Publications

Browse FSI scholarship on geopolitics, global health, energy, cybersecurity and more.

Featured Publications

Residual Governance: How South Africa Foretells Planetary Futures

Gabrielle Hecht dives into the wastes of gold and uranium mining in South Africa to explore how communities, experts, and artists fight for infrastructural and environmental justice.

Residual Governance

graphic represntations of computers and phones connected to tettering boxes of files and then connected to law enforcement in a complex web on a blue background.

The Strengths and Weaknesses of the Online Child Safety Ecosystem

Scholars from the Stanford Internet Observatory outline what needs to be done to improve the CyberTipline pipeline as incidents of AI-generated CSAM escalate.

Online Child Safety

Propaganda in Autocracies: Institutions, Information, and the Politics of Belief

Using the first global data set of autocratic propaganda, Erin Baggott Carter and Brett Carter examine the intertwined relationship between citizens' beliefs and a the security of a dictator's power.

Propaganda in Autocracies

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Journal Articles

Process Quality, Diagnosis Quality, and Patient Satisfaction of Primary Care in Rural Western China: A Study Using Standardized Pateints

Patient Education and Counseling, 2024

Maternal Dietary Diversity and Small for Gestational Age: The Effect Modification by Pre-Pregnancy Body Mass Index and Gestational Weight Gain in a Prospective Study within Rural Sichuan, China (2021–2022)

Nutrients, 2023

Journal Articles

Adherence to Micronutrient Powder for Home Fortification of Foods among Infants and Toddlers in Rural China: A Structural Equation Modeling Approach

BMC Public Health, 2022

Background

The WHO recommends daily use of micronutrient powder for infants and toddlers at risk of micronutrient deficiencies in low-and-middle-income countries. China has established a micronutrient powder distribution program in many rural townships and villages, yet adherence to micronutrient powder remains suboptimal; a little is known about the behavioral inputs that may influence adherence. This study examines direct and indirect behavioral inputs in micronutrient powder adherence among caregivers in rural western China following the Integrated Behavioral Model (IBM) framework.

Methods

Cross-sectional data were collected from April to May 2019 among 958 caregivers of children aged 6 to 24 months in six counties. Data were collected on micronutrient powder adherence behavior, direct behavioral inputs (knowledge and skills, intention, salience, environmental constraints, and habits), and indirect behavioral inputs (attitudes, perceived social norms, and personal agency). Structural equation modeling (SEM) adjusted for sociodemographic covariates was used to evaluate the IBM framework.

Results

Mean micronutrient powder adherence in the previous seven days was 53.02%, and only 22.86% of caregivers consistently fed micronutrient powder from the start of micronutrient powder distribution at six months of age. The SEM model revealed small- to medium-sized effects of salience (β = 0.440, P < 0.001), intention (β = 0.374, P < 0.001), knowledge and skills (β = 0.214, P < 0.001), personal agency (st. effect = 0.172, P < 0.001), environmental constraints (β=-0.142, P < 0.001), and caregiver generation (β = 0.119, P < 0.05) on micronutrient powder adherence. Overall, 54.7% of the variance in micronutrient powder adherence was explained by the IBM framework. Salience had the largest impact on micronutrient powder adherence (Cohen’s f 2 = 0.227). Compared to parent caregivers, grandparents had a higher degree of micronutrient powder adherence on average (P < 0.001), and behavioral inputs were consistent among both parent and grandparent caregivers.

Conclusion

There is a need to improve micronutrient powder adherence among rural caregivers. The IBM framework showed a high degree of explanatory power in predicting micronutrient powder adherence behavior. The findings suggest that increased reminders from doctors regarding micronutrient powder and coaching to improve personal agency in micronutrient powder feeding may increase adherence.

Journal Articles

Consultation Length, Process Quality and Diagnosis Quality of Primary Care in Rural China: A Cross-Sectional Standardized Patient Study

Patient Education and Counseling, 2021

Objective: Consultation length, the time spent between patient and health care provider during a visit, is an essential element in measuring quality of health care patients receive from a primary care facility. However, the linkage between consultation length and process quality and diagnosis quality of primary care is still uncertain. This study aims to examine the role consultation length plays in delivering process quality and diagnosis quality, two central components of overall primary care quality, in rural China. Methods: We recruited unannounced standardized patients (SPs) to present classic symptoms of angina and tuberculosis in selected healthcare facilities in three provinces of China. The consultation length and primary care quality of SPs were measured and compared with both international and national standards of care. Ordinary Least Squares (OLS) regressions for process quality (continuous dependent variable) and Logistic regressions for diagnosis quality (binary dependent variable) were performed to investigate the relationship between consultation length and primary care quality. Results: The average consultation lengths among patients with classic symptoms of angina and those with symptoms of tuberculosis were approximately 4.33 min and 6.28 min, respectively. Providers who spent more time with patients were significantly more likely to complete higher percentage of recommended checklist items of both questions and examinations for angina (β = 1.39, 95%CI 1.01–1.78) and tuberculosis (β = 0.89, 95%CI 0.69–1.08). Further, providers who spent more time with patients were more likely to make correct diagnosis for angina (marginal effect = 0.014, 95%CI 0.002–0.026) and for tuberculosis (marginal effect = 0.013, 95%CI 0.005–0.021). Conclusions: The average consultation length is extremely short among primary care providers in rural China. The longer consultation leads to both better process and diagnosis quality of primary care. Practice Implications: We recommend primary care providers to increase the length of their communication with patients. To do so, government should implement healthcare reforms to clarify the requirements of affordable and reliable consultation length in medical care services. Moreover, such an experience can also be extended to other developing countries.

Journal Articles

Conditional Cash Transfers, Uptake of Maternal and Child Health Services, and Health Outcomes in Western Rural China

BMC Public Health, 2020

Journal Articles

Epidemiology, Causes, Clinical Manifestation and Diagnosis, Prevention and Control of Coronavirus Disease (COVID-19) During the Early Outbreak Period: A Scoping Review

Infectious Diseases of Poverty, 2020

Journal Articles

The Impact of Social Pensions on Intergenerational Relationships: Comparative Evidence from China

The Journal of the Economics of Ageing, 2018

Working Papers

Boys, Girls, and Grandparents: The Impact of the Sex of Preschool-Age Children on Family Living Arrangements and Maternal Labour Supply

Asia Health Policy Program working paper # 44, 2017

Journal Articles

Publications

Featured Publications

Residual Governance: How South Africa Foretells Planetary Futures

The Strengths and Weaknesses of the Online Child Safety Ecosystem

Propaganda in Autocracies: Institutions, Information, and the Politics of Belief

Process Quality, Diagnosis Quality, and Patient Satisfaction of Primary Care in Rural Western China: A Study Using Standardized Pateints

Maternal Dietary Diversity and Small for Gestational Age: The Effect Modification by Pre-Pregnancy Body Mass Index and Gestational Weight Gain in a Prospective Study within Rural Sichuan, China (2021–2022)

Adherence to Micronutrient Powder for Home Fortification of Foods among Infants and Toddlers in Rural China: A Structural Equation Modeling Approach

Background

Methods

Results

Conclusion

Consultation Length, Process Quality and Diagnosis Quality of Primary Care in Rural China: A Cross-Sectional Standardized Patient Study

Conditional Cash Transfers, Uptake of Maternal and Child Health Services, and Health Outcomes in Western Rural China

Epidemiology, Causes, Clinical Manifestation and Diagnosis, Prevention and Control of Coronavirus Disease (COVID-19) During the Early Outbreak Period: A Scoping Review

The Impact of Social Pensions on Intergenerational Relationships: Comparative Evidence from China

Boys, Girls, and Grandparents: The Impact of the Sex of Preschool-Age Children on Family Living Arrangements and Maternal Labour Supply

Producing more grain with lower environmental costs

Will Demographic Change Slow China's Rise?

Will Demographic Change Slow China's Rise?

Children of China's Future

Pharmaceutical Policy in China