their institution likely has direct access to information and communications stored there, which can be used to search for violations. State Freedom of Information Act (FOIA) laws also allow citizens to request public records from employees of government hospitals and clinics.

“Additionally, state mandatory reporting laws for child abuse might be interpreted to cover abortions — particularly if life is defined as beginning at fertilization,” the authors note.

The third scenario is that information generated from a woman’s online activity could be used to show she sought an abortion or helped someone to do so. Many women use websites and apps that are not HIPAA-regulated or protected by patient-physician privilege, such as period-tracking apps used by millions of women that collect information on the timing of menstruation and sexual activity.

“There are many instances of internet service providers sharing user data with law enforcement, and prosecutors obtaining and using cellphone data in criminal prosecutions,” write Mello and Spector-Bagdady, adding commercially collected data are also frequently sold to or shared with third parties.

“Thus, pregnant persons may unwittingly create incriminating documentation that has scant legal protection and is useful for enforcing abortion restrictions,” they said.

The immediate problem, Mello notes, is in the states that have already banned abortion or passed restrictive laws.

“There could be a problem with states trying to reach outside their borders to prosecute people, but that could well be unconstitutional,” Mello said.

Some states’ laws sweep abortion pills into the definition of illegal abortions, she said, and there are legal obstacles to supplying the pills across state lines.

“There is a lot of energy going into figuring out a workaround right now, but it’s too soon to call,” Mello said.

Recommended Protections

So how can clinicians and health-care facilities protect their patients and themselves?

When counseling patients of childbearing age about reproductive health issues, clinicians should caution their patients about putting too much medical data online and refer them to expert organizations that will help them minimize their digital footprint.

When documenting reproductive health encounters, the authors said, clinicians should ask themselves: “What information needs to be in the medical record to assure safe, good-quality care, buttress our claim for reimbursement, or comply with clear legal directives?” For example, does information about why a patient may have experienced a miscarriage need to be recorded?

Patients and clinicians should be aware that email and texting may be seen by others, so conversations among staff about reproductive health issues may best be conducted by phone or in person.

Finally, if abortion-related patient information is sought by state law enforcement officials, a facility’s attorney should be consulted about asserting physician-patient privilege and determining whether the disclosure is mandated by law.

Michelle Mello

Michelle Mello

Professor of Health Policy, Law
Focuses on issues at the intersection of law, ethics and health policy.
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Fake or Fact news on coronavirus
Q&As

Does Free Speech Protect COVID-19 Vaccine Misinformation?

While some might say making or spreading known false statements related to the COVID-19 vaccine should be criminalized, the First Amendment, which guarantees free speech, continues to provide protection for people who promulgate such faulty information. So, how can the spread of misinformation be stopped without quashing free speech?
Does Free Speech Protect COVID-19 Vaccine Misinformation?
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Commentary

U.S. Public Health Law — Foundations and Emerging Shifts

The COVID-19 pandemic has focused attention on the complex and sometimes conflicting relationship between individual rights and public health protection.
U.S. Public Health Law — Foundations and Emerging Shifts
Supreme Court
Q&As

A Look at the Supreme Court Ruling on Vaccination Mandates

Two Stanford law, labor and health experts explain the legal and health implications of the Supreme Court ruling that struck down the Biden administration's COVID-19 vaccine mandate for large companies, while upholding another federal regulation calling on health-care workers in federally funded facilities to be vaccinated.
A Look at the Supreme Court Ruling on Vaccination Mandates
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Michelle Mello writes that the overturning of Roe v. Wade — ending federal protection over a woman's right to an abortion — could also expose her personal health data in court.

Local Political Incentives and Air Pollution Regulation in China

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Air pollution is a silent and invisible killer more lethal than violence, diseases, and smoking.  More than 95 percent of the global population lives in areas with unhealthy air by WHO standards.  Moreover, long-term exposure to polluted air can increase the probability of succumbing to COVID-19.  

Scientific solutions to contain air pollution are available, but limited progress has been made in implementing them.  Temporally, there has been an uneven success in reducing pollution even in the same locality over time, as exemplified by the exercise of political power to change the color of the sky leading up to the 2008 Beijing Olympics (aka Olympic Blue).  

In this talk, Professor Shen will discuss her new book, The Political Regulation Wave: A Case of How Local Incentives Systematically Shape Air Quality in China (Cambridge University Press, 2022).  Departing from extant works, which focus on air data manipulation or the effect of campaigns, the book asks, what explains the systematic temporal variation in actual and reported air quality after controlling for top-down implementation campaigns?  Making use of new data, approaches, and techniques from across social and environmental sciences, the book shows that local leaders ordered different levels of regulation over time based on what their political superiors desired, leading to the titular “waves” of regulation and pollution.  However, the effectiveness of their regulatory efforts depends on the level of ambiguity in controlling a particular pollutant.  When ambiguity dilutes regulatory effectiveness, having the right incentives and enhanced monitoring is insufficient for successful policy implementation.

You can read and download her book in pdf format here.

Portrait of Shiran Victoria Shen
Shiran Victoria Shen forged her own path at Stanford University by simultaneously completing a Ph.D. in political science and an MS in civil and environmental engineering in five years after graduating Phi Beta Kappa, Sigma Xi, and with high honors from Swarthmore College. Her research explores the intersections of political science, public policy, environmental sciences, and engineering, with a particular understanding of how local politics influence environmental governance. Her first book, The Political Regulation Wave: A Case of How Local Incentives Systematically Shape Air Quality in China, was published by Cambridge University Press in March 2022.  In dissertation form, it was the recipient of two major association awards, the American Political Science Association’s Harold D. Lasswell Award and the Association for Public Policy Analysis and Management’s Ph.D. Dissertation Award. Earlier versions of its parts received the American Political Science Association’s Paul A. Sabatier Award for the best paper in science, technology & environmental politics and the Southern Political Science Association’s Malcolm Jewell Award for the best overall graduate student paper.

You can learn more about her work at http://svshen.com and follow her on Twitter @SVictoriaShen.

Via Zoom

Shiran Victoria Shen National Fellow, Hoover Institution, Stanford University; Assistant Professor of Environmental Politics, University of Virginia
Seminars

After COVID-19: Decisions, Direction and the Future

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Please join us for an AMCHAM South China event in collaboration with Macau University of Science and Technology and Stanford Center on China's Economy and Institutions.

The event will be conducted in English, consecutive interpretation will be provided in Chinese. 

AGENDA:

6:00 – 6:05 Introduction of Dr. Zhong Nanshan and Keynote Speakers by Dr. Harley Seyedin, President AmCham South China.

6:05 – 6:45 Dr. Zhong Nanshan, Zhong Nanshan is director of the National Clinical Research Center for Respiratory Disease, an academician of the Chinese Academy of Engineering, and a leading Chinese expert in preventing and treating respiratory infectious diseases.

6:45 – 7:15 Dr. Manson Fok: Surgeon, research pioneer and philanthropist. Dean of Faculty of Medicine at Macau University of Science and Technology (MUST) and Director of the MUST hospital. Launched the city’s first degree course to train doctors. Founding chairman of Virtus Medical Group.

7:15 – 7:45 Dr. Billy Chan, philanthropist and Director of Center for Education in Medical Simulation, Macau University of Science and Technology

7:45 – 8:15 Prof. Brian Tomlinson, world renowned research scientist. Faculty of Medicine of Macau University of Science and Technology, author of 654 medical publications. 

8:15 – 8:45 Prof. Scott Rozelle, Co-Director, Stanford Center on China's Economy and Institutions, Helen F. Farnsworth Senior Fellow at Freeman Spogli Institute for International Studies.

8:45 – 8:55 Mr. Aaron Finley, Director, Central Business Development, Deloitte China.

8:55 – 9:00 Closing remarks.

SPEAKERS

Event speakers for the AMCHAM / SCCEI March 15, 2022 event.

Virtual Event | Register Here

Billy Chan
Aaron Finley
Manson Fok
Zhong Nanshan
Scott Rozelle
Harley Seyedin
Brian Tomlinson
Panel Discussions

Research Talk with David Molitor — A Causal Concentration-Response Function for Air Pollution: Evidence from Wildfire Smoke

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David Molitor
David Molitor is an Associate Professor of Finance and Economics at Gies College of Business, University of Illinois at Urbana-Champaign, and a Research Associate at the National Bureau of Economic Research (NBER). His research explores how location and the environment shape health and health care delivery in the United States. He is a Principal Investigator of the Illinois Workplace Wellness Study, a large-scale field experiment of workplace wellness conducted at the University of Illinois. His work has been supported by the National Institutes of Health, the National Science Foundation, the Social Security Administration, J‑PAL North America, and the Robert Wood Johnson Foundation. Molitor's research has been published in leading academic journals including The American Economic Review, The Quarterly Journal of Economics, and The Review of Economics and Statistics and has been covered by media outlets including The New York Times, The Wall Street Journal, and The Washington Post.

You are invited to a Zoom meeting. 

Zoom Link 

Meeting ID: 990 6232 4907

Password: 764436

Seminars

Cynthia Chen

Shorenstein APARC Encina Hall E301 Stanford University
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Visiting Scholar at APARC, 2021-2022
huijun_cynthia_chen.jpeg Ph.D

Dr. Cynthia Chen joined the Walter H. Shorenstein Asia-Pacific Research Center (APARC) as visiting scholar with the Asia Health Policy Program during the 2022 winter and spring quarters. She is an Assistant Professor at the National University of Singapore (NUS). Her current research focuses on the well-being and older adults, healthcare financing, and the economics of ageing. She is interested in how demographic, economic and social changes can affect the burden of care, financing needs and optimal resource allocation in the future. Her research has been supported by the Singapore’s Ministry of Health, Ministry of Education, the US National Institutes of Aging, and the Thai Health Promotion Foundation among others. To date, she has published more than 45 internationally peer-reviewed journals on societal ageing, the burden of chronic diseases, and cost-effectiveness research. Dr. Chen obtained her Ph.D. in Public Health, Masters and BSc in Statistics from NUS.

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Preventing Preterm Deliveries Using a Digital Approach

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Jason Wang and his team working on a project to prevent preterm births received a $150,000 grant from the Richard King Mellon Foundation to complete their randomized control trial testing a digital app that tries to prevent recurrent preterm births.

PretermConnect uses a digital strategy for prevention and follow-up of preterm births in Allegheny County, PA, to optimize the health and well-being of mothers and children. Instead of the standard care, Stanford Health Policy is collaborating with the University of Pittsburg Medical Center (UPMC) in the randomized control trial with women who have delivered a preterm baby. The women are invited to participate and then randomly put into the group that uses the digital or a control group who received paper-based discharge packets with supplemental health education on postpartum care.

“This grant allows us to continue recruiting participants through UPMC and expanding PretermConnect’s features to enhance user engagement, including a function to search for resources by geography and topic,” said Wang, MD, a professor of pediatrics and health policy. “We also intend to scale the project with additional content on high-risk infant follow-up and preterm-specific developmental care guidelines, additional engagement features — and eventually support for different languages, starting with Spanish.”

In the long term, we hope to see an overall decrease in infant morbidity and mortality, by way of reducing preterm births.
Jason Wang
Professor of Pediatrics and Health Policy

The women in the digital app group receive in-app health education and resources to improve well-being for mothers and their infants. The app includes a social interaction feature designed to foster social connections and promote self-care. They have enrolled 30 women during the pilot phase and 15 mother-infant dyads in the randomized control trial, with a goal of reaching 250.

“The digital approach also allows us to administer brief surveys and gather information on dynamic social determinants of health more frequently than can be done through traditional means,” said Shilpa Jani, an SHP project manager. She said social determinants of health — such as persistent housing instability, food insecurity and concerns of personal safety — contribute to chronic stress and health issues as well as an increased risk of pregnancy and birth complications.

“Adverse effects of social determinants of health along with health complications of preterm deliveries may exacerbate morbidities for the mother and child,” Jani said, adding that preterm-related causes of death accounted for two-thirds of infant deaths in 2019 in the United States.

Wang and Jani said the immediate project goals include increasing health education for preterm baby care, improving postpartum maternal health, and encouraging usage of local resources in Allegheny County. They eventually hope to see reductions in risk for subsequent preterm delivery and infant mortality and postpartum depression, as well as increases in mother-infant bonding and larger proportions of breastmilk feeding.

Jason Wang Stanford Health Policy

Jason Wang

Professor of Pediatrics and Health Policy
Develops tools for assessing and improving the quality of health care
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Shilpa Jani

Shilpa Jani

Research Data Analyst
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New Study Shows Support for Paid Family Leave Grew During Pandemic

In a blow to arguments that a federal paid leave law would harm small businesses, a new study co-authored by SHP's Maya Rossin-Slater finds that support for paid leave among small employers is not only strong, but also increased as the pandemic added new strain to the work-life juggle.
New Study Shows Support for Paid Family Leave Grew During Pandemic
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Babies Born Too Early Likely to Face Educational and Lifelong Behavioral Setbacks

SHP's Lee Sanders and his Stanford colleagues found that after adjusting for socioeconomic status and compared with full-term births, moderate and late preterm births are associated with increased risk of low performance in mathematics and English language arts, as well as chronic absenteeism and suspension from school.
Babies Born Too Early Likely to Face Educational and Lifelong Behavioral Setbacks
COVID Contact Tracing
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Contact-tracing App Curbed Spread of COVID in England and Wales

SHP's Jason Wang writes in this Nature article that digital contact tracing has the potential to limit the spread of COVID-19.
Contact-tracing App Curbed Spread of COVID in England and Wales
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SHP researchers awarded grant to continue their clinical trial testing out a digital app they hope will prevent preterm births.

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Publishing and Assessing the Research of Economists: Lessons from Public Health

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Scott Rozelle
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Scott Rozelle introduces his recent publication, "Publishing and Assessing the Research of Economists: Lessons from Public Health" in a blog post for the China Economic Review's official Wechat account to celebrate its 30th anniversary.

Research in Progress with Sherri Rose: New and Ongoing Projects at the Interface of Machine Learning for Health Policy

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Sherri Rose, PhD  is an Associate Professor of Health Policy at the Stanford School of Medicine and Co-Director of the Health Policy Data Science Lab. Her research is centered on developing and integrating innovative statistical machine learning approaches to improve human health and health equity. Within health policy, Dr. Rose works on risk adjustment, ethical algorithms in health care, comparative effectiveness research, and health program evaluation. She has published interdisciplinary projects across varied outlets, including Biometrics, Journal of the American Statistical Association, Journal of Health Economics, Health Affairs, and New England Journal of Medicine. In 2011, Dr. Rose coauthored the first book on machine learning for causal inference, with a sequel text released in 2018. She has been Co-Editor-in-Chief of the journal Biostatistics since 2019.

Dr. Rose has been honored with an NIH Director's New Innovator Award, the ISPOR Bernie J. O'Brien New Investigator Award, and multiple mid-career awards, including the Gertrude M. Cox Award and the Mortimer Spiegelman Award, the nation’s highest honor in biostatistics, given to a statistician younger than 40 who has made the most significant contributions to public health statistics. She was named a Fellow of the American Statistical Association in 2020 and received the 2021 Mortimer Spiegelman Award, which recognizes the statistician under age 40 who has made the most significant contributions to public health statistics. Her research has been featured in The New York Times, USA Today, and The Boston Globe. 

Title: New and Ongoing Projects at the Interface of Machine Learning for Health Policy

 

Register in advance for this meeting: https://stanford.zoom.us/meeting/register/tJIpdOispzojH9bzpXrF3_VpYcbPN9Hcgbbw After registering, you will receive a confirmation email containing information about joining the meeting.

Sherri Rose

Encina Commons,
615 Crothers Way
Stanford, CA 94305-6006

 

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Professor, Health Policy
Professor, Computer Science (by courtesy)
sherri_rose-portrait.jpg PhD

Sherri Rose, Ph.D. is a Professor of Health Policy and, by courtesy, of Computer Science at Stanford University, where she is Director of the Health Policy Data Science Lab. Her research is centered on developing and integrating innovative statistical machine learning approaches to improve human health and health equity. Within health policy, Dr. Rose works on ethical algorithms in health care, risk adjustment, chronic kidney disease, and health program evaluation. She has published interdisciplinary projects across varied outlets, including Biometrics, Journal of the American Statistical Association, Journal of Health Economics, Health Affairs, and New England Journal of Medicine. In 2011, Dr. Rose coauthored the first book on machine learning for causal inference, with a sequel text released in 2018.

Dr. Rose has been honored with an NIH Director’s Pioneer Award, NIH Director's New Innovator Award, the ISPOR Bernie J. O'Brien New Investigator Award, and multiple mid-career awards, including the Gertrude M. Cox Award. She is a Fellow of the American Statistical Association (ASA) and received the Mortimer Spiegelman Award, which recognizes the statistician under age 40 who has made the most significant contributions to public health statistics. In 2024, she received both the ASHEcon Willard G. Manning Memorial Award for Best Research in Health Econometrics and the ASA Outstanding Statistical Application Award. She was recently awarded the Open Science Champion Prize by Stanford University. Her research has been featured in The New York Times, USA Today, and The Boston Globe. She was Co-Editor-in-Chief of the journal Biostatistics from 2019-2023.

She received her Ph.D. in Biostatistics from the University of California, Berkeley and a B.S. in Statistics from The George Washington University before completing an NSF Mathematical Sciences Postdoctoral Research Fellowship at Johns Hopkins University. 

Director, Health Policy Data Science Lab
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