Indirect Effects Of Education Research Articles

Pathways from education to mortality, mediated through income.

Lower levels of education are associated with higher mortality. Lower levels of education are also associated with lower income, which is also associated with higher mortality. We investigate the impact of education on mortality and the extent to which this is mediated through income over the life course. We account for both selective educational attainment and selective income over the life course, through inverse propensity weighting (IPW) of the mortality hazard. We decompose the educational gain, that is, the decrease in mortality from more education, in the hazard into an indirect effect of education, running through changes in income and a direct effect of education, running through other factors. We use Swedish conscription data (men only), linked to parental information and individual annual income for the period 1968 till 2012. Our empirical results indicate large educational gains in mortality. We also find that this educational gradient runs through changes in income, especially for the more educated, and does not run through other factors related to education. We conduct several robustness and sensitivity checks that indicate that the results are robust.

EDUCATION AS A RISK FACTOR OF MILD COGNITIVE IMPAIRMENT—THE ROLE OF THE GUT MICROBIOME

Abstract Background Social determinants of health relate to an individual’s risk of MCI and dementia. However, pathways from identified modifiable risk factors such as education are not well understood, yet. While previous findings suggest distinct taxonomic signatures of the gut microbiome in dementia and MCI patients, and further education linked to its composition, we sought to test the possibly mediating role of the gut microbiome in the relationship between education and MCI. Method: Gut microbiome composition was ascertained with 16S rRNA gene amplicon sequencing. MCI classification was based on the Montreal Cognitive Assessment. Education in years was grouped (0-10, 10-16, 16+). Mediation analysis was conducted decomposing direct and indirect effects of education on MCI mediated by gut microbiome diversity (Chao1, Inverse Simpson, Shannon) or individual species at Genus level (ldm-med, permanova-med). Differential abundance analysis across education groups was conducted (ANCOM-BC, DESeq2). Result: After exclusion of participants with PD, below age 50, or with missing data, n=256 participants (n=58 with MCI) of the Luxembourg Parkinson’s Study were eligible for analysis (M[SD] Age=64.7[8.3] years). Education (16+ compared to 0-10 years of education) had a natural direct effect of NDE=0.36 (P<.01) on MCI, Chao1 included as mediator. We did not find significant mediation by gut microbiome composition or individual species. Conclusion Our findings indicate direct effects of education not mediated by the gut microbiome. Taxonomic analysis suggests a signature linked to lower risk of dementia in higher educated individuals. Longitudinal research is needed to investigate associations over time.

The mediating effect of HbA1c levels on the relationship between education and cognitive function

AbstractBackgroundHigher education has been shown to be positively associated with cognitive performance. However, the pathways, through which education is related to cognitive performance, have not been sufficiently explored. Higher levels of glycated hemoglobin (HbA1c) can lead to deterioration in cognitive performance. Part of the association with education may operate via the HbA1c level.MethodTo evaluate if the HbA1c level mediates the association of education with cognitive performance, we used longitudinal data from the Dutch Lifelines Cohort study (2006‐2015). Lifelines is a multi‐disciplinary prospective population‐based cohort study examining the health and health‐related behaviors of 167,729 persons living in the north of the Netherlands. The analyzed sample contained 19,878 persons observed at the baseline and the follow‐up, who were 50+ at baseline. We measured cognitive function using age‐standardized reaction time from the psychomotor function and attention tasks measured by the Cogstate Brief Battery at follow‐up. Higher reaction times indicate weaker cognitive function. The HbA1c level was measured at baseline by using participants’ blood samples. Linear Structural Equation Models were applied to estimate total, direct and indirect effects of education on cognitive function. We controlled for sex, age, income, physical activity, comorbidities and individual task accuracy.ResultHigher education was associated with faster reaction time respectively better cognitive performance (low: ref; middle: b = ‐0.125 p<0.01; high: b = ‐0.268 p<0.01). An increase in the HbA1c level (%) was associated with slower reaction time respectively poorer cognitive performance (b = 0.031 p = 0.02). Education had a significant effect on the HbA1c level (low: ref; middle: b = ‐0.023 p<0.01; high: b = ‐0.035 p<0.01). Most importantly, we found a significant indirect effect for education (low: ref; middle: b = ‐0.0007 p = 0.06; high: b = ‐0.001 p = 0.03) on cognitive function via the HbA1c level.ConclusionThe education effect of on cognitive performance was partially mediated by HbA1c levels. Early monitoring and regulation of blood glucose levels may be a potential prevention strategy to tackle cognitive impairments and mitigate the disadvantages in cognitive function of lower‐educated people.

Pathways linking educational attainment to cognitive functioning among older Brazilians

AbstractBackgroundCognitive impairment in Brazil is a growing population health concern. Studies suggest that Brazil may have one of the highest age‐standardized prevalence of Alzheimer’s disease and related dementias (ADRD) in the world. However, improving education attainment among older adults may lead to a decline in cognitive impairment across the population in the coming years. The purpose of this study is to examine the pathways that link educational attainment to cognitive functioning in Brazil, a highly unequal, resource rich society.MethodI use the 2016 Brazilian Longitudinal Study of Aging, a nationally representative study of Brazilian older adults 50+, to predicting cognitive functioning at first interview. I use structural equation modeling to predict direct and indirect effects of education via childhood socioeconomic characteristics, adulthood socioeconomic conditions, health behaviors and health conditions on overall cognitive functioning as well as specific domains of cognition (memory vs. non‐memory).ResultFindings provide evidence of both indirect and direct pathways from education to cognitive functioning. The indirect pathways were mainly found through adulthood SES achievement (although health conditions had their own association with cognitive functioning). Additionally, indirect effects were limited among adults with 8+ years of education, suggesting that prior to 8 years of education the impact of education on cognitive functioning may be through cognitive development that is carried forward into older adulthood.ConclusionThis study shows the importance of early childhood education and the potential benefits for later life cognitive functioning, which has broad implications for cognitive health in rapidly aging countries with more recent early childhood educational expansion.

Family firm entrepreneurship: An experimental study

ABSTRACT Family managers’ entrepreneurial intentions (EI) play a crucial role in the long-term success of family firms. Previous research has highlighted education as a key driver of EI but has failed to consider the unique socialization processes within business families and their impact on the education-EI relationship. This study aims to fill this gap by examining the direct and indirect effects of education on family managers’ EI. By combining the integrated model of EI and research on business families’ socialization patterns, a study was conducted with a role-playing experimental design involving 412 family firm managers. The results indicate that entrepreneurial self-efficacy (ESE) serves as a mediator between education and EI, while the ESE-EI relationship is further mediated by risk perceptions. Interestingly, no direct effect of education on EI was found, suggesting that the influence of education on EI follows distinct patterns within business families.

The indirect effects of socioeconomic position on lung function: a mediation analysis

Abstract Background There is a strong link between socioeconomic position and pulmonary health, but less is known about their connecting pathways. We analyzed the direct and indirect effects of education and deprivation on lung function using air pollutants in a mediation framework. Methods We used spirometry tests, demographic, and health information on 5703 Czechs, with a mean age of 58.3 ± 7.1 years from the Health, Alcohol, and Psychosocial Factors in Eastern Europe (HAPIEE) cohort study between 2002 to 2005. The annual means of particulate matter 10 (PM10), particulate matter 2.5 (PM2.5), and nitrogen dioxide (NO2) estimated by Shen et al. (2022) for the years 2000 to 2003 were matched to the geographic addresses of the participants. Multiple mediation analyses assessed the relationship between socioeconomic variables (education and deprivation) and the predicted percentage of Forced Expiratory Volume in the first second (FEV1) and the role of mediators: PM10 or PM2.5 or NO2, smoking behavior, and body mass index (BMI). The models were adjusted for sex, age. Results 9.27% of individuals had <70% of the predicted percentage of FEV1. We tested the first model using PM10, smoking, and BMI as mediators. We found significant indirect effects from education through PM10 (β = 0.17, CI95%: 0.10-0.25), BMI (β = 0.36, 0.25-0.47), and smoking (β = 0.17, 0.08-0.25) with indirect effects explaining 34% of the total effect of education. The indirect effect of deprivation was significant only through smoking (β=-0.11, -0.14 to -0.07), explaining 31% of the effect of deprivation. Similar results were observed when we tested a second model using PM2.5 instead of PM10, and a third model including NO2 instead of PM10. Conclusions Air pollutants seem to mediate the association between education and lung function, but not between deprivation and lung function, however, further research is needed to confirm our findings. Key messages • Higher education appears to be associated with better environmental factors that prevent loss of lung function. • Most of the routes that connect socioeconomic factors and lung function remain unclear.

The Influence of Education and Occupation Type on Birth Cohort Differences in Cognitive Function of Mexican Older Adults.

Mexico's population aging is occurring in the context of social changes such as increased educational attainment and occupational shifts from agriculture to service and industry. The current study compares cognitive function between two birth cohorts of Mexican adults aged 60-76 to determine if population-level changes in education and occupation type contribute to cohort differences in cognitive function. We used the Mexican Health and Aging Study to examine adults aged 60-76 in 2001 (men: 2,309; women: 2,761) and 2018 (men: 2,842; women: 3,825). Global cognition was calculated from five measures. Five main lifetime occupation types were created: no main job; agriculture; service; professional; and industrial. Ordinary least squares regression and structural equation models (SEM) were used to examine cohort differences in cognitive functioning. Ordinary least squares models that adjusted for age, community size, and marital status indicated that men and women had higher global cognition in 2018 than 2001 (men: b = 0.44, p < .01; women: b = 0.54, p < .01). These differences were reduced after adjusting for education and occupation type (men: b = 0.27, p < .01; women: b = 0.37, p < .01). Results from SEM indicated that the indirect effects of education on cognitive functioning were larger than occupation type for men (education: b = 0.18, p < .05; occupation: b = 0.001, p = .91) and women (education: b = 0.18, p < .05; occupation: b = 0.002, p = .22). Cognitive functioning is higher among more recent birth cohorts of older adults in Mexico. These cohort differences are partially mediated by education but not main lifetime occupation. Additional factors may contribute to cohort differences in cognitive function for older adults in Mexico.

THE ROLE OF EDUCATION AND LITERACY SKILLS ON MIDDLE-AGED AND OLDER VOLUNTEERS BY RACE AND ETHNICITY IN THE US

Abstract Volunteer participation is a form of civic engagement that benefits both the individual and society over the life course. Although education, basic skills (e.g., literacy), and race/ethnicity are individually associated with volunteering, detailed interrelations are yet to be explored. Guided by the integrated theory of volunteer work and the notion of productive aging, the goal of this study was to examine the roles of education and adult literacy in the context of volunteering in later life across racial and ethnic groups (Whites, Blacks, Hispanics) in the U.S. Using the nationally representative sample of middle-aged and older adults (age 45+; n = 3,770) from the 2012/2014/2017 Program for International Assessment of Adult Competencies (PIAAC), structural equation modeling was constructed to evaluate mediation relationships among education, literacy, and volunteering by racial and ethnic groups. Results show no statistically significant mediation (a.k.a., indirect) effect of education on volunteering through literacy, nor was there statistically significant difference in the mediation effect across racial and ethnic groups. However, there were statistically significant differences in the direct effect of education on volunteering between Black adults and White adults [b(Black) = 0.44 versus b(White = 0.24), p &amp;lt; 0.05], as well as Black adults and Hispanic adults [b(Black) = 0.44 versus b(Hispanic) = 0.08, p &amp;lt; 0.05]. These findings indicate that higher education was more strongly associated with volunteering among older Black adults, compared to White and Hispanic counterparts. Suggested policy implications include support for the promotion of volunteer participation through culturally and socioeconomically sensitive approaches.

THE ROLE OF EDUCATION AND LITERACY SKILLS ON MIDDLE-AGED AND OLDER VOLUNTEERS BY RACE AND ETHNICITY IN THE US

Abstract Volunteer participation is a form of civic engagement that benefits both the individual and society over the life course. Although education, basic skills (e.g., literacy), and race/ethnicity are individually associated with volunteering, detailed interrelations are yet to be explored. Guided by the integrated theory of volunteer work and the notion of productive aging, the goal of this study was to examine the roles of education and adult literacy in the context of volunteering in later life across racial and ethnic groups (Whites, Blacks, Hispanics) in the U.S. Using the nationally representative sample of middle-aged and older adults (age 45+; n = 3,770) from the 2012/2014/2017 Program for International Assessment of Adult Competencies (PIAAC), structural equation modeling was constructed to evaluate mediation relationships among education, literacy, and volunteering by racial and ethnic groups. Results show no statistically significant mediation (a.k.a., indirect) effect of education on volunteering through literacy, nor was there statistically significant difference in the mediation effect across racial and ethnic groups. However, there were statistically significant differences in the direct effect of education on volunteering between Black adults and White adults [b(Black) = 0.44 versus b(White = 0.24), p &amp;lt; 0.05], as well as Black adults and Hispanic adults [b(Black) = 0.44 versus b(Hispanic) = 0.08, p &amp;lt; 0.05]. These findings indicate that higher education was more strongly associated with volunteering among older Black adults, compared to White and Hispanic counterparts. Suggested policy implications include support for the promotion of volunteer participation through culturally and socioeconomically sensitive approaches.

Hubungan antara belanja pemerintah, tingkat kemiskinan, dan pertumbuhan ekonomi daerah otonomi baru di Provinsi Lampung

The application of Partial Least Square (PLS) for causal modeling has been widely used in many fields of study, especially in economics. This paper will use PLS analysis to be applied to a model testing the relationship between variables: government spending, poverty level, and economic growth. The results of the analysis show that there is an indirect effect of education (education spending) on ​​poverty of -0.509 and health spending on poverty with an effect of -0.510, parameter estimates and significant significance; There is an effect of total poverty on GRDP of -0.983, with a very significant and significant parameter estimate. Applications, it is urgency to build an analysis to find out how the relationship between government spending, poverty levels, and economic growth. This analysis will help better understand how government budget allocations can affect poverty levels, so far poverty levels ultimately affect economic growth in new autonomous regions in Lampung.

Comparative study of two birth cohorts: did the explanatory role of behavioural, social and psychological factors in educational inequalities in mortality change over time?

ObjectivesTo investigate the contribution of behavioural, social and psychological factors to inequalities in mortality by educational level between birth cohorts.DesignCohort-sequential design.SettingTwo population-based studies in the Netherlands: the Longitudinal Aging Study...

Использование метрик в измерениях эффективности высшего образования: целесообразность и ограничения

The efficiency of educational system is one of the key areas of research due to its significant impact on the development of an individual and the society, on the one hand, and the amount of resources allocated to this sector, on the other. The research is aimed at the theoretical understanding and analyzing of the practical implementation of the metrics used to evaluate higher education efficiency, and identifying possible risks associated with this assessment. The importance of the research is explained by the theoretical need to define the essence, components, and parameters of the effectiveness of education. Its practical significance is characterized by the need to form methodology and evaluating techniques that can adequately assess the direct and indirect effects of education, its impact on the development of the society. The paper gives a brief overview and comparative analysis of methodological approaches to the analysis of the higher education efficiency, identifies evaluation criteria depending on the context, object, and the research area. The authors define the methods to evaluate efficiency, among which the use of metrics is gaining popularity; however, they currently have a few limitations that form the risk of distorting the behavior of actors in the field of higher education. The analysis of a wide range of ratings, monitoring tests and other studies that use metrics allowed identifying their features that evoke systemic problems. Among such problems, the most likely and dangerous are the formation of deviant behavior of actors in the system of the higher education, combined with disregard for the goals and means of achieving them, and the likelihood of falling into the institutional trap of metrics.

Higher education innovation and reform model based on hierarchical probit

Abstract With the intensification of social competition, the rate of return to education is gradually decreasing. This leads to a reduction in the indirect effect of education on happiness. This article uses the bivariate ordered Probit model under the educational field theory to investigate the impact of higher education innovation on social class and residents’ happiness. The results show that the innovation and reform of higher education will have a certain impact on residents’ happiness. The improvement of education level can significantly improve the individual's subjective well-being, and there are significant urban-rural differences. This shows that education reform and innovation are imperative.

Socioeconomic pathways to inequalities in mental and functional health: a comparative study of three birth cohorts

BackgroundAlthough the educational expansion is often seen as a mechanism that might reduce health inequalities, socioeconomic inequalities in health (SEIH) have persisted or increased over the past decades. Theories suggest that this persistence could be due to a changing role of education as a ‘gatekeeper’ to access other socioeconomic resources such as occupation and income that are also associated with health outcomes. To test this, we examine whether the mediating role of occupation and income in the education–health relationship differs between three cohorts of 55–64 year old adults.MethodsWe used cross-sectional data from three cohorts of 988, 1002, and 1023 adults born in 1928/37, 1938/47 and 1948/57 and observed in 1992/93, 2002/03, 2012/13 respectively, who participated in the Longitudinal Aging Study Amsterdam, the Netherlands. We used multigroup structural equation modelling to compare the strength of indirect effects of education via occupational skill level and income to functional limitations and depressive symptoms between cohorts.ResultsAbsolute educational inequalities in functional limitations increased for men and women in later cohorts, and in depressive symptoms only for men. Relative inequalities in functional limitations increased only for women and in depressive symptoms only for men. The indirect effect of education via income on both health outcomes was weaker in the most recent birth cohort compared to the earlier cohorts. In contrast, the indirect effect of education via occupation on functional limitations was stronger in the most recent cohort compared to the earlier cohorts. These differences were mainly due to a decreasing direct effect of education on income and an increasing direct effect of education on occupational skill level, rather than to changes in the direct effects of occupation and income on health.ConclusionsThe role of education in determining inequalities in health appears to have changed across cohorts. While education became a less important determinant of income, it became a more important determinant of occupational level. This changing role of education in producing health inequalities should be considered in research and policy.

Determinants of youth unemployment in Uganda: The role of gender, education, residence, and age

Abstract Youth unemployment in Uganda increased from 12.7% in 2012/13 to 13.3 in 2016/17, despite a decline in the overall national unemployment rate from 11.1% to 9.2%. This poses serious development challenges, particularly to the ongoing efforts to poverty reduction. The main objective of the current study is to examine the extent to which gender, education, residence, and age determine youth unemployment in Uganda. Using recent data from the Uganda National Household Survey 2016/17 collected by the Uganda National Bureau of Statistics, we obtained a sample of 5,912 respondents for the ages between 18 years and 30 years. The main findings based on a binary logistic regression approach, reveal that education, gender, residence, and age are all critical in driving youth unemployment. The Ugandan youth who has some level of education is more likely to be unemployed compared to those with no education. But the youth that attended post-secondary education is associated with the highest unemployment probability followed by those with secondary school education and finally by primary education. While an increase in age appears to increase youth unemployment for females, the married youth have less chances of being unemployed compared to the unmarried youth. Moreover, as the probability of being unemployed reduces for the married youth, being divorced increases that probability. Similarly, the male youth are found more likely to be unemployed than their female counterparts. Additionally, the urban youth increased their chances of unemployment compared to the rural ones. Likewise, males are far more likely to remain in unemployment relative to females, just as living in the northern, eastern, or western region as a youth is less risky in terms of unemployment compared to living in the central region. On the other hand, whereas the education level of the household head is not important for youth unemployment, the marital status and gender of the household head are critical. The indirect effects of education, gender, residence, and age are clearly notable. Implications for policy and research are drawn.

What Parents Know Matters: Parental Knowledge at Birth Predicts Caregiving Behaviors at 9 Months

To examine the mediating role of socioeconomically disadvantaged parents' knowledge of early cognitive and language development at the first postpartum visit in the relation between education and caregiving behaviors at 9months. Parental knowledge was assessed at the 1-week newborn visit (n=468); anticipatory guidance received and desired at 1-month (n=212) and 6-month (n=191) visits were reported; and caregiving behaviors toward infants during a teaching task were observed at 9-month visit (n=173). We found substantial variation in knowledge and caregiving behaviors. Parents who had more knowledge of infant development at 1week were more likely to respond to cues (r=0.18; P<.05) and foster social-emotional (r=0.17; P<.05) and cognitive growth (r=0.20; P<.05) at 9months. Importantly, the indirect effect of education on cognitive growth fostering at 9months through knowledge at 1week was significant, controlling for primary language and number of other children in the home (infancy: β=0.06; B=0.07; SE=0.04; 95% CI, 0.007-0.165; early childhood: β=0.04; B=0.06; SE=0.03; 95% CI, 0.008-0.152). Open-ended responses indicated that anticipatory guidance in the first 6months focused on infant physical growth; however, parents did not request additional anticipatory guidance from their pediatricians. This study sheds light on the importance of promoting parental knowledge about cognitive and language development to foster parental cognitive stimulations and language inputs during the first year of life. This study highlights the important role of anticipatory guidance on cognitive and language development during the earliest well-child visits and the need to better understand parental baseline knowledge to tailor anticipatory guidance to the family strengths and needs.

THE DIRECT AND INDIRECT EFFECTS OF EDUCATION ON LATE-LIFE COGNITIVE ABILITY IN MEXICO

Education and cognitive ability are closely associated. Less is known regarding mechanisms of this association. We evaluate direct effects of education on cognition and indirect effects through health and socioeconomic status (SES) in Mexico. We analyze adults age 50+ from the 2016 Mexican Cognitive Aging Ancillary Study (n=2,042). We constructed latent variables of visual and verbal cognitive abilities. Using structural equation modeling, we estimated direct effects of education on cognition and indirect effects through SES (income and wealth), and health (chronic conditions and health behaviors). Small, yet statistically significant, indirect effects of education on cognition through income, wealth, and stroke (for visual ability) and through stroke (for verbal ability) were observed. However, the majority of the association between education and cognitive ability (90% and 96% for visual/verbal cognitive ability, respectively) was not explained SES or health. Interventions to reduce disparities in late-life cognitive ability should address educational disparities in early-life.

Education and hypertension in the CONSTANCES cohort: which factors mediate this association?

Abstract Background Individual socioeconomic characteristics and in particular education have been shown to be strongly associated with hypertension (HTN). Few studies have examined the mechanisms involved in such associations and understanding them would help to reduce the burden of social inequalities. We aimed to investigate whether specific risk factors of HTN intervene as mediators in the association between individual education and HTN in a large sample of French adults. Methods In this cross-sectional analysis, participants are adults aged between 18 and 69 years old recruited to the CONSTANCES cohort over the period 2012-2015. We included behavioral (poor diet, physical inactivity, alcohol consumption), anthropometric (body mass index) and socioeconomic risk factors (income and longest occupation) as potential mediators. Analyses were stratified by sex. Natural direct and indirect effects of education on HTN were estimated using weighted Poisson regression models with inverse odds weighting. Results A total of 62,247 individuals (53% women, mean age 48±13 years) were included. Prevalence of HTN was 37.3% [95%-Confidence Interval (95%-CI) =36.6-38.0] in men and 23.2% [95%-CI=22.7-23.8] in women. We found a steep educational gradient of HTN in both sexes, larger among young adults in relative terms. Low education was strongly associated with HTN: RRTotal Effect=1.16 [95%-CI=1.12-1.21] in men and 1.26 [95%-CI=1.21-1.32] in women. Behavioral, anthropometric and socioeconomic risk factors accounted for 49% and 32% of the total effect in men and women respectively. Conclusions This study underlines the importance of education in inequalities in HTN and suggests that behavioral, anthropometric and socioeconomic risk factors substantially mediate the association between education and HTN. Future research using longitudinal data should be done to help understand the causal pathway linking education and HTN. Key messages A strong gradient of decreased prevalence of hypertension with higher individual education is observed in both sexes and in early adulthood, suggesting that prevention should start early. Behavioral, anthropometric and socioeconomic characteristics at adulthood substantially mediate the association between education and hypertension.

Modelling the Socio-Economic Determinants of Fertility: A Mediation Analysis using the Parametric g-formula

SummaryTheories predict that the timing of childbearing and number of children born are determined by multiple socio-economic factors. Despite this, many methods cannot investigate the interrelationships between these determinants, including the direct and indirect influence that they have on fertility over the life course. Here we use the parametric g-formula to examine the interdependent influences of time-varying socio-economic processes—education, employment status and partnership status—on fertility. To demonstrate this approach, we study a cohort of women who were born in the UK in 1970. Our results show that socio-economic processes play an important role in determining fertility, not only directly but also indirectly. We show that increasing attendance in higher education has a largely direct effect on early childbearing up to age 25 years, resulting in a substantial increase in childlessness. However, childbearing at later ages is dominated by an indirect effect of education on fertility, via partnership status and employment status, that is twice as large as the direct effect. We also use the g-formula to examine bias due to unobserved heterogeneity, and we demonstrate that our results appear to be robust. We conclude that the method provides a valuable tool for mediation analysis in studies of interdependent life course processes.

Using confirmatory factor analysis to explore associated factors of intimate partner violence in a sample of Chinese rural women: a cross-sectional study

ObjectivesTo estimate the prevalence of intimate partner violence (IPV) among a sample of rural Chinese women and to explore associated factors.DesignCross-sectional study.SettingRural areas of Guangyuan City, Sichuan, China.ParticipantsWe recruited 1501...