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

Featured Publications

Everything Counts: Building a Control Regime for Nonstrategic Nuclear Warheads in Europe

Building a Control Regime for Nonstrategic Nuclear Warheads in Europe

A new report led by Rose Gottemoeller on non-strategic nuclear warhead policies in Europe, particulary in light of Russia's changing status in the global nuclear community.
3D mockup cover of APARC's volume 'South Korea's Democracy in Crisis'

South Korea’s Democracy in Crisis

A close look at what is driving illiberalism and democratic delcine in today’s Korea, including political polarization, politicization of institutions, societal inequality, education, and social media.
System Error book cover and authors

System Error: Where Big Tech Went Wrong and How We Can Reboot

A forward-thinking manifesto which reveals how big tech’s obsession with optimization and efficiency has sacrificed fundamental human values.

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Yue Ma
Journal Articles

Academic Performance and the Link with Depressive Symptoms among Rural Han and Minority Chinese Adolescents

Tianli Feng, Xiyuan Jia, Lucy Pappas, Xiaojun Zheng, Teresa Shao, Letao Sun, Charlie Weisberg, Madeline Lu Li, Scott Rozelle, Yue Ma
International Journal of Environmental Research and Public Health, 2022 May 16, 2022

The objectives of this paper were to examine the risk of depression and depressive symptoms among Han and minority children and adolescents in rural China, the links between academic performance and depressive symptoms, and the prevalence of these links among specific subgroups. A total of 8392 4th, 5th, and 6th grade students at 105 sample rural schools in eight low-income counties and districts in a prefectural-level city in Southwestern China were randomly selected using a three-step sampling strategy. A total of 51% of the sample were female (SD = 0.50), and the age range was 7 to 19 years (mean = 11.35 years; SD = 1.05). Using the Patient Health Questionnaire 8-item depression scale, the prevalence of depressive symptoms in the sample was assessed, while data on students’ academic performance (standardized math test) and demographic characteristics were also collected. Our results show that the rates of major depression were 19% for Han students, 18% for Tibetan students, and 22% for Yi students; the rates of severe depression were 2% for Han and Tibetan students, and 3% for Yi students. Yi students were at significantly higher risks for major and severe depression than Han students. We conducted multivariate regression and heterogeneous analyses. Academic performance was negatively and significantly correlated to depressive symptoms. Across the whole sample, students with lower math scores, minority students, boys, younger students, and students with migrant parents were most vulnerable to depressive symptoms. The heterogeneous analysis suggests that among poor-performing students, subgroups at higher risk for depression include boys, non-boarding students, and students whose mothers had graduated from high school or above. These findings indicate a need to improve mental health outcomes of rural Han and minority primary school students, targeting academic performance for possible intervention.

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Journal Articles

Off the COVID-19 Epicentre: The Impact of Quarantine Controls on Employment, Education and Health in China's Rural Communitites

Huan Wang, Sarah-Eve Dill, Huan Zhou, Yue Ma, Hao Xue, Prashant Loyalka, Sean Sylvia, Matthew Boswell, Jason Lin, Scott Rozelle
The China Quarterly, 2022 March 9, 2022

This study documents the COVID-19 disease-control measures enacted in rural China and examines the economic and social impacts of these measures. We conducted two rounds of surveys with 726 randomly selected village informants across seven provinces. Strict disease-control measures have been universally enforced and appear to have been successful in limiting disease transmission in rural communities. The infection rate in our sample was 0.001 per cent, a rate that is near the national average outside of Hubei province. None of the villages reported any COVID-19-related deaths. For a full month during the quarantine, the rate of employment of rural workers was essentially zero. Even after the quarantine measures were lifted, nearly 70 per cent of the villagers still were unable to work owing to workplace closures. Although action has been taken to mitigate the potential negative effects, these disease-control measures might have accelerated the inequality between rural and urban households in China.

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Journal Articles

The Impact of Nonboarding on the Development of Disadvantaged Boarding Students in Western Rural China

Xiyuan Jia, Xinwu Zhang, Jiangchao Jing, Ming Zhou, Haoyang Li, Dimitris Friesen, Yue Ma
2022 January 30, 2022

Rural China has seen an increase in its migrant workers returning home. As a result, many of these workers’ children, who had previously boarded at school, needed to return home as well. While the existing research indicates that boarding affects the development of disadvantaged children, the effect of the switch to nonboarding on the growth of vulnerable boarding children remains unknown. Using two-stage data from 20,594 fourth- and fifth-grade students in rural Shaanxi and Gansu provinces as well as the difference-in-differences method, this study estimates the impact of switching to nonboarding on the academic performance and mental health of vulnerable boarding students. The results suggest that the shift toward nonboarding significantly reduces boarding students’ academic performance, and further testing shows that these results are robust. Additionally, the switch to nonboarding insignificantly increased the standardized mental health scores of rural primary school students but significantly increased their standardized impulsive tendency scores. Heterogeneity analysis found that boarding students whose mothers had lower educational achievement or whose families belonged to lower economic levels had poorer academic performance after switching, while boarding students whose parents had higher education achievement or myopia possessed better mental health after switching. This study offers novel, policy-relevant insights into potential strategies that would improve the academic performance and mental health of students who transition to nonboarding, especially those with low-educated parents and those belonging to poor families.

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Journal Articles

Early Childhood Development and Parental Training Interventions in Rural China: A Systematic Review and Meta-Analysis

Dorien Emmers, Qi Jiang, Hao Xue, Yue Zhang, Yunting Zhang, Yingxue Zhao, Bin Liu, Sarah-Eve Dill, Yiwei Qian, Nele Warrinnier, Hannah Johnstone, Jianhua Cai, Xiaoli Wang, Lei Wang, Renfu Luo, Guirong Li, Jiajia Xu, Ming Liu, Yaqing Huang, Wenjie Shan, Zhihui Li, Yu Zhang, Sean Sylvia, Yue Ma, Alexis Medina, Scott Rozelle
BMJ Global Health, 2021 August 20, 2021

Introduction: Inadequate care during early childhood can lead to long-term deficits in skills. Parenting programmes that encourage investment in young children are a promising tool for improving early development outcomes and long-term opportunities in low-income and middle-income regions, such as rural China.

Methods: We conducted a systematic review and a meta-analysis to investigate the prevalence of early developmental delays and stimulating parenting practices as well as the effect of parental training programmes on child development outcomes in rural China. We obtained data in English from EconPapers, PubMed, PsycARTICLES, Cochrane Library, Web of Science and Scopus (Elsevier) and in Chinese from China National Knowledge Infrastructure, Wanfang Data and VIP Information. We conducted frequentist meta-analyses of aggregate data and estimated random-effects meta-regressions. Certainty of evidence was rated according to the Grading of Recommendations Assessment, Development and Evaluation approach.

Results: We identified 19 observational studies on the prevalence of developmental delays and stimulating parenting practices for children under 5 years of age (n=19 762) and ten studies on the impact of parental training programmes on early child development (n=13 766). Children’s risk of cognitive, language and social-emotional delays in the rural study sites (covering 14 provinces mostly in Central and Western China) was 45%, 46%, and 36%, respectively. Parental training programmes had a positive impact on child cognition, language and social-emotional development.

Conclusion: There is evidence to suggest that early developmental delay and the absence of stimulating parenting practices (ie, reading, storytelling and singing with children) may be prevalent across rural, low-income and middle-income regions in Central and Western China. Results support the effectiveness of parental training programmes to improve early development by encouraging parental engagement.

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Journal Articles

Health, Economic, and Social Implications of COVID-19 for China's Rural Population

Huan Wang, Sarah-Eve Dill, Huan Zhou, Yue Ma, Hao Xue, Sean Sylvia, Kumi Smith, Matthew Boswell, Alexis Medina, Prashant Loyalka, Cody Abbey, Dimitris Friesen, Nathan Rose, Yian Guo, Scott Rozelle
Agricultural Economics, 2021 May 11, 2021

This study examines the effects of local and nationwide COVID‐19 disease control measures on the health and economy of China's rural population. We conducted phone surveys with 726 randomly selected village informants across seven rural Chinese provinces in February 2020. Four villages (0.55%) reported infections, and none reported deaths. Disease control measures had been universally implemented in all sample villages. About 74% of informants reported that villagers with wage‐earning jobs outside the village had stopped working due to workplace closures. A higher percentage of rural individuals could not work due to transportation, housing, and other constraints. Local governments had taken measures to reduce the impact of COVID‐19. Although schools in all surveyed villages were closed, 71% of village informants reported that students were attending classes online. Overall, measures to control COVID‐19 appear to have been successful in limiting disease transmission in rural communities outside the main epidemic area. Rural Chinese citizens, however, have experienced significant economic consequences from the disease control measures.

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Journal Articles

Variations in the Home Language Environment and Early Language Development in Rural China

Yue Ma, Laura Jonsson, Tianli Feng, Tyler Weisberg, Teresa Shao, Zixin Yao, Dongming Zhang, Sarah-Eve Dill, Yian Guo, Yue Zhang, Dimitris Friesen, Scott Rozelle
International Journal of Environmental Research and Public Health, 2021 March 6, 2021

The home language environment is critical to early language development and subsequent skills. However, few studies have quantitatively measured the home language environment in low-income, developing settings. This study explores variations in the home language environment and child language skills among households in poor rural villages in northwestern China. Audio recordings were collected for 38 children aged 20–28 months and analyzed using Language Environment Analysis (LENA) software; language skills were measured using the MacArthur–Bates Mandarin Communicative Developmental Inventories expressive vocabulary scale. The results revealed large variability in both child language skills and home language environment measures (adult words, conversational turns, and child vocalizations) with 5- to 6-fold differences between the highest and lowest scores. Despite variation, however, the average number of adult words and conversational turns were lower than found among urban Chinese children. Correlation analyses did not identify significant correlations between demographic characteristics and the home language environment. However, the results do indicate significant correlations between the home language environment and child language skills, with conversational turns showing the strongest correlation. The results point to a need for further research on language engagement and ways to increase parent–child interactions to improve early language development among young children in rural China.

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Journal Articles

The Impact of Internet Use on Adolescent Learning Outcomes: Evidence from Rural China

Lili Li, Yue Ma, Dimitris Friesen, Zhonggen Zhang, Songqing Jin, Scott Rozelle
China Agricultural Economic Review, 2021 February 12, 2021

Purpose:
Internet use has become particularly prevalent among adolescents, prompting much thought and concern about both its potential benefits and adverse effects on adolescent learning outcomes. Much of the empirical literature on the impact of Internet use on adolescent learning outcomes is mixed, and few studies examine the causal relationship between the two in rural China. In order to bridge these gaps, we use empirical analysis to investigate the effect of Internet use on the learning outcomes of adolescents in rural China.

Design/methodology/approach:
We use fixed effect models with samples drawn from a large nationally representative dataset (the China Family Panel Studies—CFPS) to identify the causal impacts of Internet use on the learning outcomes of three cohorts (Cohort A (N = 540), Cohort B (N = 287) and Cohort C (N = 827)) of adolescents in rural China.

Findings:
The results of the descriptive analysis show a continued increase in the number of adolescents accessing the Internet and the amount of time they spend online. The results of the fixed effect models show that Internet use has positive (in many of the analyses), but mostly insignificant impacts, on the learning outcomes of adolescents. In the sets of results that find significant associations between Internet use and learning outcomes, the measured effects are moderate.

Originality/value:
This study investigates the causal relationship between Internet use and adolescent learning outcomes in rural China. The findings claim that there is not a great need to worry about adverse effects of Internet use on adolescent learning development. Attention, however, should focus on seeking ways to improve the positive effects of the Internet use on adolescent learning outcomes. The study will provide a reference and experience for the development of education and the Internet in rural areas and promote the integrated development of urban and rural areas in China.

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Journal Articles

The Impact of Online Computer Assisted Learning at Home for Disadvantaged Children in Taiwan: Evidence from a Randomized Experiment

Bin Tang, Te-Tien Ting, Chyi-In Wu, Yue Ma, Di Mo, Wei-Ting Hung, Scott Rozelle
Sustainability, 2020 December 3, 2020
In Taiwan, thousands of students from Yuanzhumin (aboriginal) families lag far behind their Han counterparts in academic achievement. When they fall behind, they often have no way to catch up. There is increased interest among both educators and policymakers in helping underperforming students catch up using computer-assisted learning (CAL). The objective of this paper is to examine the impact of an intervention aimed at raising the academic performance of students using an in-home CAL program. According to intention-to-treat estimates, in-home CAL improved the overall math scores of students in the treatment group relative to the control group by 0.08 to 0.20 standard deviations (depending on whether the treatment was for one or two semesters). Furthermore, Average Treatment Effect on the Treated analysis was used for solving the compliance problem in our experiment, showing that in-home CAL raised academic performance by 0.36 standard deviations among compliers. This study thus presents preliminary evidence that an in-home CAL program has the potential to boost the learning outcomes of disadvantaged students.
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Journal Articles

Maternal Health Behaviors During Pregnancy in Rural Northwestern China

Yue Ma, Yujuan Gao, Jason Li, Andrew Sun, Baozhu Wang, Jun Zhang, Sarah-Eve Dill, Alexis Medina, Scott Rozelle
BMC Pregnancy and Childbirth, 2020 December 1, 2020

Background: Maternal health during pregnancy is a key input in fetal health and child development. This study
aims to systematically describe the health behaviors of pregnant women in rural China and identify which
subgroups of women are more likely to engage in unhealthy behaviors during pregnancy.

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Working Papers

Off the Epicenter: COVID-19 Quarantine Controls and Employment, Education, and Health Impacts in Rural Communities

Huan Wang, Sarah-Eve Dill, Huan Zhou, Yue Ma, Hao Xue, Prashant Loyalka, Sean Sylvia, Matthew Boswell, Jason Lin, Scott Rozelle
2020 October 19, 2020

In late January 2020, China’s government initiated its first aggressive measures to combat COVID-19 by forbidding individuals from leaving their homes, radically limiting public transportation, cancelling or postponing large public events, and closing schools across the country. The rollout of these measures coincided with China’s Lunar New Year holiday, during which more than 280 million people had returned from their places of work to their home villages in rural areas. The disease control policies remained in place until late February and early March, when they were gradually loosened to

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Journal Articles

Visual Impairment in Rural and Migrant Chinese School-Going Children: Prevalence, Severity, Correction and Association

Yue Ma, Xinwu Zhang, Fei He, Xiaochen Ma, Hongmei Yi, Nathan Rose, Alexis Medina, Scott Rozelle, Nathan Congdon
BMJ Ophthalmology, 2020 October 11, 2020
Purpose To describe changes in the prevalence of visual impairment and glasses ownership with age and as associated with income and population density for visual impairment among rural and urban migrant Chinese students. Design Meta-analysis of 12 cross-sectional, school-based studies conducted between 2012 and 2017. Setting Rural and urban migrant schools in seven Chinese provinces. Participants A total of 83 273 rural and urban migrant Chinese students aged 6–17 years. Results Prevalence of visual impairment (uncorrected visual acuity ≤6/12 in either eye) rose from 19.0% at age 6 to 66.9% at 17, with the overall age-adjusted prevalence higher for girls (35.8%) than for boys (30.1%, p
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Journal Articles

Safety of Eyeglasses Wear for Visual Acuity among Middle School Students in Northwestern Rural China: A Cluster-randomised Controlled Trial

Yue Ma, Xinwu Zhang, Haoyang Li, Xiaochen Ma, Dimitris Friesen, Scott Rozelle, Xiaopeng Pang, Ming Zhou, Nathan Congdon
BMJ Open Ophthalmology, 2020 September 5, 2020
Objective: To assess the effect of free eyeglasses provision on visual acuity among middle school students in northwestern rural China. Methods and analysis: Among 31 middle schools randomly selected from 47 middle schools in northwestern rural China, students were randomly allocated by school to one of two interventions: free eyeglasses (intervention group), and eyeglasses prescriptions given only to the parents (control group). The main outcome of this study is uncorrected visual acuity after 9 months, adjusted for baseline visual acuity. Results: Among 2095 students from 31 middle schools, 995 (47.5%) failed the visual acuity screening, 515 (51.8%, 15 schools) of which were randomly assigned to the intervention group, with the remaining 480 students (48.2%, 16 schools) assigned to the control group. Among these, a total of 910 students were followed up and analysed. Endline eyeglasses wear in the intervention group was 44%, and 36% in the control group. Endline visual acuity of students in the intervention group was significantly better than students in the control group, adjusting for other variables (0.045 LogMAR units, 95% CI 0.006 to 0.084, equivalent to 0.45 lines, p=0.027), and insignificantly better only for baseline visual acuity (difference of 0.008 LogMAR units, 95% CI −0.018 to 0.034, equivalent to 0.08 lines). Conclusion: We found no evidence that receiving free eyeglasses worsened visual acuity among middle school students in northwestern rural China.
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Working Papers

Education and EdTech during COVID-19: Evidence from a Large-Scale Survey during School Closures in China

Guirong Li, Xinwu Zhang, Delei Liu, Hao Xue, Derek Hu, Oliver Lee, Chris Rilling, Yue Ma, Cody Abbey, Robert Fairlie, Prashant Loyalka, Scott Rozelle
2020 August 10, 2020
In response to the COVID-19 epidemic, many education systems have relied on distance learning and educational technologies to an unprecedented degree. However, rigorous empirical research on the impacts on learning under these conditions is still scarce. We present the first large-scale, quantitative evidence detailing how school closures affected education in China. The data set includes households and teachers of 4,360 rural and urban primary school students. We find that although the majority of students engaged in distance education, many households encountered difficulties including barriers to learning (such as access to appropriate digital devices and study spaces), curricular delays, and costs to parents equivalent to about two months of income. We also find significant disparities across rural and urban households.
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Working Papers

The Impact of Computer Assisted Learning on Rural Taiwanese Children: Evidence from a Randomized Experiment

Yue Ma, Cody Abbey, Derek Hu, Oliver Lee, Weiting Hung, Xinwu Zhang, Chiayuan Chang, Chyi-In Wu, Scott Rozelle
2020 August 10, 2020
The effectiveness of educational technology (EdTech) in improving the outcomes of poor, marginalized students has primarily been documented by studies conducted in developing countries; however, relevant research involving randomized studies in developed country contexts is relatively scarce. The objective of the current study is to examine whether an in-school computer assisted learning (CAL) intervention can improve the math performance (the primary outcome) and academic attitudes (secondary outcomes) of rural students in Taiwan, including a marginalized subgroup of rural students called Xinzhumin. We also seek to identify which factors are associated with the effectiveness of the intervention. In order to achieve this, we conducted a randomized control trial involving 1,840 sixth-grade students at 95 schools in four relatively poor counties and municipalities of Taiwan during the spring semester of 2019. According to the ITT analysis, the O-CAL intervention had no significant ITT impacts on the primary outcome of student math performance as well as on most secondary outcomes of the overall treatment group (who on average used the software for only about one quarter of the protocol’s minimum required time of 30 minutes per week, indicating that compliance was low). However, the LATE analysis revealed significant improvements in the math performance of the 30% most active students in the treatment group (who used the software for about two thirds of the minimum required time). Effect sizes of active users overall (0.16 SD-0.22 SD) increased in accordance with increases in usage and were larger for active Xinzhumin users specifically (0.21 SD-0.35 SD). A wide range of student-level and (in particular) teacher-level characteristics were associated with the low compliance to the intervention, which are findings that may help inform educational policymakers and administrators of the potential challenges of introducing school-based interventions that depend heavily on teacher adoption and integration.  
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Journal Articles

Impact of Spectacles Wear on Uncorrected Visual Acuity among Urban Migrant Primary School Children in China: A Cluster-Randomised Clinical Trial

Xinwu Zhang, Ming Zhou, Xiaochen Ma, Hongmei Yi, Haiqing Zhang, Xiuqing Wang, Ling Jin, Kovin Naidoo, Hasan Minto, Haidong Zou, Scott Rozelle, Nathan Congdon, Yue Ma
British Journal of Opthalmology, 2020 July 30, 2020
Objective: To estimate the effect of providing free spectacles on uncorrected visual acuity (VA) among urban migrant Chinese school children. Design Exploratory analysis from a parallel cluster-randomised clinical trial. Methods: After baseline survey and VA screening, eligible children were randomised by school to receive one of the two interventions: free glasses and a teacher incentive (tablet computer if ≥80% of children given glasses were wearing them on un-announced examination) (treatment group) or glasses prescription and letter to parents (control group). The primary outcome was uncorrected logarithm of the minimal angle of resolution (LogMAR) VA at study closeout, adjusted for baseline uncorrected VA. Results: Among 4376 randomly selected children, 728 (16.6%, mean age 10.9 years, 51.0% boys) at 94 schools failed VA screening and met eligibility criteria. Of these, 358 children (49.2%) at 47 schools were randomised to treatment and 370 children (50.8%) at 47 schools to control. Among these, 679 children (93.3%) completed follow-up and underwent analysis. Spectacle wear in the treatment and control groups was 68.3% and 29.3%(p
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Journal Articles

Depressive Symptoms and the Link with Academic Performance among Rural Taiwanese Children

Yujuan Gao, Derek Hu, Evan Peng, Cody Abbey, Yue Ma, Chyi-In Wu, Chia-Yuan Chang, Wei-Ting Hung, Scott Rozelle
International Journal of Environmental Research and Public Health, 2020 April 17, 2020
Previous studies reflect a high prevalence of depressive symptoms among Taiwanese adolescents (ages 13–18), but there is an absence of literature related to the risk of depression of children in Taiwan (ages 6–12), particularly among potentially vulnerable subgroups. To provide insight into the distribution of depressive symptoms among children in rural Taiwan and measure the correlation between academic performance, we conducted a survey of 1655 randomly selected fourth and fifth-grade students at 92 sample schools in four relatively low-income counties or municipalities. Using the Center for Epidemiological Studies-Depression Scale (CES-D) we assessed the prevalence of depressive symptoms in this sample, in addition to collecting other data, such as performance on a standardized math test as well as information on a number of individual and household characteristics. We demonstrate that the share of children with clinically significant symptoms is high: 38% of the students were at risk of general depression (depression score ≥ 16) and 8% of the students were at risk of major depression (depression score > 28). The results of the multivariate regression and heterogeneous analysis suggest that poor academic performance is closely associated with a high prevalence of depressive symptoms. Among low-performing students, certain groups were disproportionately affected, including girls and students whose parents have migrated away for work. Results also suggest that, overall, students who had a parent who was an immigrant from another country were at greater risk of depression. These findings highlight the need for greater resource allocation toward mental health services for elementary school students in rural Taiwan, particularly for at-risk groups. 
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Working Papers

Isolating the "Tech" from EdTech: Experimental Evidence on Computer Assisted Learning in China

Yue Ma, Robert Fairlie, Prashant Loyalka, Scott Rozelle
The National Bureau of Economic Research , 2020 April 10, 2020
EdTech which includes online education, computer assisted learning (CAL), and remote instruction was expanding rapidly even before the current full-scale substitution for in-person learning at all levels of education around the world because of the coronavirus pandemic. Studies of CAL interventions have consistently found large positive effects, bolstering arguments for the widespread use of EdTech. However CAL programs, often held after school, provide not only computer-based instruction, but often additional non-technology based inputs such as more time on learning and instructional support by facilitators. In this paper, we develop a theoretical model to carefully explore the possible channels by which CAL programs might affect academic outcomes among schoolchildren. We isolate and test the technology-based effects of CAL and additional parameters from the theoretical model, by designing a novel multi-treatment field experiment with more than four thousand schoolchildren in rural China. Although we find evidence of positive overall CAL program effects on academic outcomes, when we isolate the technology-based effect of CAL (over and above traditional pencil-and-paper learning) we generally find small to null effects. Our empirical results suggest that, at times, the “Tech” in EdTech may have relatively small effects on academic outcomes, which has important implications for the continued, rapid expansion of technologies such as CAL throughout the world.
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Working Papers

EdTech for Equity in China: Can Technology Improve Teaching for Millions of Rural Students?

Cody Abbey, Yue Ma, Guirong Li, Matthew Boswell, Claire Cheng, Robert Fairlie, Oliver Lee, Prashant Loyalka, Andrew Mi, Evan Peng, Scott Rozelle, Adrian Sun, Andy Zeng, Jenny Zhao
2019 October 21, 2019

Previous literature suggests subpar teaching is a primary reason why rural Chinese students lag behind academically. We initiate an investigation into the potential of educational technology (EdTech) to increase teaching quality in rural China. First, we discuss why conventional approaches of improving teaching in remote schools are infeasible in China’s context, referring to past research. We then explore the capacity of technology-assisted instruction to improve academic performance by examining previous empirical analyses. Third, we show that China is not limited by the resource constraints of other developing countries due to substantial policy support and a thriving EdTech industry. Finally, we identify potential implementation-related challenges based on the results of a preliminary qualitative survey of pilots of EdTech interventions. With this paper, we lay the foundation for a long-term research investigation into whether EdTech can narrow China’s education gap.

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Journal Articles

The Landscape of Early Childhood Development in Rural China

Sarah-Eve Dill, Yue Ma, Andrew Sun, Scott Rozelle
The Asia-Pacific Journal, 2019 August 10, 2019

In China, low levels of early childhood development (ECD) in rural areas may inhibit economic development as the nation attempts to transition from a middle-income manufacturing-based economy to a high-income innovation economy. This paper surveys the recent literature on ECD among children ages 0-3 years in rural China, including rates of developmental delays, causes of delays, and implications for the future of China’s economy. Recent studies have found high rates of developmental delays among young children in rural China and point to poor nutrition and psychosocial stimulation as the primary causes. This review highlights the need for large-scale ECD interventions in rural China to raise human capital and support future economic growth.

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Journal Articles

Impact of a Local Vision Care Center on Glasses Ownership and Wearing Behavior in Northwestern Rural China: A Cluster-Randomized Controlled Trial

Yue Ma, Yujuan Gao, Yue Wang, Haoyang Li, Lina Ma, Jiangchao Jing, Yaojiang Shi , Hongyu Guan , Nathan Congdon
International Journal of Environmental Research and Public Health, 2018 December 8, 2018

Abstract: Visual impairment is common among rural Chinese children, but fewer than a quarter of children who need glasses actually own and use them. To study the effect of rural county hospital vision centers (VC) on self-reported glasses ownership and wearing behavior (primary outcome) among rural children in China, we conducted a cluster-randomized controlled trial at a VC in the government hospital of Qinan County, a nationally-designated poor county. All rural primary schools (n = 164) in the county were invited to participate. Schools were randomly assigned to either the treatment group to receive free vision care and eyeglasses, if needed, or control group, who received glasses only at the end of the study. Among 2806 eligible children with visiual impairment (visual acuity ≤ 6/12 in either eye), 93 (3.31%) were lost to follow-up, leaving 2713 students (45.0% boys). Among these, glasses ownership at the end of the school year was 68.6% among 1252 treatment group students (82 schools), and 26.4% (p < 0.01) among 1461 controls (82 schools). The rate of wearing glasses was 55.2% in the treatment group and 23.4% (p < 0.01) among the control group. In logistic regression models, treatment group membership was significantly associated with spectacle ownership (Odds Ratio [OR] = 11.9, p < 0.001) and wearing behavior (OR = 7.2, p < 0.001). County hospital-based vision centers appear effective in delivering childrens’ glasses in rural China.

 

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Journal Articles

Teachers' Influence on Purchase and Wear of Children's Glasses in Rural China: The PRICE Study

Xiuqin Wang, Yue Ma, Mi Hu, Ling Jin, Baixiang Xiao, Ming Ni, Hongmei Yi , Xiaochen Ma, Congyao Wang, Beatrice Varga, Yiwen Huang, Scott Rozelle , Nathan Congdon
Clinical & Experimental Ophthalmology, 2018 August 11, 2018
Importance:Uncorrected refractive error causes 90% of poor vision among Chinese children. Background:Little is known about teachers' influence on children's glasses wear. Design:Cohort study. Participants:Children at 138 randomly selected primary schools in Guangdong and Yunnan provinces, China, with uncorrected visual acuity (VA)≤6/12 in either eye correctable to >6/12 in both eyes, and their teachers. Methods:Teachers and children underwent VA testing and completed questionnaires about spectacles use and attitudes towards children's vision. Main Outcome Measures:Children's acceptance of free glasses, spectacle purchase and wear. Results: A total of 882 children (mean age 10.6 years, 45.5% boys) and276 teachers (mean age 37.9 years, 67.8% female) participated. Among teachers,20.4% (56/275) believed glasses worsened children's vision, 68.4% (188/275) felt eye exercises prevented myopia, 55.0% (151/275) thought children with modest myopia should not wear glasses and 93.1% (256/275) encouraged children to obtain glasses.Teacher factors associated with children's glasses-related behaviour included believing glasses harm children's vision (decreased purchase, univariate model: relative risk [RR] 0.65, 95% CI 0.43, 0.98,P
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Journal Articles

Effect of a Local Vision Care Center on Eyeglasses Use and School Performance in Rural China A Cluster Randomized Clinical Trial

Yue Ma, Nathan Congdon, Yaojiang Shi, Ruth Hogg, Alexis Medina, Matthew Boswell, Scott Rozelle, Mony Iver
JAMA Ophthalmology, 2018 May 10, 2018

Can a county-based vision center increase eyeglasses use and improve school performance among primary schoolchildren in rural China? This cluster randomized clinical trial of 31 schools and 2613 participants showed that children who received eyeglasses earlier in the school year performed significantly better on an end-of-year mathematics test than children who received eyeglasses later in the year, equivalent to half a semester. Provision of free eyeglasses also improved children's use of spectacles.

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Journal Articles

Cluster-randomized Controlled Trial of the Effects of Free Glasses on Purchase of Children's Glasses in China: The PRICE (Potentiating Rural Investment in Children's Eyecare) Study

Xiuqin Wang, Nathan Congdon, Yue Ma, Min Hu, Yuan Zhou, Weiqi Liao, Ling Jin, Xiaoyi Wu, Ming Ni, Hongmei Yi , Yiwen Huang, Beatrice Varga, Hong Zhang, Yongkang Cun, Xianshun Li, Luhua Yang, Chaoguang Liang, Wan Huang, Scott Rozelle, Xiaochen Ma
PLOS ONE, 2017 November 21, 2017
Background: Offering free glasses can be important to increase children's wear. We sought to assess whether ªUpgrade glassesº 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 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 eligibleand 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.
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Journal Articles

Inequities in the Allocation of Medical Resources in China's Township Health Centers

Yue Ma, Linxiu Zhang, Matthew Boswell
China Agricultural Economic Review , 2016 August 25, 2016

Purpose – The purpose of this paper is to produce a high-quality measure of the nature of healthcare resources available in China’s Township Health Centers (THCs), paying particular attention to equity between high- and low-income areas.

Design/methodology/approach – This study makes use of data from a nearly nationally representative survey in rural China conducted by the Center for Chinese Agricultural Policy at the Chinese Academy of Sciences in 2011. The samples of towns were selected randomly from 25 counties located in five provinces from different regions of China. Data were collected through questionnaires and direct observation.

Findings – The THCs located in rich areas have higher levels of human resources than poor areas. THCs in rich areas also have more fixed assets than those in poor areas. In fact, even though the Chinese Ministry of Health mandates that all THCs have certain basic levels of medical equipment and facilities, many THCs in poor areas do not have them. The allocation of mandated equipment is unequal. 

Practical implications – These findings suggest that Chinas government should pay more attention to THCs located in poor areas, especially in light of new initiatives to improve health care in poor rural areas.

Originality/value – This is the first nationally representative study to employ rigorous empirics to investigate the extent of inequality in allocation of resources within THCs across China.

Keywords China, Health, Inequality, Rural development, Medical resources, Township health centers 

Paper type Research paper 

 

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Journal Articles

Dropping Out of Rural China's Secondary Schools: A Mixed-Methods Analysis

Yaojiang Shi, Linxiu Zhang, Yue Ma, Hongmei Yi, Chengfang Liu, Natalie Johnson, James Chu, Prashant Loyalka, Scott Rozelle
The China Quarterly, 2015 December 15, 2015

Students in rural China are dropping out of secondary school at troubling rates. While there is considerable quantitative research on this issue, no systematic effort has been made to assess the deeper reasons behind student decision making through a mixed-methods approach. This article seeks to explore the prevalence, correlates and potential reasons for rural dropout throughout the secondary education process. It brings together results from eight large-scale survey studies covering 24,931 rural secondary students across four provinces, as well as analysis of extensive interviews with 52 students from these same study sites. The results show that the cumulative dropout rate across all windows of secondary education may be as high as 63 per cent. Dropping out is significantly correlated with low academic performance, high opportunity cost, low socioeconomic status and poor mental health. A model is developed to suggest that rural dropout is primarily driven by two mechanisms: rational cost-benefit analysis or impulsive, stress-induced decision making. 

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