Why am I late for school? Peer effects on delayed school entry in rural northwestern China

This article estimates the causal effect of primary school entry age on children's cognitive development in rural northwestern China, using data on nearly 1,800 primary school aged children from the Gansu Survey of Children and Families. Instrumental variable estimates, exploiting the discontinuity structure in children's school entry age around the enrolment cut‐off date, indicate that a 1‐year delay in school entry reduces children's scores on a cognitive ability test administered when they were aged 9–12 by 0.11–0.16 standard deviations (of the distribution of test scores). The negative late‐school‐entry effect is significantly larger in villages with no preprimary schools. It also persists as children advance to higher grades. These findings suggest that delayed school entry, even if it may be rural parents' rational response to resource constraints, can be harmful for children's cognitive development in developing areas with underdeveloped preprimary school systems.

The Culture of Guanxi in a North China Village

In rural north-western China, the tension between economic growth and ecological crises demonstrates the limitations of dominant top-down approaches to water management. In the 1990s, the Chinese government adopted the Integrated Water Resources Management (IWRM) approach to combat the degradation of water and ecological systems throughout its rural regions. While the approach has had some success at reducing desertification, water shortage, and ecological deterioration, there are important limitations and obstacles that continue to impede optimum outcomes in water management. As the current IWRM approach is instituted through a top-down centralized bureaucratic structure, it often fails to address the socio-political context in which water management is embedded and therefore lacks a complete treatment of how power is embedded in the bureaucracy and how it articulates through economic growth imperatives set by the Chinese state. The approach has relied on infrastructure heavy and technocratic solutions to govern water demand, which has worked to undermine the focus on integration and public participation. Finally, the historical process through which water management mechanisms have been instituted are fraught with bureaucratic fragmentation and processes of centralization that work against some of its primary goals such as reducing uncertainty and risk in water management systems. This article reveals the historical, social, political, and economic processes behind these shortcomings in water management in rural northwestern China by focusing on the limitations of a top-down approach that rely on infrastructure, technology, and quantification, and thereby advances a more holistic, socio-political perspective for water management that considers the state-society dynamics inherent in water governance in rural China.

Relationship Between Age of School Entry and Behaviour Problems Recent studies demonstrated that children who are relatively young within a school year show more behaviour problems, are at greater risk of being diagnosed with attention- eficit/hyperactivity disorder (ADHD) and treated with stimulants compared to their older classmates. In this paper we examine the association of age at school entry and behavioural problems for a German sample of elementary school children, who were enrolled in 2009 (N = 928). We used teacher ratings on the Strengths and Difficulties Questionnaire (SDQ) as well as the prevalence of ADHD diagnosis and medication. Our analyses showed that those children with a relatively younger age at school entry were judged more hyperactive than their older peers when sex was controlled for. After stratifying for sex, the effect of age at school entry on hyperactivity was now only significant for boys. No association with age at school entry could be found for the other SDQ-subscales as well as for ADHD diagnosis and medication. Although we could only partially demonstrate a significant relationship between age at school entry and behavioral problems in German elementary school-children, understanding these associations may help to consider children´s maturity differences when evaluating the child´s behavior.

Intrahousehold flypaper effects — Quasi-experimental evidence from a randomized school-feeding program in rural northwestern China

Introduction: The long-term impact of iron deficiency anemia on female children was significantly reducing physical growth, neurological development and learning performance. There is limited data about the magnitude of iron deficiency anemia in Saudi Arabia in young children. This study aimed to assess the prevalence and determinants of iron deficiency anemia in children attending primary health care at the age of the school entry. Methods: This is a cross-sectional study including children at the age of school entry and they should be tested for detection of anemia after their parents sign an informed consent. Children with other types of anemia were excluded from this study. The minimal sample size is calculated using Raosoft calculator based on the equation for proportion estimation. Based on this proportion, at the confidence level of 95% and estimation error of 0.05 the initial sample size is calculated to be 384 participants. A questionnaire was used to collect data from the mothers or caregiver for the children. Results: A total sample of 384 attendants in PHC centers responded to the questionnaire, of them 59.5% were males. About 68% of the mothers have a high level of education as university or postgraduate studies and 83% were married. The prevalence of anemia was found to be 24% among children for both genders. Only nationality was a significant predictor for iron-deficiency anemia among children. Saudis children had a significantly lower prevalence of anemia than non-Saudis. Conclusions: The prevalence of anemia among children at age of school entry was high and more attention to the nutritional habits of children should be given by mothers and health specialists. Educational campaign should be conducted to increase awareness about proper children nutrition among women, particularly women with non-Saudi nationality.

BackgroundThe global aging trend has heightened attention to chronic diseases (CDs) among the elderly, highlighting the importance of improving medication adherence. China, home to a fifth of the world’s elderly population, exemplifies the challenges of managing medication adherence in rural settings. This study aimed to assess the prevalence of medication adherence among elderly individuals with CDs in rural northwestern China, and to examine multilevel factors based on the Social Ecological Model (SEM) as the theoretical framework.MethodsA total of 700 rural residents aged ≥ 60 years were surveyed through structured face-to-face interviews in Shaanxi Province, China. Descriptive statistics, t-tests, and chi-square tests were used to compare group differences. Univariate and multivariable logistic regression analyses were conducted to identify factors associated with medication adherence within the SEM framework.ResultsAmong all 700 participants, 496 (70.86%) had at least one CD, and among these, 55.04% had multiple conditions. Overall, 59.68% of patients exhibited full adherence to their medication regimens, while 22.78% and 17.54% reported partial and non-adherence, respectively. Multivariable analysis showed that comorbidity, employment status, travel time to primary healthcare centers, distance to county hospitals, and exposure to community health education were significantly correlated with adherence (p < 0.05).ConclusionsMedication adherence among rural elderly with CDs remains suboptimal and is shaped by factors spanning individual, interpersonal, organizational, and community levels. Interventions should integrate these multilevel influences to strengthen adherence and chronic disease management in resource-limited rural settings.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12877-026-06998-7.

BackgroundVery preterm children are at greater risk of academic difficulties (AD). Some of them start school a year earlier than anticipated during pregnancy due to being born preterm. The aim of this study was to analyze the relationship between neurodevelopment, school-entry age, and AD at age seven. MethodAD were assessed at age seven in children born before 33 weeks of gestation between January 1st, 2007 and December 31, 2014 and enrolled in LIFT cohort. To analyze the relationship between school-entry age and AD, we used generalized equations with adjustment for perinatal, socio-economic factors, and neurodevelopment assessed by Age Stages Questionnaire (ASQ) at 5 years. Moreover, we used Global Scholar Adaptation (GSA) score to evaluate the school adaptation. Results2599 children were in routine schooling. Entering school a year earlier was observed in 597 (23.0%). AD was known for 1943/2599 (74.8%). Starting school a year earlier was associated with an increased rate of AD: 35.4% in the exposed group versus 20.2% in the non-exposed group, with a relative risk of 1.76 (95% CI: 1.48; 2.08). Both starting school a year earlier and ASQ at 5 years old were independently associated with the GSA score at age 7: standardized β=-0.15 (95% CI:-0.10;-0.20) and 0.40 (95% CI: 0.35; 0.45) respectively. ConclusionStarting school a year earlier than anticipated during pregnancy was associated with an increased rate of AD at age 7 in children born very preterm, independently of their neurodevelopment at age 5 assessed by ASQ. Basing school entry age on corrected age seems appropriate to mitigate this risk.

Instrumental variables estimates of peer effects in social networks

Stunting is associated with adverse outcomes in adulthood. This article specifically aims to analyse the relationship between childhood stunting and education as well as cognitive outcomes for adults in Indonesia. Pooled data from wave one (1) and two (2) of the Indonesia Family Life Survey (IFLS) in 1993 and 1997 identified a sub-sample of 4,379 children aged 0-5 by their height-for-age (HAZ) to be compared for their differences in educational outcomes and cognitive abilities in 2014. HAZ was used to proxy relative height to determine stunting status based on 2006 WHO child's growth standards. Education and cognitive abilities outcomes include years of schooling, age of school entry, grade repetition, and scores for cognitive and math tests. The study employs estimation models of pooled regressions and instrumental variable (IV) to address problems of endogeneity and bias from omitted variables. Stunting and relatively small stature had significant associations with cognitive development, and they worked as intermediaries to cognitive developmental barriers as manifested in reduced educational outcomes. A lack of one SD in HAZ was associated with 0.6 years shortened length of the school, 3% higher chances of dropouts from secondary school, and 0.10-0.23 SD lowered cognitive and numerical scores. Similarly, stunting is associated with decrease cognitive test scores by 0.56-0.8 SD compared to non-stunting, two years less schooling, and 0.4 years of delayed entry to school. As for cognitive abilities, stunting is associated with lower cognitive and numerical abilities by 0.38-0.82 z-scores. Growth retardation during childhood in Indonesia was associated with lower cognitive abilities, particularly during school age, and this correlation faded as individuals grew up. Subsequently, growth retardation is significantly linked to lower educational outcomes. Impaired growth has implications for reduced lifetime earnings potential mediated by diminished cognitive capacity and lower educational attainment. The finding suggests that development in Indonesia during recent decades has not provided an adequate environment to enable children to achieve their potential educational outcomes.

This quasi-experimental study estimates academic peer effects in China's middle school (7th–9th grade) classrooms, using data from a large-scale nationally representative survey of middle schoolers in China. Our study design circumvents endogenous sorting by focusing on 52 schools that randomly assigned incoming 7th graders to different 7th-grade classes. Further, reverse causality is addressed by regressing students' 8th-grade test scores on their (randomly assigned) classmates' average 7th-grade test scores. Our analysis reals that all else equal, a one-standard-deviation increase in (8th-grade) classmates' average 7th-grade test scores raises an individual student's 8th-grade mathematics and English test scores, respectively, by 0.13–0.18 and 0.11–0.17 standard deviations. These estimates remain stable when peer characteristics examined in related peer-effect studies are included in the model. Further analysis reveals that peer effects work through raising individual students' time spent studying per week and their confidence in learning. Finally, classroom peer effects are found to be heterogeneous across subgroups: larger for boys, academically stronger students, students attending better schools (i.e., schools with smaller classes and urban schools), and students with relatively disadvantaged family backgrounds (e.g., lower levels of parental education and family wealth).

Biometrical JournalVolume 46, Issue S1 p. 122-122 Poster Sessions Abstracts P2.01: Results of a study on “respiratory symptoms and allergies in children at school entry age in a rural region (AABEL)”: internal and external comparison of prevalence rates Michael Hoopmann, Michael Hoopmann Michael.Hoopmann@nlga.niedersachsen.de Search for more papers by this authorSandra Heidrich, Sandra HeidrichSearch for more papers by this authorFriederike Neisel, Friederike NeiselSearch for more papers by this author Michael Hoopmann, Michael Hoopmann Michael.Hoopmann@nlga.niedersachsen.de Search for more papers by this authorSandra Heidrich, Sandra HeidrichSearch for more papers by this authorFriederike Neisel, Friederike NeiselSearch for more papers by this author First published: 17 March 2004 https://doi.org/10.1002/bimj.200490181AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume46, IssueS1Supplement: Abstracts of the Joint Meeting of the IBS-DR and the DAEMarch 2004Pages 122-122 RelatedInformation

BackgroundGlobally, escalating mental health issues among postpartum women underscore their significant impact on individuals, children, and society. This study investigates the associations between breastfeeding difficulties and maternal mental health in rural areas of northwestern China. Additionally, we examine how mothers’ perceived family support and home visits by community health workers (CHWs) are associated with variations in maternal mental health outcomes.MethodsData for this study were collected in March and December 2021. Descriptive statistics and multivariate linear regression analyses were conducted to examine the prevalence of maternal mental health problems and the association between breastfeeding difficulties and maternal mental health. Maternal mental health was assessed using Depression, Anxiety, and Stress Scale (DASS-21), while breastfeeding difficulties were measured based on mothers’ self-reported experiences with common breastfeeding challenges. Perceived family support for breastfeeding and a community-based home visit intervention were analyzed to explore differences in associations across subgroups.ResultsGreater overall breastfeeding difficulty was significantly associated with higher maternal stress (β = 2.391, P = 0.001), and showed marginally positive associations with depression (β = 1.186, P = 0.102) and anxiety (β = 0.953, P = 0.082). Among specific categories, feeding process difficulties were significantly associated with increased anxiety (β = 1.173, P = 0.031) and stress (β = 2.031, P = 0.008). Among mothers with lower practical support, breastfeeding difficulties were significantly associated with higher depression (β = 1.782, P = 0.009), anxiety (β = 1.577, P = 0.002), and stress (β = 2.722, P < 0.001), whereas associations in the higher support group were not significant. For emotional support, a stronger association with stress was observed in the lower support group (β = 2.748, P = 0.008) but not in the higher support group. Stratification by community health worker home visits showed minimal subgroup differences. ConclusionsIn essence, this study underscores the impact of breastfeeding challenges on maternal mental health and highlights family support’s pivotal role, calling for targeted intervention to support rural mothers.Trial registrationThe study was approved by the Medical Ethics Committee of Shaanxi Normal University and Xi’an Jiaotong University of China (No: 2020 − 1240) on 08/03/2019. Meantime, the study obtained the registration numbers ISRCTN98898991 from the ISRCTN registry, which is recognized by WHO and ICMJE, on 26/03/2019.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12884-025-08186-8.

High-protein foods and physical activity are crucial for bone growth in early life. This study first examined whether a protein-rich multi-nutrient intervention combined with rope-skipping training could prevent bone loss during winter in prepubertal children. A 10 week randomized controlled trial involving 120 children aged 9-12 years in rural northwestern China was conducted. Participants were assigned to a treatment group (protein-rich multi-nutritional drink plus rope-skipping training) or a control group (rope-skipping training only). Forearm bone mineral density (BMD) was measured at the baseline and week 10 of the trial, along with serum calcium, parathyroid hormone (PTH), insulin-like growth factor 1 (IGF-1), and bone turnover biomarkers. Second, we estimated the effects of three protein sources enriched in the drink, milk protein concentrates (MPC), collagen peptides (CP), and whey protein hydrolysates (WPH), on zebrafish backbone development. In children, BMD decreased in both groups, but the treatment group showed a smaller reduction and a positive intervention effect (relative change: 0.023 g cm-2, P = 0.037). The treatment group also had a smaller increase in PTH (relative change: -8.53 ng L-1, P = 0.012) and a smaller decrease in IGF-1 (relative change: 20.75 ng mL-1, P = 0.076). No significant differences were found in bone turnover biomarkers. In zebrafish, MPC, CP, and WPH individually and synergistically promoted bone growth without adverse effects, as shown by dose-dependent increases in the backbone fluorescence intensity. These findings suggest that protein-rich multi-nutrient supplementation combined with rope-skipping training could prevent bone loss in prepubertal children during winter, potentially through changes in serum PTH and IGF-1, and highlight the synergistic effects of these proteins on bone development.

The long-term neurodevelopmental effects of antenatal Zika virus (ZIKV) exposure in children without congenital Zika syndrome (CZS) remain unclear, as few children have been examined to the age of school entry level. A total of 51 Colombian children with antenatal ZIKV exposure without CZS and 70 unexposed controls were evaluated at 4-5 years of age using the Behavior Rating Inventory of Executive Function (BRIEF), the Pediatric Evaluation of Disability Inventory (PEDI-CAT), the Bracken School Readiness Assessment (BSRA), and the Movement Assessment Battery for Children (MABC). The mean ages at evaluation were 5.3 and 5.2 years for cases and controls, respectively. Elevated BRIEF scores in Shift and Emotional Control may suggest lower emotional regulation in cases. A greater number of cases were reported by parents to have behavior and mood problems. BSRA and PEDI-CAT activity scores were unexpectedly higher in cases, most likely related to the COVID-19 pandemic and a delayed school entry among the controls. Although PEDI-CAT mobility scores were lower in cases, there were no differences in motor scores on the MABC. Of 40 cases with neonatal neuroimaging, neurodevelopment in 17 with mild non-specific findings was no different from 23 cases with normal neuroimaging. Normocephalic children with ZIKV exposure have positive developmental trajectories at 4-5 years of age but differ from controls in measures of emotional regulation and adaptive mobility, necessitating continued follow-up.