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This paper reports the development and baseline data of a vignettes-based measure of gender equality. Methods: Vignettes were developed through 3-day long focus groups. After piloting in 13 sites and repiloting a revised version in 6 countries, responses were categorized by the construct tapped and a scoring system developed. Finalized vignettes were then tested in DR Congo, Ecuador and China. Results: Young adolescents can successfully respond to vignettes; and can differentiate self from hypothetical protagonists of same and opposite sex. Response differences by sex of respondent and protagonist were statistically significant across a range of scenarios and settings. Conclusion: This is the first vignettes-based measure for young adolescents assessing young adolescent perceptions of relationships differentiated by sex of the protagonist. [ABSTRACT FROM AUTHOR]

Limited data exist related to low birth weight (LBW) incidence and risk factors in Western China. This paper aims to assess LBW and its relationship with antenatal care (ANC) in the poor counties of Western China. A community-based study in rural Western China was conducted in 2011. A kernel distribution was used to estimate the adjusted LBW incidence, and associations between LBW and socio-demographic or maternal factors were examined using multilevel logistic regression. Among 8,964 participants, 65.7% were weighed at birth. Crude LBW incidence was 6.6% and the adjusted rate was 9.3%. The study revealed that risk factors of LBW are being female, raised within a minority group, and with a family income below the national poverty line. For maternal risk factors, LBW was positively associated with not attending at least five or eight ANC visits, not receiving any ANC during the first trimester, and not having access to assess certain ANC content (weight, blood pressure, blood test, urine test, B-scan ultrasound, and folic acid supplement). There is urgent need to promote quality ANC in poor and rural areas of Western China and to prioritize vulnerable women and children who will benefit from quality ANC. [ABSTRACT FROM AUTHOR]

This paper aimed to investigate the role of parental education in child disability in China. We used nationally representative data from China’s National Sample Survey on Disability, iterated twice, in 1987 and 2006, with data of 764,718 children aged 0–14 years. Logit models were used for statistical analysis. Results showed that the prevalence of child disability was significantly associated with each parent’s education. Maternal education was more important than paternal education in child disability in both surveys. The analysis of marginal effect indicated a one-year increase in maternal and paternal schooling led to an average decrease of 0.121% and 0.091% in the probability of child disability in 1987, and 19 years later, these figures had dwindled to 0.091% and 0.072%, respectively. [ABSTRACT FROM AUTHOR]

Research has found that preschoolers’ imitation demonstrates in-group bias and is guided by behavior efficacy. However, little is known about whether children’s sensitivity to behavior efficacy affects their in-group imitation. This study aimed to investigate preschoolers’ imitation tendency when group preference and behavior efficacy are in conflict. Participants were 4-year-old (N = 72) and 6-year-old (N = 72) preschoolers in China. They observed two demonstrators (one in-group and one out-group) pressing two different buttons, respectively, to turn on a music box, and were then asked to try it themselves. In the experimental condition, the out-group demonstrator always succeeded, whereas the in-group demonstrator failed half the time. The results showed that more 6-year-old children imitated the less-effective behaviors of the in-group demonstrator, whereas 4-year-old children showed no such inclination. Two control conditions confirmed that children chose to imitate in-group rather than out-group members (Control 1: both in-group and out-group demonstrators succeeded all four times), and could imitate according to efficacy (Control 2: two in-group demonstrators succeeded two and four times, respectively). These results indicated that 6-year-olds faithfully followed the in-group modeled behavior, regardless of behavior efficacy. Results are discussed through the social function of in-group imitative learning. [ABSTRACT FROM AUTHOR]

Choosing a valid and feasible method to measure child developmental outcomes is key to addressing developmental delays, which have been shown to be associated with high levels of unemployment, participation in crime, and teen pregnancies. However, measuring early childhood development (ECD) with multi-dimensional diagnostic tests such as the Bayley Scales of Infant and Toddler Development III (Bayley-III) can be time-consuming and expensive; therefore, parental screening tools such as the Ages and Stages Questionnaire (ASQ-3) are frequently an alternative measure of early childhood development in large-scale research. The ASQ is also becoming more frequently used as the first step to identify children at risk for developmental delays before conducting a diagnostic test to confirm. However, the effectiveness of the ASQ-3 is uncertain. In this study, we evaluate the accuracy of the ASQ-3 as a screening measure for children at risk of developmental delay in rural China by age group. To do so, we administered the Bayley-III, widely considered to be the “gold standard” of ECD diagnostic tests, to a sample of 1,831 five to twenty-four month-old children and also administered the ASQ-3 to their caregivers. We then compared the outcomes of the ASQ-3 test to those of the Bayley-III. We find that the ASQ-3 was significantly though weakly correlated with the Bayley-III and that the strength of this correlation increased with child age and was stronger when the mother was the primary caregiver (as compared to the grandmother). We also find that the sensitivity and specificity of ASQ-3 ranged widely. The overall findings suggest that the ASQ-3 may not be a very accurate screening tool for identifying developmentally delayed children, especially for children under 13 months of age or children whose primary caregiver is not the mother. [ABSTRACT FROM AUTHOR]

Objectives: The main objective of this study was to explore the associations of family relationships and negative life events with depressive symptoms among Chinese adolescents. Methods: A cross-sectional study of 3081 middle school students was conducted in Ganzhou City, Jiangxi Province, China. Students were asked to complete questionnaires regarding family relationships, negative life events, and depressive symptoms. A mediation analysis was carried out using a multiple regression analysis and the PROCESS macro method. Results: Of all participants, 19.9% reported experiencing depressive symptoms. The prevalence of depressive symptoms was 13.0% and 29.2% in participants with good and poor parental relationships, and the prevalence of depressive symptoms was 11.4% and 30.9% in participants with closed and alienated parental-child relationships, respectively. Parental relationships, parental-child relationships, and negative life events were positively correlated with depressive symptoms. The effect of parental relationships on depressive symptoms was fully mediated by negative life events (Effect = 0.052, 95% CI = [0.023, 0.082]), while the effect of parent-child relationships on adolescent depressive symptoms was partially mediated by negative life events (Effect = 0.075, 95% CI = [0.048, 0.104]). Conclusions: Our results showed a high prevalence of depressive symptoms in Chinese adolescents. Poor family relationships may have the potential to increase the risk of depressive symptoms, and they could affect depressive symptoms through negative life events. [ABSTRACT FROM AUTHOR]

Children attending kindergarten are at high risk for contracting infections, for which hand hygiene (HH) has been recognized as the most cost-effective prevention measure globally. Kindergarten teachers’ HH behavior plays a vital role in encouraging favorable hygiene techniques and environment. This study aims to evaluate the effectiveness of a multimodal intervention at changing kindergarten teachers’ HH behavior and social cognitive factors that influences HH behavior in China. The intervention named “Clean Hands, Happy Life” includes HH products with refills, reminders and cues for action, a kick-off event with awards, and training programs. We evaluated the intervention using a self-administrative questionnaire with a stratified random sample of 12 kindergartens. Two surveys was completed by 176 teachers at baseline and 185 after the 6-month intervention. Compared with the baseline scores, there was a significant improvement in the overall self-reported HH compliance of teachers (9.38 vs. 9.68 out of 10, p = 0.006), as well as teachers’ perceived disease susceptibility, disease severity and behavioral control after the intervention (p<0.05). We found that teachers’ HH compliance was likely to be higher among those who have better HH guideline awareness (β = 0.48, p<0.01) and perceived behavioral control (β = 0.26, p = 0.01), which explained 24.2% of the variance of self-reported compliance of teachers at baseline. The assessed intervention may provide Chinese kindergarten teachers with behavioral skills and cognitions that associated with the compliance of HH behavior. We thus recommend future intervention studies consider our HH behavior change techniques, address multiple social cognitive determinants of HH behavior and include the change of targeted influences in the impact evaluation. [ABSTRACT FROM AUTHOR]

The existing literature concentrates on the relationship between amenities and migrants or residents. However, only a few studies have focused on the role of city amenities in determining the intentions of rural–urban migrants. Such a relation is a key issue in Chinese urbanisation development. The current study investigates the effects of urban amenities on the settlement intentions of rural–urban migrants in China. We find that medical amenities have a significantly positive effect on rural–urban migrants’ intentions. We also indicate that educational amenities and transportation services attract rural–urban migrants to settle in cities. Furthermore, we explore the heterogeneous effects of amenities on different cohorts by education and age. High- and low-skilled rural–urban migrants focus on transportation amenities, while young and middle–aged migrants are attracted by urban educational amenities. Results suggest that increasing access to urban amenities for rural–urban migrants and improving urban amenities enhance the willingness of rural–urban migrants to stay in cities. [ABSTRACT FROM AUTHOR]

There is evidence of a bidirectional association between dental caries and anthropometric measures among children. This dual relationship has not been examined in the same population. The objectives of this study are (1) to examine the relationship between baseline caries and changes in weight and height; and (2) to assess whether baseline weight and height are associated with changes in dental caries in a sample of preschool Chinese children. Children were recruited from 15 kindergarten in Liaoning Province at baseline (8 in rural area and 7 in urban area), a total of 1,111 of children were included at baseline. The mean age of children at baseline was 50.82 months. Data were collected through clinical oral examination, assessment of anthropometric measures and structured questionnaire. Dental caries was assessed according World Health Organization (WHO) methods by one dentist. Sociodemographic and behaviour data were also collected. At follow-up, 772 children were included (attrition rate: 30%), dental caries and anthropometric measures were assessed again. Z-score for weight-for-age and height-for-age were calculated using the 2006 and 2007 WHO Child Growth Standards. The sum of decayed, missing and filled primary teeth (dmft) were used in the analysis. Multilevel analysis for longitudinal data was conducted to explore the relationship between z-score for weight-for-age and height-for-age, and dental caries among children. The median follow-up time was 10.12 months. There was a significant negative association between dmft at baseline and change in height-for-age. On the other hand, weight-for-age at baseline was negatively associated with change in dmft at follow-up. The findings suggest that dental caries impedes children’s growth indicated by height for age. Low weight children appear to be more susceptible to dental caries in the same population. [ABSTRACT FROM AUTHOR]

Objective: To examine the correlation between birth season and early childhood development. Background: Almost all previous studies that examine the effect of birth season on early childhood development were conducted in developed countries with a limited sample size. The present study was conducted in poor, rural areas of western China, a developing region with a continental monsoon climate. Method: We administered a hemoglobin test to 650 infants (52% boys), aged 8–10 months, using a Hemocue Hb 201+ finger prick system, and assessed the cognitive and psychomotor development of sample infants using Bayley Scales of Infant Development. Results: Infants born in winter have higher Hb concentrations (t = 3.63, p < 0.001) compared to infants born in summer. Similarly, cognitive development scores (t = 5.17, p < 0.001) and psychomotor development scores (t = 10.60, p < 0.001) were significantly higher among winter-born infants. Conclusion: The findings point to the involvement of birth season in early childhood development and suggest that aspects of the environment shape the experiences that contribute to early childhood development. Policy suggestions such as providing infants with ample opportunities for movement and stimulation during the cold season are discussed. [ABSTRACT FROM AUTHOR]

Births outside marriage (BoM) account for around 15% of all births globally. However, the distribution around the world is very uneven, as are cultural and political attitudes towards them. Studies from East Asia have shown that the percentage of such births is very low, with only modest increases in recent years. The orthodox demographic view holds that the maintenance of conservative views around the relationship between marriage and childbearing can play a role in keeping fertility low. Prenuptial pregnancies (PNP) (where births occur within eight months of marriage) have been identified as a growing phenomenon in Japan, possibly being an ‘alternative’ Asian pathway to family formation. As yet, no comprehensive statistical analysis of the trends of BoM or PNP has been performed for Hong Kong. Using a comprehensive microdata set of birth registration in Hong Kong from 1984–2015 (N = 1,680,831) we provide evidence of recent trends in such ‘alternative pathways’ to family formation and examine predictors through regression analysis. Our results indicate, in common with elsewhere in East Asia, low overall period rates of either BoM or PNP (although the latter has risen notably in recent years). While more recent birth cohorts exhibit higher prevalence of such births, their incomplete nature and higher expected propensity suggests that the figures are exaggerated. In our regression analysis, we find that lower educational attainment is a strong predictor of both BoM and PNP, suggesting that a bifurcation of experience may be occurring. This adds further evidence to the theory that the maintenance of traditional family formation systems in the context of revolutionised educational and work opportunities for women mean that the opportunity costs of the ‘marriage package’ become too high. Current disparities in rights and privileges between married and unmarried parents–and especially their children–means that targeted family planning services and support for vulnerable families are policy priorities. [ABSTRACT FROM AUTHOR]

Well-child health care services are essential for maintaining optimum child health and development. This study’s aim was to evaluate the quality of such services and identify factors affecting service quality from the perspective of well-child health care providers located in China’s Hunan Province. To achieve this, a qualitative descriptive method was employed, with 22 well-child health care providers being recruited, using purposive sampling, from among the provinces’ government community health centers. The participants completed individual semi-structured interviews lasting approximately 25–30 minutes that were designed to obtain their views on well-child health care administration in the province. Then, the interview transcripts were analyzed thematically. The main finding was that participants felt that the delivery of well-child health care services in Hunan Province is insufficient. Factors they mentioned as negatively affecting the delivery of such services included the region’s fragmented primary health care system, inadequate attention to this issue from parents and community health care center managers, and a lack of specialized well-child care knowledge. Thus, currently, well-child health care is not being successfully implemented in Hunan Province; consequently, in order to successfully implement well-child health care in this region, community health care centers should invest more resources and funding, particularly into education programs for well-child health care providers. [ABSTRACT FROM AUTHOR]

Background: Offering free glasses can be important to increase children’s wear. We sought to assess whether “Upgrade glasses” could avoid reduced glasses sales when offering free glasses to children in China. Methods: In this cluster-randomized, controlled trial, children with uncorrected visual acuity (VA)< = 6/12 in either eye correctable to >6/12 in both eyes at 138 randomly-selected primary schools in 9 counties in Guangdong and Yunnan provinces, China, were randomized by school to one of four groups: glasses prescription only (Control); Free Glasses; Free Glasses + offer of $15 Upgrade Glasses; Free Glasses + offer of $30 Upgrade Glasses. Spectacle purchase (main outcome) was assessed 6 months after randomization. Results: Among 10,234 children screened, 882 (8.62%, mean age 10.6 years, 45.5% boys) were eligible and randomized: 257 (29.1%) at 37 schools to Control; 253 (28.7%) at 32 schools to Free Glasses; 187 (21.2%) at 31 schools to Free Glasses + $15 Upgrade; and 185 (21.0%) at 27 schools to Free Glasses +$30 Upgrade. Baseline ownership among these children needing glasses was 11.8% (104/882), and 867 (98.3%) children completed follow-up. Glasses purchase was significantly less likely when free glasses were given: Control: 59/250 = 23.6%; Free glasses: 32/252 = 12.7%, P = 0.010. Offering Upgrade Glasses eliminated this difference: Free + $15 Upgrade: 39/183 = 21.3%, multiple regression relative risk (RR) 0.90 (0.56–1.43), P = 0.65; Free + $30 Upgrade: 38/182 = 20.9%, RR 0.91 (0.59, 1.42), P = 0.69. Conclusions: Upgrade glasses can prevent reductions in glasses purchase when free spectacles are provided, providing important program income. Trial registration: ClinicalTrials.gov Identifier: . Registered on 31 August 2014. [ABSTRACT FROM AUTHOR]

Objective: The School-based Education Program to Reduce Salt Intake in Children and Their Families study was a cluster randomized control trial among grade five students in 28 primary schools and their families in Changzhi, China. It achieved a significant effect in lowering systolic blood pressure (SBP) in all family adults by 2.3 mmHg and in elderlies (aged > = 60 years) by 9.5 mmHg. The aim of this study was to assess the cost-effectiveness of this salt reduction program. Methods: Costs of the intervention were assessed using an ingredients approach to identify resource use. A trial-based incremental cost-effectiveness ratio (ICER) was estimated based on the observed effectiveness in lowering SBP. A Markov model was used to estimate the long-term cost-effectiveness of the intervention, and then based on population data, extrapolated to a scenario where the program is scaled up nationwide. Findings were presented in terms of an incremental cost per quality-adjusted life year (QALY). The perspective was that of the health sector. Results: The intervention cost Int$19.04 per family and yielded an ICER of Int$2.74 (90% CI: 1.17–12.30) per mmHg reduction of SBP in all participants (combining children and adult participants together) compared with control group. If scaled up nationwide for 10 years and assumed deterioration in treatment effect of 50% over this period, it would reach 165 million families and estimated to avert 42,720 acute myocardial infarction deaths and 107,512 stroke deaths in China. This would represent a gain of 635,816 QALYs over 10-year time frame, translating into Int$1,358 per QALY gained. Conclusion: Based on WHO-CHOICE criteria, our analysis demonstrated that the proposed salt reduction strategy is highly cost-effective, and if scaled up nationwide, the benefits could be substantial. Trial registration: ClinicalTrials.gov [ABSTRACT FROM AUTHOR]

Background: The epidemiology of human parechovirus (HPeV) in Asia remains obscure. We elucidated the prevalence, seasonality, type distribution and clinical presentation of HPeV among children in Hong Kong. Methods: A 24-month prospective study to detect HPeV in children ≤36 months hospitalized for acute viral illnesses. Results: 2.3% of the 3911 children examined had HPeV infection, with most (87.5%) concentrated in September-January (autumn-winter). 81.3% were HPeV1 and 12.5% were HPeV4, while HPeV3 was rare (2.5%). HPeV was a probable cause of the disease in 47.7% (42/88), mostly self-limiting including acute gastroenteritis, upper respiratory tract infection and maculopapular rash. A neonate developed severe sepsis-like illness with HPeV3 as the only pathogen detected. A high proportion (60.0%) of children coinfected with HPeV and other respiratory virus(es) had acute bronchiolitis or pneumonia. Six children with HPeV coinfections developed convulsion / pallid attack. Most rash illnesses exhibited a generalized maculopapular pattern involving the trunk and limbs, and were more likely associated with HPeV4 compared to other syndrome groups (36.4% vs. 3.1%, p = 0.011). Conclusions: In Hong Kong, HPeV exhibits a clear seasonality (autumn-winter) and was found in a small proportion (2.3%) of young children (≤36 months) admitted with features of acute viral illnesses. The clinical presentation ranged from mild gastroenteritis, upper respiratory tract infection and febrile rash to convulsion and severe sepsis-like illness. HPeV3, which is reported to associate with more severe disease in neonates, is rare in Hong Kong. HPeV coinfection might associate with convulsion and aggravate other respiratory tract infections. [ABSTRACT FROM AUTHOR]

Background: Currently, there are many studies focusing on the influencing factors of the elderly people’s living arrangements or health status, but little is known about the relationship between living arrangements or health status and long-term care models for the old-age, especially the joint effects. Objective: We aimed to assess the effects of health status and living arrangements on long-term care models (LTCM) among the elderly of Xiamen, China, especially their cumulative joint effects. Methods: A total of 14,373 participants aged ≥ 60 years by multistage sampling in Xiamen of China were enrolled. Multinomial logistic regression was used to estimate the Odds ratios (ORs) regressing LTCM on health status and living arrangements using the Anderson model as theoretical framework. Results: Totally, 14,292 valid questionnaires were obtained, of which 86.37% selected home care. With the increase of disability degree, older people are more likely to choose institutional care, compared to living alone (ORs = 1.75, 2.06, 4.00, 4.01 for the “relatively independent’, “mild disability’, “moderate disability’, and “total disability’, respectively, in comparison with “completely independent’). The elderly living with children and other family members preferred to choose home care. (ORs = 0.50, 0.39, 0.40, and 0.43 for the “living with children’, “living with spouse’, “living with children and spouse’, and “living with others’, respectively, in comparison with “alone’). Additionally, residence, number of children, education level, and feelings of loneliness were the determinants of the choice of social pension. Conclusion: A multitude of older people are trended to choose home care in Xiamen of China. There was an interaction and joint effect between the degree of disability and the living arrangements on LTCM. Therefore, policymakers should pay close attention to care for those living alone, childless, and disabled elders to meet their care needs, especially in home care. In addition, the social construction of facilities for elders in rural areas should be strengthened. [ABSTRACT FROM AUTHOR]

Objective: Living arrangements are important to the elderly. However, it is common for elderly parents in urban China to not have a living situation that they consider ideal. An understanding of their preferences assists us in responding to the needs of the elderly as well as in anticipating future long-term care demands. The aim of this study is to provide a clear understanding of preferences for future living arrangements and their associated factors among middle-aged and older people in urban China. Methods: Data were extracted from the CHARLS 2011–2012 national baseline survey of middle-aged and elderly people. In the 2011 wave of the CHARLS, a total of 17,708 individual participants (10,069 main respondents and 7,638 spouses) were interviewed; 2509 of the main respondents lived in urban areas. In this group, 41 people who were younger than 45 years old and 162 who had missing data in the variable “living arrangement preference” were excluded. Additionally, 42 people were excluded because they chose “other” for the variable “living arrangement preference” (which was a choice with no specific answer). Finally, a total of 2264 participants were included in our study. Results: The most popular preference for future living arrangements was living close to their children in the same community/neighborhoods, followed by living with adult children. The degree of community handicapped access, number of surviving children, age, marital status, access to community-based elderly care centers and number of years lived in the same community were significantly associated with the preferences for future living arrangements among the respondents. Conclusion: There is a trend towards preference for living near adult children in urban China. Additionally, age has a positive effect on preference for living close to their children. Considerations should be made in housing design and urban community development plans to fulfill older adults’ expectations. In addition, increasing the accessibility of public facilities in the residential area was important to the elderly, especially for those who preferred living in proximity to their children rather than co-residing with their children. We found that more surviving children were associated with a lower likelihood of choosing “institutionalization”, and it positively contributed to preference for intergenerational living arrangements in our study. As expected, compared with their married counterparts, people who were separated/divorced/widowed preferred living with adult children rather than living independently. A relatively shorter length of residence in the same community was an important indicator of preference for independent living; this finding might require further research. [ABSTRACT FROM AUTHOR]

Chinese children are facing dual burden of malnutrition—coexistence of under-and over-nutrition. Little systematic evidence exists for explaining the simultaneous presence of under-and over-nutrition. This study aims to explore underlying mechanisms of under-and over-nutrition among children in rural China. This study used a nationwide longitudinal dataset of children (N = 5,017) from 9 provinces across China, with four exclusively categories of nutritional outcomes including under-nutrition (stunting and underweight), over-nutrition (overweight only including obesity), paradox (stunted overweight), with normal nutrition as reference. Multinomial logit models (Level-1: occasions; Level-2: children; Level-3: villages) were fitted which corrected for non-independence of observations due to geographic clustering and repeated observations of individuals. A mixture of risk factors at the individual, household and neighbourhood levels predicted under-and over-nutrition among children in rural China. Improved socioeconomic status and living in more urbanised villages reduced the risk of stunted overweight among rural children in China. Young girls appeared to have higher risk of under-nutrition, and the risk decreased with age more markedly than for boys up to age 5. From age 5 onwards, boys tended to have higher risk of under-nutrition than girls. Girls aged around 12 and older were less likely to suffer from under-nutrition, while boys’ higher risk of under-nutrition persisted throughout adolescence. Children were less likely to suffer from over-nutrition compared to normal nutrition. Boys tended to have an even lower risk of over-nutrition than girls and the gender difference widened with age until adolescence. Our results have important policy implications that improving household economic status, in particular, maternal education and health insurance for children, and living environment are important to enhance rural children’s nutritional status in China. Investments in early years of childhood can be effective to reduce gender inequality in nutritional health in rural China. [ABSTRACT FROM AUTHOR]

The purpose of this study was to construct and validate a “Perceived Physical Literacy Instrument” (PPLI) for physical education teachers. Based on literature review and focus group interviews, an 18-item instrument was developed for the initial tests. This self-report measure, using a 5-point Likert scale, formed the PPLI and was administered to 336 physical education teachers in Hong Kong. The sample was randomly split, and exploratory and confirmatory factor analyses resulted in a 9-item, 3-factor scale. Exploratory factor analysis (EFA) item loadings ranged from 0.69 to 0.87, and Cronbach’s alpha ranged from 0.73 to 0.76. Confirmatory factor analysis (CFA) showed that the construct demonstrated good fit to the model. The PPLI thus appeared to be reliable and valid to measure the perceived physical literacy of physical education teachers. It is argued that the instrument can be used for both research and applied purposes and potential uses for the instrument in physical education, medical and health settings are discussed. [ABSTRACT FROM AUTHOR]

Background: Millions of people move from rural areas to urban areas in China to pursue new opportunities while leaving their spouses and children at rural homes. Little is known about the impact of migration-related separation on mental health of these rural migrants in urban China. Methods: Survey data from a random sample of rural-to-urban migrants (n = 1113, aged 18–45) from Wuhan were analyzed. The Domestic Migration Stress Questionnaire (DMSQ), an instrument with four subconstructs, was used to measure migration-related stress. The relationship between spouse/child separation and stress was assessed using survey estimation methods to account for the multi-level sampling design. Results: 16.46% of couples were separated from their spouses (spouse-separation only), 25.81% of parents were separated from their children (child separation only). Among the participants who married and had children, 5.97% were separated from both their spouses and children (double separation). Spouse-separation only and double separation did not scored significantly higher on DMSQ than those with no separation. Compared to parents without child separation, parents with child separation scored significantly higher on DMSQ (mean score = 2.88, 95% CI: [2.81, 2.95] vs. 2.60 [2.53, 2.67], p < .05). Stratified analysis by separation type and by gender indicated that the association was stronger for child-separation only and for female participants. Conclusion: Child-separation is an important source of migration-related stress, and the effect is particularly strong for migrant women. Public policies and intervention programs should consider these factors to encourage and facilitate the co-migration of parents with their children to mitigate migration-related stress. [ABSTRACT FROM AUTHOR]

Background and Objectives: Development during the first two years of life is critical and has a lasting impact on a child’s health. Poor infant and child nutrition can lead to deficiencies in essential micronutrients, which may cause a weakened immune system and lasting effects on children's growth and development. Recent studies in rural Shaanxi Province found an anemia prevalence of 54.3% among rural children aged six to twelve months. While new large-scale, quantitative research has begun to catalogue the extent of child malnutrition and anemia, no effort has yet been made to look more closely at the potential reasons for rural children’s nutritional deficiencies through qualitative analysis. This study aims to elucidate some of the fundamental causes of poor complementary feeding practices that may lead to anemia among children in rural Shaanxi Province, China. Methodology: We interviewed sixty caregivers participating in a large survey on child health and nutrition. We conducted three waves of interviews with children’s primary caregivers in seventeen rural villages within four nationally-designated poverty counties in the southern part of Shaanxi Province. Results: The qualitative analysis reveals that poor complementary feeding practices are common across our sample. Information gathered from our interviews suggests that complementary feeding practices are impeded by two constraints: absence of understanding topics related to infant health and nutrition under caregivers, as well as inadequate sources of information on these topics. Poverty does not appear to constrain child feeding practices. Conclusion: Our results uncover lack of proper knowledge on infant and child nutrition among rural caregivers in China. This situation causes them to fail incorporating micronutrient rich foods in their children's diet. Age-appropriate complementary feeding can stimulate children’s physical and cognitive development, but in its absence it leads to iron-deficiency anemia. We suggest that steps be taken to educate caregivers to improve complementary feeding of their infants and children. [ABSTRACT FROM AUTHOR]

Objective: Study the trends in Western fast food consumption (FFC) among Chinese school-age children and the association between FFC and obesity using nationwide survey data. Design: Cross-sectional and longitudinal analyses were conducted to study the trends in FFC and the associations between FFC and weight status (overweight, obesity and body mass index (BMI) z-score). Setting: Longitudinal data from families were collected in the 2004 and 2009 China Health and Nutrition Survey (covering nine provinces throughout China). Subjects: The analysis included 2656 Chinese children aged 6 to 18 years (1542 and 1114 children in the 2004 and 2009 survey, respectively). Results: FFC (reported having consumed Western fast food in the past three months) has increased between 2004 and 2009, from 18.5% to 23.9% in those aged 6–18, and increased more rapidly among those aged 13–17, from 17.9% to 26.3%. The increase was significant in almost all groups by age, sex, family income, and residence. Our cross-sectional and longitudinal analyses did not detect a significant association between FFC and obesity/overweight or BMI z-score (e.g., for BMI z-score, boys: β = 0.02, 95% CI: -0.71, 0.75; girls: β = -0.14, 95% CI: -1.03, 0.75). Conclusions: FFC has increased in Chinese school-age children, especially in older children, boys, and those from low- and medium-income families, rural areas, and East China, but decreased among those from high-income families during 2004–2009. The data did not show a significant association between FFC and obesity. [ABSTRACT FROM AUTHOR]

Purpose: To examine legal professionals’ knowledge of a wide range of factors that affect eyewitness accuracy in China. Methods: A total of 812 participants, including 210 judges, 244 prosecutors, 202 police officers, and 156 defense attorneys, were asked to respond to 12 statements about eyewitness testimony and 3 basic demographic questions (i.e., gender, age, and prior experience). Results: Although the judges and the defense attorneys had a somewhat higher number of correct responses than the other two groups, all groups showed limited knowledge of eyewitness testimony. In addition, the participants’ responses to only four items (i.e., weapon focus, attitude and expectations, child suggestibility, and the impact of stress) were roughly unanimous within the four legal professional groups. Legal professionals’ gender showed no significant correlations with their knowledge of eyewitness testimony. Prior experiences were significantly and negatively correlated with the item on the knowledge of forgetting curve among judges but positively correlated with two items (i.e., attitudes and exposure time) among defense attorneys and with 4 statements (i.e., the knowledge of attitudes and expectations, impact of stress, child witness accuracy, and exposure time) among prosecutors. Conclusions: The findings suggest that knowledge of the factors that influence eyewitness accuracy must be more effectively communicated to legal professionals in the future. [ABSTRACT FROM AUTHOR]

Objective: The controversy that iodized salt may increase the risk of thyroid disorders has been aroused in China during the past decade. Most of studies focused on adult rather than children. We aimed to explore whether iodized salt was associated with an increased risk of thyroid nodule in Chinese children. Methods: The cross-sectional study was conducted in Hangzhou, China, in 2010. Iodized salt intake, urine iodine concentration (UIC) and thyroid nodule (by ultrasonography) were measured in 3026 children. The associations of iodized salt with thyroid nodule were evaluated using multiple logistic regression models. Results: The prevalence of thyroid nodule was 10.59% among Chinese children. Girls (11.89%) had higher prevalence of thyroid nodule than boys (9.26%). No significant association was observed between type of salt and thyroid nodule in pooled samples, boys and girls, respectively. Similar associations were observed between UIC and thyroid nodule. There was no significant association between milk consumption and thyroid nodule as well. Conclusion: The present study indicated that non-iodized salt may not increase the risk of thyroid nodules among Chinese children. Similar associations were observed between milk consumption, UIC and thyroid nodules. [ABSTRACT FROM AUTHOR]

Purpose: To determine the association of season of birth and refractive error in very young Chinese children in China. Methods: We conducted a population-based study of Chinese children aged 0 to 3 years residing in eastern China. Refraction was determined by non-cyclopegic autorefraction using a hand-held autorefractor. Date of birth was retrieved from birth certificate of the individual subjects. A generalized linear regression model was fitted to estimate the regression coefficient and 95% confidence interval (CI) of refractive error for season of birth, adjusting for confounders. Results: Of the 1385 children eligible to participate, 1222 (88.2%) were examined. Refractive error data were available for 1219 children. The mean spherical equivalent were 1.21 diopters (D) in children born Spring, 1.24 D in those born in Summer, 1.23 D in those born in Autumn, 1.15 D in Winter. After adjusting for age, sex, father's educational level, birth weight and the number of summers between birth and examination date the children have been exposed to, children born in winter had a 0.12 D more myopic refraction compared with those born in summer (regression coefficient: −0.12; 95% CI, −0.27,−0.06; P = 0.006). The association between season of birth and cylinder power was not statistically significant. Conclusions: In China, children born in winter had a more myopic refraction compared with those born in other seasons. The observed association between season of birth and refractive error was independent of parental educational level and birth weight, suggesting that light level may have a small impact on refractive development in early life. [ABSTRACT FROM AUTHOR]

This study used the latent class analysis (LCA) to identify and classify Chinese adolescent children's aggressive behaviors. It was found that (1) Adolescent children could be divided into four categories: general children, aggressive children, victimized children and aggressive victimized children. (2) There were significant gender differences among the aggressive victimized children, the aggressive children and the general children. Specifically, aggressive victimized children and aggressive children had greater probabilities of being boys; victimized children had equal probabilities of being boys or girls. (3) Significant differences in loneliness, depression, anxiety and academic achievement existed among the aggressive victims, the aggressor, the victims and the general children, in which the aggressive victims scored the worst in all questionnaires. (4) As protective factors, peer and teacher supports had important influences on children's aggressive and victimized behaviors. Relative to general children, aggressive victims, aggressive children and victimized children had lower probabilities of receiving peer supports. On the other hand, compared to general children, aggressive victims had lower probabilities of receiving teacher supports; while significant differences in the probability of receiving teacher supports did not exist between aggressive children and victimized children. [ABSTRACT FROM AUTHOR]

Background: The association of dietary pattern with chronic diseases has been investigated widely in western countries. However, information is quite limited among children in China. Our study is aimed to identify the dietary patterns of Chinese children and examine their association with obesity and related cardiometabolic risk factors. Methods: A total of 5267 children were selected using multistage random sampling from 30 primary schools of 5 provincial capital cities in China. Dietary intake was derived from 24 hour dietary recall for three consecutive days. Anthropometric measurements, glucose and lipid profiles were obtained. Factor analysis combined with cluster analysis was used for identifying major dietary patterns. The associations of dietary patterns with obesity and related cardiometabolic risk factors were examined by logistic regression analysis. Results: Three mutually exclusive dietary patterns were identified, which were labeled as the healthy dietary pattern, the transitive dietary pattern, and the Western dietary pattern. Compared with children of the healthy dietary pattern, the multiple-adjusted odds ratios (95% confidence interval (CI)) of obesity were 1.11 (0.89-1.38) for children with the transitive dietary pattern and 1.80 (1.15-2.81) for children with the Western dietary pattern, which was 1.31 (95%CI 1.09-1.56) and 1.71 (95%CI: 1.13-2.56), respectively, for abdominal obesity. The Western dietary pattern was associated with significantly higher concentrations of low-density lipoprotein cholesterol (P<.001), triglycerides (P<.001), systolic blood pressure (P = 0.0435) and fasting glucose (P = 0.0082) and a lower concentration of high-density lipoprotein cholesterol (P = 0.0023), as compared with the healthy dietary pattern. Conclusions: The Western dietary pattern characterized by red meat, eggs, refined grain and products, was positively associated with odds of obesity, the levels of plasma glucose, low-density lipoprotein cholesterol and triglycerides, and was inversely associated with the level of high-density lipoprotein cholesterol. [ABSTRACT FROM AUTHOR]

Aim: PTSD symptoms were pervasive among children and adolescents after experiencing or exposure to traumatic events. Screening and diagnosis of PTSD symptoms is crucial in trauma-related research and practice. The 13-item Children's Revised Impact of Event Scale (CRIES) has been demonstrated to be a valid and reliable tool to achieve this goal. This study was designed to examine the psychometric properties of the 13-item CRIES in a sample of Chinese debris flood victims. Methods: A total of 268 participants (145 girls, 123 boys) aged 8-18 years were recruited from an integral part of a service oriented project, supported by the Institute of Psychology, Chinese Academy of Sciences following the debris flood. The participants were given the 13-item CRIES 3 months after the debris flood. Results: The results of confirmatory factor analysis indicated that a two-factor structure (intrusion+arousal vs avoidance) emerged as the model best fit in total sample, boys and girls subsamples, respectively. The scale was also demonstrated to have good internal consistency (Cronbach's alpha = 0.83). Conclusion: The study confirmed the good psychometric properties of the CRIES and its' applicability to Chinese children and adolescents. Moreover, these findings imply that the CRIES factor structure is stable across age, gender, and different types of trauma. [ABSTRACT FROM AUTHOR]

The present study reports timed norms for 435 object pictures in Mandarin Chinese. These data include naming latency, name agreement, concept agreement, word length, and age of acquisition (AoA) based on children's naming and adult ratings, and several other adult ratings of concept familiarity, subjective word frequency, image agreement, image variability, and visual complexity. Furthermore, we examined factors that influence the naming latencies of the pictures. The results show that concept familiarity, AoA, concept agreement, name agreement, and image agreement are significant predictors of naming latencies, whereas subjective word frequency is not a reliable determinant. These results are discussed in light of picture naming data in other languages. An item-based index for the norms is provided in the Table S1. [ABSTRACT FROM AUTHOR]