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Background: Micronutrient powder (MNP or Yingyangbao, a dietary supplement that contains multiple vitamins and minerals) programs can reduce the risk of anemia among children. One such program in China distributed free MNP to children aged 6–24 months in poor rural areas. However, there are indications that the generation of primary caregiver (i.e., parent or grandparent) may influence MNP feeding behavior. The purpose of this study was to investigate the prevalence and influencing factors of effective MNP feeding behavior among parents and grandparents in a rural developing setting.

Methods: We conducted a cross-sectional study of 884 caregivers and children in formerly impoverished rural areas of Sichuan Province using multi-stage random sampling. Data were collected on caregivers’ MNP feeding behavior, their core perceptions and health beliefs about MNP, children’s responses to MNP, MNP delivery patterns, and demographic characteristics. Influencing factors of parents’ and grandparents’ MNP feeding behavior were analyzed using two-level logistic regression.

Results: Total effective MNP feeding behavior rate among caregivers was 40.95%. Grandparents demonstrated higher MNP adoption than parents (χ2 = 4.445, P = 0.035). After controlling for sociodemographic characteristics, grandparents were more likely than parents to achieve effective MNP adoption (OR = 1.360, P = 0.035); child’s preference for MNPs (ORparental subgroup = 1.736, ORgrandparental subgroup = 1.496; P < 0.050) and caregiver’s self-efficacy (ORparental subgroup = 1.157, ORgrandparental subgroup = 1.393; P < 0.050) were influencing factors of feeding behavior for caregivers of both generations. Parents were also influenced by perceived barriers to feeding MNPs (OR = 0.904, P = 0.040), while grandparents were more strongly influenced by child’s discomfort to MNPs (OR = 0.240, P = 0.023) and caregiver’s knowledge about MNPs (OR = 1.557, P = 0.014).

Conclusion: Future efforts to improve the feeding behavior of caregivers in MNP programs both in China and abroad should improve children’s preference for MNP by changing its composition and taste, and increase caregivers’ feeding self-efficacy through health education. Moreover, parents should be taught to cope with time and ability barriers that may limit MNP adoption, while grandparents should be emphasized the importance and potential side effects of MNP.

Journal Publisher
BMC Public Health
Authors
Yiran Tian
Fangqun Leng
Xinru Zhou
Yadi He
Linhua Li
Ruixue Ye
Andrew Rule
Jieyuan Feng
Scott Rozelle
Scott Rozelle
Yuju Wu
Huan Zhou
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The effects of psychological factors on complementary feeding behavior have been widely described, yet the mechanisms underlying the complex relationships among personality traits, self-efficacy, and complementary feeding behavior remain unclear. This cross-sectional study was conducted using a multi-stage cluster sampling process to select caregiver-child dyads in Western rural China. Personality traits, self-efficacy, and complementary feeding behavior were evaluated respectively. Both multiple logistic regression and Bayesian network structure (BNs) were used to explore these associations. A total of 787 caregiver-child dyads were enrolled. Results from multiple logistic regression indicated that caregivers with medium (OR = 2.05, p < 0.001) or high (OR = 1.58, p = 0.04) levels of extraversion, as well as those with high self-efficacy recording complementary feeding (OR = 2.08, p < 0.001), significantly increased the likelihood of meeting the criteria for the Infant and Child Feeding Index (ICFI) qualification. Further, BNs were employed to elucidate the pathways of influence, revealing a direct association between the caregiver's level of extraversion, level of self-efficacy and the ICFI. Additionally, the analysis indicated that a caregiver's openness indirectly influenced the ICFI through its influence on self-efficacy regarding complementary feeding. This is one of few studies exploring associations between personality traits, self-efficacy, and complementary feeding behavior. The study highlights the importance of understanding individual differences in caregiving and suggests that interventions should focus on enhancing caregivers' self-efficacy, rather than solely targeting personality traits.

Journal Publisher
Maternal and Child Nutrition
Authors
Xinru Zhou
Yiran Tian
Zhengjie Cai
Linhua Li
Yuju Wu
Guo Zeng
Jieyuan Feng
Scott Rozelle
Scott Rozelle
Hein Raat
Huan Zhou
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Join us for the fall Health Policy Forum

 

Uphill Battle Health Care Costs

 

Featuring Assemblymember Jim Wood

and

Professor Liran Einav of Stanford University.

 

U.S. Health care spending will approach $5 trillion dollars this year, and regardless of the outcome of the election, managing this staggering cost will be a priority for policymakers and the public. Meanwhile, private equity is increasingly a player in health care finance, which could bring risks as well as opportunities. This policy forum brings together two leaders who have shaped health care financing debates in elected office and in academic research, respectively. Please join us for a lively, high stakes discussion, featuring Assemblymember Jim Wood and Professor Liran Einav of Stanford University.

Space is limited. Lunch will be served to guests on the way out of the event.

 
 
(The Clark Center Auditorium is located downstairs below the Clark Center Courtyard, accessible by the courtyard staircase or by the elevators in the East wing lobby.)
 

Clark Center Auditorium
318 Discovery Walk
Stanford School of Medicine

 

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Protecting the lives of children in Gaza and other conflicts requires changes to the rules of engagement and global responses to all conflicts affecting civilian populations, argue Zulfiqar Bhutta, Georgia Dominguez, and Paul Wise.

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BMJ
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Zulfiqar A. Bhutta
Georgia B. Dominguez
Paul H. Wise
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386:e081515
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2024 SCCEI Summer Study Program group photo at Peking University.
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In 2024, SCCEI launched its inaugural Summer Study Program, marking the center’s first intensive field excursion in China with Stanford undergraduate students. To gain a deeper understanding of China, program participants traveled across urban and rural China, embarking on field visits focusing on a wide cross-section of issue areas, including education, healthcare, retail technology, and manufacturing.

Under the guidance of SCCEI’s faculty directors Hongbin Li and Scott Rozelle, program participants explored the key issues, challenges, and opportunities that China faces today. Sixteen students participated in this year’s program and hailed from multidisciplinary backgrounds, including economics, international relations, electrical engineering and computer science. Each student exhibited a passion for gaining a nuanced understanding of China and its role on the global stage as the world’s second largest economy.  

On June 24, the student cohort gathered in Shanghai for the program’s kickoff. While in Shanghai, students toured the store and warehouse of the innovative grocery chain model, Freshippo. Next, students learned about cutting-edge environmental initiatives and spoke directly with young professionals at Ant Finance. The Shanghai leg of the trip also featured a tour of the Luckin Coffee factory, which is the largest roastary in Asia, and a networking dinner with local Stanford alumni.

“It was incredible talking to people in very high positions of power in these digital companies that we took tours of, for example, the Ant group or even some of the manufacturing companies we went to...that the core thesis of their drive for profit, it's underpinned by, ‘we need to be environmentally friendly.’” Arshia Mehta, a management science and engineering major going into consulting, reflected on these visits. 

It was incredible talking to people in very high positions of power in these digital companies that we took tours of.
Arshia Mehta

From Shanghai, students traveled to Deqing, a prosperous rural county in the Yangtze river delta region, where they explored a local health clinic and a pearl farm responsible for a sizable portion of global pearl production. From Deqing, students traveled to the nearby township of Tongxiang, where they dove into China’s dynamic manufacturing sector through informative conversations with factory personnel and tours of a conveyor belt factory and fiber glass company. 

The program cohort then traveled to Xi’an, where they had the opportunity to marvel at the Terracotta Warriors and explore the city’s Muslim Quarter. From urban Xi’an, students rode a bus through tunnels and over mountains towards the rural county of Ningshan, where they visited a local parenting center, rural agricultural communities, and local hospitals. Students also visited local households where they conversed with villagers and families to learn more about rural life in Ningshan.

“Everybody wanted their children to go to college, everybody wanted to see a better future and how to help for that future,” said first year political science major Garrett Molloy, “that reminds me – no matter how distant we seem politically, people are actually very similar.”

Finally, after traveling overnight on a sleeper train, students arrived in Beijing. While in China’s capital, the cohort toured the newly operational Xiaomi EV factory, engaged with students from Tsinghua University High School and Peking University, and spoke directly with the country’s stock market regulators. Students also joined the 4th of July celebration hosted by the U.S. Embassy, where they were greeted by the U.S. Ambassador to China, Nicholas Burns.

Reflecting on her conversation with the Ambassador, Amaya Marion, a junior studying international relations, said, “This trip makes me more certain that I do want to do something in the future with U.S.-China relations.”

The student cohort also had ample opportunity to explore China’s culture and history throughout the program. They visited a paleolithic archaeological site, learned to make traditional Chinese rice cakes, practiced the art of Chinese calligraphy, and visited the Zhujiajiao Water Town. The cohort also explored traditional indigo tie-dyeing practices and cloisonné, an ancient technique for decorating metalwork with colored enamel material.

This is a really remarkable opportunity to see parts of China that otherwise wouldn't be accessible to me.
Stella Meier

Students not only gained new insights from the cultural and business visits, they also learned from one another. Stella Meier, Stanford junior studying international relations, remarked, “this is a really remarkable opportunity to see parts of China that otherwise wouldn't be accessible to me.”

This trip has altered my perception in a way that's constructive, in a way that's helping me think more critically about the information that's being fed to me.
Rahul Ajmera

Having experienced urban and rural China firsthand over the course of two weeks, students walked away with a deeper and more nuanced understanding of China’s economy and people that, according to one student, “fundamentally reshaped my global perspective.” To continue facilitating transformative student exchanges with China, planning for SCCEI’s second annual Summer Program is already well underway.
 



Watch the Program Highlights 



Visit the program page for more program details and future program announcements.


 

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Decoding China’s Economic Slowdown: A Roundtable Discussion

The Stanford Center on China’s Economy and Institutions and Asia Society Policy Institute’s Center for China Analysis co-organized a closed-door roundtable on China's recent economic slowdown and produced summary report of the discussion.
Decoding China’s Economic Slowdown: A Roundtable Discussion
Craig Allen speaks at SCCEI 2024 conference
News

Silicon Showdown: Craig Allen Unpacks the Competition for Technology Leadership between the U.S. and China

Craig Allen, the President of the U.S.-China Business Council, spoke on the evolving dynamics of technological leadership between the U.S. and China and their implications for the rest of the world.
Silicon Showdown: Craig Allen Unpacks the Competition for Technology Leadership between the U.S. and China
Peking University scenic view with tower.
News

Track 2 Diplomacy Effort on U.S.-China Scholarly Exchange Publishes Final Report

The newly released report explains the benefits of U.S.-China scholarly cooperation to the two societies and the world at large, identifies the obstacles to greater exchanges, and outlines practical strategies for overcoming these challenges.
Track 2 Diplomacy Effort on U.S.-China Scholarly Exchange Publishes Final Report
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Under the guidance of SCCEI’s faculty directors, 16 students traveled across urban and rural China, embarking on field visits including education, healthcare, retail technology, and manufacturing to gain a deeper understanding of China’s economy.

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Background
Comorbidity in mental disorders is prevalent among adolescents, with evidence suggesting a general psychopathology factor (“p” factor) that reflects shared mechanisms across different disorders. However, the association between the “p” factor and protective factors remains understudied. The current study aimed to explore the “p” factor, and its associations with psycho-social functioning, in Chinese adolescents.

Methods
2052 students, aged 9–17, were recruited from primary and secondary schools in Shanghai, China. Multiple rating scales were used to assess psychological symptoms and psycho-social functioning. Confirmatory factor analysis was conducted to verify the fit of models involving different psychopathology domains such as externalizing, internalizing, and the “p” factor. Subsequently, structural equation models were used to explore associations between the extracted factors and psycho-social functioning, including emotion regulation, mindful attention awareness, self-esteem, self-efficacy, resilience, and perceived support.

Results
The bi-factor model demonstrated a good fit, with a “p” factor accounting for 46 % of symptom variation, indicating that the psychological symptoms of Chinese adolescents could be explained by internalizing, externalizing, and the “p” factor. Psychologically, a higher “p” was positively correlated with emotion suppression and negatively correlated with mindful attention awareness, emotion reappraisal, self-esteem, and resilience. Socially, a higher “p” was associated with decreased perceived support.

Limitations
Only common symptoms were included as this study was conducted at school. Furthermore, the cross-sectional design limited our ability to investigate causal relationships.

Conclusions
A “p” factor exists among Chinese adolescents. Individuals with higher “p” factor levels were prone to experience lower levels of psycho-social functions.

Journal Publisher
Journal of Affective Disorders
Authors
Yuqing Cai
Xinshu She
Manpreet Singh
Huan Wang
Huan Wang
Min Wang
Cody Abbey
Scott Rozelle
Scott Rozelle
Lian Tong
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Purpose
China’s rapid urbanization has been associated with increased mental health challenges, especially in rural-to-urban migrant children. This study evaluates the effects of mindfulness and life-skills (LS) training on emotional regulation and anxiety symptoms from a randomized controlled trial aimed at improving the mental health of Chinese migrant children.

Methods
Two intervention arms—mindfulness training (MT) and MT plus LS mentorship (MT + LS)—were compared to a waitlist control group of 368 migrant children aged 9–17 years. Volunteers were trained to deliver interventions to 285 migrant children in small groups of 15 for eight weeks weekly. Social integration varied: migrant children mixed with local children at public schools were considered highly integrated, those in migrant-only classrooms at public schools had intermediate levels of integration, and children in private migrant schools had low integration. Emotion regulation and anxiety symptoms were assessed preintervention, postintervention, and three months postintervention.

Results
Postintervention and compared to the control group, children with high social integration in the MT arm showed increased cognitive reappraisal ability (p < .05) but higher physical anxiety (p < .01). Children with high social integration in the MT + LS arm had lower anxiety symptoms of harm avoidance (p < .01) and physical anxiety (p < .05). Children with low social integration in the MT + LS arm showed lower cognitive reappraisal (p < .01) and poorer overall emotion regulation abilities (p < .01). Three months later, children with intermediate integration in the MT + LS arm had lower separation anxiety (p < .05) and harm avoidance anxiety (p < .05). No other groups showed significant improvements in emotion regulation or reducing in anxiety symptoms three months postintervention.

Discussion
Mindfulness and LS training may benefit Chinese migrant children who have higher levels of social integration but increase anxiety in those with lower social integration. Future research should consider the sociocultural context in which a treatment is implemented.

Journal Publisher
Journal of Adolescent Health
Authors
Luwan Lan
Wanqing Liu
Chen Liu
Huan Wang
Huan Wang
Min Wang
Cody Abbey
Manpreet Singh
Scott Rozelle
Scott Rozelle
Xinshu She
Lian Tong
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Background
Mental health problems among children at preschool age are a common issue across the world. As shown in literature, a caregiver’s parenting style can play a critical role in child development. This study aims to examine the associations between a caregiver’s parenting style and the mental health problems (or not) of their child when he/she is at preschool age in rural China.

Methods
Participants were children, aged 49 to 65 months, and their primary caregivers. The primary caregivers of the sample children completed the Parenting Styles and Dimensions Questionnaire, Short Version, the Strengths and Difficulties Questionnaire, and a questionnaire that elicited their socio-demographic characteristics. The level of cognitive development of each sample child was assessed using the Wechsler Preschool and Primary Scale of Intelligence, Fourth Edition. Pearson correlation analysis, linear regression analysis, and multivariable regression analysis were used to analyze the data.

Results
The prevalence of mental health problems among sample children at preschool age was high (31.6%). If a caregiver practices an authoritative parenting style, it was found to be negatively associated with the mental health problems of their child. In contrast, a caregiver’s authoritarian parenting style was positively associated with the mental health problems of their child. Compared to those in a subgroup of primary caregivers that used a combination of low authoritative and low authoritarian parenting style, primary caregivers that used a combination of high authoritarian and low authoritative or a combination of high authoritative and high authoritarian were found to have positive association with child health problems. A number of demographic characteristics were found to be associated with the adoption of different parenting styles.

Conclusion
Different parenting styles (including authoritative, authoritarian, and combination of authoritative and authoritarian) of the sample caregivers had different associations with the mental health problems of the sample children. Parenting programs that aim to improve the parenting styles (favoring authoritative parenting styles) should be promoted in an effort to improve the status of child mental health in rural China.

Journal Publisher
BMC Psychiatry
Authors
Lei Wang
Jing Tian
Scott Rozelle
Scott Rozelle
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Brian and Jennifer Endowed Chair in Public Health, and Professor in Community Health Sciences at the University of California, Berkeley
Research Affiliate, Rural Education Action Program
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Ph.D.

Dr. Lia Fernald, PhD, MBA, has been working in the field of public health for over 20 years focusing specifically on infants and children living in poverty, with the overarching goal of improving lives of vulnerable children through systemic, strategic, and effective interventions. Dr. Fernald has written almost 200 papers using rigorous methodological approaches to design and examine integrated interventions to address inequalities, health disparities and child development outcomes. She is a global expert on the effects of community mobilization, conditional cash transfer programs, and nutrition programs on infant, child, and family health and developmental outcomes. For a complete list of publications click here. 
 

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Clinical Professor, Stanford Department of Psychiatry & Behavioral Sciences
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Ph.D.
Director, Mindfulness Program, Stanford Center for Integrative Medicine
Faculty Affiliate at the Stanford Center on China's Economy and Institutions
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