Health impacts of parental migration on left-behind children and adolescents: a systematic review and meta-analysis

The influence factors on pit and fissure sealing behavior of 12-year-old children: a cross-sectional study in Zhejiang, China

BACKGROUND

In the 21st century, dental caries remains a global burden, particularly severely affecting the growth and quality of life of 12-year-old children. Fortunately, pit and fissure sealing (PFS) procedures can effectively prevent molars from caries. Hence, this study focused on the relationship between PFS and oral epidemiological factors in 12-year-old children.

METHODS

A cross-sectional survey was conducted in 12-year-old children from 11 cities in Zhejiang Province. Their dental conditions were collected through questionnaires, as well as basic information such as relevant family information, oral health knowledge and behavior. Then, logistic regression analysis was used to identify the influencing factors associated with PFS.

RESULTS

A total of 1204 children were included, with 252 in the PFS group and 952 in the non-PFS group. There were significant differences between the two groups in terms of decayed, missing and filled teeth (DMFT) score, first permanent molar DMFT score, residential area, educational level of parents, tooth-brushing frequency, use of dental floss, oral examination in a medical institution, having taken courses on oral health care, as well as having knowledge that tooth brushing could effectively prevent gingival inflammation, PFS could protect teeth, and oral disease may affect general health. According to further logistic regression analysis, the independent factors influencing PFS included use of dental floss [odds ratios (OR) = 1.672, 95% confidence intervals (CI) = 1.235-2.263, P = 0.001], having taken courses on oral health care (OR = 0.713, 95% CI = 0.515-0.988, P = 0.042), having knowledge that tooth brushing is effective in preventing gingival inflammation (OR = 0.627, 95% CI = 0.389-0.987, P = 0.044) and having knowledge that PFS can protect teeth (OR = 0.589, 95% CI = 0.438-0.791, P < 0.001).

CONCLUSION

PFS can reduce the mean DMFT score of 12-year-old children. Independent influencing factors of PFS consist of use of dental floss, having taken courses on oral health care, oral health behavior and knowledge level.

Effect of short-term intensive design-based STEM learning on executive function: an fNIRS study of the left-behind children

Design-based STEM learning is believed to be an effective cross-disciplinary strategy for promoting children's cognitive development. Yet, its impact on executive functions, particularly for disadvantaged children, still need to be explored. This study investigated the effects of short-term intensive design-based STEM learning on executive function among left-behind children. Sixty-one Grade 4 students from a school dedicated to the left-behind children in China were sampled and randomly assigned to an experimental group (10.70 ± 0.47 years old, n = 30) or a control group (10.77 ± 0.43 years old, n = 31). The experimental group underwent a two-week design-based STEM training program, while the control group participated in a 2-week STEM-related reading program. Both groups were assessed with the brain activation from 4 brain regions of interest using functional near-infrared spectroscopy (fNIRS) and behavioral measures during a Stroop task before and after the training. Analysis disclosed: (i) a significant within-group time effect in the experimental group, with posttest brain activation in Brodmann Area 10 and 46 being notably lower during neutral and word conditions; (ii) a significant between-group difference at posttest, with the experimental group showing considerably lower brain activation in Brodmann Area 10 and Brodmann Area 46 than the control group; and (iii) a significant task effect in brain activity among the three conditions of the Stroop task. These findings indicated that this STEM learning effectively enhanced executive function in left-behind children. The discrepancy between the non-significant differences in behavioral performance and the significant ones in brain activation implies a compensatory mechanism in brain activation. This study enriches current theories about the impact of Science, Technology, Engineering, and Mathematics (STEM) learning on children's executive function development, providing biological evidence and valuable insights for educational curriculum design and assessment.

Prevalence and associated factors of adolescent psychological abuse, neglect in Western China a multi-center cross-sectional study

Background: The western region of China has a dense population, relatively underdeveloped economy, and a significant number of left-behind children. Currently, the prevalence of adolescent psychological abuse, neglect, and the factors associated with these issues in the region remain unclear. This study aims to evaluate the current status of adolescent psychological abuse and neglect and its associated factors in this region.Methods: Data were collected from 50 schools in western China through cluster sampling to target adolescents aged 12 to 18. A comprehensive survey form was used to collect socio-demographic characteristics of adolescents. The Child Psychological Abuse and Neglect Scale was employed to assess the current psychological abuse and neglect of adolescents. Independent samples t-tests were used for inter-group comparisons. A Directed Acyclic Graph was constructed for controlling confounding variables. Subsequently, binary logistic regression analysis was performed, and a nomogram risk factors model was developed using R Studio.Results: This study included 12,743 teenagers, with an average age of 15.53(±1.39) years. Among them, 4,965 individuals, accounting for 39.0%, reported experiences of psychological abuse, while 4,167 individuals, accounting for 32.7%, reported experiences of neglect. The rates of psychological abuse and neglect in adolescents are influenced by gender, grade, left-behind experience, parental marital status, and living on campus (P < .05).Conclusion: Adolescents in western China exhibit higher rates of psychological abuse and neglect compared to those in the eastern and northern regions of China. Gender, grade, left-behind experience, and family factors significantly influence the psychological abuse and neglect of adolescents.

Internet addiction and suicidal ideation in Chinese children with migrant parents: Mediating role of anxiety and moderating role of social support

INTRODUCTION

The prevalence of internet addiction among Chinese left-behind children, coupled with its potential to exacerbate anxiety and suicidal ideation, has become a critical issue. This study seeks to address the dearth of research on the psychological underpinnings of this phenomenon, particularly the mediating role of anxiety and the moderating effect of social support across different parental migration statuses. Understanding these relationships is crucial for developing targeted interventions and informing policy decisions.

METHODS

In a cross-sectional study, we administered Young's Internet Addiction Test, alongside scales for anxiety, social support, and suicidal ideation, to 2882 middle school students in China with diverse parental migration backgrounds. Utilizing an online survey approach, we ensured broad participation and participant anonymity. Advanced statistical analyses, including regression models for mediation and moderation effects, were employed to rigorously test our hypotheses.

RESULTS

Among all participants, a significant positive correlation was observed between Internet addiction and suicidal ideation. Anxiety mediated the relationship between Internet addiction and suicidal ideation across all groups, including those with mother-only migration (Effect = 0.383, 95%CI: 0.107,0.943), father-only migration (Effect = 0.806, 95%CI: 0.487-1.230), both-parent migration(Effect = 0.289, 95%CI: 0.105-0.521), and non-left-behind children (Effect = 0.469, 95%CI: 0.342-0.630). Particularly in families where only the mother was absent, the moderating role of social support was especially prominent (B = 1.174, t = 6.446, p < 0.001 for low social support), underscoring the importance of family structure in the context of Internet addiction.

CONCLUSION

Internet addiction has both direct and indirect effects on suicidal ideation, with anxiety playing a mediating role in the indirect effects. Social support moderates and alleviates the relationship between Internet addiction and anxiety specifically in the mother-only migration group. Therefore, clarifying these relationships helps in developing and implementing effective interventions to specifically improve the mental health and living conditions of left-behind children.

Mapping Adolescent Mental Well-Being - 30 PLADs, China, 2019

What is already known about this topic?

High levels of mental well-being are linked to favorable life outcomes. Nonetheless, compared to the research on psychiatric disorders, the understanding of mental well-being among Chinese adolescents is still relatively underexplored.

What is added by this report?

This report fills a significant void in the literature concerning the mental well-being of Chinese adolescents by providing updated data. This information is critical for developing evidence-based interventions and strategies aimed at improving mental well-being and addressing mental health issues among adolescents.

What are the implications for public health practice?

Enhancing psychological support for vulnerable populations is essential to improve mental well-being among adolescents, reduce health disparities, and achieve global Sustainable Development Goals.

Influence of stress on self-injury among Chinese left-behind adolescents is not cast in stone: Synergistic roles of family protective factors

BACKGROUND

Left-behind adolescents are vulnerable to stressful life events and often engage in nonsuicidal self-injury (NSSI), which is a growing public concern in China. However, little is known about the synergistic protective effect of family resources on the relationship between stressful life events and NSSI in these adolescents.

OBJECTIVE

Based on theories of family socialization and resilience, the aim of this study was to examine the synergistic protective role of maternal knowledge and mother-child cohesion in buffering the effect of stressful life events on NSSI in father-absent left-behind adolescents.

METHODS

This study used two-wave longitudinal data. The analytical sample included 673 adolescents (Mage = 13.47 ± 1.11 years, 48 % male) who were enlisted from 4 junior high schools in rural China. Respondents completed questionnaires on stressful life events, parental knowledge, parent-child cohesion, and NSSI at two-time points.

RESULTS

The effects of stressful life events on NSSI were significant in father-absent left-behind adolescents. Additionally, maternal knowledge moderated the associations between stressful life events and NSSI in father-absent left-behind adolescents. Moreover, maternal knowledge and mother-child cohesion were found to play synergistic protective roles in the relationship between stressful life events and NSSI. In father-absent left-behind adolescents, only high maternal knowledge and high-quality mother-child cohesion could eliminate the negative effect of stressful life events on NSSI.

CONCLUSION

The findings underscore the synergistic protective roles of maternal knowledge and mother-child cohesion in buffering the negative effect of stressful life events on NSSI in father-absent left-behind adolescents. Both maternal knowledge and mother-child cohesion should be considered in interventions aimed at reducing NSSI in these adolescents.

Associations between left-behind children's characteristics and psychological symptoms: a cross-sectional study from China

BACKGROUND

Parent-child separation poses a significant challenge for left-behind children (LBC). However, limited empirical evidence exists regarding the correlation between left-behind characteristics and the psychological symptoms of LBC. This study investigated psychological symptoms among LBC and explored associations between left-behind characteristics and those symptoms.

METHODS

Using stratified cluster sampling, 1,832 LBC aged 13-18 years from three cities in East China were selected for analysis. Participants' depression and anxiety symptoms were assessed with the Patient Health Questionnaire 9 and the General Anxiety Disorder 7, respectively. Chi-square tests were used to compare differences in detection rates of psychological symptoms among LBC in different groups. Binary logistic regression analysis was used to infer associations between left-behind characteristics and psychological symptoms.

RESULTS

Depression and anxiety symptoms were detected in 32.86% and 33.24%, respectively, of participating LBC. Univariate analysis showed statistically significant differences in detection rates of depression symptoms by sex, grade, and timing of parent-child separation. Statistically significant differences were observed in anxiety symptom rates by sex, grade, type of caregiver, and timing of mother-child separation. Multivariate analysis indicated a positive association between LBC's anxiety symptoms and mother-child separation that occurred during post-primary school, and type of caregiver (father only or mother only). Our findings confirm a positive association between left-behind characteristics and anxiety symptoms among LBC.

CONCLUSION

The timing of mother-child separation and type of caregiver are potential risk factors for the development of anxiety symptoms in this population.

Paternal depressive symptoms and factors associated among expectant fathers in a northeastern province of Thailand

Globally, depression is a major mental health problem among expectant fathers. Therefore, factors associated with paternal depressive symptoms (PDS) need investigation. This hospital-based cross-sectional study was aimed to investigate the prevalence of and factors associated with PDS among expectant fathers in a northeastern province of Thailand. In the north-eastern province, Sakon Nakhon, 440 expectant fathers from eight hospitals participated in the study by completing a questionnaire related to socio-demographic characteristics, the Edinburgh Postnatal Depression Scale (EPDS), psychosocial factors and social support. An EPDS score of at least eleven out of 30 was interpreted as having PDS. Multivariable linear regression analysis was applied with a statistical significance at 0.05, and the coefficient β was presented. In total, 81 expectant fathers (18.4%, 95% confidence interval 14.6-22.3) had PDS, and the mean (standard deviation) of the EPDS score was 6.65 (4.25). Insufficient money (β = - 0.099, p = 0.016), marital adjustment (β = - 0.098, p = 0.027), self-esteem (β = - 0.150, p < 0.001), wife's stress (β = 0.079, p = 0.049), and expectant father's stress (β = 0.400, p < 0.001) were factors independently associated with PDS. In conclusion, screening expectant fathers during the pregnancy period of their wives is essential, and factors associated with PDS should not be neglected by healthcare providers. Also, there is need of an intervention program to prevent the symptoms, especially for expectant fathers having insufficient money or having stress.

Prevalence of Suicidal Ideation, Suicide Plans, and Suicide Attempts Among Children and Adolescents Under 18 years of Age in Mainland China: A Systematic Review and Meta-Analysis

Despite suicide in younger population having become a severe public health issue, information on the prevalence of suicidality among Chinese children and adolescents is still limited. This study aims to estimate the prevalence of suicidal ideation, suicide plans, and suicide attempts in Chinese children and adolescents aged under 18 years. A meta-analysis was conducted based on English and Chinese publications from January 1, 2010 to December 31, 2020 using random-effects models. Based on 132 eligible studies with a combined total of 1,103,309 Chinese children and adolescents below 18 years old, the pooled prevalence of the overall suicidal ideation, suicide plans, and suicide attempts were 15.4% (95% CI [14.3, 16.6]), 6.4% (95% CI [5.5, 7.4]) and 3.5% (95% CI [3.1, 4.1]), respectively. The subgroup analyses showed that there were significant variations of prevalence of suicidal risks across genders, school stages, and geographical areas in mainland China. It was the first systematic review and meta-analysis to show suicidality among younger population aged below 18 years is prevalent in mainland China. This study suggests that gender-age-region-specific prevention and intervention programs should be urgently needed to reduce suicidal risks among Chinese children and adolescents.

The Prevalence and Severity of School Bullying among Left-Behind Children: A Meta-Analysis

The involvement of left-behind children (LBC) in school bullying has raised concern in China. However, the susceptibility of LBC to engage in bullying is controversial, and comprehensive, representative studies covering the entire country are lacking. The purpose of this study was to evaluate the prevalence and severity of school bullying among LBC. The Chinese National Knowledge Network, WanFang, VIP, PubMed, Web of Science, EMBASE, and EBSCO databases were searched for literature on being left-behind and bullying before April 2022. The effect size was measured by odds ratio (ORs), standard mean difference (SMD), and 95% confidence interval (CI). Random-effects or fixed-effects models were selected for meta-analysis, and subgroup analysis was used to explore the sources of heterogeneity. The meta-analysis included 25 studies of school bullying among LBC and non-LBC (NLBC). The prevalence of bullying perpetration and victimization among LBC were 18.58% (95% CI [3.72%, 33.44%], p < .05) and 40.62% (95% CI [25.47%, 55.78%], p < .05), respectively. Compared with NLBC, the risk of bullying perpetration and victimization among LBC increased 1.97 times (OR = 1.97, 95% CI [1.77, 2.20], p < .05) and 2.17 times (OR = 2.17, 95% CI [1.43, 3.29], p < .05), respectively. The severity of bullying experienced by LBC was higher than that of NLBC (SMD = 0.49, 95% CI [0.20, 0.79], p < .05). The prevalence and severity of school bullying were higher in LBC than in NLBC, and left-behindness was positively associated with school bullying. LBC are a crucial population to protect when developing bullying interventions.

Continuity in child mental health from preschool years to adolescence in parental migration contexts: Evidence from a longitudinal study in Thailand

Our analysis employed the life-course approach to examine whether and how mental health during the preschool stage could predict mental health during adolescence in the Thai context, where migration of parents is common. We used the longitudinal data set of the 2008 and 2021 Child Health and Migrant Parents (CHAMPSEA)-Thailand. The baseline survey of CHAMSEA-Thailand gathered data from 1030 households that met the eligibility criteria, each having a child within one of the two specified age ranges (aged 3-5 or 9-11). Our analysis used the baseline data of children aged 3 to 5 years old who were 16 to 18 years old in the subsequent survey (N = 404). In both surveys, the mental health of children was measured using the SDQ (total difficulties scores), a global standard tool for assessing children's mental health. Parental migration measured whether the parent(s) were international migrants when the child was 3 to 5 years old at the baseline. Results showed a significant, positive impact of the SDQ total difficulties scores of children aged 3 to 5 on their SDQ total difficulties scores when they grew up to 16 to 18 years old. Findings also revealed that experiencing parental international migration during the early life stage led to adverse effects on individuals' mental health when they became adolescents.

Association of early parent-child separation with depression, social and academic performance in adolescence and early adulthood: a prospective cohort study

OBJECTIVE

The present study aimed to investigate the long-term effects of parent-child separation during infancy and early childhood on depression, social relationships including parent-child and peer relationships, and academic performance during adolescence and early adulthood.

METHODS

Data from the China Family Panel Studies (CFPS) were analyzed, which included a sample of 3829 children aged 4-15 years from 25 provinces over a period of 8 years. The study examined the association between early parent-child separation and outcomes related to depression, social and academic performance, comparing outcomes between individuals with and without early separation experiences. A series of subgroup analyses were conducted to further explore these associations.

RESULTS

Parent-child separation lasting 3 months or longer was found to be associated with moderate to severe levels of depression and impaired social relationships during adolescence and early adulthood, particularly among males, adolescents, urban dwellers, and those with less educated mothers. Children who experienced parent-child separation for 3 months or longer showed a positive correlation between separation duration and depression. Short-term separations under 3 months did not show this association. The duration of separation also had a negative correlation with parent-child and peer relationships, as well as academic performance.

CONCLUSION

Early parent-child separation has significant adverse effects on the mental health, social and academic performance of adolescents and early adulthood, especially among males, adolescents, urban residents, and those with lower maternal education. The severity of depression was found to be related to the duration of separation, highlighting the importance of minimizing separation to less than 3 months for children under the age of 3. These findings underscore the critical role of early parental care and the need for targeted interventions for high-risk populations.

Parental Migration and the Social and Mental Well-Being Challenges among Indonesian Left-Behind Children: A Qualitative Study

Parental labour migration, of either one or both parents, has been associated with various challenges among left-behind children (LBC). However, there is a limited understanding of the LBC's own views and experiences of social and mental well-being and how the new daily life circumstances they encounter following their parents' migration impact them. This study aimed to understand the influence of parental migration and its aftermath on the social and mental well-being of adolescents (referred to as LBC) in two rural districts in Indonesia. Employing a qualitative design, data were collected through individual in-depth interviews with LBC (n = 24) aged 14 to 18 years, recruited using the snowball sampling technique. Data were thematically analysed, guided by a qualitative data analysis framework. The findings showed that parental migration negatively impacted the social well-being of LBC. This impact was reflected in negative labelling from friends and changes in familial roles which influenced their social interactions and activities with peers. Parental migration was also associated with challenges to the mental well-being of LBC. These manifested in the LBC experiencing fractured emotional bonds, leading to negative emotions, including stress, anxiety, sadness, depression, frustration, loss of motivation, and self-imposed isolation, which were associated with their parents' migration and abrupt disruptions in parent-child communication. The transition to new life situations with caregivers after parental migration and the dynamics within the caregivers' households were additional factors that detrimentally affected their mental well-being. Unmet basic needs and educational needs due to financial hardships faced by mothers and caregivers further exacerbated mental health challenges for the children. The findings indicate the importance and improvement of policies and interventions in Indonesia (e.g., counselling services, non-cash food assistance, family hope program, direct cash assistance) that cover and address the diverse needs of mothers or caregivers and the LBC.

Psychological Flexibility Profiles and Mental Health Among University Students with Left-Behind Experience: A Latent Profile Analysis

The left-behind experience as an adverse childhood experience has a negative impact on the mental health of university students. Psychological inflexibility mediated the relationship between adverse childhood experiences and mental disorders, but no similar findings were drawn in psychological flexibility (PF). More research is needed to understand the relationship between PF and mental health of university students with left-behind experience. To investigate the relationship between PF profiles and mental health and sleep quality of university students with left-behind experience based on latent profile analysis. A sample of 1988 Chinese university students with left-behind experience were recruited to complete an online survey. Participants provided demographic information and completed validated measures of PF and mental health. Latent profile analysis was used to identify patterns of PF, and logistic regression analysis was used to examine the relationships among these variables. We found four PF profiles among participants, with the largest number being the moderately flexible profile (n = 808, 40.6%). The level of PF was positively correlated with mental health and sleep quality (all P < 0.001). Females, being left behind at a young age and for a long time, and having little contact with parents were associated with low PF (all P < 0.05). Our study highlights the importance of focusing on the PF of university students with left-behind experience and left-behind children, and the need for interventions to improve their PF and thus their mental health.

Nutritional status of children left behind by migrant parents: Evidence from a survey in rural Anhui, eastern China

We aimed to explore and analyse the dietary intake patterns of 3-6 year-old children left behind by one or both parents and to assess their associations with body mass index (BMI) and the prevalence of childhood anaemia in rural Anhui, eastern China. We used random cluster sampling to recruit rural children aged 3-6 years in two rural areas in Anhui province. Sociodemographic information and dietary intake were collected by self-reported questionnaires. Height, weight and prevalence of anaemia were measured by trained nurses blinded to parental migration status. Factor analysis was applied to determine that major dietary patterns, binary logistic regression and generalised linear regression were used to explore the associations between anaemia and BMI Z-score with dietary patterns. Of 1720 children aged 3-6 years, 236 were left by both parents and 388 were left by a single parent. The prevalence of stunting and underweight among left-behind children with migration of both parents (BLBC) was significantly higher than that of non-left-behind children (NLBC). Three dietary patterns-"grain-vegetable," "meat-egg" and "fast food-sweet"-were identified in our study, and the total variance explained was 46.9%. The meat-egg dietary pattern was associated with a decreased risk of anaemia after adjustment for confounding factors in the left-behind children with migration of both parents (BLBC), left-behind children with single parent migration (SLBC) and non-left-behind children (NLBC) groups. After adjusting for confounding factors, the fast food-sweet dietary pattern was found to be associated with an increased risk of anaemia (OR [95% CI]: Q4: 2.21 [1.14, 4.57], p = 0.034). In addition, children with obesity had a lower intake of vegetables and fruits (β = -0.08, 95% CI: -0.13, -0.02) compared with children with a normal weight. In conclusion, there are correlations between different types of parental migration and children's nutritional status in rural Anhui. The meat-egg dietary pattern may have a preventive effect on anaemia in comparison with other dietary patterns, irrespective of whether children are left behind or not. Children with overweight and obesity had a higher intake of pork and red meat and snacks compared with children with normal BMI.

A psychometric study of the revised Chinese version of the family resilience assessment scale among children disadvantaged due to family migration

OBJECTIVE

The family system is important for children's development. Previous research has demonstrated that some families are able to maintain good adaptability or resilience in the face of stressors. This study aimed to develop the revised Chinese version of the Family Resilience Assessment Scale and examine the psychometric properties of the scale among children disadvantaged in adversity due to family migration.

METHODS

A total of 1487 children (47.6 % girls) from disadvantaged families participated in this study, whom completed the revised Chinese version of the Family Resilience Assessment Scale, the Chinese version of the Connor-Davidson Resilience Scale, and the Center for Epidemiologic Studies Depression Scale for Children.

RESULTS

(1) Good language equivalency was found (Intraclass Correlation Coefficient = 0.96); (2) Item analysis indicated that the critical ratio values of all 45 items were above 0.30 (p < 0.001), except for 7 items that were dropped from further analysis; (3) The exploratory factor analysis indicated that the best model was four-factor model; (4) The confirmatory factor analysis showed that the four-factor model had good model fit; (5) Family resilience was significantly correlated with personal resilience and depression; (6) The internal consistency reliability of the scale was 0.95.

CONCLUSIONS

This study confirmed that the revised Chinese version of the Family Resilience Assessment Scale was a reliable and valid instrument to assess family resilience of Chinese children who are disadvantaged.

Parental Migration Trajectories From Childhood Through Adolescence: Longitudinal Impact on Emotional and Behavioral Problems Among Chinese Adolescents

It is estimated that there are about 23% of all children in China experiencing parental migration and being left behind at hometown. Existing research indicated a significant association between parental migration and children development but overlooked the dynamic changes in family structure caused by parental migration. In this study, data was derived from a nationally representative longitudinal survey-the China Family Panel Studies. The main analyses employed four waves of data (2012, 2014, 2016, and 2018) and included 1401 adolescents aged 10-15 years (Mean:12.35, SD:1.67; 54.2% female). Six typical trajectories of parental migration capturing both migration status at each timepoint and changes in the status across six years were created. Children's depression and internalizing problems and externalizing problems were concerned outcomes. The mediating roles of the caregiver-child interaction and caregiver's depression were examined. Adolescents in the trajectory group described as experiencing transitions between being left behind by both parents and non had a higher risk of depression and internalizing and externalizing problems. Caregivers' depression was a significant mediator between parental migration and adolescent depression.

The association between anxiety and internet addiction among left-behind secondary school students: the moderating effect of social support and family types

BACKGROUND

The left-behind children (LBC), children and adolescents aged 0-18 whose parents have migrated for economic purposes for extended periods exceeding three months, present a unique social concern. These children remain in their place of household registration, often under the guardianship of relatives, while receiving compulsory education. LBC with growing Internet addiction (IA) have made it urgent to take a close look at the mechanisms and effective interventions for them. Anxiety has been proven to be correlated with IA in adolescents; however, the mechanisms of addiction in this population are less well-fully grasped. Based on the current theories and empirical results, the study examined whether and how social support (SS) and family types moderated the associations between anxiety and IA among left-behind secondary students.

METHODS

Stratified cluster sampling survey. A questionnaire was administered to 5290 secondary school children (2553 classified as left-behind) to explore the relationships between anxiety, IA, left-behind types, family types, and social support. This cross-sectional study employed a stratified cluster sampling survey of students in the ethnic areas of southeast Chongqing. The study sought to appraise the relationships between anxiety and IA in different types of left-behind children and to assess the potential moderating effect of SS on the relationship among the population and its family types differences.

RESULTS

The relationship between anxiety and IA was moderated significantly by social support and family types. Notably, the impact of social support on the moderating effect between IA and anxiety varied among students from both family types. For students from families where both parents had migrated, social support weakened the association between IA and anxiety. Conversely, for students from single-parent families where the parent had migrated, social support seemed to strengthen the relationships between these two issues.

CONCLUSIONS

The moderating effects of SS on the relationship between anxiety and IA differs based on family type among various groups of left-behind secondary students. Gaining insights into the IA mechanisms can guide the development of targeted intervention strategies aimed at minimizing IA among diverse groups of left-behind students.

Positive Development Patterns in Left-Behind Adolescents: Do Resilience and Making Sense of Adversity Have Beneficial Effects?

Purpose

Despite increased attention to the positive development of left-behind adolescents, research findings remain inconclusive. Utilizing latent profile analysis, we identified various positive development profiles among the left-behind adolescents and explored the association between resilience and positive development profiles, alongside the mediating role of making sense of adversity.

Methods

A multi-stage cluster sampling procedure was employed, randomly selecting four provinces-Zhejiang, Guangdong, Henan, and Jiangxi-from the central and coastal regions. The sample comprised 718 left-behind adolescents recruited from primary and junior high schools across grades 4, 5, 7, and 8. Three scales were utilized, and analyses included latent profile analysis and mediation analysis.

Results

Three latent subgroups of positive development among left-behind adolescents were identified: low, moderate, and high. Those with higher resilience and positive perceptions of adversity tended to belong to the high group rather than the low (β = -0.45, p < 0.001; β = -0.09, p < 0.001) or moderate group (β = -0.23, p < 0.001; β = -0.04, p < 0.05). Left-behind adolescents with higher negative perceptions of adversity tended to belong to the high group rather than the moderate group (β = -0.07, p < 0.01). Mediation analysis revealed that resilience facilitated the development of positive appraisals of adversity, subsequently increasing the likelihood of being categorized into the high (95% CI of -0.09 to -0.03) or moderate group (95% CI of -0.05 to -0.01) rather than the low group.

Conclusion

These findings hold significant implications for intervention formulation. Educators should focus on strengthening resilience and fostering positive perceptions of adversity among the low group. For the moderate group, maintaining moderate negative perceptions of adversity may stimulate the intrinsic potential for positive development more effectively.

Examining the effects of parental migration on youth mental health and substance use: a qualitative study in rural Yucatán, México

Background

Parental migration is common in Mexico and Latin America, where individuals pursue work to improve their family's economic opportunities and children remain home in their community under the care of the remaining parent or extended family. A research gap remains about the impact of parental migration on mental health and substance use in children who remain at home. The current study explored risk and resilience factors relating to mental health and substance use among Mexican youth remaining at home when one or more parents migrate.

Methods

This qualitative study applied attachment theory and thematic analysis to analyze 26 in-depth interviews with youth (17-21 years old), parents, and a focus group with high-school teachers in a town with history of migration both domestically and internationally (Yucatan, México).

Results

Respondents across groups perceived that parental migration was related to 1) less parental/caregiver oversight and support due to family demands on the remaining parent and 2) the deterioration of youth mental health. Lack of youth oversight and the poor mental health of youth were perceived as drivers of youth seeking out and consuming alcohol and substances. In terms of parental remittances, youth reported observing among their peers increased access to material goods such as clothing and technology (e.g., smartphones) and increased access to alcohol. Resilience factors included parental awareness of the role of good communication with youth and teachers and youth access to and utilization of self-care resources such as mutual aid meetings for substance use recovery.

Conclusion

Poor mental health and substance use among youth and parents were perceived to be related to parental absence, stressors on the remaining parent or family, and undermined healthy parent-child attachment. Youth themselves are a source of insight for recommendations on interventions to reduce youth isolation and substance use risk. We recommend the intentional engagement of youth in developing intervention research and tailoring evidence-based interventions to mitigate parental absence's impact and promote parent-child attachment for youth and families remaining at home.

Long-term effects of various experiences of parental migration on adult health: A nationwide survey in China

BACKGROUND

Despite numerous literature studies on the short-term effects of diverse experiences of being left-behind, migrant, or both on children, the research on their long-term effects remains inadequate. The purpose of current study is to explore the long-term impact of being left-behind, migrant or experiencing both during childhood on health in adulthood. Simultaneously, we investigate the impact of psychological resilience on adults in the presence of diverse experiences of parental migration.

METHOD

A total of 2,371 samples were selected from 28 provinces in China, consisting of 656 participants who had been left behind but never migrated (PLBNM), 205 participants who had migrated but never been left behind (PMNLB), 265 participants who had both been left behind and migrated (PLBM), and 1,245 participants who had no left-behind/migrant experiences (NLBM). The mental health, health condition, and psychological resilience were measured using the 12-item General Health Questionnaire (GHQ-12), Self-Rated Health, and the Connor-Davidson Resilience Scale (CD-RISC), respectively.

RESULTS

The results of the regression model indicated that PLBNM (OR = 2.10, 95% CI [1.59, 2.77], p < .001), PMNLB (1.93, [1.27, 2.94], p < .01), and PLBM (2.01, [1.37, 2.94], p < .001) displayed lower self-rated health compared to NLBM. However, only PLBNM (1.29, [1.05, 1.58], p < .05) reported higher mental health problems compared to NLBM. Our results also showed a strong association between psychological resilience and adults' lower self-rated health (0.72, [0.64, 0.82], p < .001).

CONCLUSION

The negative long-term impact of various experiences regarding being left-behind, migrant, or both, on adult's mental health and self-rated health were more pronounced. The Chinese government ought to create unique policy frameworks that offer assistance to those adults.

Urbanization, self-harm, and suicidal ideation in left-behind children and adolescents in China: a systematic review and meta-analysis

PURPOSE OF REVIEW

Economic development and urbanisation have prompted many Chinese parents to move from rural to urban regions for better job opportunities. Their children, who remain behind in rural regions, become left-behind children (LBC). With absent parents, children and adolescents are unable to maintain the secure attachment required for healthy social and emotional development, increasing the risk of mental illness. This study aimed to compare risk of self-harm and suicidal ideation in LBC and non-LBC in China.

RECENT FINDINGS

Greater risks for poor mental health outcomes including worse depression, loneliness and anxiety have been identified in LBC in cross-sectional studies. Previous studies have also identified higher prevalence of bullying victimization, poorer school performance and worse school attendance amongst LBC.

SUMMARY

Findings indicate that prolonged separation from parents put LBC at greater risks of poor mental health. Policy changes to allow children to migrate with their parents and policies to reduce inequalities in job opportunities between urban and rural regions are needed.

Parental Educational Expectations and Academic Achievement of Left-Behind Children in China: The Mediating Role of Parental Involvement

Migrant workers from rural China often leave their children at home to be raised by grandparents or other family members. This study explored the relationship between parents' educational expectations, parental involvement, and the academic performance of left-behind children in China. A total of 19,487 student samples were obtained from the China Education Panel Survey (CEPS), and 5078 of these met the criteria for being considered as 'left behind' children. Results indicated: (1) a significant positive correlation between parents' educational expectations and left-behind children's academic achievement; (2) parental education involvement plays a partial mediating role between parents' educational expectations and left-behind children's academic performance; (3) a significant negative correlation between parental intellectual involvement and educational expectations of left-behind children; (4) parental management involvement was not significantly correlated with parents' educational expectations and left-behind children's academic performance; and (5) a significant positive correlation between parental emotional involvement and educational expectations of left-behind children. The findings highlight the important role of parental educational expectations and have implications for the improvement of educational outcomes in China.

Adolescent suicide risk factors and the integration of social-emotional skills in school-based prevention programs

Adolescents are considered one of the most vulnerable groups affected by suicide. Rapid changes in adolescents' physical and mental states, as well as in their lives, significantly and undeniably increase the risk of suicide. Psychological, social, family, individual, and environmental factors are important risk factors for suicidal behavior among teenagers and may contribute to suicide risk through various direct, indirect, or combined pathways. Social-emotional learning is considered a powerful intervention measure for addressing the crisis of adolescent suicide. When deliberately cultivated, fostered, and enhanced, self-awareness, self-management, social awareness, interpersonal skills, and responsible decision-making, as the five core competencies of social-emotional learning, can be used to effectively target various risk factors for adolescent suicide and provide necessary mental and interpersonal support. Among numerous suicide intervention methods, school-based interventions based on social-emotional competence have shown great potential in preventing and addressing suicide risk factors in adolescents. The characteristics of school-based interventions based on social-emotional competence, including their appropriateness, necessity, cost-effectiveness, comprehensiveness, and effectiveness, make these interventions an important means of addressing the crisis of adolescent suicide. To further determine the potential of school-based interventions based on social-emotional competence and better address the issue of adolescent suicide, additional financial support should be provided, the combination of social-emotional learning and other suicide prevention programs within schools should be fully leveraged, and cooperation between schools and families, society, and other environments should be maximized. These efforts should be considered future research directions.

Research Review: Grandparental care and child mental health - a systematic review and meta-analysis

BACKGROUND

The number of children residing in grandfamilies is growing worldwide, leading to more research attention on grandparental care over the past decades. Grandparental care can influence child well-being in various forms and the effects vary across contexts. In this systematic review and meta-analysis, we synthesize the evidence on the relation between grandparental care and children's mental health status.

METHODS

We identified 5,745 records from seven databases, among which 38 articles were included for review. Random effects meta-analyses were used to synthesize evidence from eligible studies. We also examined the variability across study and participant characteristics, including study design, recruitment method, child age, child gender, study region, family type, comparison group, and outcome rater.

RESULTS

The meta-analysis consisted of 344,860 children from the included studies, whose average age was 10.29, and of which 51.39% were female. Compared with their counterparts, children being cared for by their grandparents had worse mental health status, including more internalizing problems (d = -0.20, 95% CI [-0.31, -0.09], p = .001), externalizing problems (d = -0.11, 95% CI [-0.21, -0.01], p = .03), overall mental problems (d = -0.37, 95% CI [-0.70, -0.04], p = .03), and poorer socioemotional well-being (d = -0.26, 95% CI [-0.49, -0.03], p = .03). The effects varied by study design and child gender.

CONCLUSIONS

The findings highlight that grandparental care is negatively associated with child mental health outcomes with trivial-to-small effect sizes. More supportive programs and interventions should be delivered to grandfamilies, especially in disadvantaged communities.

Association Between Parental Absence and Depressive Symptoms in Adolescence: Evidence From a National Household Longitudinal Survey

Longitudinal evidence demonstrating the association between parental absence and depressive symptoms in adolescence is limited. The present study aimed to explore this relationship in a Chinese national representative sample. This research was based on the China Family Panel Studies and included 1481 subjects. Depressive symptoms were assessed using the self-reported Center for Epidemiologic Studies Depression questionnaire. A multiple logistic regression model with a generalized estimating equation was used to test the association between parental absence and adolescent depressive symptoms. In the baseline year, 2012, 29.03% and 43.75% of adolescents had maternal and paternal absence, respectively. The prevalence of depressive symptoms increased from 23.23% to 28.12% in subsequent years. After controlling for covariates, maternal absence was positively associated with depressive symptoms (odds ratio 1.69, 95% confidence interval 1.06-2.68). Maternal absence led to depression in adolescents. It may be beneficial for adolescents with depression to spend more time with their mothers.

Parental absence as an adverse childhood experience among young adults in sub-Saharan Africa

BACKGROUND

Parental absence in childhood has been associated with multiple negative consequences, such as depression and anxiety in young adulthood.

OBJECTIVE

To assess whether parental absence for six months or more in childhood is associated with poor mental health and substance use in young adulthood and whether parental absence accounts for additional variance beyond those explained by other adverse childhood experiences (ACEs) among youth in sub-Saharan Africa.

PARTICIPANTS AND SETTINGS

We used combined Violence Against Children and Youth Survey (VACS) data from Cote d'Ivoire (2018), Lesotho (2018), Kenya (2019), Namibia (2019), and Mozambique (2019). Analyses were restricted to 18-24-year-olds (nf = 7699; nm = 2482).

METHODS

We used logistic regression to examine sex-stratified relationships between parental absence in childhood (defined as biological mother or father being away for six months or more before age 18) and mental health problems and substance use and whether parental absence explained additional variance beyond those explained by other ACEs.

RESULTS

In sub-Saharan Africa, parental absence in childhood was common (30.5 % in females and 25.1 % in males), significantly associated with poor mental health and substance use among females and males and accounted for additional variance beyond those explained by conventional ACEs. For example, after controlling for study covariates and other ACEs, females who experienced any parental absence had 1.52 (95 % CI = 1.02-2.26) higher odds of experiencing moderate/serious psychological distress compared with those who did not.

CONCLUSION

The observed association between parental absence and poor mental health suggests that this experience has significant adverse consequences and merits consideration as an ACE.

Psychometric properties of the Mobile Phone Parenting Practices Questionnaire (MPPPQ) for Chinese separated families with young children

The current study aimed to examine the psychometric properties of the newly developed Mobile Phone Parenting Practices Questionnaire (MPPPQ) in a sample of Chinese migrant parents experiencing long-term parent-child separation. A total of 547 rural-to-urban migrant parents with 3-to-6-year-old children left in rural hometowns were recruited online and completed electronic questionnaires. Exploratory (N1 = 288) and confirmatory (N2 = 259) factor analyses were successively used to identify the factor structure. The results indicated that the MPPPQ consists of six dimensions, responsivity, autonomy granting, proactive control, directive control, psychological control, and harsh punitive control, with a good model fit. The dimensions showed good internal consistency and composite reliability. By examining associations with constructs of the Parenting Styles and Dimensions Questionnaire, convergent validity was well established. The criterion validity of the MPPPQ was confirmed by its associations with parental stress, indicated by the Parental Stress Scale. This initial examination of the MPPPQ conveys that it holds good psychometric properties and may contribute to theoretical, methodological, and practical applications regarding parenting in the context of family separation and media use.

Emotional and behavioural problems of left behind children in Lithuania: a comparative analysis of youth self-reports and parent/caregiver reports using ASEBA

BACKGROUND

Children being left behind (LBC) in their home countries due to parental emigration is a global issue. Research shows that parents' emigration negatively affects children's mental health and well-being. Despite a high number of LBC, there is a dearth of data from Eastern European countries. The present study aims to collect and analyse self-reported data on LBC emotional and behavioural problems and compare children's reports with those of parents/caregivers.

METHODS

A cross-sectional study was conducted in 24 Lithuanian schools, involving parents/caregivers and their children aged 12 to 17. We employed self-reported measures, including the Achenbach System of Empirically Based Assessment (ASEBA) tools - Child Behaviour Checklist (CBCL 6/18) and Youth Self Report (YSR 11/18), to evaluate the emotional and behavioural problems of the children. These instruments had been translated, standardised, and validated for the Lithuanian population. Data collection took place between January 2022 and April 2023. In addition to descriptive analysis, multivariate regression was used to adjust for various sociodemographic factors.

RESULTS

A total of 760 parents/caregivers and 728 of their children participated in the study. LBC exhibited higher total problem scores (57.7; 95% CI 52.0-63.4) compared to non-LBC (47.1; 95% CI 44.7-49.4). These differences were consistent across all YSR 11/18 problem scales. However, no significant differences were observed in CBCL 6/18 scores. Furthermore, LBC self-reported a higher total problem score (57.7; 95% CI 52.0-63.4) compared to their parents/caregivers (24.9; 95% CI 18.9-30.9), and this pattern persisted across all scales. Being female, having school-related problems and having LBC status were associated with higher YSR 11/18 scores in the multivariable regression, while female gender, living in rural areas, school-related problems, and having hobbies were associated with higher CBCL 6/18 scores.

CONCLUSION

This study highlights that LBC report more emotional and behavioural challenges than their non-LBC peers, while parent/caregiver assessments show lower problem scores for LBC. Gender, living environment, school-related issues, and engagement in hobbies have influenced these outcomes. These findings underscore the multifaceted nature of the experiences of LBC and the importance of considering various contextual factors in understanding and addressing their emotional and behavioural well-being.

Prevalence of undernutrition among migrant, refugee, internally displaced children and children of migrated parents in lower-middle-income countries: A meta-analysis of published studies from last twelve years

BACKGROUND AND AIMS

This review aims to estimate the prevalence of undernutrition among migrants, refugees, internally displaced children, and children of migrated parents living in lower-middle-income countries.

METHODS

PubMed, Scopus, Science-Direct, CINAHL-Plus, & Google Scholar were searched for peer-reviewed evidence published between January 2010 to March 2023. Two researchers independently examined the studies and retrieved the data. The internal and external validity of the studies was assessed using the NIH quality assessment tool, and a checklist adapted from Downs & Black, Bracht & Glass, and Del Siegle's guidelines. A random effect model was chosen to pool the estimates. Subgroup analysis, Meta-regression, and sensitivity analysis were done to explore the source of heterogeneity and the robustness of estimates.

RESULTS

Among the 1978 records initially searched, 21 studies were selected for analysis. The pooled prevalence estimates for stunting, wasting, and underweight were estimated to be 29.39% (Confidence Interval [CI] 21.69-37.73; I2 99%; p < 0.01), 12.76% (CI 7.84-18.68; I2 99%; P < 0.01), and 24.05% (CI 16.17-32.94; I2 100%; p < 0.001) respectively. Among different WHO regions, all three undernutrition estimates were higher in LMICs belonging to the Southeast Asian region (Stunting 37.62%; wasting 14.28% and underweight 31.24%). Undernutrition among migrant Indian children was 43.55%, 18.71%, and 37.45% respectively. High heterogeneity was noted across all estimates with I2-value >90%. Sensitivity analysis across indicators showed the stability of our estimates.

CONCLUSIONS

The extent of undernutrition, particularly wasting was high among migrant/refugee children living in lower-middle-income countries. Measures should be taken to strengthen the government-subsidized public food distribution system, increase healthcare outreach, and ensure public health insurance coverage among the migrant population.

Uncovering the symptom relationship between anxiety, depression, and internet addiction among left-behind children: A large-scale purposive sampling network analysis

Facing long-term separation from their parents, left-behind children are at risk of the co-occurrence of internalizing and externalizing problems. Although previous research has gained substantial information examining the relationship between anxiety, depression, and internet addiction at the aggregate level of variables, little is known about the heterogeneity and interactions between these components at the symptom level with a large-scale purposive sample. Adopting the network approach, two network pathways, depression and anxiety, and associations between these variables and internet addiction were constructed. Our sample included 5367 left-behind children (Mage = 13.57; SDage = 1.37; 50.07% females). Relevant bridging, central symptoms, and network stability were identified. Two relatively stable networks were obtained. For the network of anxiety and depression, sleep problems and tachycardia were vital bridging symptoms. Central symptoms, including tachycardia, restlessness, fatigue, and emptiness, were symptoms of depression. For the network of symptoms of anxiety, depression, and internet addiction, the bridging symptoms remained the same, and the central symptoms included tachycardia, restlessness, loss of control, and emptiness. By identifying relevant bridging and central symptoms, those with higher levels of these symptoms could be regarded as intervention targets, providing a reference for the current issue of valuing diagnosis over prevention in left-behind children.

Parental migration and cyberbullying victimization among Chinese left-behind children: understanding the association and mediating factors

Introduction

Parental absence is greatly associated with school bullying victimization of left-behind children (LBC) in migrant families. With the increasing popularity of the Internet, little is known about the association between parental migration and cyberbullying victimization, and potential mediators.

Methods

We conducted a cross-sectional study in Anhui and Zhejiang Province, China, in 2020. With a sample of 792 currently left-behind children (CLBC), 541 previously left-behind children (PLBC), and 628 never left-behind children (NLBC), path analysis was used to explore the association between parental migration and cyberbullying victimization among children, while considering the independent and sequential mediating roles of parent-child communication, and time spent online.

Results

The prevalence of cyberbullying victimization was 29.3% among CLBC, 29.2% among PLBC, and 23.4% among NLBC. Path analysis showed that current left-behind status was positively associated with cyberbullying victimization among children (p = 0.024). Furthermore, current left-behind status was associated with worse parent-child communication, which, in turn, predicted a higher prevalence of cyberbullying victimization [95% CI = (0.007, 0.036)]. Similarly, the previous left-behind experience was associated with worse parent-child communication, which, in turn, predicted a higher prevalence of cyberbullying victimization [95% CI = (0.013, 0.043)]. Current left-behind status was associated with increased time spent online, which, in turn, predicted a higher prevalence of cyberbullying victimization [95% CI = (0.013, 0.038)]. Additionally, the current left-behind status positively predicted cyberbullying victimization among children through the serial mediating roles of parent-child communication and time spent online [95% CI = (0.001, 0.006)]. Similarly, previous left-behind experience positively predicted cyberbullying victimization among children through the serial mediating roles of parent-child communication and time spent online [95% CI = (0.002, 0.007)].

Discussion

We propose that to protect CLBC and PLBC from cyberbullying victimization, it is of great importance for migrant parents to regulate children's time spent online and promote daily parent-child communication.

Labor Migration of Parents and Aggression Among Their Offspring in China

Importance

In China, parental labor migration often leaves children behind and is potentially adversely associated with children's health. However, the association between parental migration and aggression among their offspring remains largely underexplored.

Objective

To investigate the associations of parental labor migration with total and subtypes of aggression among their offspring as well as potential sex differences therein.

Design, Setting, and Participants

This cross-sectional study was conducted from February to October 2015 among students aged 11 to 20 years from 45 public middle and high schools across 5 provinces of China. Data analysis was performed from December 1, 2022, to August 1, 2023.

Exposures

Parental migration, including migration status (yes or no), pattern (father, mother, or both), and the child's age at the initial parent-child separation.

Main Outcomes and Measures

Total and subtypes of aggression (including physical aggression [PA], verbal aggression [VA], indirect aggression [IA], anger, and hostility) were measured using the Chinese version of the Buss-Warren Aggression Questionnaire. Binomial logistic regression analyses were used separately to estimate adjusted odds ratios (aORs) and 95% CIs of parental migration by total and subtypes of aggression.

Results

A total of 15 301 participants (7900 [51.6%] male and 7401 [48.4%] female) aged 11 to 20 years (mean [SD] age, 15.1 [1.8] years) were included. Of these participants, 5961 (39.0%) experienced parental migration; 2451 (16.0%) met the criteria for total aggression, 2407 (15.7%) for PA, 2283 (14.9%) for VA, 2899 (18.9%) for IA, 2307 (15.1%) for anger, and 2564 (16.8%) for hostility. Parental migration was associated with total aggression (aOR, 1.11; 95% CI, 1.01-1.22); no significant association between parental migration and subtypes of aggression was found except for PA (aOR, 1.14; 95% CI, 1.03-1.25). Compared with children whose parents did not migrate, the aORs for total aggression and PA for participants whose father migrated were 1.12 (95% CI, 1.01-1.28) and 1.15 (95% CI, 1.03-1.29), respectively; for participants with both parents having migrated, the aORs were 1.16 (95% CI, 1.02-1.31) and 1.12 (95% CI, 1.04-1.24), respectively. Compared with children whose parents did not migrate, children who experienced initial separation from 1 or both parents at adolescence had an aOR for total aggression of 1.20 (95% CI, 1.04-1.36), children who experienced initial separation from 1 or both parents at school age or adolescence had an aOR for PA of 1.15 (95% CI, 1.01-1.32) and 1.26 (95% CI, 1.04-1.51), respectively. No sex differences were found in these associations.

Conclusions and Relevance

In this cross-sectional study of Chinese children and adolescents, we found that parental migration, mainly of the father or both parents or an initial separation at adolescence or school age from 1 or both parents, was associated with higher odds of total aggression and PA among offspring. These associations were similar between male and female participants.

The mediating role of childhood maltreatment in the association between residence migration and adolescent depression

BACKGROUND

It is well established that residence migration can negatively affect the mental health of adolescents. However, the related factors that mediate the association between residence migration and depression are still uncertain.

METHODS

The participants were 16,037 adolescents in junior middle schools. A self-administered questionnaire was used for the survey. In addition to collecting general demographic characteristics of the participants, including age, gender, local residence status, only child status, parental marriage status and parent-child relationship, the questionnaire also contained the 9-item Patient Health Questionnaire, the short form of the Childhood Trauma Questionnaire and the Connor-Davidson Resilience Scale. Data analysis was conducted using SPSS software.

RESULTS

A total of 14,059 valid questionnaires were collected, resulting in 12,122 local adolescents, defined as being born and raised locally, and 1937 migrant adolescents, defined as being transferred from other regions. Meanwhile, 53.3 % of local adolescents and 58.2 % of migrant adolescents reported depressive symptoms. This result indicated that residence migration might contribute to depression symptoms(OR = 1.136, 95%CI: 1.013-1.273, p < 0.05). Childhood maltreatment and parental divorce are risk factors for depression in migrant adolescents. For all adolescents, resilience and a good parent-child relationship may reduce the risk of depression. Childhood maltreatment completely mediates residence migration-related depression(95 % bootstrap CI = 0.146, 0.323).

CONCLUSION

This study revealed that residence migration could contribute to adolescent depression, and childhood maltreatment may largely mediate this process, providing new insight into the relationship between adolescent depressive symptoms and residence migration. Reducing childhood maltreatment may effectively improve the depressive symptoms of migrant adolescents.

Serotonin 2A Receptor (5-HT2AR) Agonists: Psychedelics and Non-Hallucinogenic Analogues as Emerging Antidepressants

Psychedelics make up a group of psychoactive compounds that induce hallucinogenic effects by activating the serotonin 2A receptor (5-HT2AR). Clinical trials have demonstrated the traditional psychedelic substances like psilocybin as a class of rapid-acting and long-lasting antidepressants. However, there is a pressing need for rationally designed 5-HT2AR agonists that possess optimal pharmacological profiles in order to fully reveal the therapeutic potential of these agonists and identify safer drug candidates devoid of hallucinogenic effects. This Perspective provides an overview of the structure-activity relationships of existing 5-HT2AR agonists based on their chemical classifications and discusses recent advancements in understanding their molecular pharmacology at a structural level. The encouraging clinical outcomes of psychedelics in depression treatment have sparked drug discovery endeavors aimed at developing novel 5-HT2AR agonists with improved subtype selectivity and signaling bias properties, which could serve as safer and potentially nonhallucinogenic antidepressants. These efforts can be significantly expedited through the utilization of structure-based methods and functional selectivity-directed screening.

Trajectories of psychosocial environmental factors and their associations with asthma symptom trajectories among children in Australia

INTRODUCTION

Several psychosocial factors, such as maternal mental health and parents' financial hardship, are associated with asthma symptoms among children. So, we aim to investigate the changing patterns of important psychosocial environmental factors and their associations with asthma symptom trajectories among children in Australia.

METHODS

We considered asthma symptoms as wheezing (outcome) and psychosocial environmental factors (exposures) from 0/1 year to 14/15 years of the participants from the "Longitudinal Study of Australian Children (LSAC)" for this study. We used group-based trajectory modeling to identify the trajectory groups for both exposure and outcome variables. Associations between psychosocial factors and three distinct asthma symptom trajectories were assessed by multivariable logistic regression.

RESULTS

We included 3917 children from the LSAC birth cohort in our study. We identified distinct trajectories for maternal depression, parents' financial hardship, parents' stressful life events and parents' availability to their children from birth to 14/15 years of age. Compared to the "low/no" asthma symptom trajectory group, children exposed to a "moderate & increasing" maternal depression, "moderate & declining" parents' financial hardship, and "moderate & increasing" parents' stressful life events were significantly associated (relative risk ratio [RRR]: 1.55, 95% confidence interval [CI]: 1.27, 1.91; RRR: 1.40, 95%; CI: 1.15, 1.70; RRR: 1.77, 95%; CI: 1.45, 2.16) with "persistent high" asthma symptom trajectory.

CONCLUSION

Several psychosocial factors that are potential stressors for mental health increase the risk of having an adverse asthma symptom trajectory during childhood. Further attention should be given to reducing exposure to maternal depression, parents' financial hardship, and parents' stressful live events for long-term asthma control in children.

Urban Violence, Migration and Alcohol, Tobacco, and Marijuana Use among Transnational Students in Northern Mexico

This article reports on the findings of a study of the relationship between transnational experiences in the United States (US) and the use of alcohol, tobacco, and marijuana among 7th grade students (n = 1418). The study was guided by a cross-national framework for research on immigrant health and assessed the accumulation of risk factors for transnational adolescents. Data came from a survey conducted in 2017 in Nogales, Mexico. In this study, the last 30-day prevalence of use of alcohol, tobacco, and marijuana among students was 21.7%, 8.3%, and 2.4%, respectively. Most students were born in Nogales (69.6%), while 10.5% were born in the US, 7.5% attended school in the US, and 3.6% engaged in health-related risk behaviors while living in or visiting the US. Students with transnational experiences, such as attending school in the US, reported the highest 30-day prevalence of tobacco (13.3%) and marijuana (9.5%) use. After adjusting for family, school, access to substances and neighborhood violence variables, students who engaged in health-related risk behavior in the US had significantly increased odds of alcohol and marijuana use while later attending school in Mexico. The article discusses the findings from a prevention science perspective and provides implications for policy, practice, and future research on the Mexico-US border region.

Comparison of the Mental Health Status of Left-Behind Children Before and After the COVID-19 Pandemic

Purpose

To investigate and discuss the mental health status of left-behind children in Anhui Province before and after the COVID-19 pandemic and analyze its influencing factors.

Methods

A total of 82 left-behind children studying in grades 4 to 6 in Anhui Province, China were investigated by using the Symptom Check List-90 (SCL-90), Perceived Social Support Scale (PSSS) and Self-Esteem Scale (SES). Differences in the mental health status, perceived social support, and self-esteem of left-behind children before and after the COVID-19 pandemic were analyzed using the independent sample t-test. The relationship between mental health, perceived social support, and self-esteem before and after the pandemic was determined using the Pearson product-moment correlation test, and the factors influencing mental health before and after the pandemic were identified using regression analysis.

Results

The SCL-90 scores of left-behind children during and after the pandemic were 134.45 ± 23.17 and 114.52 ± 22.56, respectively, indicating that the SCL-90 score during the pandemic was significantly higher than that after the pandemic. The perceived social support scores of left-behind children during and after the pandemic were 58.99 ± 12.45 and 65.57 ± 11.76, respectively, indicating that the score during the pandemic was significantly lower than that after the pandemic. The self-esteem scores of left-behind children during and after the pandemic were 25.04 ± 4.95 and 28.39 ± 3.84, respectively, indicating that the score during the pandemic was significantly lower than that after the pandemic. The SCL-90 scores before and after the pandemic were significantly negatively correlated with perceived social support and self-esteem. The regression analysis results showed that self-esteem and perceived social support together could explain 25% of variations in the SCL-90 score during the pandemic and 34% of variations in the SCL-90 score after the pandemic.

Conclusion

The mental health level, perceived social support, and self-esteem of left-behind children improved after the pandemic compared with those during the pandemic. Good perceived social support and self-esteem can effectively promote the mental health of left-behind children.

Long-term effects of the left-behind experience on health and its mechanisms: Empirical evidence from China

Previous studies have primarily focused on the contemporaneous, short-term and medium-term effects of the childhood left-behind experience on subsequent health, but ignored its long-term effects and the mediating mechanisms of health outcomes. Using nationally representative data from the 2018 China Labor-force Dynamic Survey, this study uses self-rated health as a measure of health outcomes to examine the long-term effects of the left-behind experience and elucidate the underlying mechanisms that contribute to health inequality from a life-course perspective. The results show: (1) the childhood left-behind experience exerts a long-term negative impact on self-rated health in adulthood, and this impact persists and does not fade over time after ending the left-behind status; (2) the influence of the childhood left-behind experience on self-rated health demonstrates a cumulative disadvantage effect, with longer duration of being left-behind resulting in greater negative impacts; additionally, there's a critical window effect, with earlier left-behind experience leading to more significant negative outcomes; (3) the experience of being left behind during childhood has a negative impact and threshold effect on social trust in adulthood, meaning that the left-behind experience negatively affects social trust, but the duration of being left behind doesn't exacerbate this reduction; and (4) social trust is a key mediating factor between left-behind experiences and health, explaining 8.70% of this effect, and explaining 12.15% and 7.71% of mediation effects for adults with left-behind experience in middle and primary school stages, respectively.

Effects of parental migration on early childhood development of left-behind children in Bangladesh: Evidence from a nationally representative survey

BACKGROUND

In Bangladesh, as in other low- and middle-income countries, parents frequently migrate to other areas, often for employment opportunities, leaving their children behind with the hope that their earnings will contribute to securing a better future for them. However, the absence of parents due to migration can have negative implications for the well-being of these left-behind children. Despite the existence of studies investigating this phenomenon, the evidence thus far has produced inconclusive findings, with no specific data available from Bangladesh. Therefore, the objective of this study was to examine the effects of parental migration on the early childhood development of left-behind children in Bangladesh.

METHODS

The present study utilized data from the Bangladesh Multiple Indicator Cluster Survey (MICS) conducted in 2019. A sample of 8,833 children aged 3-4 years was included in the analysis. The Early Childhood Development Index (ECDI) and its individual domains served as the outcome variables of interest. The primary explanatory variables considered in the analysis were father migration, mother migration, migration of both parents, and migration of either parent. To assess the association between the outcomes and explanatory variables, multilevel logistic regression analysis was employed, controlling for relevant covariates.

RESULTS

Approximately 29% of all children in the study were not developmentally on track, as measured by the ECDI. When examining the individual domains of the ECDI, only 9% of the total children demonstrated developmental progress in the learning domain. Regarding the association between parental migration and ECDI outcomes, we observed a 26% decrease in the likelihood of overall ECDI among children with a migrated father (OR: 0.74, 95% CI: 0.54-0.93). This decrease became even more pronounced, reaching 37% (OR: 0.63, 95% CI: 0.48-0.97), among children with both parents migrated, compared to children with neither parent migrated.

CONCLUSION

The findings of this study indicate that parental migration, especially when both parents are involved, has a substantial negative impact on the likelihood of achieving favourable ECDI outcomes for children in Bangladesh. To ensure the optimal development of children with migrating parents, it is crucial to strengthen early childhood development education programs and implement robust social safety nets. These efforts should specifically target the unique needs and challenges faced by children with migrated parents, providing them with the necessary support and resources for their holistic development.

Early stimulation and responsive care: A mediator of caregivers' depression on the suspected developmental delay of left-behind children in China

BACKGROUND

Due to multiple factors, left-behind children in rural areas suffer from neurodevelopment delay and their caregivers suffer from depressive symptoms. This study aimed to analyze the effect of caregivers' depressive symptoms on left-behind children's neurodevelopment, with early stimulation and responsive care mediating.

METHODS

We conducted a cross-sectional survey in five counties in China. A total of 904 left-behind children aged 0-3 and their primary caregivers were enrolled. The Zung Self-rating Depression Scale (ZSDS) was used to measure caregivers' depressive symptoms. The Ages and Stages questionnaires-third edition (ASQ-3), which contains five domains: communication (CM), gross motor (GM), fine motor (FM), problem-solving (CG), and personal social (PS), was used to screen children for suspected developmental delay (SDD).

RESULTS

31.4 % of left-behind children suffered from SDD, while 39.7 % of left-behind children's caregivers experienced depressive symptoms. Caregivers' ZSDS scores were positively correlated with the SDD on four domains (FM, GM, CG, and PS), while Early stimulation and responsive care was negatively correlated with the SDD on four domains (CM, FM, CG, and PS).

LIMITATIONS

The cross-sectional design limited the ability to ascertain causal relations. Besides, the findings may not be generalized to all regions of China due to the heterogeneity of the study population.

CONCLUSIONS

Left-behind children under three years old in rural China were at high risk of SDD, while a substantial proportion of their caregivers had depressive symptoms. Caregivers' depressive symptoms may negatively affect the SDD of left-behind children through caregivers providing less early stimulation and responsive care.

Discrimination Experiences of Orphans and Left-Behind Children in China as Predictors of Suicidal Thoughts and Behaviors

Background: Suicide has been recognized as a serious problem in orphans and left-behind children. It is important to examine the differences in the factors affecting suicidal thoughts and behaviors between the two groups. Aims: To compare the lifetime rates of suicidal thoughts and behaviors between orphans, left-behind children, and other children, and to assess the impact of discrimination experiences and the mediating role of self-esteem. Methods: A total of 2,413 children from middle schools in China completed standardized anonymous questionnaires that assessed child type, suicidal thoughts and behaviors, discrimination experiences, and self-esteem. Data analysis employed χ2 test, Pearson correlation test, and structural equation modeling (SEM). Results: Left-behind children had a significantly higher lifetime rates of suicidal ideation than orphans and other children (χ2 = 9.35, p < .05). Discrimination experiences significantly and positively predicted suicidal thoughts and behaviors through the mediating effect of self-esteem in orphaned children, and there was no self-esteem mediating effect found for left-behind children. Discrimination experiences had a greater impact on suicidal thoughts and behaviors for orphans than for left-behind children. Limitations: Cross-sectional studies based on self-report might lead to biased results and mean that causality cannot be inferred. Conclusions: Attention should be paid to suicidal thoughts and behaviors among vulnerable groups, especially left-behind children. Reducing discrimination and improving orphans' self-esteem can be considered as targets of prevention and intervention for suicidal thoughts and behaviors.

The practice of social protection policies in China: a systematic review on how left-behind children's mental health can be optimised

AIMS

By discussing the mental health challenges faced by left-behind children, this article recommends or comments on existing social protection policies that can affect left-behind children's mental health at the micro-, meso- and macro-levels to holistically understand how a range of parties can jointly socially include left-behind children, a process which is conducive to the latter's mental health development.

METHODS

J.H. carried out a systematic review by searching through the English bibliographical databases Google Scholar, Web of Science and Scopus, in addition to Chinese bibliographic databases CNKI, Wanfang Data and VIP Chinese Science and Technology Periodicals. Here J.H. searched for the words ('social protection' OR 'socially protected') AND ('mental health' OR 'psychological wellbeing' OR 'mental problems' OR 'psychological problems') AND ('left-behind children' OR 'LBC' OR 'leftover children') AND ('China' OR 'Chinese'). Publication dates of the search results were limited to between 2010 and 2022.

RESULTS

One of the primary problems encountered by left-behind children is their inadequate home supervision. A further study indicates that parental migration serves as a crucial risk factor for child depression. State-level provision of insurance programmes helps curtail these children's encounters of mental health challenges. Moreover, an improvement in family and school protection is essential when optimising the protection system for left-behind rural Chinese children from poor villages. It is necessary for upper-level government units to re-structure their lower-level counterparts to improve the local administration. This allows lower-level government units to exploit preferential policies, refine relevant regulations and policies on child protection, and facilitate the establishment of social organisations where local policies can be successfully implemented to socially include and protect left-behind children in villages.

CONCLUSIONS

At the meso-level, community environment construction should be emphasised. At macro- and meso-levels, government authorities and social organisations should encourage the marketisation of hiring professional surrogate parents. At the micro-level, migrant parents should proactively take an initiative to contact their left-behind children via telecommunications.

Decreased frontal lobe complexity in left-behind children during joint attention: a fNIRS study with multivariable and multiscale sample entropy analysis

Human brain development is shaped by experiences, especially during preschool, the critical period for cognitive and socioemotional development. This study employed the functional Near-Infrared Spectroscopy technique to explore the neural differences between left-behind children (LBC) and non-left-behind children (NLBC) on joint attention. Through collecting brain image data of 50 children (26 boys, aged 65.08 ± 6.28 months) and conducting multivariable and multiscale sample entropy (MMSE) analysis, the present study found that: (i) LBC showed lower brain complexity than NLBC in right prefrontal cortex; (ii) all participants demonstrated higher brain complexity in responding to joint attention conditions, compared to initiating joint attention ones; (iii) their brain complexity during joint attention was negatively associated with their emotional abilities. The findings advance our understanding of early brain development in LBC by providing evidence for the neural process characteristics of joint attention. Implications for early intervention to promote their brain development are also addressed.

Immunization coverage, knowledge, satisfaction, and associated factors of non-National Immunization Program vaccines among migrant and left-behind families in China: evidence from Zhejiang and Henan provinces

BACKGROUND

Migrant and left-behind families are vulnerable in health services utilization, but little is known about their disparities in immunization of non-National Immunization Program (NIP) vaccines. This study aims to evaluate the immunization coverage, knowledge, satisfaction, and associated factors of non-NIP vaccines among local and migrant families in the urban areas and non-left-behind and left-behind families in the rural areas of China.

METHODS

A cross-sectional survey was conducted in urban areas of Zhejiang and rural areas of Henan in China. A total of 1648 caregivers of children aged 1-6 years were interviewed face-to-face by a pre-designed online questionnaire, and their families were grouped into four types: local urban, migrant, non-left-behind, and left-behind. Non-NIP vaccines included Hemophilus influenza b (Hib) vaccine, varicella vaccine, rotavirus vaccine, enterovirus 71 vaccine (EV71) and 13-valent pneumonia vaccine (PCV13). Log-binomial regression models were used to calculate prevalence ratios (PRs) and 95% confidence intervals (CIs) for the difference on immunization coverage of children, and knowledge and satisfaction of caregivers among families. The network models were conducted to explore the interplay of immunization coverage, knowledge, and satisfaction. Logistic regression models with odds ratios (ORs) and 95% CIs were used to estimate the associated factors of non-NIP vaccination.

RESULTS

The immunization coverage of all non-NIP vaccines and knowledge of all items of local urban families was the highest, followed by migrant, non-left-behind and left-behind families. Compared with local urban children, the PRs (95% CIs) for getting all vaccinated were 0.65 (0.52-0.81), 0.29 (0.22-0.37) and 0.14 (0.09-0.21) among migrant children, non-left-behind children and left-behind children, respectively. The coverage-knowledge-satisfaction network model showed the core node was the satisfaction of vaccination schedule. Non-NIP vaccination was associated with characteristics of both children and caregivers, including age of children (> 2 years-OR: 1.69, 95% CI: 1.07-2.68 for local urban children; 2.67, 1.39-5.13 for migrant children; 3.09, 1.23-7.76 for non-left-behind children); and below caregivers' characteristics: family role (parents: 0.37, 0.14-0.99 for non-left-behind children), age (≤ 35 years: 7.27, 1.39-37.94 for non-left-behind children), sex (female: 0.49, 0.30-0.81 for local urban children; 0.31, 0.15-0.62 for non-left-behind children), physical health (more than average: 1.58, 1.07-2.35 for local urban children) and non-NIP vaccines knowledge (good: 0.45, 0.30-0.68 for local urban children; 7.54, 2.64-21.50 for left-behind children).

CONCLUSIONS

There were immunization disparities in non-NIP vaccines among migrant and left-behind families compared with their local counterparts. Non-NIP vaccination promotion strategies, including education on caregivers, and optimization of the immunization information system, should be delivered particularly among left-behind and migrant families.

The impact of a skipped-generation family structure on early child development in Khon Kaen Province: a prospective cohort study

Parenting in early childhood is related to child development. This study aimed to investigate the impact of a skipped-generation family structure on early child development. This prospective cohort study collected data on children aged 6 to 18 months from 132 non-skipped-generation families and 115 skipped-generation families from primary care units in Khon Kaen province for 1 year. The data were collected using a structured questionnaire administered through face-to-face interviews, as well as the Denver II instrument for assessing child development. Using multivariate logistic regression, the impact of a skipped-generation family structure on infant development was analysed, and adjusted relative risks (aRRs) are presented. We found that 19.83% (49/247) of the children had suspected delayed development in all domains. Most of these children resided in skipped-generation families, accounting for 27.82% of the sample (32/115). After adjusting for other factors, it was found that male children from skipped-generation families had a higher risk of suspected delayed language development (aRR = 14.56, 95% CI = 1.34 to 158.34, p = 0.028). In conclusion, the parental practices of skipped-generation families are suspected of causing delayed language development in boys. Models of early childhood development should be established for skipped-generation families.

Immediate and longer-term changes in mental health of children with parent-child separation experiences during the COVID-19 pandemic

BACKGROUND

The psychological impact of the COVID-19 pandemic has been understudied among vulnerable populations. This study aimed to examine the immediate and longer-term changes in the mental health of children with parent-child separation experiences during the COVID-19 pandemic, and identify potential buffering opportunities for mental health.

METHODS

This longitudinal cohort study used data from 723 rural Chinese children who provided data before (Oct. 2019) the COVID-19 pandemic and during the following 2 years. Changes in the probability of depressive symptoms, anxiety symptoms, non-suicide self-injurious (NSSI), suicidal ideation, suicide plan, and suicide attempt were tested across four waves using generalized estimating models (GEE).

RESULTS

Compared with children who never experienced parent-child separation, children persistently separated from parents since birth experienced greater deterioration in all mental health in the 2-year follow-up (average change: depressive symptoms: β = 0.59, 95% CI [0.26, 0.93]; anxiety symptoms: β = 0.45, 95% CI [0.10, 0.81]; NSSI: β = 0.66, 95% CI [0.31, 1.01]; suicide ideation: β = 0.67, 95% CI [0.38, 0.96]; suicide plan: β = 0.77, 95% CI [0.38, 1.15]; suicide attempt: β = 1.12, 95% CI [0.63, 1.62]). However, children with childhood separation from their parents but reunited with them during the transition to adolescence showed similar even lower changes to counterparts who never experienced parent-child separation (all ps > 0.05).

CONCLUSION

These results indicating improvements in supportiveness of the caregiving environment during the transition to adolescence may provide the opportunity to buffer the adverse impact of COVID-19 on mental health. Translating such knowledge to inform intervention and prevention strategies for youths exposed to adversity is a critical goal for the field.

The Endless Vulnerability of Migrant Children In-Transit across the Darién Gap

Many people from poverty-stricken countries are migrating across South and Central America to reach the México-United States border, a movement exacerbated by the COVID-19 pandemic. Migrant people who begin their northbound journey in South America must transit across a significant geographic bottleneck, the Darién Gap, a mountainous rainforest region between Colombia and Panama. Most migrant people crossing this region originate from Cuba, Haiti, and Venezuela. Other people reach the shores of South American countries from west and central Africa or central and southeastern Asia and continue to the Darién Gap. Poverty and violence drive families with children to flee their homes and endure incalculable risks in their path. Children traveling with their families or as unaccompanied minors across the Darién Gap are exposed to life-threatening situations and human rights violations, including abuse, exploitation, malnourishment, and limited access to medical care. In addition to experiencing untreated medical illnesses, children experience mental health disorders during migration and after they reach their destination as a result of victimization and adverse traumatic experiences. Therefore, providing migrants, especially children, with rapid medical screenings and mental health support when they arrive at their destination is critical to reduce health inequities. Furthermore, making these interventions available during their transit and ensuring their safety may prevent further human rights abuses in children and families. Latin American governments must address the ongoing humanitarian crisis endured by migrants throughout their migratory path by offering access to essential healthcare services and safeguarding the rights and security of children and vulnerable groups.

Profiles of Intolerance of Uncertainty Among 108,540 Adolescents: Associations with Sociodemographic Variables and Mental Health

Intolerance of uncertainty (IU) is widely considered a transdiagnostic risk and maintaining factor for psychiatric disorders. However, little is known about the overall nature and profile of IU among adolescents. This study aims to investigate the profiles of IU among Chinese adolescents and explore their associations with sociodemographic characteristics and mental health problems. A sample of 108,540 adolescents provided data on IU, sociodemographic characteristics, and mental health via an online platform. Latent profile analysis revealed three profiles: Low IU, Medium IU, and High IU. Girls, older adolescents, and those with specific sociodemographics were more likely to belong to the "High IU" profile. Furthermore, the "High IU" profile was associated with the highest risk of several mental health problems. These findings provided valuable information for early prevention and intervention strategies targeting IU and highlighted the importance of IU-based interventions for mental health among adolescents.

How do remittances impact child mortality and are there preconditions?

While recent research suggests that remittances affect child mortality, little is known about how remittances influence this outcome and what conditions may moderate its effectiveness. This article investigates whether and how remittances affect child mortality in developing countries. We examine the impact of remittances on the three leading causes of child mortality, explore potential channels through which this may occur and examine whether socioeconomic or political factors affect the remittances-mortality relationship. Using data for 122 developing countries over the period 2003-2018 and a dynamic panel estimator, with both internal instruments and a shift-share external instrument, we find that remittances reduce child mortality from diarrheal diseases. Our findings suggest that sanitation usage is a possible channel through which remittances affect diarrheal mortality. We also find that the mortality-reducing effect of remittances does not appear to be contingent on the level of governance or health infrastructure. However, it remains unclear whether the effect is influenced by other forms of health funding. These findings suggest that remittances serve an important role in improving child health, and the effectiveness of these inflows is not reliant on onerous preconditions being met. Thus, remittances may be important to public health dialogue, especially in developing countries where diarrheal diseases are prevalent.