Non-fatal injury rates among the "left-behind children" of rural China

Unique and interactive effects of parental neglect, school connectedness, and trait self-control on mobile short-form video dependence among Chinese left-behind adolescents

BACKGROUND

Mobile short-form video is becoming increasingly popular among Chinese adolescents. Mobile short-form video dependence has become a pressing issue in Chinese adolescents, especially in left-behind adolescents. Previous studies, however, have focused on general mobile phone dependence and neglected specific types of mobile phone dependence. Few studies have explored the environmental and individual predictors of mobile short-form video dependence.

OBJECTIVE

Based on theoretical and empirical evidence, the present study examined the unique and interactive effects of parental neglect, school connectedness, and trait self-control on mobile short-form video dependence among Chinese left-behind adolescents.

METHODS

A total of 618 left-behind adolescents between 11 and 15 years of age completed the anonymous self-report survey. The PROCESS macro for SPSS was applied for data analysis.

RESULTS

Parental neglect was positively associated with mobile short-form video dependence, whereas school connectedness and trait self-control were negatively associated with mobile short-form video dependence in left-behind adolescents. Examination of the two-way interactions indicated that school connectedness and trait self-control could buffer the association between parental neglect and left-behind adolescents' mobile short-form video dependence. However, self-control could not moderate the association between school connectedness and mobile short-form video dependence. In addition, the three-way interaction of parental neglect, school connectedness, and trait self-control showed a significant effect on mobile short-form video dependence. The moderating role of school connectedness was stronger for left-behind adolescents with low trait self-control than for those with high trait self-control, and the moderating role of trait self-control was stronger for left-behind adolescents with low school connectedness than for those with high school connectedness.

CONCLUSIONS

The findings contribute significantly to revealing the complex mechanisms of mobile short-form video dependence and providing comprehensive and specific practical suggestions for the prevention and intervention of mobile short-form video dependence among left-behind adolescents.

Farmers' behavior in reading and using risk information displayed on pesticide labels: a test with the theory of planned behavior

BACKGROUND

Labels are the first source of information for the safe use of pesticides, but farmers rarely read labels before pesticide use. Using data from a sample of 300 orchard farmers in Meshginshar County, Iran, this study examined farmers' intention and behavior in reading and using risk information displayed on pesticide labels, using the theory of planned behavior (TPB).

RESULTS

Only 26% of the respondents mentioned that they read pesticide labels. Most farmers showed a low tendency towards reading pesticide labels due to low education, advanced age, and label-related problems, i.e., use of too technical language and unclear texts with small and illegible fonts. From the three basic variables of the TPB, subjective norms and perceived behavioral control (PBC) showed a significant impact on intention, while attitudes showed no significant impact. The three main variables of the TPB explained 90.2% of the variance in farmers' intention to read and use the labels. Furthermore, PBC and intention significantly affected farmers' actual behavior in reading and using the labels, explaining 78.5% of the variance in farmers' actual behavior. Age, experience in farming, and experience in spraying were negatively correlated with all variables of the TPB.

CONCLUSION

Findings provide new insights into farmers' behavior in reading pesticide labels by using for the first time the TPB. Pesticide manufacturers should consider the special conditions of subsistence farmers (low education and advanced age) when preparing pesticide labels and the extension services could use those findings to improve farmers' training in the use of pesticide labels. © 2021 Society of Chemical Industry.

Prevalence of unintentional injury among left-behind children in mainland China: Evidence from epidemiological surveys

BACKGROUND

Left-behind children have become a particular concern in mainland China, and unintentional injury among these children has attracted increasing attention. This review aims to present the prevalence of unintentional injury among left-behind children and subgroups in mainland China.

METHODS

A systematic literature search was conducted using four Chinese and two English databases. The included publications were cross-sectional studies in mainland China, of which the population was recruited according to inclusion and exclusion criteria. Information was collected using self-administered questionnaires. The risk of bias was estimated using the Strengthening the Reporting of Observational Studies in Epidemiology, and pooled prevalence was estimated through the DerSimonian-Laird proportion method.

RESULTS

This review included 34 cross-sectional studies consisting 58,348 left-behind children in mainland China. Results showed that the pooled prevalence of unintentional injury was 38.24% (95% confidence interval (CI): 28.40-48.08) among left-behind children. The prevalence was higher among left-behind children (38.76%) than among non-left-behind children (27.94%), with an odds ratio of 1.65 (95% CI: 1.47-1.85). Furthermore, the prevalence of injury was higher among boys (39.12%) than among girls (28.61%), with an odds ratio of 1.58 (95% CI: 1.41-1.77). Falls had the highest prevalence of 20.79% among the types of unintentional injury. Furthermore, home was the occurrence location with the highest prevalence (16.20%). No significant difference in injury prevalence was observed among left-behind children without accompanying parents and those with single parent accompanying them.

CONCLUSIONS

This review showed a relatively high injury prevalence among left-behind children in mainland China. Boys had a higher prevalence than girls. Falls had the highest prevalence, and home was the most common occurrence location.

Parent Emigration, Physical Health and Related Risk and Preventive Factors of Children Left Behind: A Systematic Review of Literature

The aim of our study was to systematically review the literature on physical health and related consequences of internal and international parental migration on left-behind children (LBC). This review followed PRISMA guidelines. We searched the PubMed, Web of Science, Academic Search Complete, PsycINFO, and Cochrane databases and included studies reporting physical health-related outcomes of children affected by parental migration. The quality of the studies was assessed using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. We selected 34 publications from a total of 6061 search results. The study found that LBC suffer from poor physical health as compared with non-LBC. Physical health-related risk factors such as underweight, lower weight, stunted growth, unhealthy food preferences, lower physical activity, smoking, alcohol consumption, injuries, and incomplete vaccination tend to be more prevalent among LBC in China. Studies focussing on international migration argue that having migrant parents might be preventive for undernutrition. Overall, our study showed that children affected by internal or international migration tend to have similar physical health outcomes. Moreover, we identified a lack of evidence on international parental migration that may have influenced the overall impacts. Further studies addressing international migration would contribute to better understand the impacts of migration for LBC.

Parental Migration, Children's Safety and Psychological Adjustment in Rural China: A Meta-Analysis

Studies concerning left-behind children in rural China have shown that parental absence due to migration is associated with greater risk of child victimization and accidental injuries, and a range of psychosocial problems. The authors conducted this meta-analysis to determine the extent to which left-behind children are affected by parental migration, as compared to children in nonmigrant rural families. A comprehensive literature search was conducted, and 90 studies published before 2017 were included in the data synthesis and analysis. The results revealed that compared to non-left-behind children, rural left-behind children are generally more disadvantaged in regard to child safety (d = 0.27) and psychological adjustment (d = 0.25). The effect sizes, though interpreted as small, revealed that children in rural China are significantly affected by parental migration. Children's educational stage was a significant variable that moderated the effect sizes of child safety and psychological adjustment. The findings of the meta-analysis indicated that mother-only migration may have the most harmful effect on children. In terms of implications for interventions, the results suggest more attention should be given to rural left-behind children and to "mother-absent children" in particular. Future research is warranted to explore the association between left-behind children's psychological adjustment and their exposure to injury and victimization.

The Impact of Primary Treatment on Post-Traumatic Endophthalmitis in Children with Open Globe Injuries: A Study in China

Post-traumatic endophthalmitis (PTE) is considered as one of the most serious complications after open globe injuries (OGIs), especially in children. Poor prognosis of this disease can lead to a variety of socioeconomic problems. This study aimed to investigate the clinical characteristics of pediatric OGIs and the factors associated with the development of PTE in China. 131 patients under 14 years old and needed hospitalization for management of OGIs were enrolled. There were 90 males and 41 females. 44 patients were left-behind children, the majority were 3–6 years old (n = 71, 71/131, 54.2%) and living in rural area (n = 106, 106/131, 80.9%). After injury, 82 patients received primary repair within 24 h, with the remaining 49 patients receiving primary repair after 24 h. Eventually, there were 28 (28/131, 21.4%) patients presented with PTE. In those 49 patients, the frequency of PTE achieving 32.7% (16/49). Univariate analysis showed that the timing of primary repair is significantly associated with the development of PTE (p < 0.05). Moreover, left-behind children took higher risks in having delayed treatment that over 24 h after OGIs (OR = 2.466, 95% CI: 1.16–5.26). Reducing the time before primary repair is a useful strategy to prevent the development of PTE. Special supervision is needed for pre-school-aged boys living in rural areas, especially for left-behind children.

Knowledge and behavior regarding pesticide use: a survey among caregivers of children aged 1-6 years from rural China

Little is known about pesticide exposure risks for children in rural areas in China, many of whom have been left behind by migrant workers. To survey caregivers of children in rural China and assess their pesticide use and disposal methods, the measures were used to protect the children and their perceptions of the adverse effects of pesticides on children's health. Three or four villages in each of Xinhua, Gongan and Sansui Counties in China were selected by random cluster sampling. The main caregivers of children aged 1-6 years were surveyed in face-to-face interviews. The questionnaire used was adapted from the World Health Organization "Exposure to Pesticides: Standard Protocol" survey and similar studies. The study included 464 caregivers (mean age, 46.4 years), who were most commonly the children's grandparents (65.3%). Among the caregivers, 41.9% were educated to middle school level or higher, 45.4% had a household income < 297 USD, and 29.7% had received education/training about pesticide use/adverse health effects in children. The score for caregivers' knowledge of the adverse effects of pesticides on children's health was higher in those who had received education/training (5.1 ± 2.6 vs. 3.4 ± 2.5, P < 0.001). Factors associated with unsafe behaviors during pesticide use included grandparent as the caregiver (odds ratio [OR] 0.551; 95% confidence interval [95% CI] 0.368-0.824; P = 0.004), annual income < 297 USD (OR 0.580; 95% CI 0.395-0.853; P = 0.006), and insufficient health-related education/training (OR 0.436; 95% CI 0.286-0.665; P < 0.001). Improved education and training are needed to promote the safe use of pesticides by caregivers of children in rural China.

Left-Behind Children and Risk of Unintentional Injury in Rural China-A Cross-Sectional Survey

Unintentional injury is the leading cause of childhood death and disability in many countries worldwide. This study aimed to quantify rates and risk factors for childhood unintentional injury in areas of rural China, where many children are left behind by migrant worker parents. We administered a questionnaire to children aged 9 to 15, in 56 schools in five counties in Zhejiang and Guizhou provinces. Of the 3791 respondents, 44% lived with both parents, 23% with one parent, and 33% with neither. Around half the children (47.9%) had suffered at least one unintentional injury in the past year, with burns (26%), animal bites (20%) and mechanical injury (18%) the most common. Left-behind children had no increased risk of unintentional injury, but children living in poorer Guizhou (p = 0.001), of divorced parents (p = 0.02), and less well-educated mothers (p = 0.02) were associated with higher risk. Virtual absence of personal level risk factors highlights the importance of addressing environmental risk to reduce childhood injury. The findings have informed a community-based intervention to reduce injury risk through raising awareness of environmental hazards, and through removal of specific hazards. Importantly, the Chinese government should ensure that known effective interventions are subject to legislation and enforcement.

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

BACKGROUND

Globally, a growing number of children and adolescents are left behind when parents migrate. We investigated the effect of parental migration on the health of left behind-children and adolescents in low-income and middle-income countries (LMICs).

METHODS

For this systematic review and meta-analysis we searched MEDLINE, Embase, CINAHL, the Cochrane Library, Web of Science, PsychINFO, Global Index Medicus, Scopus, and Popline from inception to April 27, 2017, without language restrictions, for observational studies investigating the effects of parental migration on nutrition, mental health, unintentional injuries, infectious disease, substance use, unprotected sex, early pregnancy, and abuse in left-behind children (aged 0-19 years) in LMICs. We excluded studies in which less than 50% of participants were aged 0-19 years, the mean or median age of participants was more than 19 years, fewer than 50% of parents had migrated for more than 6 months, or the mean or median duration of migration was less than 6 months. We screened studies using systematic review software and extracted summary estimates from published reports independently. The main outcomes were risk and prevalence of health outcomes, including nutrition (stunting, wasting, underweight, overweight and obesity, low birthweight, and anaemia), mental health (depressive disorder, anxiety disorder, conduct disorders, self-harm, and suicide), unintentional injuries, substance use, abuse, and infectious disease. We calculated pooled risk ratios (RRs) and standardised mean differences (SMDs) using random-effects models. This study is registered with PROSPERO, number CRD42017064871.

FINDINGS

Our search identified 10 284 records, of which 111 studies were included for analysis, including a total of 264 967 children (n=106 167 left-behind children and adolescents; n=158 800 children and adolescents of non-migrant parents). 91 studies were done in China and focused on effects of internal labour migration. Compared with children of non-migrants, left-behind children had increased risk of depression and higher depression scores (RR 1·52 [95% CI 1·27-1·82]; SMD 0·16 [0·10-0·21]), anxiety (RR 1·85 [1·36-2·53]; SMD 0·18 [0·11-0·26]), suicidal ideation (RR 1·70 [1·28-2·26]), conduct disorder (SMD 0·16 [0·04-0·28]), substance use (RR 1·24 [1·00-1·52]), wasting (RR 1·13 [1·02-1·24]) and stunting (RR 1·12 [1·00-1·26]). No differences were identified between left-behind children and children of non-migrants for other nutrition outcomes, unintentional injury, abuse, or diarrhoea. No studies reported outcomes for other infectious diseases, self-harm, unprotected sex, or early pregnancy. Study quality varied across the included studies, with 43% of studies at high or unclear risk of bias across five or more domains.

INTERPRETATION

Parental migration is detrimental to the health of left-behind children and adolescents, with no evidence of any benefit. Policy makers and health-care professionals need to take action to improve the health of these young people.

FUNDING

Wellcome Trust.

Epidemiologic characteristics, knowledge and risk factors of unintentional burns in rural children in Zunyi, Southwest China

We investigated the knowledge level and risk factors for pediatric unintentional burns in rural Southwest China with an aim to provide basic evidence for the prevention strategies. A stratified sampling method was used to recruit 1842 rural children from 9 schools. Self-reported burns during the past 12 months and relevant risk factors were collected by questionnaires. The burn incidence of all surveyed children was 12.7% (95% confidence interval [95% CI] 11.2–14.2%). We found that burn incidence had a trend to increase with the increasing school grade level and a trend to decrease with increasing knowledge scores on burns. The top two causes of burns were hot liquids (36.3%) and hot object (29.5%). More than 30% of children had little knowledge about preventive measures and how to give first-aid after burns. The main risk factors for burns included female gender, left-behind children by parents who were working in cities, and poor mother school education level. As the incidence of pediatric unintentional burns was high in rural southwest China, schools, families, and local public health agencies should put efforts into health education targeting burn prevention and first-aid measures after burns, particularly in “left-behind” children and those with mothers with poor education.

Parental migration patterns and risk of depression and anxiety disorder among rural children aged 10-18 years in China: a cross-sectional study

OBJECTIVES

This study aims to explore the prevalence of depression and anxiety in left-behind children, and to identify patterns of parents' migration and relative factors associated with depression and anxiety risk in this population.

SETTING

A cross-sectional survey using a school-based sample was conducted in Puyang, Hebei, North China in December 2012.

PARTICIPANTS

2283 students aged 10-18 years.

MAIN OUTCOME MEASURES

Parental migration status, depression and anxiety disorder.

RESULTS

61.2% of participants were left-behind children. The prevalence rate of depression among left-behind children with both parents migrating (14.2%) was higher than that of children with one parent migrating (11.7%) and no parent migrating (12.6%). The prevalence rate of anxiety disorder for children with no parent migrating (25.1%) was higher than that for children living with one or neither parent (22.2% and 22.0%). The risk factors for depression were low-level social support (OR=3.46, 95% CI 2.00 to 6.01), average academic performance (OR=2.37, 95% CI 1.7 to 3.3) and low academic performance (OR=3.01, 95% CI 1.92 to 4.72), staying up late (OR=1.67, 95% CI 1.17 to 2.39), having difficulty falling asleep (OR=2.04, 95% CI 1.48 to 2.82) and being an only child (OR=1.73, 95% CI 1.04 to 2.89). The factors associated with anxiety disorder were being female (OR=2.09, 95% CI 1.64 to 2.66), being in high school (OR=1.8, 95% CI 1.38 to 2.36), physical abuse (OR=1.5, 95% CI 1.04 to 2.15), having difficulty falling asleep (OR=1.67, 95% CI 1.33 to 2.10) and low-level social support (OR=2.17, 95% CI 1.44 to 3.28) and middle-level social support (OR=1.82, 95% CI 1.3 to 2.56).

CONCLUSIONS

Parents' migration was not associated with depression and anxiety in rural children aged 10-18 years, but academic performance at school, sleep problems and lack of social support were associated with depression and anxiety.

Left behind or moving forward? Effects of possible selves and strategies to attain them among rural Chinese children

Are possible selves and strategies to attain them universally helpful even among children with few resources? We test this question in rural China. Rural Chinese children are commonly "left behind" (LB) by parents seizing economic opportunities by migrating, hoping the family will "move forward" and their children will attain their predestined better future. Media, teachers, and peers negatively represent LB children as unruly and undisciplined, with negative fates, making LB a negative stereotype that includes the idea of destiny or fate. Indeed, making the idea of LB salient increases children's fatalism (Study 1 n = 144, Study 2 n = 124). However, having strategies to attain possible future selves predicts better in-class behavior, fewer depressive symptoms, and better exam performance even a year later and controlling for prior performance (Study 3 n = 176, Study 4 n = 145). Possible selves have mixed effects, not always predicting better grades and undermining LB children's self-control.

Children left behind in romania: anxiety and predictor variables

Children left behind while their parents immigrate or travel for employment are becoming a widespread phenomenon for economic reasons, creating potentially stressful and inadequate developmental support for a substantial portion of some countries' working class populations. This study assessed the emotional status and coping skills of two matched samples of 163 Romanian children left behind and 163 comparable children living with their parents. The State-Trait Anxiety Inventory for Children, the Anger Expression Scale for Children, the Short Mood and Feelings Questionnaire, and the Children's Coping Strategies Checklist were utilized. Higher anxiety and depression were observed in left-behind children compared to the control group living with parents. Hierarchical multiple regression supported the relevance of coping strategies, controlled for sociodemographic characteristics, to help explain anxiety in left-behind children. Strategies to promote psychological health and general well being are discussed.

Features and risk factors of nonfatal injury among the rural children: a survey of seven schools in a mountain area in Southwest China

Objective

We aimed to investigate the patterns and risk factors of nonfatal injuries among rural mountain-area children in southwest China.

Methods

A stratified sampling method was used to recruit rural children aged 8 to 17 years (mainly 9–14 years) from 7 schools. Self-reported injuries during the past 12 months and relevant concerns were collected from June to December 2012 by using a structured questionnaire in a class interview.

Results

The mean age of the 2,854 children was 12.2±1.5 years. The probability of annual injury was 16.7% (95% confidence interval [95% CI] 15.3–18.1%), with slightly higher injury risk for boys than girls (17.7% vs. 16.0%; P>0.05). The top 3 causes of injuries were falls (37.3%), animal-related incidents (20.6%), and burns (14.9%). The main injury risk factors included being involved in a violent episode (odds ratio [OR] 1.34, 95% CI 1.08–1.66, P = 0.007), maltreatment by parents or guardians (1.42, 1.17–1.72, P<0.001), and being from a single-child family (1.30, 1.10–1.66, P = 0.039). Older age was a protective factor (0.81, 0.76–0.87, P<0.001).

Conclusions

The incidence of nonfatal injury among rural children was high, and falls were the leading cause. Younger children and boys from poor-care and poor-living environments were at increased risk of injury, which requires urgent attention. Injury prevention programs targeting these issues are needed in this mountain area and similar rural regions of China.

A multi-site study on knowledge, attitudes, beliefs and practice of child-dog interactions in rural China

This study examines demographic, cognitive and behavioral factors that predict pediatric dog-bite injury risk in rural China. A total of 1,537 children (grades 4–6) in rural regions of Anhui, Hebei and Zhejiang Provinces, China completed self-report questionnaires assessing beliefs about and behaviors with dogs. The results showed that almost 30% of children reported a history of dog bites. Children answered 56% of dog-safety knowledge items correctly. Regressions revealed both demographic and cognitive/behavioral factors predicted children’s risky interactions with dogs and dog-bite history. Boys behaved more riskily with dogs and were more frequently bitten. Older children reported greater risks with dogs and more bites. With demographics controlled, attitudes/beliefs of invulnerability, exposure frequency, and dog ownership predicted children’s self-reported risky practice with dogs. Attitudes/beliefs of invulnerability, dog exposure, and dog ownership predicted dog bites. In conclusion, both demographic and cognitive/behavioral factors influenced rural Chinese children’s dog-bite injury risk. Theory-based, empirically-supported intervention programs might reduce dog-bite injuries in rural China.

The social cost of China's economic growth: messages from China's 2012 parliamentary session

The fifth and final session of China's Eleventh National People's Congress (NPC), or parliament, was held in Beijing from March 5 to March 14, 2012. Several episodes stand out in this year's session. One is the abrupt dismissal immediately after the session of Bo Xilai, party chief of a major Chinese municipality and Politburo member. That has been arguably linked to the political and economic model he championed, which incorporated redistributive social policies and proactive government intervention. Also worthy of note is that nearly all NPC delegate seats are occupied by the country's elites, while working people are overwhelmingly under-represented, if not unrepresented. Last but not least, although neoliberalism has been widely discredited since the global economic crisis, the government work report delivered at this year's NPC session signals further embracement of private investment--not only domestic, but also foreign--in key industries and social services controlled by the state. These episodes merit reflection as they send important messages about the challenges facing the country's political economy now and in the future.

Agricultural exposures and farm-related injuries among adolescents in rural China

This cross-sectional study explored the incidence of farm injuries and the relationship between agricultural exposures and injury among 2053 adolescents aged 13-19 years in Macheng, China. A comprehensive self-administered questionnaire was given to adolescents. The cumulative incidence rate of farm injury was 19.8%. Adolescents who were male, aged 10-15 years, left behind, working more days each month and living on the plains, reported higher rates. Specific agricultural exposures, such as large animals, pesticides and operating farm machinery were associated with higher injury rates. Prevention programmes are needed to reduce farm injuries.

Urbanisation and health in China

China has seen the largest human migration in history, and the country's rapid urbanisation has important consequences for public health. A provincial analysis of its urbanisation trends shows shifting and accelerating rural-to-urban migration across the country and accompanying rapid increases in city size and population. The growing disease burden in urban areas attributable to nutrition and lifestyle choices is a major public health challenge, as are troubling disparities in health-care access, vaccination coverage, and accidents and injuries in China's rural-to-urban migrant population. Urban environmental quality, including air and water pollution, contributes to disease both in urban and in rural areas, and traffic-related accidents pose a major public health threat as the country becomes increasingly motorised. To address the health challenges and maximise the benefits that accompany this rapid urbanisation, innovative health policies focused on the needs of migrants and research that could close knowledge gaps on urban population exposures are needed.

One country, two worlds - the health disparity in China

As result of its spectacular economic growth, millions of Chinese have been lifted out of poverty, making China a model for impoverished countries. Although, for many, economic growth has led to prosperity, ever-growing disparities exist between those who have benefited from the economic advancement and those left behind. Massive gaps in development exist between: regions, urban and rural and social groups. This contribution is to develop a detailed understanding of the health disparity in China by examining the discrepancies in major health indicators. Current efforts to reduce the disparities, and its challenges, opportunities and global implications are also assessed.